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Summary

This on-demand teaching session is perfect for medical professionals looking to delve into the specialty of sexual health and HIV. Led by consultant Deborah Kirk, the presentation will bring attendees through a typical week in the field - what to expect from gum clinics and HIV clinics, safeguarding considerations, contraception, HIV management and prevention, comorbidities and more. Along with a deep exploration of the good and bad of this dynamic specialty, attendees will benefit from insights on how to improve the quality of patient care and treatment.

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Learning objectives

Learning objectives:

  1. Discuss a typical week in a medical care professional specializing in sexual health and HIV.
  2. Distinguish between sexually transmitted and non sexually transmitted infections.
  3. Describe the process and importance of safeguarding in a medical setting.
  4. Outline the administration of pre exposure prophylaxis in order to reduce the risk of HIV.
  5. Explain the process of prescribing HIV medications and managing comorbidities.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

no. So I think that, frankly is having some technical difficulties with the Internet this evening. Uh, so what I'm hoping is that everybody can. Who's watching can hear me and see the slides as well. If there's. If there's any problems with that, then please do, um, put something in the chat. Uh, so we know and we can sort out any any sound issues. So my name's Deborah Kirk. Um, and I'm a consultant in sexual health and HIV, or to give it's official name, Genital urinary medicine. Uh, I've been asked to have a to give a talk today about the career about the good, the bad and the ugly, how you can get into it, what the application tells, what training entails and why you want to join me in this fantastic specialty. So the first thing that I was asked to talk about was a week in the life, and it's tricky because if you speak to any gum registrar or any gum consultant, it's going to be a different week for them all. And that's the beauty of the specialty that it lends itself to a portfolio career into doing different things. But I'll go through the basics. I'll talk a little bit about what I do and what other opportunities there are. So what most people will do as a significant part of their week is a gun clinic or sexual health clinic. And in this regard, it's anything from diagnosing, treating, explaining infections. So chlamydia, gonorrhea, herpes, warts, trichomonas, mycoplasma genitalia. Um, uh, you might be dealing with skin issues. So the cross section that we've got on the right hand side, that's like and sclerosis. So we deal with any genital dermatosis as well. And some sexual health clinics will have specialist clinics because as we examine so many genitals, patients have to come to us first and think that, um, they've got an infection. But actually, it's not infectious at all. It's It's a skin condition like lichen simplex or like, um, planus lichen sclerosis. Like in the picture, we see non sexually transmitted infections. Um, there are still infections, but not past on bio sex. So things like thrush, you can see the top right. That's a microscopy of spores and high fee. So the spores, a little round blobs and the high fever, the long, thin lines that you can see. And that's the sign that somebody's got a candida infection. If they've got symptoms as well, uh, some gum doctors will do contraception. And it depends on the clinic. You working? So in our clinic, we're not fully integrated And that, um if you come to the sexual health clinic, then we won't, for example, put an implant in you or do an injection. But I would do a contraception consultation if it's something like the pill that I can describe there, and then I would do that. Otherwise I would refer over to our contraception side who are co located. But we just have separate clinics. Um, there is a move towards integration. So it's more common that, uh, if you see a woman, for example, that you'll be doing everything from their sexual health screen to the contraception, But it depends on the clear that you work in. And, uh, then I put up at the top, so safeguarding So, um, again, depending on where you work, will be different. So I work in Croydon. Um, it's a very young borough, unfortunately, quite a lot of deprivation. So we see a lot of safeguarding of Children but also adults as well. So we need to be on high alert, really, as all our colleagues do across the country. Um, but we do a specific questionnaires called Spotting the Signs, which help us to gather information from the individuals to ascertain whether or not there may be any safeguarding concerns and what we can do to help them. Um, and then in the middle, we do preventative work as well. So this is prep pre exposure prophylaxis. So this is a relatively new intervention started a few years ago to reduce people's risk of getting HIV. So it's a tablet that you take either every day or around the time that you have sex, which reduces by 86% the risk of acquiring HIV from somebody that's got it. Um, and actually, if you looked at the 14% of people who got HIV, their drug levels were either absent or very low, so they weren't taking the tablets. Um, so it's just the gun clinic on its own. We see so many different things, then a big, big proportion of what I do. I do 1.5 HIV clinics a week, which compared to go my do three gun clinics. But actually, my HIV clinic generates a lot more work outside of the clinic than my gum clinics do. So from the HIV clinic, there's all sorts of different things that we address. So the first thing is looking after people with HIV and making sure that their HIV is well controlled. And that means using HIV medications, antiretrovirals and choosing the correct ones for the individual. So we're incredibly lucky that, you know, 30 40 years into the epidemic, we now have wonderful drugs with very few side effects that we can use to keep people's HIV well controlled and so that they can pass it on to other people. But it's still, um, important that we tailor the medications to individuals. There isn't a one size fits all, so it might be that people want fewer tablets, or it might be that they don't want to have to eat with their meds, or it may be that they've got comorbidities that mean we have to be careful because some of the medications can affect your kidneys or your heart, for example, so we choose are medications that way, and we deal with all the additional issues that come with a diagnosis of HIV. And it is different to being diagnosed with cancer or diabetes because it comes with an incredible stigma, which is a leftover, really from the early days when it was a death sentence, Um, and stigmatized as well by the mode of transmission, which is usually sex, Um, and in the UK usually sex between men. So there's there's all these layers of of stigma which have accumulated and which were fighting hard to get rid of. But unfortunately it's still stigmatized, even within healthcare, let alone with in the general population. Um, so we support patients to to deal with that and a lot of our patients, um on are advocates. This is nationally and an advocate for people living with HIV. Just put on here as well some of the other things that we deal with. So I mentioned that there are comorbidities that we have to think about, and it's not just comorbidities. People might come with already. The HIV causes comorbidities. So even in somebody with well controlled HIV, they are at higher risk of, for example, renal issues and cardiovascular disease. So we need to keep an eye on these things. And some larger clinics will have joint clinic set up with the renal physicians or with the Hepatologists, for example. You can see at the top that's, um, an MRI scan of HIV and careful opathy. So if people have had HIV for a while, it can cause opportunistic infections and cancers. And so if people are late diagnoses, for example, or if they've not been engaging in care for any reason, then we can, unfortunately see complications of HIV and then have to manage those on a longer term basis. Um, top right. This is the array of HIV medications we have. So again, if people have whatever reason not been taking the medication as as prescribed and they can develop resistance, so then we have to really think about how we, um, how we give them the combination that will best work for them and then in my population in Croydon. Um, the majority of our patients weren't born in the UK, so we support them mainly by sign posting. But we have links with a lot of the third sector organizations for immigration issues. For example, we now have a psychiatry team, HIV liaison, psychiatry team that I'm just checking that that people can hear me because I can see that Frankie said please type. Yes. And nobody's typed. Yes, yet. So I just want to double check. I'm not talking to myself. If you can hear, can you just type? Yes, in the chat box. Oh, brilliant. Thank you, Olivia. Um, so we have an HIV liaison psychiatry team, Um, that join us for our weekly MG t s, for example, that we can refer patients to, um, to support them with any psychiatric comorbidities, which again are incredibly common in people living with HIV. And so it's estimated to about a third of patients. Um, we look after patients about the pregnancy. Uh, and again, it depends. It depends which clinic you're in. So when I worked in Manchester, we had about 2000 patients living with HIV, but the majority of them were men who have sex with men. So although there were pregnancies, they weren't they weren't loads. Whereas in Croydon, about half of our population are women. So there's a lot more pregnancies than, um than they were in Manchester. So depending on your demographic all depends on the kind of they're kind of not issues, but the things that the people that you will see and the problems or the diagnosis that they bring with them and then finally, just like, um, we do a lot of preventative work in HIV medicine. So it was estimated in one study that people diagnosed with HIV these days actually live 10 years longer, um, than people who weren't diagnosed with HIV because we pick up things early. So, for example, everyone over 40 has a key risk three every year, which is a cardiovascular risk score. So we talked about smoking. We talked to them about cholesterol. We talk to them about weight management and exercise and diet. We pick up the fact that the kidneys aren't doing so well. We pick up the hypertension, um, in there, six monthly visits to the clinic. So again, very broad, um, broad spectrum of of what we deal with in the in the outpatient clinic and then gi um, and HIV inpatient care. So again, that depends where you're working and some hospitals don't offer inpatient care. It depends on your population. Obviously, the hospitals with the bigger HIV populations will offer the inpatient care, or sometimes it will be centralized. Um, but I've seen in patients without HIV who have severe herpes, for example, who've needed super pubic catheters and need some sexual health advice. People sexually acquired reactive arthritis and then on an HIV side of things, um, primary HIV infections. So, for example, I saw someone with HIV meningitis, um, those with opportunistic infections who are either a late diagnosis or haven't been taking HIV medications. So TB is very common cryptococcal meningitis, which I just realized I spelt wrong. Apologies, PCP, pneumonia and then HIV associated conditions. So, like I said, not those conditions that are caused, um, by HIV themselves necessarily, but but that are associated with HIV and HIV can definitely contribute to those conditions developing. So cardiovascular disease, chronic kidney disease and addiction and psychiatric diagnoses. So not just obviously the clinical part is is a massive part of what we do. But there's lots of other aspects of the job, so quality improvement. I just wanted to give an example. So this is the team that I work with at Croydon. That's my colleague in the middle in Cormack and our registrar who left last year. Linda, um, they were our team, but they were leaving. It were awarded the Universal Healthcare Excellent Global Award. And my colleague Ian just got back from South Korea last week, um, to be presented with this award. So we started opt out HIV testing in the emergency department at Croydon. And, um, it decreased mortality from 23% to 0% over an 18 month period. Length of stay went from 23 days to four days. Um, it's just been an absolutely fantastic intervention. We've picked up lots of new diagnoses, I think were 35 new diagnoses now over a two year period. And these are people who don't attend the sexual health department so would be missed in the screening that we would usually do, um, in terms of quality improvement. Obviously, there's there's loads of things. So in sexual health, I developed a traffic light tool for breastfeeding. So that stuff new which medications were safe for breast feeding, Um, and which weren't and spoiler alert. Most of them are safe, which is great news for the patients. Um, we have introduced, uh, testing for latent TB in our HIV patients. I've rewritten our pregnancy in HIV and, um, pregnancy with syphilis guidelines, and we worked much closely, much more closely now as an M D t than we did. So there's like anything that takes your fancy in terms of quality improvement and the I think it's difficult when you're a junior, because you might see something that you think needs to improve, that you don't have the time perhaps to to focus on it or you're so busy with all the other things that you have to get done like exams and very onerous on core rotors, etcetera. But what I really love about now being consultant is that actually, I can see something that doesn't work as well as it should and say, All right, I'm going to change that. I'm going to make that better So in terms of education, because it's mainly, um, outpatient specialty. So although we have in patients at Croydon, we normally have anything between sort of one and five in patients, So this isn't sort of a an inpatient heavy job. There's lots of time to incorporate other aspects into your job plan. So, um, as an example, one of the things that I do is I'm an educational supervisor for the registrar in sexual health, but also for an F one who doesn't even work in sexual health. But I'm there. Educational supervisor um, the top right picture. That's the worshipful society of apothecaries who run our diploma in HIV and Diploma MG medicine exams. So there's opportunities to be an examiner in the bottom. Left Supporting Excellence of Medical Education Act is the Organization for Healthcare educators. So I'm the deputy director of medical education. Our trust, Um, there's also opportunities within the medical school. So Saint George's is the medical school, along with kings that sends, uh, students to cordon. But wherever you are in the country, they will be links with medical schools. Whether you're a teaching hospital, district General hospital, most hospitals will have medical students in a higher or lower proportion. So one of the things I really enjoy about my job is is it's very varied. I think if I just did clinical medicine all day, I'd get quite board. But having the other aspects to my job. I find really rewarding and interesting, and I'm constantly learning, so management and leadership again, just loads of opportunities to get involved in things so clinically, you can be the clinical director of the unit if you want to. Um, you can rise up the the echelons of the hospital if our one of our sexual health consultants was deputy medical director until she retired. Um, in terms of the, uh, GMC there's rolls that you can do, um, in terms of medical school assessments and visits. Uh, one of my colleagues is a medical examiner. So all deaths now in the hospital have to be run by the medical examiner, and they examine the case. Make sure there's nothing, um, that needs looking at further. Um, so the sessional work very much lends itself to these additional rolls if you're interested. That said, if you want to fill your day with clinical medicine, then that's absolutely fine, too. And research as well. So I did a Google for PhD programs and HIV, and the top one was what came up. So if you're very bench, um, research, focus, then here you go peptide hydrogel. There's a long acting multi multi purpose drug delivery platform for combined contraception HIV prevention. It sounds very interesting. They're not up my street and in HIV medicine with all the drugs, there's an abundance of drug trials that go on and then in sexual health. There was recently from 2016, 2021. There was a long term study which looked at things like giving, um, epidemiological, um, antibiotics to people with chlamydia. So, for example, not waiting for people to test positive but giving antibiotics in advance and seeing how effective that was, reducing infection and onward transmission. And there's about 20 HIV vaccine clinical trials on going. And this isn't even including all the qualitative research that you can do. So looking at how people deal with their diagnosis, how HIV is perceived by healthcare professionals, for example, you know how patients deal with the diagnosis of herpes and and how healthcare professionals can support them in that. So, in terms of the positives of the specialty, I think it's incredibly varied and interesting. Obviously, I would say that because it's my chosen career. I think one of the things that I was reflecting on as I was preparing this talk was how every couple of years, something new comes up. So, um, I remember going off on maternity leave, and I came back and they were about five new HIV drugs that I didn't know, um, and had to keep looking them up and try to remember what they were. And that was just being off for a year. Um, prep, as I mentioned before, was a new intervention which has been incredibly successful. And we're now seeing, um, the first couple of years of decreased HIV diagnoses, which we've never seen before, and we think that is real decrease rather than decreased. Testing is the testing has stayed steady, but the diagnosis rate has has gone down. Um, and then, more recently, you've probably seen the news Monkey pox. So sexual health are taking the front and center role with monkey pox because a lot of the patients, um, that the majority of patients being diagnosed at the moment are men who have sex with men. Um and so they're being seen in the sexual health clinic with with co existent, um, infections as well, like chlamydia, gonorrhea, syphilis, et cetera. I can't believe I got this far, and I have not mentioned syphilis yet. Syphilis is brilliant. Um, I love the fact that I can cure patients, so it's really nice that when a patient comes in and they're absolutely devastated when you tell them the diagnosis of whatever S t I, it is. And I say, Don't worry, we can sort it out for you. Take these antibiotics for a week and don't go away. Um, things that are not curable but treatable, like warts and herpes. Again, so much stigma surrounds these diagnoses. And you know, patients will be subbing in my room, and I'll be able to tell them that it's really not a big deal in terms of their health that this is something that feels horrendous today. But in six months it'll be one tiny part of them that you know hope is just just a cold sore, but on your genitals rather than on your mouth. It's incredibly common. By the age of 80/90 percent of people will have antibodies for HSV one and two, so most people will be exposed to it in their lifetimes, etcetera. It's it's really nice to have somebody leaving your clinic much happier than when they came in, and I feel like other specialties, particularly where you're giving really bad news on a regular basis. You know, you have to have that mental resilience to deal with the the devastation that you're not causing people's lives. But the diagnosis you've given has caused, and what I love about sexual health is really there isn't any diagnosis that I can give. That's bad news, because even if it's HIV, I can say to them, Look, actually, this is really great that we've found this at this point because we can give you treatment and within a year you're going to be living a completely normal life again. Um, I like the fact that it's we care holistically for patients, and that includes prevention, mental health, preconception, pregnancy care. We see this massive demographic of patients, so men and women, we do see Children in the sexual health clinic. Um, so if they're sexually active and it's consensual, then we will see them. We see women through their childbearing years and postmenopausal as well. I like the fact that my patients don't often die. Um, when I was choosing what specialty to do, I thought I might want to do palliative medicine, and I did an F two, um, placement in palliative medicine and, yeah, nearly broke me. And I realized, actually, a specialty where all my patients die or majority of them die isn't actually for me. Um, and that's one of the really good things about sexual health is that you give patients a normal life with the interventions that we have. And like I said, clinical work is easily combined with the non clinical opportunities. What are the challenges in the specialty at the moment? So I'd say we're going through this transitional period, and I'll talk more about that in a second because new trainees in sexual health are now going to be a dual crediting in, um, internal medicine. There's also been some transition over the past, probably 10 years with the Health and Care Social act and tendering of services. So, um, services did move to private companies, for example. I think a lot of that storm has now been weathered, and there's more stability, and people understand that sexual health isn't necessarily a money making enterprise. And so, uh, some companies have stopped bidding for the tenders, and, uh, it's moved more back into the N. H. s, um it annoys me when people ask me, Why would anybody want to do that? I mean, hopefully I've convinced you with my, um with my chat about why people would want to do that, because it's brilliant and it's interesting and it's varied, and I get to make a real difference to people's lives on a daily basis. It's a smaller specialty, Um, so that means two things. One is that you are somewhat limited in terms of jobs. You know, it's not like geriatrics, where there's, like eight jobs at each hospital, um, in smaller areas there, maybe one or two consultants in the hospital. But there's still plenty of jobs out there, and even rural areas need sexual health doctors. Although your HIV cohort may be smaller than in Brighton, for example, And if you're if you're somebody who needs, um, that heroism and to, you know, to save lives on a daily basis, then I'm afraid we can offer that, um, in the in the short term. But I would argue that we save a lot of lives over the longer term with our HIV diagnoses, um, and the interventions that we can offer for people living with HIV. So I'm going to move on now. Two application to the specialty. I'm hoping that with everything I've talked about, have convinced you that you want to apply. Um, and this is how you do it. So you do your foundation training, which is two years, and then you apply to internal medicine training, which is now three years. So when you get to I m t three, you apply for your specialty training, and at that point, you would apply for gum. Um, so you do your MRI C p while you're doing I m t. And then, um, you would apply for gum and get a post, and then it's four years. And during those four years, you do your sexual health, HIV and also internal medicine competencies that that after the four years, you would see CT with a C c. T in GI, um, and internal medicine. And at that point, you can apply for a consultant posts. So in terms of the examinations that you do during specialty training, there are two compulsory exams which are the diplomacy medicine diploma in HIV medicine that have the best of five paper and and our ski. And then there are some optional assessments now, So one of those is diploma of the faculty of sexual reproductive Health Care. So that's more about contraception and then less of competence and intrauterine devices and sub dermal implant. So that's being able to do coils and implants as well. So as an example, like in my job, I don't do I don't do contraception, um, in a major way. So, like I said, I can explain to you about an implant and the side effects and the failure rate, et cetera. But I don't have an implant clinic where I put them in where some of my colleagues, particularly in smaller services, um, they will do an implant clinic. One of the things it's worth being aware of is it's generally speaking, it's very expensive to use a consultant to put in implants and coils when you can employ the band. Six Nurse, for example, to do that, probably a third of the price. So, uh, generally speaking, it will be the consultant that would run a complex call clinic, for example. So perhaps with patients with fibroids or, um, you know, stenosed cervical loss or something along those lines. So just to explain a little bit more about how training will work, Um, so it's this is all very new. Um, and there will be some flexibility, particularly between regions, depending on how training is set up. But these are some of the options that have been suggested for people to train in gum and, um, internal medicine. So you might do, for example, three months of internal medicine, nine months of gum, three months internal medicine, nine months of gum. And then it goes, There's certain stipulations about you have to do, um, at least three months in your final year. And that's so when you see CT, if you get a job that includes general medicine, you're you're ready to go, Um, and throughout the four years, you need to do at least, um, 12 months of internal medicine. But part of that internal medicine three months of that can be when you're doing HIV in patients. So actually, only nine months of it needs to be general medicine. Although it would depend on you know, the speed at which you read your competencies so you can see the other options here. It might be that you do six months of gum, um, and then three months of internal medicine, then nine months or a year of gum, then four months of internal medicine. So it very much there's. There's lots of flexibility there, and it will depend on how the training program is set up in the region that you apply to. So the application process is national recruitment, and Round One generally opens in November and closes in December. And that's where the sort of traditional August September start and then round to generally opens in July and closes in August. And that's for a sort of traditional February or around that time. Start round one tends to be the big around, where most people applying around to is sort of a more of a backup round and round, too, doesn't it? Doesn't open every year, so it depends on how many posts are still available. So if you want to apply for gum, um, in the future, please don't presume that Round two will definitely run because there is a possibility that it may not. So the application criteria. There are 10 categories. Um, and I've put the link for where you can find these on the G A R C E P T B Web site, but in brief, they are additional undergraduate degrees, post graduate degrees and qualifications. Additional achievements, M R C E P. Presentations and posters, publications, teaching experience, training and teaching, quality improvement and leadership management. And each category. You self assign yourself a score, um, and, for example, with, uh, trying to think, um, RCP. So the highest score would be if you've got part one part, too, and paces and lower score would be if you had part one part, too, and then the lower score a lower score again would be if you just had part one, and then the lower score would be if you didn't have any of your ERCP. For example, um, so what I would really recommend doing, and whatever specialty that you want to apply for is having a look at what the application criteria are now. Even if you're a medical student or a foundation doctor and just seeing what it is, what are they looking for? And then it means that you can tailor the extracurricular activities, your quality improvement activities, et cetera that you do to that application because there's no point doing quality improvement project for something that you're not really interested in when you might have been doing one in a specialty that you are interested in, that can then also count towards your application. So the interview, um, at the moment and this does it does it can change on a on an annual basis. So, for example, with the pandemic, it went from panel interviews to just having to interviewers that I asked you all the questions. Um, so at the moment, there are four question. So the first one assesses your clinical clinical scenario and your communication skills. The second question looks at your suitability to the medical registrar. The third question is an ethical scenario, and the fourth question is, uh, suitability and commitment to the specialty. Um, and then they calculate a raw interview score. Um, and they add that with your application score to give your total score. And there's certain criteria like you can't score lower than a certain amount in more than one question. Um, but if you reach a minimum score, then you are a point toble at that level. So, um, I'm just showing you this before I show you about building a portfolio. So the gum competition ratios, hopefully for you guys are good news. So I'm sorry. The text is a bit small, but this is one here. So one means that there is one applicant for every post available. So what you can see here is that so? This is 2015. So in 2015, it was 1.2 applicants for every post, so the odds are pretty good. And then in 2016, that went down to 1 2017, it went up again. But since 2017, every year, the number of applicants has been lower than the number of post available. So if you want to do sexual health, your chances are exceedingly good at getting it at the moment. Now, obviously, I'm hoping that that improves because I want everyone to realize what a wonderful especially it is. When I applied in 2013, I couldn't find any figures for before 2015. But in 2013, it was incredibly competitive. Um but I think with the Health and Social Care Act people got a bit worried about what was going to be happening. Where jobs going to be available, Um, their consultant jobs going to be available. I can tell you now, there are lots of consultant jobs. Um, and there are lots of people coming up for retirement in the next 10 years. So we are very keen to recruit new enthusiastic registrars to fill those consultant posts. And this is just the figures. So you can see, in 2015, there were 35 applications for 29 posts. Um, and you know, there's been some pretty bad years, so 2000 and, um oh, sorry. Duplicated. So 2019 was a particularly bad year where there was only 20 applicants, but there were 46 posts. So, um, you know, half of the post went unfilled, but then it has improved somewhat, and hopefully the directory we're seeing I mean, from my perspective, is improving from your perspective. You might like it to stay a good competition ratio from your perspective. So building your portfolio. So if you're interested in sexual health, there's there's loads that you can do. So I'll just briefly talk about what I did. Um, and the things I did, they weren't really, Um I didn't know that I wanted to do sexual health as a as a career. I knew that. I found it interesting. Um, And so as a medical student, I trained to be appear educator. So I used to go to high schools in sulfur in Manchester and do peer education, sex education for a year, nine students, which I think has took me in good stead for for the patients that I see these days. Um, I also did my elective in Tanzania, so that wasn't planned because it had a high prevalence of HIV. There were other reasons that I went there, but then I ended up sitting in a lot of HIV clinics and finding it really fascinating. Um, I also used to be involved in girl guiding and threw them. I did a project on on sexual health and HIV. I went to talks that the university was putting on etcetera, so I had quite a lot of experience as an undergraduate and then as an f two, I didn't have any post. Um, I still didn't know what I was going to apply for at that point. And I was in the termination clinic and we were doing, um, sexual health screening and also talking about ongoing contraception post termination. And I just found that really interesting. But I knew that I wasn't a surgeon and I didn't want to be an obstetrician. Um, and so sexual health seems like a really good, um, specialty for me to go into. So that was sort of my my experience. And then I did shadowing as well, because I never had the opportunity to do a sexual health job before I applied for it. So I sat in, I think, on three clinics. But I knew that I wanted to do it, and I wasn't wrong. So think about if your medical student think about where you might want to go on your elective. Um, do you want to go to a country that's got a high prevalence of HIV? Maybe you don't want it to be an HIV focus, but if you go to a country that's got a or not even a country, if you want to stay in the UK, you might choose to go to London HIV clinic or Brighton or Manchester or leads Birmingham somewhere with high prevalence of HIV. And if you go to a country where the HIV prevalence is high, then even if you're not doing an HIV job per se, you'll find that HIV touches all of the specialties because you're thinking about drug interactions. And you're thinking about how HIV might be contributing to the diagnosis that you're seeing in terms of volunteering. So I just put a few examples here. So I'm volunteering according Pride, next weekend, we're going to be giving out condoms. We're going to be doing, um, point of care HIV test so people get their results there and then George House Trust is a charity in Manchester. Um, but I volunteered with for a short time, and they support people living with HIV. The food chain is a charity in London that supports people with HIV, Um, living in food poverty. It helps with cooking classes and also, um, food Parcells and, um, food and financial management. So they look for volunteers. National age trust, looking for volunteers. Positive East is a charity in East London. So wherever you you live, um, they'll be charities, organizations that are looking for volunteers to support them. One of my colleagues. So if you know, if they don't live in an area where HIV is particularly, um, prevalent, then there may not be as many of opportunities like that. But, for example, one of my colleagues, he volunteered with the Sex Workers Outreach Center, so he'd go there every week and, you know, make people cups of tea, have a chat with them. And actually, he never told them that he was a doctor because he didn't want to be providing medical advice. He was there as a as a supporter, Um, in terms of projects like I mentioned earlier, you know, be smart. So think about how if you need to do an audit or quality improvement project or you're interested in research, think about how it's going to complement your, um, career goals. So don't just take any old project. Think about how you might be able to incorporate what you're interested in with taking your box on the form, because unfortunately, you have to play the game a little bit, um, to to get where you want to be, so I'll talk about this in a second. But you know, as a medical student or junior doctor, you can be on the guidelines writing group for chlamydia, for example, or prep. Or, uh, there's lots of special interest groups via some of the national associations that would love to have non specialists on the group to provide them with a bit more balance and ideas outside the specialty. Because we all know that when you've worked somewhere for a long time, you can get a bit blanket and not be so innovative anymore. Shadowing really helps taste of weeks if you're in foundation, and there's also these national gum taste a day. So I did that many moons ago, 10 years ago now, which was a day of talks and lectures in London and then a day in a clinic in London. So I went to a clinic in East London, and I was in living in Manchester at the time, so that's open to anybody, um, clinical fellowships as well. So we have. We employ to clinical fellows a year who work in our sexual health department for for a year. They look after the HIV in patients. Um, they do go, um, clinic downstairs so they get a great foundation in in the job and and learning what it is. And, um, you know, hopefully we convince them that they want to be sexual health doctors. So national associations. There's two main ones. So the British Association for Sexual Health and HIV, which is free for students to join. So please do join if you're interested in sexual health and you're a student and for doctors in training. So this is at any stage of training, including registrars. It's 95 lbs a year, and that includes both sexual health journals as well. Um, and then the British HIV Association, um, costs 40 lbs a year for a medical student to join, and it's 95 lbs a year for a non consultant. And what I would say, You know, you don't necessarily need to join both of those, But if you are interested in in the specialty, then I would recommend joining one and then that opens up your opportunities to get involved in other things. So, for example, as a cash member, you can get involved in the special interest groups. So there's one for racial minorities communities. There's one for Well, they changed its name. Gender. It used to be the, um, might be gender minorities group, so it's basically for people who don't identify as straight. Um, there's the gentle dermato See Special interest group. There's the bacterial, um ST I special interest group. There's the viral STD, a special interest groups. So, um and this is the way as well that you can get involved with the writing guidelines so bad I will send out the newsletters with the opportunities that are there and and things that you can be involved in if you want to. And like I said, you know, we love it when people who are keen and enthusiastic and perhaps you've got a bit more times Well, I want to get involved in these things. There's also a dedicated, um oh, sorry organization called Stash, which is the student and Training Association for sexual Health in HIV, which sits under bash, Um, and that was formed only last year. But they want to highlight the specialty because I think a lot of us feel that we're a bit to hidden. Um, you know, they always put the buildings sort of in some faraway part of the hospital um so we don't necessarily get to liaise with colleagues as much as we like to. And we're not a big specialty, like gastro or geriatrics or respiratory that I don't think you can avoid during your training. Um, so I would really encourage you to to engage with Stash and the Rash trainees as well. So I've put the There's an email address trainees that back dot org you can contact. Um, and if you go to the Twitter page and follow them, there's more information on there. There's these two opportunities that were on their Twitter page. So they're looking for a stash to stash committee members, an ambassador, coordinator and the secretary. Um, and both the deadlines for applying for those roles closes on the 13th of July, which is in two days time. So if you are interested, please do drop it, um, an application. So, um, sorry is Texas is very small, but it's basically saying the steering committee aims to provide education opportunities related to sexual health and HIV medicine, including revision session, especially workshops, support career development through mentoring career fairs and creating for um for networking, promote and facilitate opportunities for collaborative audits, research and quality improvement led by medical students and training doctors across the UK and facilitate opportunities for presentation of student projects at local and national Conference is, um so the ambassador coordinated the role in involves recruitment and management of stash local ambassadors, sharing updates, quarterly meetings, um, sharing student perspective to the steering group, um, promotion of stash activities and active participation stash events. And then the secretary roll involves producing minutes and the steering Committee maintaining organization of the Gmail, Google Dr and Slack promotion of stash activities. Um, an active participation stash events. So if you are interested, then again, this would be a wonderful portfolio building exercise, but also a great way of meeting people getting to know more about the specialty. So I just added a few references and useful links there. But if there's anything that you're you want and you can't find, just drop me an email, and I'm very happy to forward it on to you. Um, just wanted to to draw too close really and say thank you so much for for your attention. I wanted to leave it on this slide because I think if you are interested in special TVs are going to be your first go to people. But please, do you get in touch with me? Um, if there's anything that you you want to know, or I can, you know, sign post you to to the right people. So, yeah, I'm looking forward to to you all applying in the next few years. Frankly, if you're still having trouble with the internet, feel free to write in the chart, and I'll answer any questions there. Yeah, I can't hear you, but I can see the chat. Fine. So So, question is, is being a med wedge the only route to get in? So now, yes. So gum has joined the group one specialties along with palliative care and neurology, I think. Um, so to do gum training, you have to do I m t. And there is no, um, option to do some training without doing I m t competencies. So internal medicine competencies during your training. That doesn't mean that when you see ct, you have to do internal medicine. Um, it depends what jobs available. So at the moment, for example, you won't find any jobs that I got internal medicine with them because none of the trainees who are cc teeing have got internal medicine competencies as well. But I think as people are coming out with more internal medicine competencies, that those jobs will grow. But they're you know, it's hard to predict the future, but there may well be pure gone post that don't have internal medicine in them as well, depending on what the trust or the organization needs. I think particularly, um, those services at the moment that are run by non NHS providers who don't provide inpatient care, for example, they're not going to be looking for, um, somebody with a massive interested internal medicine because, um, they don't provide those services. So I think there's always going to be opportunities for for for both. But I think as the number of people with internal medicines, um, dual accreditation increases, the consultant posts will start to reflect that more so work life balance. Um, and it's really, really good. Um, so I'm not ashamed to say that one of the reasons I chose gum was because I wanted a good work life balance. I was older when I came to medicine, and I didn't want to be in my forties and still doing nights and weekends. Um, as a as a registrar, Your sexual It depends where you work. But I worked in really big centers, so, you know, routinely had sort of 4500 patients living with HIV. Um, so we would generally do nonresident on calls, so we'd have the phone and and people would bring us overnight. And that might be with queries about whether to give post exposure prophylaxis. Or it might be that a new patient had come in with late stage HIV, for example, and the team wanted some advice. On what? To you know what to do, what investigations to do, that kind of thing. Um, there are lots of, uh, people, lots of department at the moment where there isn't an encore commitment because there isn't the sort of need for that 24 7 advice. Um, I'm just trying to think so. Yeah. To So in the four years I worked in four different departments and two of them didn't have an encore commitment, and two of them did, Um, but my uncle commitments were switched to sort of more out of ours. commitments, evening clinics and things. Um, so I still got banding, which was, which was fantastic as a consultant. Now, so we have nearly 1000 patients living with HIV. We do look after in patients, so I do, um, at the moment of one in three nonresident encore greater with with two consultant colleagues. But it is It's very manageable. And it is unusual for me to get called in the night. Um, and, you know, we do get called weekend sometimes, but we don't I don't ever have to go in. All the advice I give is over the phone. So it doesn't stop me from doing nice things that the weekend or in the evening if I want to. Obviously, if I'm on call, I can't drink. But that's the only sort of, um, that's the only issue. Really? Uh, so, yeah, it's It's brilliant work, life balance. I think the sessional nature, the fact that it's mainly outpatients, really lends itself to part time, working as well, flexible working. A lot of my colleagues in other departments work from home, particularly post pandemic. Um, so yeah, that's I'd say one of it's probably should have mentioned that earlier. Shouldn't That's one of its main drawers, I think is the work life balance that you get. And that's in training as well. So I think a lot of specialties you get the work life balance once you're consultant, but not in training and actually in training is when you're trying to live your life, you're buying a house. You're having kids, etcetera. So, yeah, what do you enjoy the most and what I found the most challenging. The most challenging bit of training was the first two years. Um, I was the only registrars. No, that's not quite true. So in my first year, I actually worked in the infectious diseases department. Um, although there were infectious diseases, registrars there weren't any other gun registrars. So that was a bit lonely in terms of just somebody understanding what the challenges of my job were, you know, having somebody to chat to about what I needed for a r c e p. Um, that peer support, Um, And similarly, in my second year as a Reg, I was the only Reg in that department. I was only at all in that department. Um, so, you know, there's pros and cons of that. The pros are that you get undivided attention because you're the only trainee. But the cons are that you don't get that that support from your colleagues. Um, so that was that was quite challenging. Um, challenges. Now, as a consultant, I think just not enough hours in the day to do all the things that I want to do. Um, so I've done the typical. I've been a consultant for three years now, so I'm fairly new. Uh, still, but I've done the typical thing of taking on far too much and then not having enough time to do it also. And that's because it's also interesting. So I'm sitting on the guide National Chlamydia Guidelines writing group, and I've become the external assessor for the deployment HIV medicine. And I'm an appraiser, an educational supervisor. Now, I trust deputy director for medical education. Um, probably forgotten things, so, yeah, I have an outside, um, role in industry, so I work as a consultant for another organization. Um, sort of using my sexual health in HIV knowledge. Um, so, yeah, I just need I need more time to to do all the things that I'm interested in or need to learn to say no, that's the other one and what I enjoyed the most. I can genuinely say that I really love my job. I It's quite normal for me to have a laugh with the patients and to share some share real moments of connection with them. When I understand what they're going through, I understand why they're upset or you know what's happened in their relationship. That's led them to be in that seat. Um, I love the fact that I can put people at the reason people who've never been to the clinic before. I mean, last week I saw a 76 year old who had never been to the clinic and, you know, he was really nervous about coming and, you know, same can be said for a 20 something year old when they have not been before that you can put them at their reason. You send them out of the clinic happier than when they came in. I think that feels like it's quite unusual for a medical job, Um, and also making such a massive difference to people living with HIV as well and being their advocate and, you know, supporting them to register with a GP practice when they've been denied registration. Because they don't have the passport, for example. Um, so, yeah, I just find it really rewarding role. And I I really enjoy the patient interactions and the job that yeah, I get paid to do. I feel very lucky that somebody pays me to to do what I do all day. Any other questions in the last four minutes? No. Last one. Make it a good one. Keep me in suspense. Okay. When did I start working on my portfolio? So, I mean, I accidentally so interesting to move my legacy, the cramping, um, accidentally. I started working on it as an undergraduate. Um, but that was mainly just because I was doing things that I was interested in, and I didn't know at that point, I wanted to do sexual health. Um, I think I'm one of those sort of geeky, slightly, uh, neurotic individuals that started looking at the core medical training as it was, um, application in F one. And just looking at what it wanted me to do, So I could, like I said, be smart and tailor what I was doing to to the application, Um, in terms of finding the time, Well, it's stuff that you've got to do anyway. So in foundation, for example, you've got to do a quality improvement project, Um, in, um, call medical training. You know, you've got to show that you've got some interest, I think, in research or whatever. Whether that's going to journal club and critically appraising a paper, you know, choose the paper that's related to the specialty that you're interested in. So I'd say you can spend loads of time doing additional things. But actually, if you choose the right things and you can take the you can tie it into whatever you've got to do anyway for your training, whether that's undergraduate or Post graduate. So, for example, going on an elective to somewhere that's relevant to the specialty that you're interested in just makes sense whether that's in the UK or abroad, because then you know, I could write in my S t three application as a finding a medical student. I went to Tanzania and sat in on the HIV clinic there, so showing that I've got an interest and had an understanding of specialty. Uh, and then finally, any tips for medical students for opportunities to look out for? So join stash, get in touch with them, email them, say that you're keen, and they will fall over backwards to give you opportunities and let you know what to do. Um, also get in touch with your local sexual health clinic and, you know, tell them just just google the sexual health clinic and find out who the clinical leaders or one of the doctors there and find them on NHs dot net and send them an email and just say, I'm interested in sexual health. Like, is there anything that can do? Have you got any audits? Um, that you need help with or, you know, is there Is there anything else? So, yeah. I mean, if if somebody got in touch with me and ask to to do some stuff, I'll be delighted. If anybody wants to help me with a UTI and sexual health audit, you're very welcome. So Frank is just saying, Please fill out the feedback form. You'll get a certificate of attendants which will show your interest in the future. There you go. Boom. One portfolio building activity done. So thanks, everyone. I hope you enjoyed it. I hope it was helpful. And yep. Get in touch with me. Get in touch with stash and, um, apply for gum because it's great.