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Okay. Okay. Hi, everyone. Welcome to another career series. Um, we've got em a call earlier today, Um, an ST for an emergency medicine. Just talking about her career and how she got in to see where she is now. So, um, take it away. Emma. Hi, everybody. Thank you for coming along. Um, now, hopefully at the moment, you can see a power point being shared. I don't really have your perspective, but I'm just going to stop sharing that for a second, if I can, because I want to just get a little bit of an idea about who is here this evening and and just, um what what backgrounds you are. So if your medical students Foundation years and then that would be really helpful if you want to just pop that in the chat for everybody who is here. Um, and if people want to see where they are tuning in from, and then that would be very nice as well. And so if anybody wants to volunteer in the chats, thank you very much again for coming along, and hopefully, um, you all have some interest in potentially pursuing a career in emergency medicine, which obviously is my chosen specialty. I'm very glad to have you. It's nice to see that we've got some. Got a bit of a mixture of people in the group. Got some, if one's, if to a couple people coming from abroad and very nice to see some people that are coming to you or in Scotland as well. And as I, as you can, may be able to tell from my accent that is from where I'm where I'm from originally. Great. Okay, so if you keep popping that in, Frankie is going to stay on the line as well. So if any kind of questions pop up and then we'll she'll be able to highlight them. And also, I will take you through a short presentation just a little bit about my background. What I think emergency medicine is, um, and a little bit more focus on the training program and the applications process as well. Um, which will be a bit of an overview for some of you may be kind of in your earlier stages and potentially some quite useful insights for those of you who are getting towards putting in applications in the near future. I've managed to get some advice from the applications for this year's applicants for CCS, so hopefully some of those things will be useful for you guys as well. Um, so I'm now going to go on to the PowerPoint presentation, and so I want us to be able to see the chat. But, Frankie, we'll keep keep in touch and so right. So this is what we're going to cover it this evening, and we're going to talk a little bit about emergency medicine. Um, for somebody that will be quite new ones for some, you know, kind of have a bit of an idea about what emergency medicine is, um, in the UK and what it might feel like to be working in an any already. Um, and we'll talk to you a little bit about, um, what kind of the job role, um entails, and also a little bit about the wider career opportunities, the positives, negatives and the reason that we turned up to work every day. Um and then we'll go over some of the things, um, in terms of the training route and national recruitment, which some of you may be familiar with, but is about the head spoon for people trying to get used to it for the first time. And then we'll have plenty of time for questions at the end. I'm sure you don't want to hear me talk for the whole time, so I'm very happy to answer those questions. Um, so we'll talk a little bit about who I am first and what my background is and how I got to this stage. Um, as Frankie said, I am now ST for equivalent. Not quite ST for officially yet. Um, I graduated in 2013 from the University of Glasgow, and originally I wanted to be an obstetrician, and I think it was the combination of classic combination of surgery dealing with obstetric emergencies that sort of pull me towards it. Also, a little bit medicine, which, as you can sort of see, does translate to, um does translate to a any. And I did my foundation years in Glasgow and was very fortunate to do my first rotation of f I to in here my ears hospital, um, in any which then made me realize that actually, that was what I what I loved and I wanted to go into, um, so after that time and I put my my ambitions for obstetrics on hold and went off to Australia, which was and still is a very common thing to do and a great opportunity for those of you that we're able to do it. And I was working in any any there for about 18 months before coming back and spending a few months low coming, Um, and also a bit of traveling. Um, during that time obviously applied, and I got into the CCS for emergency medicine. I decided to do apply for the first three years, and I didn't apply for a run through training program. And I came down to West Yorkshire for that, which is for those of you who don't know, um, that leads area in the north of England. Um, And then after I did my A CCS training and then stayed in leads hospitals as a senior clinical fellow, um, doing a bit of e m registering and also undergraduate education. And then I've gone through national recruitment yet again, and I'm officially starting my S t four in Southeast Scotland in coming this coming August. So I think the One thing I always think about is an emergency. Medicine is a little bit like joining club, and I think probably every specialty feels that. And what you might think of is the Emergency Medicine Club is lots of really loud, and it's sporty adrenaline junkies. But I think there's a bit of a mixture within that sense, certainly on the quieter end of the spectrum, Um, I think these are kind of some of the essential things that I think you need to have when you want to pursue a career in emergency medicine. And certainly some of the things that I discovered during my foundation years of things that I really like to get from from work. And I enjoy working with the team. I liked having lots of different people to work with, enjoyed having regular patient contact, and I think you have to be very comfortable with the uncertainty. It's certainly it's not like a minor ops list where you can be doing the same thing with little variations. You can literally be resuscitated one patient and doing crazy things to, um, sort of a broken finger or ask. Someone asks you what? The rash that appeared on their foot two weeks ago is so it's all very, very variable, and that also applies to the job pattern and the shifts. And we obviously do a lot of just work, and that continues for the whole career in emergency medicine. And I think you need to like that sort of hands on approach. There is a reason that medical drama is quite often focused on E. R's because it's that sort of classic. What the public think I think the doctor is is very much history examination for me, formulating diagnosis and doing kind of basic tests. And I think some of the sort of impression that people get from the outside of of emergency medicine being, you know, the emergency medicines are potentially quite loud and outspoken. And I don't generally don't. I haven't found that that people are particularly bullish or I mean, but they will advocate for their patients and for their team and can sometimes be quite outspoken about that. So some of you may have already experienced life as S H. O. Um, an emergency medicine. Um, the shifts tend to be focused predominantly on evening, um, and night shifts just given that that's been a lot of our load of work happens, but you will have some days spaced out throughout that, um, some teaching a non clinical time is often worked in. It's not always the most flexible Rotas, because we do need to have a lot of coverage for our out of ours work, and you will find that typically the shifts will be maybe shorter than some other specialties and kind of 8 to 10 hour shift patterns. Um, at the moment I work nine hour shifts maximum, including my night shifts, which can be very busy. But it does take the pressure off, and you can imagine a very intense shift. Lasting 12 hours doesn't put anyone in the best of mood. So it's sticking to shorter shifts. For A and D is generally what people do, and I think that kind of reflects across across the country now, Um, I think for registrars, they generally say it's a better rotor pattern and my current job self rosters and which means it's very, very flexible. Um, but that again will vary depending on where you work across the country, um, consultants, which may seem like a far, far place away will are increasingly working night shifts. Um, at the hospital, I work as a major trauma center and requires consultants to do They're night shifts there. And I think that's probably more common practice than it was a 5 10 years ago having, um, the new consultant contracts involving night shifts. But they're night shifts are proportionally worth a lot more, so they may work to night shifts in a week and then have the rest of the week off or do some non clinical time. Um, so generally, the consultants find that their balance of shifts works out quite well, but again can vary from hospital to hospital. We obviously work across the whole department, which is contained. So it's very different. Two different specialties where you might work someplace somewhere one day and another another place another. But we do obviously have very different work demands, depending on where in the department you're working. Um, so we've got, uh, obviously the recess area majors, ambulatory. Sometimes you have a minor injuries, you know, although that might be separate from the emergency department, some hospitals will have clinical decisions, units as well as they might have a short stage one for our in patients or places where people come for, um, routine investigations. Um, such as things like, um, DVT investigations during the day. And they have certain protocols. We certainly lost our CDU capacity during, um, the changes with coded, but it was part of the department that I worked in. Yeah. Okay, so I guess that's that's how we work. I guess I want to have a lot to think about what we do and what is emergency medicine. Um, and emergency medicine is fairly new specialty. It's only been around for the Royal College of Emergency Medicine and just celebrated it's 50th anniversary a couple of years ago. We should probably know that, um, but so it's a fairly new specialty, and I think what I can say about it is that we are generalists were also resuscitation experts and we in terms of the medicine, we have such varied presentations and deal with multi system trauma, isolated traumas, medical emergencies, cardiac emergencies, major illness, and also a whole host of minor illness. Mental health, social care. Um, as you you can probably tell just from vague mentions in the news the and is melting pot of kind of what's happening in the kind of general population, politically and economically. So we we see a lot of impact from other areas, as it's a kind of first stop for everybody. And but I think being a generalist is kind of something that I was very much drawn to talking about being an obstetrician to like the medical surgical being all mixed together. And that's kind of how I got into emergency medicine and certainly compared to obstetrics. I think I have much cleaner and dryer shoes and as we're quite good at getting out of the way of in the puddles of blood that come towards us, um, but you have to realize that you are a generalist and you're a specialist of very limited, limited things. And so you're relying on working with some specialists as an emergency medic, and actually, that comes down to what the skills of Emergency Medic are in. That really is about teamwork, leadership, communication, diagnostic. It's much more about the management and the running of facilitating that that patients pathway through the hospital as much as it is about the medicine, and that's something that you sort of start to develop in your in your later years. Once you built up a bit more experience with the medicine and really, some people might see the ent department, um, an emergency medicine as an extended triage, and in some ways, they're not wrong. You know, you always used to joke when you're a junior that it would either be discharge, admit to medicine, admit to surgery, um, or, you know, they're so so well that they go to I see you it would it And it does. Sometimes somedays feel very much like that guy that you're sort of sifting through patients and getting them to the right bit. But there's a lot of satisfaction in that as well. And I think in and in developing good working relationships with your colleagues. And, of course, there is the glory bits as well. You get good at, um, putting in all sorts of lines, drains intubation, sedation, manipulation. There's generally some blood, uh, somewhere, hopefully not on you. And you can get to get lots of problem solving work as well. Just trying to figure out what's what you're going to do with somebody. Um, you know, people come in with all sorts of things attached to them and certainly remember a case where I had to figure out what was going to do about a guy with a nail through his finger Is that from the nail was also attached to a plank of wood? Um, so there's lots of little things you can use your clinical experience to figure out what you're going to do about the reality in front of you. So I think one of the good things about emergency medicine is that there are lots of opportunities, and I have clearly taken some of those opportunities. And I was working as a clinical fellow, and I know lots of my friends and colleagues have done the same. Um, So I've just pop down a few different types of clinical fellow jobs that I can think of, um, that I've heard of or things that people do. Um, so obviously, education is quite a big, quite popular with emergency medics. Some people like to do quality improvement. Definitely not me. Um, but also, the more clinical and things like trauma, um, ultrasound. There are clinical fellows in musculoskeletal medicine. Sports medicine. Um, there is always that person that's gone off to Antarctica or done other fun expedition type medicine because those these are the skills that you get and they really do lend themselves to quite independent work, Um, and potentially in quite remote areas. And there's lots of prehospital crowd, crowd medicine and other areas that you can develop interest, I think because you are a generalist, you've got lots of options open to you. And there's some official training pathways that can be taken after getting into your initial training pathway. And that would be things like dual training with intensive care pediatrics, um, and prehospital medicine. So there are the kind of other training pathways that you can take in conjunction with emergency medicine and the pediatrics, obviously, pediatric emergency medicine and what I haven't been down there, and some people will exclusively work as pediatric in consultants, and they can come from pediatric backgrounds, or they can come through the route as well. So let me just take a drink. Hopefully, I haven't bored to tears yet. I'm going to just mention what's in this little box here in that there are and there are other specialties opportunities to take out of program experiences. Um, so you can either do that out of program experience, which is out of training. Or you can do that as an out of program experience for training. Um, and you can Usually you can, depending on the day you can do that any point. And so people will use that to do their clinical fellows. But they might use it for, um, something a little bit more exciting as well. Certainly know people that have gone down and joined hems for six months to a year. People might use it to do expedition medicine, and I have a friend who's just come back from working and New Zealand for the last 18 months while still maintaining his training number in leads. So I think, really, the your imagination is the is the limit on that one, and also what the dinner we will approve, which is definitely variable. But I think people are quite keen to let people have other experiences and realize that that's something that enriches them as a as a clinician rather than detracts from their training, which is not quite such a common, Um, and in some of the other specialties in the same way less than full time training is very much an achievable goal. Um, an emergency medicine and the Royal College. Certainly it was kind of one of the forerunners of trying to implement less than full time training. Um, partly because so many they kept losing so many registrars, um, from the specialty. And I think that's been a big a big boost, really, in terms of retention and certainly something that I would be considering over the next few years without without having any kind of particular reason other than I don't want to work quite so much, which is fine. And I think when you talked about portfolio careers and obviously very popular and general practice is something that's seen as a good route into having a portfolio career. But I would say the emergency medicine, although it's a longer training pathway, is also great as well. But there's lots of positives, um, lots of negatives as well. And and for those of you that you are already working, you know that it's, um it's not all easy. Um, and emergency medicine gets a lot of bad press, really, doesn't it? Um, I think on a more personal level. Um, there is a lot of hours work. You have to work around your weekends, evenings and nights, and that's a lifelong prospect. Um, also from clinical perspective, you're making some really high risk decisions, Um, deciding when to send people home, deciding when to when to do a CT scan or not. The CT scan. Can you work out from your clinical decision making that someone doesn't have an aortic dissection? You send them home, they might die, Um, which really does take its toll. And there's ways of working around that. But you're only human, and we do miss things, and that's that's kind of the nature of the game. And it's the constant decision making as well. Um, you are very much interrupted and kind of every every few minutes. Sometimes there will be decisions made on. Does this patient get seen over this patient? You will be constantly being asked to review blood gases. Easy gs. Um, when you get a bit more senior, you'll be interrupted from your own patients because the juniors need to ask advice about there's um so it is just you're constantly making decisions. You make. I don't even know how many decisions within the space of an hour, which is. One of the reasons that the shifts pattern tends to be quite short is because they recognize that your your brain can only cope with so much before it becomes over overloaded uncertainly. It's It's a very noisy environment, and I think if that's something you find particularly stimulating, then potentially emergency medicine is not for you. It's noisy, it's smelly. Um, and certainly I know that sometimes I come home and I can still hear the the monitors ringing in my head as I'm falling asleep because you are, you just learn to cut out when you're at work. But it is still something that you notice. Um, and it is. It's sometimes, especially where you are seeing the very worst of patients on the public. There will be violent and aggressive patients, not necessarily, not necessarily because they are trying to be Sometimes, um, obviously we do have people who are quite psychiatric, just psychiatrically disturbed or demented, But you also have people who are potentially carrying weapons who are in police custody who are just generally quite angry because they've been waiting for eight hours, and they haven't been seen by a patient yet. And they don't quite appreciate that. You've been, um, potentially dealing with some quite heavy emotional things on the other side. And so sometimes that sort of conflict between what you're doing and what the public's expectations can make people quite angry. Um, and there's a lot of obviously a lot of sadness that we see as well, and we do learn to sort of separate ourselves from that. But that in itself has its own kind of impact. So it's certainly it's a bit of an emotional roller coaster from time to time. But for me, it it does tend to balance itself out with a lot of the satisfying interactions I get with with patients and with my colleagues. So trying to get a little think about why, actually, after looking at the negatives, why you might want to be, um, Emergency Medic. Um, and I think one of the things that I've always thought was you just you've got such a privileged position. Um, as the first clinician to see a patient as they are coming into the hospital, you can really make a difference by explaining things to them and and giving them time, um, and understanding. And it is a really privileged place to be. If you see a lot of people sometimes potentially the worst, worst day and you get to try and do that, we try and do that. Well, um, because I think you've got that feeling that you've done the best that you can. You've not caused them to cause them to be on Well, you're just trying to figure out what's going on and give them the best. And one of the things that I found contrasted to that was when I was doing my anesthetics was that I was giving them the drugs that could make them really well and and that didn't quite sit as well with me after coming from a kind of emergency background and way of feeling that you're doing the best to try and help someone get something fixed. Um, so I think you can really get a lot of satisfaction with your interactions with patients in an emergency medicine. But I'm also completely okay with not having an extensive continuity of care, and I think that's one of the aspects of things for me that I like about emergency medicine and didn't find work for me with other specialties that I didn't feel like I wanted to do. Clinics and I, um I didn't necessarily want to be the doctor, and that's looking after them because that has its own responsibilities in terms of your own free time as well. Um, you probably have seen that with people who are specialist physicians and surgeons having patients that will be able to phone them up at all hours, which is great if that's the type of person you are, but certainly wasn't for me. And I think because it is a skills based specialty as well get lots of satisfaction out of doing kind of a nice practical skills and doing them well. Um, and I think I kind of I've already mentioned about how you get to be quite creative. Um, and I like working in the team, work with some really great people. Um, and sometimes those people are quite funny, and sometimes the patients themselves and, as you can imagine, are quite entertaining. Um, and I think for me just getting seeing seeing the last in life is is quite important. And I think emergency medicine Foster is that, um So for some of you, this is what you have been waiting for. It is a little bit about how to get into emergency medicine. This might be familiar to some of you. It's not new information. It's certainly very easy to find. But essentially six Emergency medicine is a six year training program after, um, after your foundation years. And you can apply to that dance. Yeah, three different levels. Um, the most common level, I think I would say now is after your foundation years plus or minus an F three or four applying in ST one, which is for your AHCCCS first three years and then continuing as a run through training into S T four to S t. Six. But you can also apply in ST three if you're eligible. And that's usually people who are maybe trained internationally or from if you've done something like course surgical program. You can also change over V a national recruitment into emergency medicine. Um, and it might be worthwhile pointing out that there is no such thing as switching for a CCS. Um, they you have to apply to your college. So, in this case, the Royal College of Emergency Medicine. Um, but there are interchangeable, um, skills that you gain, and there are other ways to switch, but it's not. As you don't just get to choose, you have to choose from the start. Um, and you can do what I did, um, and apply, um, in ST four. After having the competencies, um, of a CC s. I did a CCS, but you can also apply it as an international, um, student with a student. Sorry from other backgrounds as well, as long as you meet the criteria. Um, so, yeah, it's just a bit more of a breakdown. Um, and, uh, certainly, if there's any questions on a ccs at the end, then please feel free to ask them. But I'll try and just explain, because I think this is sometimes, um, but this is an assumption Is that a CCS is is the same. And then you get to choose your specialty after a CCS, which is certainly not the case. Um, you do have to reapply into the specialty of choice if you wanted to change. But the first two years are essentially the same. You do six months of any six months of acute medicine, six months of anesthetics and six months of, um, I see you for any your s t three, um, or sort of pre read baby Reg, sometimes treated as Full Ridge kind of year, depending on where you are, um will be 12 months in any way with you expected to complete competencies in pediatric pediatrics and trauma. Um, I do know people that have started off in any and then gone into anesthetics, but they've got usually gone, taken non training pathways to gain the skills to then apply to They're higher specialty training in anesthetics and then from essentially from ST three onwards, you doing pure any with with kind of rotations, usually every 12 months. But depending on which area working might be as little as every every six months, it's never any shorter than this. Um, as far as I'm aware. And if you wanted to do a training in pediatric emergency medicine, pre hospital or dual training with, I see, then that obviously take some additional training years into account. Okay. So sorry. This is already something that you're aware of I am. But, um, national recruitment for emergency medicine is, uh, essentially national. It's an annual, um, annual thing. It's central recruitment for post in England, Wales and Scotland. And I just included, um, the little snapshot from where the S t four vacancies were for this year. Um, for the 2020 to start dates, just to give you a bit of an idea of what sceneries there are across, um, across the UK Uh, and it might be worthwhile pointing out that Scotland is, although counted as one greenery during the application process, it does get broken down into south, east, west, east and north. So there's four areas. So if you get into Scotland, you don't necessarily just get thrown about wherever is much more selective than that. But they get lumped together in the numbers as a scenery. So it's an online application, which is submitted through a website called Aerial, and this usually happens around about November, and the CCS recruitment, um, now requires the MRSA. It's, um, which contributes to 40% of your score, and then that's followed up by an interview. And I believe that the interview most eligible applicants rather than using the MRSA as a screening screening tool. Obviously, you can see that the interview is quite a big percentage of your score and then generally offered a job around about March time. And you can You can decide to accept a post with upgrades as well. So potentially, if somebody doesn't want their post, and then you'll get upgraded, Um, your rankings. So I haven't gone through national recruitment in the last year. This was, uh, and having applied to a CC s Previously, this was kind of what I thought the kind of the main areas that you need to be looking at in your application. And I think these are the things that you need to be trying to get something for, for everything apart from maybe exams. Um, So I think one of the essential thing is experience, um, of emergency medicine and understanding what career in emergency medicine is and what it entails. And you can do that through, um, trying to having a have a placement and and do kind of various work experience. Um, in that taster weeks, and if you don't get a job in it and you don't necessarily have to have worked in emergency medicine, um, to get a training post. Um, as long as you find other ways to demonstrate that you understand what the specialty means, Um, something that they always ask. And I hate. It's just not just not for me is audit for Q I projects. Um, so this is it's kind of something to look at fairly early and particularly if you do some audits that are related to emergency medicine that certainly ties in with trying to get some kind of show demonstrate experience and understanding. But it doesn't necessarily have to be if you followed through an audit cycle audit cycle, Um, or if you've had an ongoing big quick project and the skills are still there, and I think it's really about trying to develop, develop those, um, and obviously things are doing like course is relevant. Am Everyone tries to get into an A TLS, um, one, because it gets, um, gets points in the application. But there are lots of other courses that you can sort of demonstrate that you are interested and that, um, that you want to get a training post, um teaching or kind of being involved in education. Um, I think it's quite important as well. And other things like demonstrating teamwork and leadership. Um, it is something that they want to see evidence of. Um, I think for applying to emergency medicine exams are less important, and I wouldn't worry about them too much. If you are, say, applying from your F Y two, you've got time to do them during your training program. If you've got a little bit more time and you've got an easygoing F three F four year and you want to set the, um, our MMR came primary exam, then that's great. But I think that's an added bonus rather than an essential um, and I would like to I came up with this before, um, getting hold of what the, um what? The categories were from this year's yes, um, training programs. So this was the from a someone who's just obtained a post and he says yes and emergency medicine starting in August. And this is what they got asked on their electronic and application. And these were the headings, and I think that kind of fits with what I was saying in terms of audit audit and research teaching. They want to know that you understand and what is what is to be working in emergency medicine. And they also want to know why. So you need to sell yourself and say why you would be good at it. It's kind of like the mucus personal statement. For those of you that had to do that, you got to really sell what you've done and why, why you would be a good E m clinician. And that also includes, um, achievements outside of medicine. Uh, because I think that's value to it in emergency medicine as kind of showing potential leadership qualities. And then, of course, the training courses, such as life support courses like a TLS. So you're successful. Then in your application, you will get an interview. Um, and from what I gather, most people asked all the same questions more or less last year. Uh, and these are the questions. So I will let you have a little look at those for those of you who are interested. Um, I suspect that the future years of interviews will be fairly similar, and it's certainly quite reflective of kind of things that I was asked in an interview. Uh, the last couple of years interviews have been done on Microsoft teams, but although so they've done away with some of the stations that were part of the face to face interviews when I was applying. But certainly some of these questions were quite reflective of what I was asked at the time as well, so they won't change very much. Uh huh. Okay, So a couple of things I would think about for application is you have to read the person specification, Um, for CCS emergency medicine. There's an essential and desirable criteria for applicants. And and if we go back to what was asked for the electronic portfolio, there is mentioned that the skills and attributes those should map up to the person's specifications. Um, I would have a little look at the Royal College Emergency Medicine website, which will tell you a little bit more about specialty training and exams and and obviously going to get asked about issues relating to emergency medicine. So it's a good idea to keep an eye out for what the current issues are. Uh, this interview book is the one that everyone has and recommends. Um, and certainly for the type of questions you asked for any STDs application. I think it is quite good in terms of learning how to structure your answers. And I think it's really important to find out what to really say, why you want to do it. Because that's really the kind of slant of the questions and also to have a little think about. If you're thinking of applying, there are certainly for emergency medicine, no real harm in delaying your application and see if you do want to take some time out three or fours and fives and then it's not really going to harm your applications. I will think about when you want to do that as well. And so just to end on a little thing, apparently, we are. Emergency medics are John's know, Uh, I think because we know nothing. Um, but on that note, I will try and answer some questions for you. Uh, if you have any. So I'm gonna come back and much. That was really interesting. And really informative. Actually, um, we haven't had any questions pop up just yet. Um, guys, make sure you pop them in the chat box. and I can ask any because we still got another 15 minutes there. Um, but I might just ask you a couple of additional questions now, if that's all right, if no one else is asking. Yeah, so, I mean, you've covered quite a lot of these briefly anyway. But maybe maybe go into a little bit more detail on a couple of them. Um, so I mean, just following on from the portfolio conversation. What? What was it that you did for your portfolio? Is there anything specific you would recommend for medical students Or, you know, if one is to look out for, like, opportunities to gain easy points and things like that? I think I was very lucky in that. I had the opportunity to work as an f i to, uh in in any I would say that, and I then I worked in Australia. After that, I don't think I had anything particularly exciting. Um, other than I did a qualified kind of qualification, um, in Australia, run by the Australian College of Emergency Medicine, which was a kind of sort of entry level. It sort of basic interest thing. Not like it's not quite close to diploma, but something along those lines. But most of my quality improvement projects and things were all kind of related to because I wanted to do a career obstetric. So things like that. So I'm not sure there was anything. I didn't do a TLS either before applying, and, uh, so I wouldn't say I did anything particularly spectacular. Well, pretty cool that you went to, uh, to be honest, but I just It was it was time like, But if you if you're kind of cleaner to get through quicker than you might need more of the definite things. Yeah, So I know with other specialties, you sort of you almost penalized if you've worked for too long in that specialty, Is that the same for a and A? No, I don't There's not, uh, as far as I'm aware, there's not a limit to experience. So for most specialties, it's 18 months that, you know, it said before you become too qualified to be an STD one. Yeah, but generally I think it's all experiences good experience for any. We've got some questions popping up now, so we've got one that says I have health issues and I'm an ambulatory wheelchair user. I mostly use a stick. I coped with an F Y. One in the PM, but worry how I would manage as I become a senior is I am still a possibility. I think that was a difficult question to answer. Um, I mean, certainly as unable, able bodied clinician. It's difficult for me to get a full perspective, but it certainly is a very physical job. And a lot of emergency departments are not well designed for wheelchair users. Um, and I have worked with colleagues, uh, wheelchair users and anesthetics who did have to be quite confident in what he wanted and what he needed but was certainly hope, a bowl of performing emergency procedures and intubations. Um, we do have a consultant who is part part wheelchair user, currently working emergency departments. Um, but she was already qualified before she required to use a wheelchair, so she had already done all the training so and she can't do a lot of the out of ours work. So I think it might be quite challenging to gain the experience to get to consultancy without having done a lot of the physical skills if that's something you would be limited by, so I I don't know for sure, but that's just my I've seen in the workplace. Okay? Yeah, a little bit of a difficult one to answer. Um, that it's good that you've experienced discuss and get a bit of a wider range of kind of feeling for how possible that make me. Yeah, definitely. Um, we've also got another one saying, um I also currently can't work nights. Would reasonable adjustments cover me or nights and absolute requirement for training? Um, I don't know for sure from a a kind of point of view, but I wouldn't say that they have to be. Nights are certainly a good opportunity to be on your own and take more responsibility, but you can still get the same amount of experience from working. Um, working days and evenings, I would say Yeah, and then we've got how do you build confidence for more serious situations? I feel worried about the increasing respond responsibility as a registrar and consultant, but happy to be an s h o. Um, but do you want to progress? Um, it definitely comes with with time. Um, in terms of and it for me. I feel like I've got to a certain level, but I still have. I still have progress, and I think even for consultants, there'll be certain situations where they will question the question themselves and their decision making. Um, and you really is kind of engaging yourself in training and kind of wondering, kind of reflecting on experience that you have and rehearsing kind of decisions and why you would do and reasoning with yourself for me anyway. And you progress Well, as long as you put yourself in the situation, you progress without even really realizing. If I look back to a couple of years ago like people coming up to me and asking me questions about what to do about the patient was just such an alien experience, and then a few years on, I'll just be like, yeah, okay, cool. What do you want to ask me? Throw myself into a completely different situations and much more confident with, you know, managing cardiac arrests and being the team leader making the decisions. And I think that just comes with time and experience in a lot of ways, Um, and having also having some supportive colleagues. You do? Okay, um, we've got a couple of you might say. Apparently you might see someone in a Andy come August. Hopefully, well, then I'm like Saint Johns. And if you're there, that's where I'll be. And I think there's someone concerned about not getting experience in major trauma or recess. Would love to gain skills and portfolio points and expedition medicine just very doubtful of how I'll do it and intimidate it. Oh, um, yeah, it's still really difficult. And if I too isn't it to get experience in trauma and recess? Because annoying registrars push everyone of the week and then the consultants push us? By the way, um, so it's I mean, as an I think, as an f Y two. You're you're still, um, you're still at the start really a career and you've got lots of good experience behind you already. Um, but I think, and there's lots of roots into expedition medicine, I would say any and GP are probably kind of to training programs that are probably best suited for that. But there's lots of other courses and things you can do Looking at expedition medicine. Um, uh, there's a Also, there is some expedition medicine conference. I've definitely been, too, at some point, which is quite useful, probably lots of resources. And I think expedition medicine is is really variable as well. So there's, um, you know, there's been a ship, a ship's doctor that's an expedition to there's, you know, going into the heart and cross, like going to the tracking across the South Pole and being the doctor for that. So it's It's actually much more about the decision making than trying to deal with lots of major trauma. I think a lot of the time, so you probably do have a lot of the skills already, but so don't do it yourself. And if that's what you want to do, go for it. That's really interesting. Actually, I don't know much about expedition medicine. I don't think I've even heard of that as a specialty before. Not really a specialty, but it's certainly something that people do. Okay, Yeah, and the next minute it's not like a consultant in an expedition. Medicine be cool. Um, can you get any extra points for work in er working in er during your studies? I've been working the weekend as a doctor assistant in Poland during my six year. Yeah, um, I'm not sure if points is the right way to put it, but it's definitely a good thing to sell in terms of your, um, your experience and your understanding. So it's not coming back to those skills and attributes that you show if you can demonstrate that from from doing extra work. And then then that all applies. I worked in a bar when I was a medical at some medical school, which actually think set me up quite well for emergency medicine. So I think that was definitely my application somewhere, because, I mean, even even if it's not points, it would definitely still show commitment to the specialty. And you know that you've been thinking about things like that. I've heard a lot about GPS with special interest in emergency medicine. How easy is it realistically to do this? Um, I think quite I don't know all about the end of the nights of it, but I would say it is quite easy to do. Um, we we do have GPS that are based in any, but that's essentially working as a GP in any But we also have, particularly in smaller hospital GPS who also do a and he shifts. And they tend to come in as a as a meal comes. And although sometimes have a more formal arrangement with the hospital, uh, and will work as other shor register level depending on their experience. Um, generally, that's just through working as an A S h O and doing gp training as far as my work. Okay, so So you almost stopped. So you do, uh, any an f two, and then you do gp training and you can do it via that route. Yeah. So, um, if you do you have enough. Any experience, then you can come and essentially look, um, in any so whether that's working the way to or being a Jeep trainee really have any in its rotation. And it's really just three establishing links with local departments, people to sort of split it half and half. Or is that or is it more more GP more a Andy or I think it's really personal preference because it is. It's, I think, formally it's more on a locum basis because people who might say look, look, um and um, or maybe have a couple of sessions is a GP, and then we'll come in any but it's less of a formal pathway, but it's very, very possible to do. Yeah, aviation, especially. I don't really know what they do in the feet. I'm sorry. I think there's like, I don't mean to be interrupting. Um, So I just pop the feedback link on for you guys. Um, if you fill that out, you'll get a certificate of attendance and, you know, keep all these and it will show commitment to the specialty later down the line. Um, if there's not any questions, I think we've pretty much reached the end of the talk. Um, but yeah, Thank you so much. That was really interesting and informative. And hopefully everyone's got a bit more of a better idea about how to tackle all of this. Now, um, and we'll sign off their Yeah, well, good luck to everybody in the future. Thanks for coming. Thanks. Everyone, for coming. Um, yeah,