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I think it's just like just taking its time. Okay, Amazing. All right. Good evening, everyone. Thank you for attending. Mind the bleeps. Webinar Siris. I'll talk This evening is on the inside out. Soft life as a medical registrar with a particular look at diabetes and endocrinology given by doctor and her shots. So they will also be an opportunity for Q and A a The end. So without further ado, doctor Hi, nice to meet everybody. As I go along, I'll shut my screen so you can see the slides. But if you just type any questions you have in the chat, um, I probably won't be able to see it whilst the slides were up, but I'll be able to answer these questions at the end. Say lovely. What? So I mostly followed on fix on endocrinology and diabetes, but I've also put in a little bit about being a general medical regimen on, But, um, because they paired together very well. So I'm a registrar in Wales and Cardiff on I'm currently s C six, although I should already be a consultant. But I've taken my time on enjoyed it along the way. So the main part about the Webinar. I'll say a little bit about myself, and my experience is, but the main part is going to be part one, which is what is diabetes? Enterology. What's his general medicine when you think about it as a registrar, was my usual week like and then prepare for your applications. So I'm not sure at what level you guys are most of your medical students or foundation or I'm T. But it's really good to just have a look if you're doing once you messing all surgery at some of the scoring points for the applications, they change every year that at broadly the same. And it will help you if you give in an opportunity to do a Project one S S E teo kind of realize that you can take a box of you. Just present that to the to a local meeting, something you've got points that you didn't realize that you would have on them. Part three is going to hopefully be majority where you can ask questions. I'm not one ounce of them because I know that it's a Thursday evenings. I'll keep you too long. So you're mine. So there's a while started back at medical school, but actually, I did foundation in 2011, and, like I said, I could have. If I go on straight through a haven't taken any time out or going parttime along the way, I would already be a consultant for the last two or three years. But I'm still 35 which to me is in that old. So it just shows you that you can do a lot along the way. Um, in Wales. It's very encouraging on, but there's what's opportune to you. So they did an academic call. Medical training, which is what internal medicine training was, has yes, on bunch get masters of research on. That was a little bit of a fluke and being in the right place at the right time on. But I did that during my call medical training, and I really enjoyed all my jobs, but I wasn't sure which medical speciality to go into a little What do I do? So I just took a year out on, but it gave me that time to build up experiences. A general medical registrar on D. I fell in, and knowledge it was meant to cover it for a few weeks and realized, I think I hated that medical school absolutely loved on. I got so much stuff done in that year that helped me for my specialty 20 application. And then I kind of got talked into doing a bit of research, which, um, thankfully is coming to them now being very good. But over the last few years, I've realized I just really love the clinical part. Um, but there's lots of opportunities, especially in endocrinology and diabetes, and because I never want to go up, even though I'm only a year away from me and consultant now I got to take another year on be a whole fellow and cystic fibrosis, because there's lots of overlap with metabolic medicine and county and diabetes there, too. So this is what I've copied and pasted off a website. The War College of Positions have a medical care website, and actually it's quite good for this medical specialties. It's got lots of information. So the reason why I really enjoy diabetes endocrinology is hormones and endocrine glands are everywhere on effect. Most things in the body on it, So it's got a wide range of skills on Do you have a wide range of expertise. So if you never be bald So you brought your little human, you got the pituitary. You've got the thyroid and the parathyroids pancreas adrenals on a bone. Ads on do all the other stuff. Um, Mary out of woman's in between. It affects so many things. The tablets, um, reproduction, your stress, you are being on these all in turn affect each other. So this is why it's also a great specialty to do if you like general medicine. So you like variety likely acute on call because as an internal, just you have to be aware of every part of the body on to get the feedback loops. I did not understand diabetes, our endocrinology at medical school, these negative feedback loops. I didn't really get it. My brain turned off, but, um, the way I think about it, your body is like a see saw. If you imagine, say, thyroid stimulating hormone on one end and t four on the other, both your body like supposed to be a normal range, like a nice, stable see saw on. Then if something goes wrong on to get low t four. Then there's an equal on reaction. Your TSH should go up from your pituitary to try and shout at the thyroid gland. Come on, wake up, wake up on If it's the other way, we'll TSH is too high for us. Too low than yeah, So it's all opposite and reactive on. Then I get excited when the seasonal brakes on either both things are high and they shouldn't be both things alone. So high. TSH You shouldn't have a, um ah, high t four. That's not what your access is meant to do. So I'm not gonna go into that too much cause much easier to write it down as I go along. But I think if you're medical school and you're struggling with endocrinology, think about the glands talking to each other. So if you were the pituitary, they're trying to tell the thyroid or the adrenal glands what to do. If they're not listening to you, what would you do with the shot louder, Or if they're making too many hormones, then you would just shut up because you don't want them to make any more on. Now is what I find interesting about specialty It's quite imaginative on DSM. Things on the screen may not be up in red or highlighted as out of range, but the pattern isn't right. And then you could be a bit of a detective. So Jessica something's normal on the readout doesn't mean in that clinical picture that it's the right thing on. There are other specialties where it's a lot more black and white, and frankly, that's they're boring. So as under chronology, Registrar, my typical week is a mixture off general medical wardrobes on. But if we're doing our job right as endocrinologists, we shouldn't have that many end of crime patients as impatience. And usually they are in the hospital there, in neurosurgery or into surgery or no intensive care. And most of it we manage his outpatients. Diabetes? Yes, you get more of those in patients, but a large majority of our ward there usually general medicine on D. I've done a look. I did three gastroenterology jobs, Onda respiratory job, all of which were very busy on. There was always a disaster about 55. you can still get those sick patients in your general medical warders the diabetes range, but you're less likely to have lots of people bleeding all at once, like in gastroenterology. So it sometimes on the whole, more predictable You got your, um A few connects a week, maybe about three on. They'll be a mixture of diabetes and endocrinology on, but that's a really nice change in pace because you're still on the General Medical Road, as as an end decline Wretch on D. You got all your kind of fast paced emergencies then? And it just means that you've got more energy in between, because what I found when for the last two months of my call medical training I acted up as a respiratory rate, a strong which I enjoyed that you're always on the go and everything kicks off at the end of the day on. But they need to drain that once. Where is endocrinology on this? Some of the practical procedure is that enjoyed and call medical training. But to be honest, a few of my friends who have gone into respiratory within a few months they are tired off doing drains because actually, after you've done 10, there were quite the same on they take a lot of time, lot of stuff. So it's about really talking to the people who were going to do a specialty that you think you want to do on talking to the consultants. Because most respiratory consultants we'll never do a drain again. So I've got that nice mixture variety. I've got a nice group people to work with. You will also work with the diabetes nurse is on there really useful because they do the education that you know, lots of hints and tips. They've come follow up patients is an outpatient on increasingly, with diabetes on with insulin pumps. The amount off amazing data and grafts on demonetisation that you get, um, is make it in a way normal complex, but is meaning that you can tailor things more and more. Onda. I really enjoy that part because and the chronology you're being a detective. Why is this person tired or they just tired all the time? Or have they got cushings or how they got this? Or have they got that? Um, and then diabetes is a lot more, in a way psychological. You've got all these amazing methods of controlling diabetes now, and people are living in a normal life expectancies. But why do some people struggle? Or why are some people who were getting on great with the diabetes? It's suddenly all just tailed out and has gone up the creek, and it's about finding out finding compromises. So I really like that balance on you now having increasing amount of opportunities for working less in full time, either with, you know, a day a week for research or teaching, depending on which Dina, you are applying. Thio. And there are lots of fellowships out there once you're registrar, where you can take a year and you just recently he's going to America. But there are some really great ones as well in Birmingham or in London, where once you know more where you might want to subspecializes you can go there on the training is it has changed just recently. So when I started ST three so after your call medical training until ST seven. But now you got I m. T. So that s t three years or I am t three year where you won't necessarily do a specialty. You're going to come and consult it in, but you get more experience is a general medical registrar on Ben. You've only got your ST 456 and seven best, so we'll have to see how they squeeze and all the training there. But I think it's doable if they somehow would use the amount General medical on calls and you'll have more time for your own specialty, so on day will do a fairly equal mix of garbage. He's an endocrinology, but you may find it also depends which rotations we're doing which year. So in Cardiff, the main hospital is the kind of key endocrinology and territory hospital is you wear as you will, where they have referrals about but you it regime is, and adrenal team is from all around whales on. So you were quite closely a Z department with the surgical departments and the newer surgical departments. So when I'm in the main hospital and Cardiff at least once or twice a week, I'll go to the new surgical ward to see POSTOP preservative protect patients who've got transient diabetes insipidus, and we have to figure out how many of the church hormones are left. Are there any left? What we do on D start, um, hum on their journey and then we follow them up for life. And then other times I get called to lie to you, get some advice, and then I won't ever have to see that patient again. So lots of variety where is in a small hospital in Cardiff? That's where the consultants who specialize in insulin pumps are. So there are a lot more diabetes clinics on D. Um, specialist meetings. And they've even, you know, I sat in on an eating disorder clinic. There's weight management clinics. This endocrinology covers everything, and diabetes is really varied. A swell on, actually, in Cardiff, they've got a special assistant fibrosis diabetes clinics because cystic fibrosis patients also get diabetes. So if your tacky you can really get into the tech off. These, um, if you see those reliever monitors that people can just use that phone on, scan over to see their blood sugars, and it'll show continual reading or pumps. But if that's not what you're interested in, then you can. Yours just see a mixture of Type one diabetes and Type two diabetes, where he blanked on insulin pumps. Or, if you want to do as a consultant, both endocrinology and diabetes you can combine those. Or if you want to become the world leading expert on pushing his disease, then you know who my towards that. So a huge variety off opportunities on then General Medical Register. All everyone I was off applying as well for specialty trainings. Great after call Medical because everyone said, Oh my God, you want to be a medical regimen? That's so hard. Why would you do that? You must be crazy. Well, I realize most of the people who were saying that where people who almost you enjoy and went into anesthetics or surgery. Orthopedic surgery? Um, no. Everyone in each specialty has the same personality, but you will find you gravitate towards and specialties on D if you go into a general medical on calls, especially in the first couple of years, always going to be a bit, you know, bit on edge. But it doesn't actually excitement there on you. And when everything's well starved and it's not completely going crazy, like is a little bit the moment. If you're enjoying that variety of a chest pain or breathless person or a headache on, do you enjoy that? That I'm sorry, you're probably um, a drug in the making. On what one of my friends said when I was in F one, he was a CT choose So now when I empty, too. So he was about to come a medical registrar and they said, Aren't you terrified on He said, No, because I'm like you. I have seen four years off medicine. So after medical school, and by the time he arrives somewhere, he's already seen somebody in heart failure before or seeing someone with sexists on D. As a medical registrar, I get called where most of the stuff has been done by you guys, where the fluid bolus has been given. The Bloods have been taken, the chest X rays done. I have a Navy G given to me, and so that's why it looks like medical registrars, like are amazing because they turn up, they look at things and you've been there for a now on a bit, trying, struggling and not knowing what's happening. So leave This person arrives and it says, Oh, when you do this, this, this and that anything Wow, I couldn't do that, but really, if someone else had done all the work for you and you came in fresh on know kind of panicked. Then you would be able, with a bit of experience, to do that too. So I think don't see a medical registrar as a terrifying prospect. You're not going to do it for at least for a bit years after you qualify, because you need to build up your experience on what I'm seeing. A lot off is where people are taking out a year after a two to a three on That's fine. They don't stick around there too long. Because if you start locating and doing a 45, then if Unless you're really having to, like, apply for very competitive specialty and really build your CV, then actually, what you're doing is you're learning your trade to come on, Medical registrar, I'll I'm doing all the rubbish jobs. That s h o t. Have to do like, phone this person or do that and you're on the phone for half an hour, and it turns out nobody will cares about that result. Anybody you suddenly Then I have to go back on do those three years again as an I M. T. And I've seen people who actually think that they would have wanted to be medical registrars in the end, designed not to on and take excision to go into GP because it's not so they training is long enough, and they've already done it, but they just got the patch for it. But competencies, air coming on, the curriculum changing. So it may be that if you can evidence what skills you picked up along the way, you might be able to get some of those to count. So it's just seeing what things are when you get that. But I really enjoyed having my locum year in between my core medical training. My shh, on my formally becoming a training registrar. It gave me a lot of opportunities. Um, Andi him in, like, be really sure. And you got I think you're gonna be doing this for decades, so don't take forever. But also, you don't need to be panicked about rushing either. So I think I'm not talking about a medical registrar to really do it justice. We probably have to have a few of us here from different specialties, because in the UK, um, all muscle medical specialties now your training your specialty, but you'll be Jul accredited in general medicine. And why do I love it? Well, I love diabetes and your allergies to the variety, and I also have general medicine because of the variety, every age group, every and endocrinology with doing a lot more transcend things as well. But it's still very specialist. So, um, you know it's not that common. It's not in your day to day basis and very specialist clinics that every age of region, uh, you get to problem sold on. You get to follow people up for a long time, and you also get sweep and give your opinion. Everyone's very grateful and sweep out again. So the variety off my day off my clinics off my weeks of my month. I really value because I acted up a respiratory reg for two months at the end of CMT on D. I'm enjoying it. It that I felt within those two months I've become quite comfortable in the clinic. Where is when I start on? Then you have another, however many decades off that obviously you're building up your specialist knowledge and I was just doing very simple things, but in endocrinology when I sat in with one of the top professors, even he had to look things up a times on. But if you're having to do that, 30 is down the line. That's that's exciting because I know everything that you've taught is rare is actually rare. So there are seven different hormones in the pituitary on, but they could all the wrong in different ways. So as individually, each of those things going wrong is rare. But when you were in Endocrine Clinic, you'll have lots of pituitary patients with different combinations, and, um, and that's really nice to follow them through. And it's rare to necessarily diagnose somebody for the first time with the pituitary tumor that a couple of months ago I had 22 in a week, Um, that I came across the hospital so and I like going round different parts. The hospital, different teams know just within the very varied multidisciplinary team and diabetes, which is nurses diet wrists, dieticians on there already, Specialist um, but also in endocrinology, we have pituitary mg tease with the neurosurgeons once a month with we have ended kind surgery mg tease with the endocrine surgeons. So, um is really, really variety, like really varied on also quite a few of the by chemists. We were quite closely with Andre. You some and hardest even get involved in bone clinics or weight management services, and we have to cover all of those. So you've got that mixture. You got that varied pace and you got a mixture of science, psychology, sociology, onda, huge range of potential subspecialties. Or you could just stay very general if you want to. So you can. I'm still trying to choose exactly what my future will be a consultant, but the world is always on, but you're not just going to get stuck with a small group of on but kind of options so hard to, um, applying. I'm sorry if anyone's writing the chat, I can't see it, but I'll answer questions if they're they're later. So whatever stage or act, I would look at the application scoring. You can just Google let or you look at this website on. They change every year. So even for medical school, I was a little bit clueless. I knew that orders existed, but I didn't really understand what they were. I knew that it was good to get a poster, but I didn't really understand how to do it. Actually, I just wasn't asking the right people or in the right way. And if you can get things ticked off at medical school, they will count for you all specialty applications and make her life easier on. But if you haven't done anything, then it's fine. You still got time on. But keep a rough cvv if it's just a list of presentations off. Um, not necessarily publications, because they're hard to come by. But anything you do write it down on D because it's amazing. After a couple of years of working, you're completely forget that you delivered a teaching session or that you presented this thing for your boss anything while I wasn't that much. But actually, when you come to the application form suddenly that gives you two extra points over some deals, Um, on D. When you look at the application form, which I'm going to go through, some bits are easier to score and another some. If you've done an interplay to degree, great, you got those points. If you haven't you have got this points. It's too late you know, it may be that you got time to solve that, and that's okay, but what you don't want to be doing is just doing teaching, teaching, teaching. And then it turns out that you're no scoring. Quite right. And you haven't got anything in post nasal presentations or quality improvement expected to get a few points and everything, then just some wings and one on D. The scoring system is Concerta every year. So you need to kind of spread your bets a little bit. Um, on doesn't really matter. The scoring system is there for you to get an interview on an even a thing. Something doesn't technically school. If it shows how committed you are on other parts of your personality, then then I'll squeeze, pull it points in the end. So this is has changed since when I applied. You suddenly got these points for commitment on. But if you look at the bottom, it's not quite, um, part, you know, it helps you get the offer, but it doesn't, um, we'll get the interview, but it doesn't necessarily help. You want to get to the interview because in the into you you need to prove this again means that just because you've worked in endocrinology job Onda had a presentation. Well, you could have done that if you want another specialty on. Also, they don't want no. Everyone do a job in the specialty. They want Teo as an f one f two or I am t one um, so they're trying to make it fair. So if you can take advantage of taste two days or that you find out there's local meetings, regional meetings, some whales twice a year we have the Welsh in decline of diabetes society, where you get good food on be good talks, and it's just in afternoon twice a year, and some, you know and they get a lot of medical students or F ones to either do a postal present. Then that's going to be taking boxes on D for everything with poor people, phone use or applications. There are boxes you need to take that if you can take the approach that you're trying to, you're trying to enjoy what you're doing and find it interesting with just a I to make sure that you've done 90% of the work. Just make sure that extra 10% is done so that I can count on that tick box. But if you just slave, it's really going to the tick boxes have don't enjoy what you're doing. Then stop. Um, it should be interesting. Otherwise, it's not the right thing. So you can look this up on the on the website that I showed on the previous slide bends you've got to see here. I don't understand why you get 10.6 weeks and two points. That just makes a lot that you, if you do it, taste a day, even if it's not an official taste a day when you do something, type it down on that rough sieving because in 23 years you'll have forgotten about it on, then under graduate degrees. If we have them or you don't, um on I am, they may be taking some of this these scores away because again, with the cost of living on the price of university fees, this isn't achievable for everybody. So in the next year it may be that this isn't in a school, but I'm not sure the heap providing Katie about it on then post graduate schools in a days all relevant on D, But again, you know, everyone can get it. I feel that often post graduate diplomas and certificates just add a whole lot of work in your spare time and take a lot of money off the time off You. So yes, they school things that you can see that they don't, um they're not scored A huge amounts two points. So don't rush in something. If you want to do any know you're really interested in it, then do it. But don't just do it, because because you'll you burning yourself out, wasting money, wasting time and two years down the line, you realize, Oh, I should have spent that time and that money on this thing that I really love. There are other ways on these other points of additional of presentations, publications, quality improvement, that you could be scoring even more points. So don't panic about this. They're nice Children on top. It's additional achievements again. You do you have, um, a medical school or not? Um, that's, um you can Also there are lots off if you look at all sites of medicine, right? College of Physicians, the Endocrine Society, diabetes, UK. There were so many essay competitions that I didn't even know existed for. It's too late, really? On D. If you find a new area that you find interesting or is overlapping with a an essay already doing, then if you don't apply you'll you don't have the opportunity to win these prices. So, um you know, So I think on what's unfortunate is a They work out as a national price, which sounds a little bit intimidating. But some of these prizes and that's a prizes people don't know about. So actually, not that many people apply on D. So you watching a much better chance and you realize so. Presentations. These are case reports or quality of provement projects. Lots of different things on you can go back and look at this in more detail. Um, that my pet fairy is for there are millions of conferences, millions of medical conferences, and they're all quite expensive. They always do a much to parade or free for medical students. But the way that we get people to turn up to um is they hold out of this current off. You could have a poster on day or presentation on. Actually, you know, if you find a consultant or a registrar who also all need to be showing that they're involved in quality improvement or audits, is there a very simple data collection thing that I conducive on be involved in on D? If there is, would it be able to be opposed to that? After geriatrics meeting all the endocrinology meeting on D, Suddenly you get it done. A post I removing as an f one cause bleeding into it by registrar, I thought, What is this Black magic? But they're lots of templates online. Essentially, it's 900 words on a page. All really big pictures on people will be very willing to help you on. Suddenly you've got almost a many marks, as if you'd done into place Degree on. I didn't interrelated to degree and got no presentations and know publications. So, you know, really, a poster is a really easy thing to get. If you have somebody to help you show you the first time on what I find with projects and things is that one Somebody showed a new you can help somebody else either your friend or someone in the air below you. And suddenly they get their name on opposed on because you've helped. Do you get it on the poster and suddenly it kind of, you know, sables. But if you had a first or the presentation or poster at a national meeting, you don't need five of them unless you know you're really into a project because you're not gonna get any more marks. So you think publications on D Mind oblique offers opportunities to score? Some of these are non peer reviewed articles on by the BMJ have lots of opportunities as well. So even after you finish medical school for the first two years, F one F two, you can still write in the student BMJ and that will still count. So, um on do until you will know what pump medicine. So you have to kind of check this problem. That or not and cold there. Is that your one of the authors? So if you helped collect some data that has taken hours and hours and then you hand it over to somebody and they do all the magic, you should still be in a leather, so just make sure if you're collecting a load of data. I was just gonna be published anywhere. Or can you let me know when it is? Here's my email. Don't forget me. Um, because one. And you know, because a lot of people at every stage are looking, Teo publish on be present on they'll be multiple authors. So you know you can get points on this is Well, been teaching has really changed on D. It used to be, um you know that you've got a lot more marks for providing regular teaching, but it is a bit better because it used to be that you'd have Teo, you know, have it would only count if you'd organized it and run it for six months and designed and all these things. So, you know, I think this is pretty good. Um, on d you know you and go from there. So the quality and also teaching your colleagues and your peers, you're all have to I'm sorry, but keep revising for exams throughout training. So teaching people is a great way to revise on. But endocrinology and diabetes, once you have the cup, join a specialty. There is an exam which, um is you to multiple choice um, you know, question papers that you do part way to training, but it's It's mostly about guidelines, but it's really interesting because you chose an endocrinology and diabetes. Hopefully, because you find it interesting on, I learned a lot more than I thought I would on down, You know, the past markets and too bad. So, but and you can claim the money back against tax that you spent on it. But you will be doing lifelong learning. So if you can incorporate, teach other people into it, then in school marks your application as well on then quality improvement. There are, um This, I think, is very difficult when you start to get out to know what it's quality improvement on, do a lot of the time I get involved in something that's either not achievable because of the Sultan has given it to you is over ambitious or it's using old. You pick something that's really boring, but the way that I've done it is getting involved with people. You know what they're doing. Make sure it's small defined, and you know what you're gonna get out of it on. Then, as you build up time on experience working. I know. Look, a quality improvement project says what is annoying me most. Fine. Can I measure it? Can I change it? Did it change? I would have done anyway, I'm and measure again on then. Yeah, well, I thought this would help that it hasn't helped as much because we need to do this other thing, and then you change the other thing, and then bang, you've got your two cycles on. Do you presented APS? The dean remedial or somewhere? And so you got loser points. So all these things you don't need when you believe medical school you don't even need is an F one or two. This is what you'll be doing. Any of your I m t on d. Um, And just find a friend straw, or I am tea person who has kind of done it a bit before and has a good idea on. Then just learn from them and go from there. And then I forgot I got the leadership it. Sorry. Um, I'll show you guys that at the end, But leave ship is now becoming more involved. And that also includes, um, things like, you know, if you've been involved on committees or charities, not just medicine. Onda is increasingly an important part because when you become a consultant, you become a manager on. But that's really important. So to start building your CV, just try it. Just write down what you've already done on things you did to get into medical school. You already have to think for your personal statement and things. Some of those things will be relevant to your future applications. You you know, I've stuck at something. I was a team leader. I did this. I did that. Don't discount it just because you were 16 when you did it on. Just keep asking. I realized that when I tried to ask, Can I help with an order or something like that? People go, Oh, no, no, it's boring. Don't worry. Boring is great. Put on your music, spending the evening going through some notes, and suddenly you got points on points and experience on. Then, when you find something more interesting that you're interested in, you know how to do it. Onda. That starts more with easy wins because I've started a few projects of people and then realized it was never going to be measurable, never going to be achievable in the short time that I was on that specialty or in that rotation and don't discount myself just like Oh, it wasn't that much. Well, if it means the criteria, it ends a point on, then commitment is up to next and taste of days on asking all other kind of you know what meetings are there. So endocrinology also overlaps with neuroendocrine tumors on that I have a last gastroenterology. So there are specialists and DT's around country for that, and that's very interesting. And just find out you'll be surprised what's in your hospital and then find a friendly and keen restaurant consultant and just say I want to be a date a monkey. I want the most boring data that I've been collecting, like two or three hours that is going to get presented somewhere on. Then if you've done that for them, then that person will go. Oh yeah, they were keying. Or do you want to do the poster and go on from that on some of these, If you want medical school, you can combine in your special study modules or it's already working you try and find time that you conducive it in work hours that sometimes you just need to know if you can team up with a friend to do a project ice. Recently, I stayed back with an S H 0.5 2 on. We just got some and just got some coffee and stuff and just sat for two hours in the mess after work on bashed it through and got it done on. There are lots of local meetings. Loads of National conference is an international conference Is that you don't know about. If you Google, it will ask Ask Ask them, people tell you about on the British Endocrine Society conference was every November lows of oxygen to posters that give discounts the anniversaries to medical students on diabetes. UK is a great charity, and they also really want medical students involved. So come on, go often even a foundation. Doctors. You're getting big discounts on diabetes on a membership, and you'll get a lot of great advice from there. So let me come out of that that I can stopped sharing on day, see if there's anything in the tract. Has anyone got any questions for me because there's a lot of me talking at you. Yeah. Um, yes, that was Well went. Whatever you want to ask them. Very happy to answer. Thank you so much for your talk, doctor. And so I think anything. There are any questions in the chart at the minute, But you feel free to put any questions into the trap, guys. But what I will do is I'll kick you off. We could get off with a question myself. So why did you pick this specialty? And what is it exactly? That you enjoy the most about it. So I didn't. I went to medical school wanting to do plastic surgery in hand surgery, and then I realized partway through that why I enjoyed about it was problems old ing on the variety, Onda, all the different types of patients who worked with on my phone that I was going to if ti more towards medicine. But I didn't. I just endocrinology has almost of it's really rare. Um, I'm going to see some of that car megaly diabetes. It's just like sugar goes up, sugars down on. Then, even during my call medical training, I didn't I would see a high calcium or low sodium and I don't know on. Then I took that. I'm gonna that year off to make up my mind with GP or Med ridging after call medical training on D. I helpful in and declined job in a big hospital on D. They were just really friendly. And they said it will come to clinic. You can just sit in on clinics, is quiet on the ward, Or do you want to come and see some referrals with the ST seven Reg? And so then I saw what endocrinology and diabetes was. It wasn't this dry stuff in textbooks I couldn't really understand. It was very much you had to think on your feet. Be inventive. Patients awaited. If you actually ask people, How much do you drink? A lot are normal amount. How much is that? Ah, it's three giant months of tea every hour, which means seven liters a day. That's why your sodium is low or you never results. But you drink seven liters a day, so people are weird and wonderful on. But I just love the variety. You can never become complacent and on D. I'm I'm interested in people. But you've also got enough time to kind of be a B B, A bit geeky. So it's no award, Nothing. You have a big variety, and I like the ward, But I wouldn't want to do water. And all the times it was any mad. It's just about thinking, whatever rotation you do. Medical school, right? One. What did you enjoy and what didn't you enjoy on? Don't just think about it. I like that clinic. Think Well, why, like Variety I like this or like that. I didn't mind that, but I hated those ward rounds. I never want to go on a walk around again. Then general medicine probably isn't for you, but what they've done is they've made it. So the most gentle medical consultants on have breaks off the ward for a month or two, where they used to just continually be on the ward, and then the well, I'm at So um yeah, because a lot of specialties will actually overlap with similar qualities of what you enjoy on one of my friends did buy fell into by chemistry is similar way that I did. She was just feeling a year she not to one know what she wanted to do you on. She does little clinics, weight management clinics, genetic clinics, metabolic medicine clinics and works in the lab on. But she's the person you call when you go or my gold, the stadiums 170 or these lipids with this high. And so we work with them quite closely, saying Thank you. We've also got a question in from Tash, who I can really relate. This is well, she's a student. And the idea of doing quality improvement project is such a mystery. So what skills do you need before? How much support can you get? Stay it. You know, it does kind of it makes most doctors go because it just sounds like such a tick box thing on. A lot of people go away. I've done this. I was involved in one about antibiotic stickers. Didn't do any day. What was the point? What? You what I would say think about is to think about. So they used to call it an old it. Where you have a nor do is there's a gold standard guideline on. Then you, Mark, is what is happening to that patient matching that. That actually a lot of change that really needed to happen was in about, um, gold standard guidelines. It was about how the world runs, which isn't I guideline necessarily. So if you think about it as a process else ist, um, that isn't working as well as it should. And you think you and I would really stressed this Talk to the nurses and other people because you may not thought something or they may have already tried it. So think about it. This thing annoys me. Well, this thing isn't working right. I think this could change it. And I think, Well, how could I measure it? And then how could I change it? And then we measure it and then ask people how what they think do they agree that it's been a good change? They'll make some suggestions on. Then if you're on a foundation job, you're rotating every four months, your makes coming on the next job, and he saved them. Can you reorder it it? And so you've got two cycles lovely on the main way that I found my feet is some people they get experienced during medical school because of their special study module on or luck some people. It's much later. Like with May. I had a registrar who did loads off orders and projects, and he needed million's to do them. You don't need to be clever. You need to just have a very clear spreadsheet. Minutes, 10 minutes. With someone talking through you need to You need to look up 20 patients here. The 20 patients, What was originally a one C here ago. What is it now? What medications are they old? Something like that. And you go, Yes. No, Yes, no, Yes, No, Enter it on then. Now that mole seen a person can analyze and do everything on, then that experience will build up. Over time, you'll get more confident with how to use Excel or have watched more presentations on one of the best quality improvements. You know, being involved in one where that I designed spreadsheet that counted as it went along animals and we covered 500 patients. So the secret was there were six of us and we split it up on. But when you're working with somebody else's much easier. Otherwise we just give up. I'm not became a really big presentation on Depo stuff, that national conference and all these kind of things. But it wasn't rocket science. It was just patience on. Lots of doctors are really busy, or even the diet Trista or dieticians, because a lot of the march really seen you. And if you ask, Is there something you need somebody to go through, notes for online systems and just collect really boring data? I have two hours that I am willing or how many hours I'm willing to give you on, because there are also specially diabetes, lots of national ditz and also, in all specialties, asthma ordered smoking audits on mostly love to work the specialties, one deadly boring. But then, no, you don't have to be very clever to do them so just really stressed. It could be those boring, most mind numbing thing. But if it's going to actually come to something, a new person and that's that's the way to do it because you conducive online, like there's the bronze qualification for like, you know, I pee holding proven projects, which helps, but these cycles and PGS A. I find I go, I just like turn off on. That was what happened in medical with endocrinology. If I see see that loops and algorithms I'm like, I don't stand it when Actually, when you do it, I'm much better And see if he thinks you to me. Really? Sounds like one of the most key things is Teo. Find someone who's a lot more senior. That is really just happy to have you take a look on them for them and it doesn't always need to be seen here. So when I was on my first job as f one was ent Andres was that red? She got me in my the other F one and I involved in lots of projects on D. I would was leading one. She was leading another. So we both got first author on a poster, but then we'd be the other one second author and so men that we stayed behind for a couple of evenings in the office to go through this work and then But we were together and we had pizza and it was fun and we got to orders. And one evening so and actually, one of the medical students that then joined on a special study model. He was way he done loads opposed to, So he actually showed us how to make the poster. So it's not always a one. C is up above you. It's just asking around. So you did one like, What is it? Because once you do it on my own, everybody with I hated making most of the primary school. Remember? You know, English, like Make a Pacer tonight, you know, wanted Romeo and Juliet or something. It's literally of it like that. Just nobody really reads thumb. It's just making it look nice on. Then the conference people get more bombs on suits, and if you think about it like that is much less scary stuff. I didn't medical school. I so could have done it that way. But realize and actually a medical school, we had to do an essay in final year about, you know, in case about something. And so I actually asked one of the plastic surgeons that I did a special study much Aleve. Is there anything that I could do this on that you need to get published? So it was two case reports because I'd already done line to send to that as, ah, 3000. Let s a then, you know, the rent. I gave it to the plastic surgeon Extra, Who wrote it? Like a proper thing. And so he was first also, which, in retrospect, um, but we probably should have been joined first off. But, you know, I was still second off there, and I still see in the process. So, you know, if you're doing something and a lot of stuff in medical school now is much more switched on. You probably already had to present it. Posters or case reports. You've done the work. Find someone to help you put in a student, be in jail something or mind the bleed website. Thank you. And touch those things well, and that makes it seem a lot. That's scary. I think we had any We've had any new other questions, but personally, I also wanted to ask, When did you personally start working on your portfolio? And do you have any advice on actually getting along? Mm, I think I can't think so. For, um, for call medical training, which is now internal medicine called trading. You need to when you're filling out. This upped a sh inform. You start having to think Well, what have I done on is not that much you're having to remember. It's two years worth, but then you'll have to start thinking about Oh, I also did that in medical school or when I did that. Oh, yeah, And actually, if I had written cattle just a list as I went along, which so I do now it would be much easier that, um, it's a lot a long to remember, but once you get into under all 17, portfolio is quite nice. Way to cause upload. It works just to ask you guys the foundation in the library, you can upload things on, but because I didn't have to rush, I had equal fairly. That's following me all the way through. So I've got all my RCPs, which is our annual reviews on there and which is kind of starts more from I m T. So they will be out there. But I remember my application call medical training. It was stressful because it took so long to try and think What have I done? Find evidence for it? But then well, I applied for my specialty training I had a printout copy of my core medical training on a lot of it was copy and paste because I didn't really think that stuff that I did as an f one would still count now. And it does so And if you've been a bit late starting, it doesn't matter. You got time on. But it's not that you've had 10 publications. One is enough, Onda. A lot of people will have any publications, even if so, I've heard stories where somebody's really excited. Somebody was really excited that they've got on, um, you know, poster presentation at this London meat of this national meeting in London on somebody they were talking to you, that peer in the fall was like, Oh, how much? How many you know, other presentations? Have you done like, always my first, Like even you don't want a later on, they found that hasn't done none. So you know where his other places mostly survive? What devils Very excited. If you're doing something, um, it's just finding the right the right people on d um, bribing with coffee. We'll just turn it up and just being a bit annoying, because even consultants now have a knee portfolio, and they need to show that they're keeping up to date, especially registrars and things they will need to do. Bell me to do audits and quality improvement projects many millions. And you just need to say, Take advantage off may as long as you get this in some workable format. So I've got evidence like Just use me. But day full for something that's going to take months for is a how we fix the 80 or how we fix the ambulance service. Don't run away because you can't do that in two months. Thank you so much. We haven't had any new questions, so I feel like everyone's Oh, Easter talk was really, really informative. Everyone's got their questions left. Um, but thank you again So much for your time. So, China, that's all right. And, um, yes, all the best, and actually one of my one of the I empties I work with. It's quite keen. So I've I've said to her she on Day one lefties he's interested. Want Teo. If they want me to help them write an article on mine, the sleep about it, then I'm gonna help him do that. And it's things like that that if you see an opportunity, go ask somebody. People love to help if they asked, but everyone's a bit busy and they may not have thought about it. You can say I want to do this. If I do make the work, would you help me on? Most people will be a like be pleasantly surprised and say Yes. No, thank you. Well, that's thank you. Take it.