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Hello, everybody. We're just allowing some time for people to filter in from other workshops. I know some of them have just finished. Welcome to the cardiology workshop. Okay, so today we are very lucky to have a continuous. You can join us, um, to give a workshop about pediatric cardiology and his work in that, um, he works in Newcastle upon time in pediatric cardiology and has also spent some time abroad working in Ontario, Canada, and the Sick Kids Hospital there. His research interests include interventional cardiology. And we're very pleased to have you join us here today to tell us about your work. And thank you very much for giving up your time and joining us. Um, if you have got slides that you would like to start sharing and you can do that whenever you're ready. Perfect. Thanks, Kate. And I'll just share my slides. Okay. Lets me and can you see that I can't see anything apart from there's no slides. Come up for me just more. Um, Would you like me to try and Sure and perhaps, actually, sorry. One second. Oh, that's that's better. Yeah. Super. Is that better? Yeah, that's great. Good good afternoon, and thank you very much. Kate, having me join join the conference. Um uh, Kate mentioned I, uh I would guess. Want to spend the next few minutes talking about why it is I'm, uh, currently practicing within this specialty. Um, what a typical day for for for me is and I think that, perhaps is somewhat representative of others within pediatric cardiology. I'll talk to the training program and what it involves. My wife has said I have to talk about the not so good aspects of training. And, uh, if if there's anyone here who is interested or is sitting on the fence or in fact is uninterested, that happens to be in this breakout group, Hopefully, I'll I can find some interest in and point you in the right direction. If if that's you, um, I applied to the cardiology primarily because that, uh, the end of my f two. Um, I was very unsure as to whether I wanted to do core cortical training, uh, against going into pediatrics. Um, difficult decision decided to go into pediatrics, but my my reason for being interested in your medical training was because I really enjoyed cardiology and, um, over that time, I must say, the experience of peas, cardiology as an S t a trainee showed me that my my idea of trying to sort of mix pediatrics and cardiology it was very different to what the specialty is. Um, that said, it's remained a specialty that I thoroughly enjoy. And hopefully I can I can point you guys in a few or at least highlight a few aspects of specialty that I find interesting. Um, first, being that, it's, uh it's unique in, uh, being a relatively new sub specialty. A lot of interventions in pediatric cardiology are, uh, you know, if not in our lifetime have been in our parent's life. Uh, lifetime. Um, it's only what, 80 years ago that, uh, patients with cyanotic heart conditions would have otherwise not survived. Whereas now you know we have so much and and the conversation is no longer about mortality, it's now more about reducing mobility. And and there's a lot that still going on from that point of view. So if you're one who, you know is uh, interested in innovation, this is a sort of subspecialty that lends itself to that As you know patients are born with congenital heart conditions, and we live with our lives. And whilst we have a good number of, uh, procedures, uh, and interventions to completely repair certain lesions But others it's palliative, palliative to enable a good quality of life for for a long period of time. And and you're involved in these patients care throughout their lifetime. Uh, I was thinking about, uh, a couple of weeks ago I saw I saw a a two year old who had spent most of the first year of her life in the hospital with dilated cardiomyopathy on mechanical circulatory support, and, uh, and she had gone through that was transplanted and then presented to clinic a few weeks after that. It was beautiful to see, and it's that sort of ongoing sort of continuity of care that I've always enjoyed and that some of my older colleagues, uh, continue to enjoy so that whilst I'm seeing, I'm seeing this patient in two years. They're saying the same patient at 10 15 years, um, along the same lines. Uh, at Newcastle, we have a, uh a C H adult congenital heart disease, uh, program that is very much run side by side with the pediatric program. So in the morning you might be taller or seeing a patient who is only a few hours to days old. And in the afternoon you can be seeing a 70 year old patient with a lesion that requires your your your expertise. So from that point of view, uh, there's there's a there's a fair amount of variety. I'll talk more about variety in a second within the soft specialty. If you like working with other members of a multidisciplinary team, it's it's It's definitely a specialty that that's that's heavy on, um, it's very much a medical speciality, but it also relies heavily on intervention, whether that's transcatheter interventions or surgical interventions. And uh, I mean combined with that that there there are a good number of subspecialties with in pediatrics, but also other members of the multidisciplinary team that are required to get patients through there stay in the hospital. I've particularly like the teaching aspect of of of pediatric cardiology, and if if you're one who's interested in research, they're ample, ample opportunities for for research. Like I say, there's a lot and we'll see that in a second. Um, that has changed within the within the sub specialty over the years. And I'm sure you know, that will continue to be the case. Unlike our adult colleagues there, there aren't guidelines for every single thing. A lot of a lot of the research that guides our work is recent. Um uh, a fair amount of decisions are taken based on experience. And, you know, this comes back to the point of working within a team that you're able to, uh, not make decisions in isolation. You can You can be sure that when decisions are made, as many as many brains have thought through each case and have decided on what the best thing for each patient is. Um, I grew up in Lagos and have had the chance to get involved in a number of mission trips to areas around there. And I have colleagues who go to other parts of the world, Um, and like pediatrics and other other specialties of pediatrics and cardiology, cardiology is one where there is, uh, an opportunity to get involved in, uh, in other parts of the world where perhaps services aren't as developed as they are here. Um I was mentioning about the variety once once a year within pediatric cardiology, the door opens to just, you know, myriad opportunities of other subspecialties. I'm talking with an interventional cardiology hat on, but, you know, uh, there are five years of you. Your training and the final two years are subspecialty years. Where you honing on a particular excuse me? A particular area be that cross sectional image. So ct an MRI scanning be that electrophysiology? I haven't put in everything here. The hexagon only allows a number of options, But what I haven't in included here are there are subspecialties, including adult congenital heart disease. There are inherited cardiac conditions. If you have a genetic slant to your work, that's something that's an area that you definitely fit fit very well into, um, in certain parts of the world. Not so much here. Um, critical care Medicine is a is a key component. So, uh, pediatric cardiology trainings start their training, do the three years of core pediatric cardiology training and then stop specialize in critical cardiac critical care and would then go onto working in the P I. C. U and managing single ventricle patients. That happens in in some centers. Um um, chart is tiny, so I apologize. But I put it there just to stress a couple of things. The first is I mentioned earlier on that This is a subspecialty that is relatively new. I mean, I guess news. And 80 years ago, but only 80 years ago, there wasn't such a thing as a blocked tear. Thomas shunt. And patients who were born with dependent pulmonary circulation would otherwise have died. And in that time, we've gone right the way across through to having bypass. And there are, you know, complete repairs of certain conditions is found in palliation of patients who are born with single ventricles or single ventricle physiology. Defects can now live into, you know, adulthood. Um and then there's the option for transplant, and that's that's just thinking about things from a surgical point of view, from a transcatheter intervention point of view, things have developed, uh, perhaps more recently over the last 40 years, or more and more with me. I'll just, uh, make sure he doesn't die. In the last 40 years, there have been, uh, transcatheter interventions for procedures that would otherwise have meant a week perhaps longer in hospital, patients can come in for a transcatheter, uh, home revolve implantation and be home the next day or within 24 48 hours A s ds and more and more. VSD is these days we're closing by a transcatheter means, um uh, and at the extremes of age, we are we are closing. Uh, premier pds uh, patent doctors arteriosus in premature and found that really, you know, less than a kilogram in weight. Uh, so there's there's there's if if if this is the sort of, uh, you know, vision that you're interested in And, uh, this is this is a specialty that you almost certainly at least want to have to think about and in the same vein, if you can think about the fact that these services the services right at the sort of right, what aspect of this slide aren't already available throughout the world and and so you know, there there there are opportunities to assist other other cardiac programs tend to develop themselves to a point where what were saying about the morbidity being the issue currently would not just be in the UK or in certain countries, but But throughout the board, um, I have been asked to talk about a typical day. Typical day for me. Start, Uh, the wake up time depends on what? The day before it's been like but myself and my wife would work work between ourselves as far as dropping off, making a nursery drop off sometime around 7 30 and then I have an M D t meeting on most days, or a journal club or departmental teaching type meeting that lasts for about 30 minutes to an hour. And I mentioned already that you know, it's a it's a it's a subspecialty that's very heavy on a joint decision making. Um, uh, so, you know, take for instance, at some point this week in one of these mg team meeting, we have discussed a patient who has a VSD who is small and who has pulmonary vein stenosis. Uh, such a patient. Not in this case. If it was a patient who had a trance catheter intervention that was necessary, then come to the cath lab on, uh, later on in the day. Of course, I'm mixing a couple of days together here, but as far as this, this typically is concerned. I've used this last Wednesday. So on Wednesday I had a 30 something year old gentleman who needed a right heart catheterization. It's past the transplant assessment and then, uh, went down and met with the registrars. Good, uh, nicely done award around and caught up with her through what? Any issues that were pending from that point of view. Um, and then we're prepared for an M. D T meeting that started. It says one o'clock start at two o'clock and goes for about three hours, where we discuss urgent in patients referred patients, patients who are followed up at Newcastle but at home and stable, who require interventions be that surgical or transcatheter interventions. And then I was on call and then on call for us for, uh as a as a trained in Newcastle as a trainee was one in seven and and as a consultant remains about the same one in seven for interventions. It's slightly more. It's one in four, but actually the on calls, you know, I would say they're out of there out of hospital and calls here in Newcastle and I would say about 50% of the time as a training, I would have been, uh, woken up call, advise that sort of thing. And perhaps to 30% of the time, I would I would need to go into the hospital. And that's probably the same now as as a consultant, maybe less phone calls. Because, because, you know, often times the registrar's are able to deal deal with this. Um, of course, in addition to this are other administrative tasks that, uh, clinical governments rolls that we would take, You know, your educational supervisor, that sort of thing and and within within your day schedule, there is usually at meantime at some point during the week to catch up on the week or two. Get some of these non clinical duties completed. This is the current training pathway for Pete's cardiology and very much what? What? My training has been so, uh, two years, uh, foundation training following which, uh, pediatric level one training takes place In the past, a lot of trainees would have spent more than three years at this point either because, uh they wanted to complete the pediatric training prior to applying for Pete's cardiology. Or they just weren't enough numbers. I'm not too sure of the numbers of my heart, But my understanding is that there are more numbers that might be wrong. Quote me on that. And, uh, and generally, a lot more trainees, Uh, complete three years of General Pedes training. So s t 123, and then apply for ST for impedes cardiology. Um, Pete, cardiology training is five years. Like I said, the last two years are subspecialty training years. Where you holding on one of these areas around the hexagon that I mentioned earlier on? Uh, and for a lot of trainees, Although it's not compulsory, a post CT fellowship is performed just again to to develop what skills you've you've gained at at the center outside of yours, not least just to see how things are done elsewhere. Uh, for Pete's point of view, you would need to have completed um, our see PCH at the time you apply, Uh, during during the course of your training, there is a knowledge based assessment, which is somewhat some motive or rather, formative. You have to have to have done it and passed it. But the past, Marc, I think the last I checked was something like 50%. And for the vast majority of trainees, you know, it's it tests things that you do on the job. And so it's It's not it's not. It's certainly not I didn't find it is difficult. I found the M R P C H as an example, and what I will see is, um, the fact that you would be going from being, uh and that's what's happening more often, uh, from being a S h 02 registrar an S t four and then registering a different sub specialty. It's It's, I guess, vitally important that during your training you you have that mindset. If you've made the decision early that you know by the end of your S t. Three, you want to feel absolutely competent and confident as far as general pediatrics is concerned, because there still is a little bit of general pediatrics on on the war and whilst year, uh, doing radiology and if you are, if you think this is primarily for foundation trainees, but you are no trainees who, like me, had an interest in general core mental training and are still on. Sure, it's still very much possible. And there's a root for such trainees is such that they complete the first two years of internal medical training and and then do a year of Pete specific training. I think part of that needs to be in new inmates. The M R C E P exam is sufficient, and they can apply and, you know, carry on like a PT training. And if you have other friends who are in, uh, core medical training and, uh, doing cardiology and say, Hey, you know, I like congenital work. There is always also the option to do adult congenital heart disease via cardiology stream stream. So there are countless opportunities at varying stages, I guess is is the message. And so I I get There's, uh The fact that there are only so many training centers across the country means that, uh, one when you apply, you're limited in how much control you have over where you go. Of course, if you rank highly, you're more likely to get your first option. Um, excuse me, but that's as far as training is concerned. But then you have to think beyond training, think where do I want to work? Um, that's perhaps the downside having said that, uh, most centers and near enough cities or villages that you would want to be around two. For the vast majority of people, it's still possible to be in the vicinity. You know, if you want to be down south or north, you can you can you can You can be in the vicinity of where you want to be And if that isn't the case, which wasn't the case for me. So I moved up north for my training. You may just find like me that you like it where you are and decide to stay there. Um uh, long term hours are like pediatrics can be, uh, plenty. Um, uh, I think it's useful to bear that in mind when you apply. Of course, things are changing, and hopefully things will continue to change with with time. But it's not uncommon to require extra hours just to get up to speed with work. Having said that, uh, it is very much possible, too, uh, to, uh, complete the tasks that are required within working hours. And I think that's something that I've said to myself throughout my training. I need to push for and encouraged for, uh, there are trainees and colleagues of mine who have worked less than full time and excellent training. So that's an option. If that's something that that that you are thinking about just a few things. If, for anyone who's you know, has pediatric cardiology at the back of their mind, I would say, you know, at an early stage, get get, get accustomed to what, uh, points are in. The person speaks for applying that's readily available. You can Google that, um And then, you know, from an early stage, you can just do the normal things. And but do them in a timely fashion such that you're ready to apply to the stage. You want to come in, come in to the sub specialty. Um, having experience, I think, is vitally important. Uh, not always possible to get a cardiology rotation during your training, but you can get a taste a week you can very early if you're interested in cardiology that your program directors know and and certainly for me, that was I didn't have a cardiology training. Initially, I wrote the program director and it was possible to move things around such that I I did get a cardiology training and I had to leave this stage. And then if you know, feeling all that or if you get two s t three and you think, Well, I'm not too sure I want to see what the specialty is like As a registrar, you can apply fellowships, and there are a good number of fellowships across the country if you just keep an eye out, uh, such that you do a year of that as a year out of training, take break example and then come back in it as and when, Um, there are courses that you can do, and you don't have to be in training to do these courses. Uh, cardiac morphology course is quite important to get your head around congenital heart, uh, lesions and the description of congenital heart lesions of the language of congenital cardiology. And there are a number of echocardiographic courses across the country, just as a sort of minor know of, uh, great Ormond Street do on the Royal Brunton do one. There's one somewhere between Southampton and Birmingham and Cambridge. You know, they're they're all over the place that you can have a look out for the Echo and PCG courses. I put their website if you're interested because I I one of the things that I initially thought about was sorry. Have overrun, uh was getting my head around echo. And there's a nice website that goes through that. The final thing I will see is, if you're interested, you have to apply. Uh, there's no point in waiting until the perfect time to apply. I would just recommend that you apply. I don't know whether you have any questions or any comments at all. I'm really sorry. I think I've done quite a bit. I apologize, but, um, you're okay, and we have another couple of minutes for questions, and then we're going to break anyway. So, um, we're okay for claim. If anybody has any questions, when they pop up chat and we have one from Claudia, I don't know if you can see that. Do you know whether you can do general pediatrics with a special? Yes, you can, Claudia, by all means. And so the two options available to you are either working as a general pediatrician with a specialist interest in Pedes cardiology or working as a pediatric cardiologist and, uh, so at any given time at any of the centers across the country on the registrar route, they would usually be, uh, two or three, uh, pediatric cardiology trainees and, uh, somewhere between one and two peck cigs. Uh, it's It's a very fine, uh, balance, I guess. Yes, in that it's You have the beauty of doing general pediatrics at the same time as doing Pedes cardiology. Most pecs eggs work within district generals, and they're able to essentially provide a card neurology service acutely there. And they would have one or two clinics a week that are specific to pediatric cardiology at the same time as for feeling their general pediatrics or neonatology, uh, requirements. Whilst whilst they're they're. So yes, you can do that. And there's a There's a question from Mohammed. How much knowledge from adult cardiology is transfer So and earlier. And I was saying, You know, I I enjoyed, uh, cardiology, and I enjoyed pediatrics and and that's that was a key reason for my interest in peace cardiology. But actually, it's, um, it's, uh, there's a it's it's it's adult cardiology. I rather pediatric cardiology and is intervention heavy in terms of surgical and transcatheter. And as an essay to, for example, if you have. If there's anyone who's done a who's gone through a Pedes cardiology rotation, it feels very much like a surgical subspecialty. Whereas I don't think that's the case from a respiratory point of view for adult cardiology. Um, there are certain things that are transferrable. But if you think you know the vast majority of the work of adult cardiology is ischemic heart disease and the vast majority of the work in pediatric cardiology is congenital heart disease. Um, so, uh, that difference is quite stark. And the management those, uh, those two large groups that form the bulk of work is very different. There's a fair amount that's transferrable, Um, and like I say, there are trainees who come in via the adult streams, are adult trained, and then and then do come into either a, c, H D or pediatric cardiology. And in some cases, what's the relationship like? Does that does that answer the question for Mohammed? Perhaps, uh, Abigail's asked, What's the relationship like to impede cardiology impedes cardiothoracic surgery, I think. Very good. Um, so, uh, you know, in in an ideal world. The best case scenario or the best situation would be such that you have an excellent team dynamic. Such that, uh, surgeon feels very comfortable with their cardiology colleagues and the cardiology colleagues trust their surgeon and and feel exactly the same way as, uh, As you know, they reciprocate that. And that's that's what I've had throughout my training here. Uh, like I said, I I currently, uh, sub specialize in interventional cardiology. And, uh, as you have seen from that slide there a good number of procedures that can be done via transcatheter interventions and can be done via surgical interventions. Uh, and having having a good relationship with your surgical colleagues is necessary to be able to tease out what the best option is for the patient and not to think what the best option is for the person providing the same service. So I I think there's a good relationship. And, uh, if if you are asking the question as far as wanting to do one or the other, uh, both options are readily available, I would highly recommend both both options. It's, uh, teamwork. Is is the mainstay of pediatric cardiology and and you would see that if you if you spend any period of time time within the department. Of course I can tell you that the ideal scenario I can't say that that occurs all the time. But But if you do become a pediatric cardiologist, you need to sort of fight for that Because because that's the the bedrock of excellent patient care, I think. And then thanks. Uh, since pizza is very much infatuated with a background in surgical No, no, no, I would I wouldn't think so. So sorry. I've I've come at this talk with an interventional hat, but I think in the same way as I've sort of, you know, spoken about things from that point of view, if if one of my colleagues who is, um, uh, into cross sexual imaging So MRI is giving the talk, he will give very MRI, heavy talk and imaging heavy talk. He would highlight the significant advances that have happened in a subspecialty from an imaging point of view. And there have been a lot. Um uh, he would, uh yeah, so So I I don't think a surgical, so I don't think a surgical subspecialty is essential um, if you are interested in, um, things like interventional electrophysiology. There is some benefit in knowing how to tie a knot, which I never learned. And, uh, things for the minor things. You know, at the end of the case, that might be helpful, but you don't need a surgical rotation to do that. Um, so if you if you have a surgical rotation, that's brilliant if you haven't got one, I wouldn't necessarily get a surgical rotation, because because of pizza cardiology, I think the most important would be to to do a taster in pediatric cardiology as a starting point. Um, and that will, you know, within within a week or two, you would have a very good idea as to whether or not it special for you. Thank you very much for your talk. I think that's probably all the time that we have for questions before we move on to our break. And that was an excellent overview of pediatric cardiology. And and thank you for taking the time to answer these questions as well. Um, we really appreciate you coming in this afternoon. Thanks a lot. It's been a pleasure all the best. Thank you enjoy the rest of your, um, for everybody that's in this room just to let you know that we're going for a 10 minute break when you come back, if you can go into whichever session you would like to go into next. So the options I put in the chat. But it's it's intensive care, emergency medicine and respiratory medicine, so if you just head straight into those afterwards, we should be ready to start at about four o'clock.