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next on our agenda is Mr Well, if Mohammed and he will be talking about a Korean cardiothoracic surgery. Well, it is the representative for S C. T s, which is a society for cardiothoracic surgery. Thanks, Willie. Hi. Thank thank you, Ryan. Hi, everyone. I'm really sorry. I can't join with my camera. It's just because I'm on call at the moment from the red room. Uh, but I'm really pleased to to do this presentation today, and it's a pleasure to join you all. I'm going to talk about a career in cardio thoracic surgery. So this is, um, the presentation slide. So, essentially the overviews, we're just going to give an overview of cardiothoracic surgery and subspecialties, the training pathways, uh, some recruitment stats, future directions, the interview structure. And then we're going to talk about I'm just going to share my experience in cardio thoracic surgery in, um, my foundation years, my course surgical training and as a clinical fellow give you some pros and cons of the specialty and some advice on interview prep tips and resources as well. So if if anyone wants to, um, contact me, I'll share my details at the end of the presentation. I'm happy to discuss anything if you if you want to. Um, some more advice about the Korean cardiothoracic. So, um, if you want to get involved in anything with the society, please let me know. So, um, the first topic is subspecialties. Obviously, if if you have any questions, please share them in the chat can go through them after the presentation. So there are three main subspecialties in cardio 36 In the UK there's adult cardiac. There's general, thoracic and congenital. And obviously they overlap a lot with with their, um uh with their presentations, their history, the anatomy, um, and and the training pathway as well. To an extent, obviously, there are some differences between particularly cardiac and thoracic. Those are the two main subspecialties in in in the UK congenital has a much smaller number of consultants and much smaller case volume as well between cardiac and plastic. Obviously there are different teams that you get involved in with Sorry, the respiratory teams and the cardiology teams and different types of research is different cultures as well. There's different disease processes and presentations. Um, in other cardiac surgery, it's it has a relatively short history cord compared to other some surgical specialties. But it's obviously very interesting, and it's a very brief, you know, history of, uh, landmarks that happened in other cardiac surgery. Um, heart team approach is is being increasingly adopted in in everywhere. Really, it's It's a discussion between the cardiologist, the cardiac surgeons and radiologists and different members of the MG t Um, and obviously the it's It's one of the recommended, um, concepts bye bye. All guidelines. And it's it's obviously other cardiac surgery. You have to have a good working knowledge of physiology and pharmacology anatomy. Um, E C G imaging interpretation. There's lots of, um, non surgical, uh, knowledge that you should have And you know, depends on whether you find that interesting or not. Some people do. Some people don't, and but you can see it as a pro in a calm, this is really good. He was a very famous Polish surgeon. Um, and he pioneered heart transplantation in Poland, and this is a very famous picture on the left of him. After 23 hours of surgery, uh, watching, uh, monitor on the patient. He's doing his first heart transplantation for that patient, uh, in Poland, one of the first few heart transportations in the world. And on the right is the patient who, uh, survived until his eighties, Um, and pictured with the picture in in place. Obviously, it can be a very rewarding career, and it is hard work. But obviously it's. As with other surgery, it's, uh, it's very rewarding subspecialties in other cardiac. So, um, the common ones are the ones. Highlighted are the ones that have been considered by the GMC for credentialing. So there's a lot of surgery, mitral, mitral valve surgery and transportation or heart failure surgery. There's relatively few centers. There's six centers in the UK and is around 200 of surgeries per year 200 the UK waiting list. So there's very few surgeries that happened in heart transplantation. But most all heart transplantation consultants will will also have another cardiac practice or aortic surgery. There's, you know, the pathologist that you encounter emergency electives in situations like Type A dissections and and aneurysms. Um, and then there's much of a surgery that it mostly involves much of our repair for all valve pathologies and then coronary revascularizations not a subspecialty per se, but it's it's most of the other cardiac work clothes is related to coronary revascularization, which is essentially cabbage and then minimal invasive cardiac surgery is is gaining popularity. So there are a few centers in the UK that do it, but it's it's something that you know. It's some seat is the future. Some others are a bit skeptical about it, but hopefully in the future, we'll know it's It's not been around for that long, about 20 years or so, but it's something that is gaining popularity to an extent in the UK catheter procedures. They overlap with cardiologists, vascular surgeons and I are. But obviously that, um, that's more of their domain. General Thoracic surgery again, a relatively short history, but it's it's evolved into a separate specialty, almost a separate specialty, not a subspecialty even and and more and more operative numbers. Obviously, they have retained the diagnostic domain compared to cardiac surgeons, so there's minimal competition from respiratory doctors, and there's generally earlier opportunities operative opportunities there earlier autonomy as well. It's generally a friendlier environment, and and there's more consultant posts. So there's a recent publication or or h e uh, report that suggests that will need about 50 new 30 or 50 new, uh, thoracic consultants in the next five years. So there's definitely more room for thoracic surgeons, uh, in the next few years. And, um, there's a lot of shifts towards training pathways being geared towards the thoracic surgery. The this is some of the incisions that that happened in thoracic surgery. Mostly, that's so this is a substitute for a decision. So it's used for, uh, lower lower sections. Anatomic resections. It can be used for thymectomy. He's, uh it's not a very common incision, but it's just to show you how small an incision can be to remove either part of the lung or the thymus or any mediastinal mass. If anyone has any questions, please share on the chat and then the subspecialties in thoracic surgery. So again, the ones are that are highlighted in, in in bold Are are being considered by the GMC for credentialing. Uh, there's no separate subspecialties or sub subspecialties and thoracic at present. If if anyone qualifies the general thoracic surgeon, uh, robotic are is robotic. Uh uh, surgery. So obviously, that's done for major resections for long. Neoplasm and uh, anatomic resections. Musically, um, a surgery is is there it has to be in a specialized center. Obviously, they're they're very invasive tumors and, uh, has to be a team approach involved to To management. Tokyo surgery is also something that's not very common. But, you know, some some specialized centers do turkey receptions, reconstructions and stenting. And then the rest of these procedures are almost all centers in the UK would do them. They're quite routine. So rib fixation, bronchoscopies, whether for benign or or or, uh, malignant disease, chest wall reconstruction, diaphragmatic surgery, pectus surgery and benign pathologies like abscesses, empyema. And so on a pneumothorax surgery, which is very, very common esophageal surgery is there's very few centers in the UK, I think only two centers that do esophageal surgery. So most of it has gone to the upper GI I and then congenital cardiac surgery is the last of special. It's highly specialized, but it's a very low volume surgery. There's 11 centers in the UK They do about 100 and 20 surgeries per surgeon per year. Uh, and if you think about it, that's about two surgeries a week. So obviously it's it's It's very complicated surgery. It can take a long time, and and it can be quite variable as well. So it's It's not just, you know, cabbage and and valve, but, um, and and there's lots of redo surgery. It requires lots of collaboration with different teams, and it's It's a different type compared to other cardiac and thoracic surgery, so it's very, uh, different. It has a different flavor from from the other special subspecialties. This is a picture of, uh, Francis. Fontan is a very famous congenital cardiac surgeon, established the fontan circulation with the procedure. And, uh, that's the nature of the procedure pathology is involved in. In congenital, there's They deal a lot with structural heart anomalies like, uh, receptor defect, ventricular septal defect, hyperplastic left heart, and to travel your follow up, um, vessel anomalies. So transposition PD a valve anomalies like tricuspid and pulmonary atresia and then other cardiac heart disease. So a C, H, D or Gooch? It includes all of the above, but obviously it's in an adult cohort. So there's there's overlap to an extent with other cardiac surgery, the training pathway. So this is the important bit, Um, there, there there's an old pathway that we won't really focus on, um, too much, but essentially was two years of core training and then six years of specialty training. If you If you If you're entering at the ST three point, if you're entering at the ST one point, then obviously it's eight years and it's a run through. Okay, And that's changed. So it's changed from last year. So from August 2021 there's a new pathway with the advent of the ICP curriculum. So there's three. There's two phases. Phase one is equivalent to court training. Okay, if you enter at ST one, it's It's three years. So s T 123 and you acquire general cardiothoracic skills, including emergency cardiothoracic six. If you enter at ST three, this phase will take you two years. So s T three and four. Okay. And then phase two is, um ST 56784. so So, uh, five years for, uh, sorry. Four years for for ST three entrance and for ST one entrance. It's again four years because they spent three years here and four years here. So it's a new a new path way That's seven years only for ST One. So, essentially, if you enter at ST one from now on, you only spent seven years in the program and and s t seven. You you You finished? Uh, whereas the ST three s t three is actually been canceled this year. So so? So this year is the, uh, sorry. Last year was the last year for S t three, and this year, they've introduced as with the last year as well. ST for Entry ST for entry goes to ST eight. So it's it's still four years, but it's only in thoracic surgery. So again, we'll talk about that in a bit. But that's the nature of the new pathway. Uh, in phase to you, Do you do your f. R. C s exams at ST six after ST six. And then you spend the if you're s t three entry. Uh, and if you're ST one entry and you're on the seven year curriculum, then you do it before the last two years, so you do it after your ST five. If you want to pursue congenital cardiac surgery, then you do. Then you do it after your f r C s. So once you finish your f r. C s, you can apply for a congenital cardiac surgery fellowship. And it's a national fellowship. It's two years it's done in three centers or four centers. Um, and it's just it's a separate training at the end of your, um, other cardiac training. The key changes that happened in 2021 that there was a seven year training program instituted for ST One starters. It's still six years for S t three, but obviously that's that's phased out. Now, Um, Phase one, there's the core competencies we talked about, and phase two is a subspecialty training. Uh, and then, uh, as with other specialties, the new curriculum introduced the GI PCs and the C I. P. S. I won't talk about them again. Um, and then there's, you know, Level Two should be the aim for phase one and level four as a day one consultant for phase two in most if not all domains. And then we talked about congestive cardiac surgery. There's an opportunity also to recognize training excellence to shorten training, although I doubt that will happen much in other cardiac, um, in terms of recruitment so there were two entry points. They're still still to entry points now. So there's ST one, which was introduced in 2013 and s t four. That's only in thoracic. And the reason we, um we, uh we, uh the there's been a shift to S t four in thoracics is to encourage trainees to do three sticks more than cardiac. At the moment. Um, I would say about 50% of trainees want to do cardiac. So there's there's a bit more, uh, more of a move towards thoracics in training. Um, mainly because of, you know, obviously we we've talked about the lifestyle to an extent. Environments a bit friendlier. The autonomy comes a bit earlier on, and there's more consultant posts. It's the likelihood of you getting a consultant job once you finish. Your training is more higher than cardiac. At the moment, there's about 15 to 20 people CCT fellows in cardiac surgery awaiting consultant jobs. So there's still a backlog. And to reduce the backlog will get rid of it in over the next few years. The plan was to institute the S t four and 36 and keep the ST one obviously because it's still a run through entry for both cardiac and 36. Uh, the S T one and S T four have similar short, short listing criteria, but there's different waiting. Obviously, the operative experience counts for a lot in in S t three, and it counts for very little in ST One. And it's also not very specific to cardio thoracic. It's just to demonstrate how many appendicectomy is you. Could you've done or supervised trainer scrubbed. How many? Uh um, DHS is, I think, that there's a few. There's a few procedures that none of them are really specific to cardio thoracic spine harvesting might be the only one and sternotomy that are specific to cardio thoracic, but generally you're not expecting to do a minimum of anything on ST one. It's all just to score points. Um, whereas an S t three and now s t four. There is a very strict operative matrix, Um and then obviously there's been a gradual increase in ST one and decrease in S t three, which culminated in in ST three being stopped. The competition issues have generally been quite high, so it's it is a competitive recruitment ST one was 9.92 in 2020 and s t three was 5.86. But generally in in ST three people are applied for ST three are very much geared towards cardiothoracic. Whereas in ST one more people apply to, um uh, two different, uh, specialties, Uh, recruitments. And there's roughly about again some stats. 5 to 8. Substantive 5 to 8. Local consultant jobs advertised in cardiac and the Lasix, Uh, with 15 to 20 training or the CT. These competition ratios have changed a bit over coated because the, uh, the numbers have decreased a lot. So usually there's there was usually around, um 13 or, um, sorry, 16 or 18 posts in total. So, up till 2020 there was, um, 10 or 11 s t one jobs and six s t three during Covina that decreased to six. S. T one and two s t three posts, which was very little, uh, and then that's going to likely increase again this year. I can't share too much, but, uh, obviously, uh, it's being considered, but we'll see how things go. This is the ST one. Short listing score and descriptors. Um, obviously, there's an employment history, there's there's evidence. Um, I'd urge anyone who's considering quite traumatic, especially at an ST one level, to to have a very good look at the short listing matrix. I think someone's asked about when this year's portfolio matrix will be released and when is it usually released? So it's usually released around this time, so it's usually released. Um, now, actually, so there's been a bit of a delay this year, but it's likely going to be released in the next few weeks at the most. And it's at, you know, generally, there's no huge change in the short listing, Uh, matrix or criteria for ST One or S T four. It's generally there's no huge change, uh, year from here. So, um, and then there's an I've shared the ST three shortlisted matrix for 2021. Obviously, that's now gone, but the S T four matrixes very similar to it. So I I haven't shared it here, but it's very, very similar to it. So again you get marked for presentations, publications teaching, hold it. And then there's some undergraduate postgraduate prizes. There's some courses involved as well, and, um, operative experience counts for a lot, as you can see 20 out of 40 marks. That's very similar to the ST for Matrix, and the operative experience gets divided according to the numbers. A number of months you've done in the specialty. So 0 to 6, you're expected to do little to gain the maximum marks 7 to 12 more and so on. And once you get to this point, it gets very difficult to get into training. So 25 to 36 I don't know if you can see my mouse 25 to 36 months is you shouldn't really exceed 24 months because it gets very difficult to get into training with ST four. It's a bit different, obviously, because you're you're you're marked more on thoracic operative criteria than cardiac. So most people, I mean, it's it's it's a relatively new entry points, so it's only started last year, but in the next few years, I'm sure we'll we'll discover. But most people I don't think they'll they'll struggle to, um, to get their thoracic, uh, numbers within two years, so they shouldn't really exceed 24 months. And this is an example of the stuff that you you need to do to get the maximum marks in, Um, if you're doing 7 to 12 months, this was the category I was in when I first applied. Uh, CT, too. And in terms of the interview structure, this is the last bit. So ST one s t three. They have a similar format. Um, the ST for now is is has replaced s t three. So it's It's the same thing they used to when it was face to face. There were there were some skills scenarios and there were also shots as well. So Assad's were the practical stations. There were two stations. Um, this might happen in the next few years. There is some appetite to go back to face to face, uh, interviews, but obviously there are some difficulties with that. So for the for the for the moment, it's it's virtual interviews only for for cardiothoracic, as with other surgical specialties. And this interview structure has been replaced to an extent. So it's only five questions now. So there's, uh, they've changed the virtual interviews. There's 25 minutes of structured questions and five minutes of motivation slash portfolio questions. Uh, and the structured questions are always, Um, sorry. Let me just go back here. So there's the structure. Questions are five questions. There are five questions on clinical management, ethical scenarios or hot topics, and there's five minutes each and your your your scored by five consultants. So there's 25 marks for each question. Um, and then obviously they're added up and and waited at the end. So I think the portfolio accounts for about a third or or 30% of the total mark and most of the market on the interview. So, um, it's very, you know, the purpose of the because of your portfolio is too short list you rather than score you in the end once you're shortlisted, which is always that bottleneck. The main hurdle. Once you pass that, then it's it's You know, you stand a very equal chance in the interview, especially with virtual interviews to get a good score and a good job, and I'll just touch briefly on my personal experience. So this this is where I did my foundation and I did some cardiology. An F one I did some t e n o in in f y to vascular wasn't really an F one wasn't really a surgical rotation. I didn't really go to theater. And then I decided on cardio thoracic quite late in my F one. And at that point, I just try to take some annual, even tried some study leave with to do some taster's at Brompton and Kings and, um, let him enter their They started some projects, um, and got exposed to the to the practice and applicants. And obviously you learn a lot when when you talk to other people, it's a very small specialty. Um, and, uh, my main theater experience came from, uh, Ortho and the tasters did some presentations, did some publications, but not much at that point and the same with leadership. But I didn't really apply for ST One because I knew that at that point, I was I was too late. So and quite late in f y one, um, so and I wasn't really prepared to take a year out, so I just applied for your surgical training and then course surgical training. I tried to hear my portfolio towards s t three. So this is what I did in my core training. I did a year of cardiac and thoracic surgery in total. And, um, this is my operative experience by the time I applied the first time. And, uh, and the in terms of publications, I try to really work on that, because what, you get full marks for four publications. Um, and that's pretty much it. I didn't get the the job the first time, so I I got short listed for interview, but I missed out by a few marks. So it took a year as a clinical fellow, a regimen, chronic surgery, and again that helped me quite a lot with, you know, uh, theater opportunities with a non resident Rolled also gave me some more time to get exposure and work on on the rest of the stuff that I needed. Um, and finally, yeah. So I got my s t three. Uh, job pros. Cons. Um, it's this is the last bit. So pros of cardiac surgery. Heart, lung physiology. Anatomy is really interesting. If you if you don't mind, um, learning a lot about medicine and critical care and surgery. If you're interested in that sort of thing, then and EKGs and different investigations read how to read the CT scan. How to, um, do a bronchoscopy, that sort of thing. Then, uh, then this is the specialty for you. Um, technical skills. Uh, there's a There's a high degree of technical skill involved in in most procedures, and there are varieties in techniques and prevalence of operations. And there's a lot of research potential in 36 and cardiac surgery, and it's a very specialized surgery. So the slight upside is you get very few in appropriate referrals. The patient is, you know, ready. By the time they come to to refer to us the cons there there are long operations, and they're usually the norm. The minimum procedures is, you know, 1 to 3 hours for routine on pump case and can get very, very long in the water can complex procedures. Um, autonomy comes later in other specialties in cardiac surgery, and the variety can be less than extent. But, you know, it depends on how you view things, varieties and everything, so the same procedure can be done in very different ways. The same procedure can be done on different patients, and, um, that can be, um, you know, you can you can get exposed to very different complications with the same procedure on even similar patients. And that's it, Uh, myths. I think someone has asked this as well. With increasing use of technology robotics. Do you think that there will be seen demand for doctors in this area over the next 20 years? By the time we become consultants, of course there is. So it's a It's a well known myth and, you know, this has been sent to me several times, and I again I struggled a lot with with choosing a specialty in court training. I used to obsess about what I I wanted to, uh, choose. And I was considering general surgery and cardiothoracic for a very long time in court training. Uh, not just about, you know, whether it's a dying specialty or not, but also the next point whether consultant jobs and, um, the relative difficulty of getting into training as well. But if you unless you work in cardiac surgery in particular thoracics, there will always be demand for thoracic. It's actually increasing a lot now and honestly. I mean, if you become a thoracic surgery, you won't have time compared to other specialties, it's It's It's really, really, really busy. Okay, so I don't think the Lasix is in any way of dying. Specialty in cardiac surgery. Still not a dying specialty. Unless you have worked in the specialty, you won't realize that there's a lot of work. Okay, um, I work in Southampton. Southampton is a relatively high volume center, and it's not. All centers are like this, but we have three operating lists a day other cardiac, one congenital list and to thoracic lists every day. And the the the total number of procedures is about 2200 for for seven consultants in a year, and that's a lot. That's a lot of operating. Okay. In total, the UK numbers for other cardiac surgery have remained steady around 35,000 per year, despite an increasing PCI, so cabbage is always stable. There's always an indication for cabbage, cabbage and PCI, a complimentary that can never replace each other. Valve surgery has has decreased a bit over the past 10 years with the introduction of TV, but again there will always be an indication for surgical ward, the valve replacement. It will never go away. Okay, there are no consultant jobs in plastic surgery. Yes, it is an issue at the moment to an extent, but honestly, there's lots of good examples of people finishing the training, taking a year out at the most after CCT getting a consultant job. Okay, it's not that difficult. Um, it depends on obviously, there is a bit of luck involved, but it's It's very similar to other surgical specialties like neurosurgery, where there's a backlog to an extent of consultant uh uh CCT fellows, Um, but it really isn't something that's that's unique. And it's only in cardiac surgery, and it's only predicted for the next few years, so hopefully it's something that can improve later on. And that's it. So I'm just some advice on interview prep. It's very similar to call surgical training interviews, especially with virtual uh, interviews. If anyone wants was any any questions about about the interview wants, wants to do even some interview, uh, practice in future if they're if they get an interview this year or next year? I'm I'm really happy to be contacted at any point, and, uh, there's there's relatively few resources, but the scenarios are really, really the same. Almost every year, so So they recur quite a lot. And my advice is to prepare early on, uh, work through your answers and practice with someone who's going for the interview. Uh, ideally, and, uh, I see medical medical interview book is helpful just for the ethical and management scenarios. Uh, the skills is not part of the interview anymore because of the virtual, uh, interviews. Um, and also it's again, it's not part of the interview, but the clinical scenarios. They focus more on emergencies, and they're more in ST for, uh, interviews. That s t one interviews. They're very usually quite basic, and there's lots of good resources for them. I will share them in in, uh, in the next slide. But again, there's there's a There's a very good cause done by Mr Big, uh, in in, uh, Thomas atSaint Thomas. And he does it every year. It's a really good cause, um, and I'm sure you're, uh well, welcome you all to to attend. Uh, that's it. I think, uh, thank you very much. All right. Good. So that's the list of resources. If anyone wants to copy them or do anything, I'm happy to share these slides. as well. I'm sure there is a way that Ryan will find, and that's it. Thank you for listening, everyone. Thank you very much for that talk. And, uh, will you will be happy to answer some questions.