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Hello guys. Um If you can see us and here as well, can you just put it in the chat piece? Yes. OK. So someone said they Yes, good, perfect. OK. So welcome to on today's talk. Um I'm gonna quickly introduce uh Bim SA and then I'll hand it over to doctor Foza to do her talk on clinical attachments. Um So for Bim A, our aim is to build a more uh connected community for international medical students studying in Bulgaria and make it more accessible for students to reach out for help and support. We are dedicated to having students overcome the challenges of adapting a culture, a new culture and education system by providing essential resources for academic suc success, cultural integration and personal growth. Our aim is to create an inclusive community where every student can thrive. We offer our support as graduates navigate through the process of reintegrating into the NHS. Um Recognizing the unique challenges faced by II M Gs who study in the in Bulgaria. Um and graduate from Bulgaria. We are committed to simplify the transition to professional practice and to ensure you're well cu you are well equipped for your medical career. Um If you ever have any questions or suggestions about invitations that you that could um help students at your university, please feel free to reach out to us on Instagram or um that on Instagram, you'll be able to find our email or you can reach out to our email ID as well. Um With that being said, um I'm gonna hand it over to doctor for now. Hello? Hi guys. Can you hear me? Hello? Hi, my name is Foa and today I'll be talking about um clinical attachment and beyond essentially I'll be going into um what I've learned on clinical attachment, my own experience and um what I've learned by the NHS as well being a system that, you know, I think I'm going into training and I think some of you guys might also um be going into training in the NHS. Yeah. Um, so let's just make this little screen. Can you see that? Yeah, that's fine. Um, so sorry, I don't think the slides are being shared. Oh, I mean, sh but no, no. Mhm. And um sorry, everyone for the technical issues. We tried this before and it was perfect. Um, sorry. Um but if anyone has any questions um about the talk, they can leave in the chat, we'll do AQ and a session towards the end of the talk. Mhm. Um Let's just figure this out quickly. I'll just stop sharing and then reha and see if it works again. I know. Yeah, I just start sharing again. Is that OK? Now? Yeah, it's working. Perfect. It's working. Yeah, perfect. So, yeah, perfect. OK. Good. Right. Start again. OK. Yes. So um we're talk we were talking about clinical attachment um based on my own, I'll be going into my own experience. Um what I've learned and what I've learnt about the NHS as a whole. Um and I'll be going to talk about the, what is the aim of clinical attachment? How you can uh benefit out of it, how to get the most out of your observer? Um How you can understand the NHS system a bit better. Um I'll be talking a little bit about ad E assessment, what it is and how to assess your patients using that system. Um and a little bit about sbar handover and again, how to use that and provide new score systems and C six. Yeah. So these are just things that I've learned when I was on my attachment and I thought I'd just share it with you guys. Yeah. Um So clinical attachment uh also known as observer is a period of um shadowing that a medical student or an international graduate would do. Um So this is unpaid and voluntary and there is no hands on responsibility as such. All you do is just observe, it can range from 11 week to six weeks or longer even depending on, you know, um how you work it out with your um supervisor and the medical education department. And um you then get as assigned to an educational supervisor uh or a consultant who um is an educational supervisor and also an assessor. So why do we need it for the NHS? Um Specifically, um it allows foreign trained doctors to familiarize themselves with the healthcare system that they wish to train in um the NHS like other systems um around the world um have it has its own unique system and the way it trains doctors and healthcare professionals, it helps you to understand the standard of care expected of P um to patients. Um what the GMC requires um doctors to have and clinical protocols. Um Any nice guidelines and also how to conduct um delivery of bad news and um you know, breaking bad news and also how to do a, you know, um how to take history, how to do an examination, all these things. Yeah. Um the NHS um a way in which it shows you how to manage ethical dilemmas, how to um handle difficult um conversations with patients and make decisions that prioritize patients welfare. Um all whilst adhering to the policies and the standards set out by GMC. Um when you become a doctor in the NHS, it has a kind of a pathway of training and exams that you need to take. So for doctors that are, that got graduated outside of Europe, I think they have to take PLB and um just PL one and two which is basically an exam that um focuses both, both on theoretical knowledge as well as Ay. And I'll go into what OSK is in a minute. There's an exam as well called M RCP, which is for um doctors that wish to go into internal medicine training. M RSA, which is a multi recruitment speciality um application, which is an exam again that you take if you want to go into GP psych, um I think it was co surgical training as well and uh many other um specialities like Opsonin and then you have the Fellow Royal College of Surgeons as well and other um certification pathways. The NHS um uses systems for um electronic patient record keeping. Um The one that in my trust, they use uh E PR in other trusts. I think they use electronic um health records and some trusts even use paper records as well. So they have like a hybrid system which is paper, like they have a component of um keeping some information on paper. Um some of it being digital and some hospitals like I think the ones in London, I think they've converted to fully being digital at the moment. Um You get to understand the range of different healthcare professionals that make up the NHS um because the care of some patients are very comprehensive and they need um input from various different um kind of um professionals like physiotherapist, um speech and language therapist, um occupational therapist, community carers, district nurses, um substance misuse team. Uh obviously, the nurses as well that are on the wards and um more specialized nurses as well as social care workers as well. The NHS kind of focuses on cradle to career, sorry, cradle to grave as a phenomena, which is basically that patients um care is we, the approach that we take is holistic. So we kind of consider every aspect of the care we we consider um like kind of the situation at home. Um We consider other is patient able to kind of um kind of get around their house. Um You know, do they have medications, access to medications? Do they have access to GP do they have access to pharmacists? Like you kind of consider all elements when you're kind of taking care of a patient and just kind of giving them the best opportunities to kind of like um have the quality of care that they deserve. Um So shadowing allows you to build personal relationships, networking opportunities and learn from experienced doctors. Um This is valuable um for mentorship, um career guidances and even sometimes even getting a future job in the NHS. Um And also just to learn about how the system is as a whole and just become familiar with it so that when you do go in, you're not as lost um how to make the most of your attachment and setting goals going in. So when I did my attachment initially, I wish I set goals, like, really, I wish I set goals. I wish I kind of had a list of um criterias that I wanted to achieve. Because when you go into an attachment, um and you kind of speak to your consultant, they would ask you, what are you looking to get out of this, what um areas do you want to focus in on? And I remember saying like, I wanna shadow the junior doctors because my role will be, you know, going in, it will be potentially like um an F one or an S hr role. So it will be spending a lot of time on the wards but to be more specific as well, like do you want to observe um more clinical proceed um more co procedures and clinical procedures. Do you want to learn how to do more history taking? Do you want to learn how to do an examination? Like, you know, these, of course, there is an observer, you can't have any hands on kind of like responsibilities, but you can learn a lot from just watching. And if you say that they will kind of prioritize that and they will kind of um kind of make it work for you. Yeah. So setting your goals early going into it will make will help you to get the most out of your attachment um making good impression. Um having good engagement coming in and being very prepared. So like coming in with your theory, knowledge, kind of like pattern, you know, because consultants are gonna ask you questions when you're on the attachment and they're looking to see your level level of knowledge as well. It's not that it's intimidating. It's just because they wanna teach you. But if you look very lost, then you know, it, you kind of just want to make a better impression and just come in prepared. If you're working in like surgery, then you wanna go home and like read over a bit of your material. So that, you know, um you know, you do know certain concepts when they ask you essentially. Um oh, sorry, being professional as well, remember that you are in a professional workplace. Um You are representing, you know, the hospital, uh not really, but you're kind of essentially part of the team. So, you know, when patients see you, they see you as, you know, um part of the team and you have to portray that image as well. Um So look neat, speak well, um kind of, you know, um communicate and all these things professionally, um make use of your um networking opportunities given. So um build up your relationships with, you know, people that you work with, you know, because essentially you can use these connections later on in the line. Um People are very, very helpful, they are willing to give you advice and tips, they're willing to guide you. And so essentially just fostering those relationships when you can on attachment is gonna be much useful, um, inquire about opportunities that are available to you as well. So ask the, you know, anyone like in the team or your consultant and be like, actually what opportunities are available to me? Like, what can I do? And they'll tell you like, you know, if you're in surgery, like you can come and see an operation, you can like um come to a teaching with EF ones um and just seek support um with continuous professional development as well, which is CBD, um which you kind of hear more about as you go into um the NHS and start working, reflect on your experiences. That's key. I put it in bold because essentially it's really important. It's when you kind of keep a journal notes of like what you've done, any cases that you've seen when it comes to doing your application and your interview later on, it can help you to kind of talk about them more. You can, you know, give more detailed reflection and be like, actually when I was in attachment, an example of like good communication skill was when I was doing an examination on the patient or I was talking to a patient. Um when I was taking history and you know, I conducted myself this way and I use this technique and all these kind of um things and it can really help you out later on when you're doing um interviews and all these things. Um So some NHS Trusts actually have a specific program used to support RN DS. Um So international medical graduates um it's aimed at offering them clinical attachments to allow them to integrate into the NHS more easily and more smoothly and it helps them to adjust to training in the UK, but as well as life in the UK. So my, so when I did my attachment, they sent me a leaflet like a like a thick leaflet and it was like life in the UK um kind of local supermarkets that are around the area. Like I was like, I live in, I live in London, but it was just nice to see that they kind of provided that. So people knew like, you know, how to do the taxes, how to, you know, um pay bills and all these things like it was a big booklet and it had pretty good information. So if anyone needed to kind of um was adjusting to life in the UK, that would have been very useful. So some consultants in these programs as well um can also help you with um preparing for the pla exam um especially if they themselves have done pla so they can give you a more detailed insight and more guidance on it as well. So just ask questions on attachment, be very engaging. Um and just be involved, don't just sit back and just kind of let time pass cos you're there to just soak in as much of the experience and as much of the knowledge as possible. Yeah. So going on to the next slide. So the NHS kind of essentially um emphasizes on team based care. So you gotta, you gotta be a team player. Um So just knowing how important that is, it's kind of, I think one of their values as well. So if you look at their core values, they emphasize on um you know, patient centered care um team based, you know, kind of like being team worker and communication and all the rest of it. So if you know what their core values are, what they're looking for when you go, um when you go and work in these trusts, you know, what you need kind of to be, you know, a good health professional in their eyes, they're looking for, you know, team effort they're looking for. Um you know, you being like kind of essentially always being concerned about your patients and like, you know, being aware of patient safety. So, um yeah, going on to um good medical practice. This is a set of ethical guidelines and professional standards published by the GMC in the UK. So my advice is if you are going, if you're a graduate and you're thinking about working in the NHS, there is um kind of a workshop that the GMC does. I think it's welcome to the UK, um, working in the UK or something like that. I can't remember the name exactly. But it's a good kind of, um, it's like a, on a webinar that they do and you can just sign up and you'll get a certificate at the end of it. And that's one of the things that you can kind of put in your, like portfolio essentially if you want to, you can keep that and present it and be like, actually, you know, I attended the workshop, you know, I'm familiar with the GMC guidelines a little bit. I've looked into good medical practice, good clinical skills and good competency skills, like what, what they require and just kind of makes you look like you've done your research, you've, you looked into it and you've made an effort to kind of be aware of these things. So an example of like opportunities that are available to you um will be clinical audits and um quality improvement projects. So clinical audits are basically um kind of essentially it's like you do, OK. The best way to explain it is when you're kind of focusing on an issue or like maybe something that needs improvement, like an aspect of like practice and you're just like, you know, we could improve this. So you bring an idea and you kind of implement strategies to improve it and then you reassess the situation to see if it's gone better and same with quality improvement projects as well. So you set out goals uh as part of a project and you work to implement improvements to make the s to make it better in the service as well. So that's something that they prioritize a lot. Um If you, as you go through the NHS, as you go through jobs as you go through your training, um you'll find that, that quality um clinical audits and quality improvement projects are heavily emphasized on and um you know, to do it as often as you can as well and to have an idea of going in early as well, so that when you do um go into attachments, you can highlight to your um consultant or your supervisor and be like, actually, I want to do an audit. I want to get familiar with an audit because it can come up in interviews, it can come up in your applications as well. They'll be like, can a candidate demonstrate that they have a good understanding what ac of what a clinical order is and you can demonstrate that if you've done it or if you've seen one being done, but preferably to do one is the goal. Um The second one is to look into any research opportunities that are available. Um A lot of um teaching hospitals um especially like bigger hospitals like UCL H or kind of like the big centers um will have research opportunities which you can get your hands on. And again, this just comes from asking questions and asking earlier on so that they can um see if during the time of your clinical attachment, if you can get one in essentially or start one even um observing practical skills and surgeries. This is a good one attending teaching sessions. So going on, going into um MDT meetings um which is multidisciplinary, multidisciplinary meetings um and kind of seeing case discussions of patients who have had like um you know, a complex care patients who've had cancer have had cancer. Sorry, and they need more um input from like more specialities and all these things um teaching seminars um which are aimed at kind of um doctors are going through the training program um kind of equipping them with knowledge and skills that they need and post tech meetings as well, which I'll go into later. So another thing is also a clinical governance meeting. Um I saw one and I've only seen it once ever. Um It's basically um when consultants um come together and it, it can be like for hours like maybe 22 hours maybe. And they discussed like um a couple of cases of patients who um kind of they review it and they assess it and be like what went wrong. Like we had a case of a patient who came in um they had surgery. Um The outcome wasn't as expected patient had multiple complications after the operation and just kind of going through the case and seeing like at what point did things go wrong? And what can we implement? Like what protocol can we implement in the future to prevent that from happening again? And how can we better the patient care uh all in all? Yeah. So there's two different types of um I think kind of um themes that they center on. So one of them will be um mortality and morbidity as well. So just patients that have gone sicker or patients that even fortunately have passed away. Um So key things as you transit transition into the NHS will be um to essentially zoom in onto the role that you wish to enter in. So if you're entering a junior level, a lot of the time you would spend time on the ward, shadowing junior doctors getting familiar with um how to do a discharge summary, how to do a handover, um how to do a ward round note, um how to document patients um kind of examinations and just getting better at doing these things requesting um scans, vetting scans and um bloods and all these things. So just be kind of like learning more about the role in which you wish to enter the NHS in. Um and just kind of this is like, I've just written up like a little bit of what junior doctors do. Um So they do a lot of like MTT A S um kind of do any follow up appointments with the patient after discharge, give them any like um packages to take away. Um, they do ward rounds in the morning as well, which is daily ward rounds done with a senior doctor or maybe like um, a senior, um I MT or a reg and they will kind of like make a plan for the patient at the beginning of the day And your job as a junior doctor will be to take that kind of plan away, make it into a job list and essentially complete that job plan. So request the bloods, request the scans, um discharge any patients um and get the summary and any medications that they need to take home, um prescribe any medications of patients who need fluids, any patients that need painkillers and the rest of it. Yeah, and that's it really. So just my own experience, I'm gonna talk a little bit more about how I found my attachment, what I did and how I got the attachment as well. Um So I worked in two different departments in the same trust. Um But basically I split my attachment um which is unusual. I think a lot of people don't do this, but I did one earlier on when I was a student and I did one now. So I did one in general medicine, but specifically in gastroenterology. Um So this was um I think this was in 2022 I think it was. And then I did one in general surgery like a few months ago. And, um, so both of them kind of offer you different experience when I was in, um, gastroenterology. It was like more medical obviously. And we saw patients that were also with other, um, kind of medical problems. Um, so we had a patient who had a collapsed lung who was under the Gastro team, but just, it wasn't anything gastro related, but it was just, you know, a medical kind of complication that they had and in surgery as well. So, um we saw patients, uh surgery is kind of split into three in where I did my attachment. Um They had three teams and, you know, you kind of can go with each team if you want. So if you have an attachment for three weeks, you can say like, um I wanna be with bariatrics, you know, 11 week and I wanna be with Colorectal the next week and I wanna be in emergency surgery the other week and you kind of can maximize your exposure like of all kind of three different things. Um And they kind of work differently as well and I'll explain that in a minute. Um So what I saw was, um I saw um essentially um how to do a full neurological exam on a patient who had a hepatic hepatic encephalopathy. Um I kind of helped award round notes with an I MT. So an internal medical training, I observed a medical management, I completed a draft on a discharge summary. Um So in most of like uh clinical attachments, you're not really allowed to do a lot, but um they could still get you to do lots like it's not unheard of and it's not uncommon. So if the junior doctors say, hey, do you wanna just like come, I'll watch you take bloods like you can do it, you know, obviously it's gonna be supervised, so you're not gonna be on your own. Um I did that on my first attachment. Um in general med uh I didn't do that in my surgery attachment, so it can be different, you'd have different experiences completely. Um and obviously observe how to do um a post take meeting. So a post take meeting is um and I didn't know this actually before I went to surgery, like I was like, what is a post take meeting? But a post take meeting is essentially when um patients get handed over from ed. So emergency department or they get handed over from admission wards and you have to kind of put them into like different um surgical kind of like I wouldn't say specialties but like different surgical teams. So you split the patients into the teams that are most appropriate to take care of them. So we had a huddle of patients um Monday morning who got admitted over the weekend and some of them were for emergency surgeries, cos they had like kind of um acute kind of problems so that needed to be dealt with urgently. And some patients who came in with like um lower gi problems, but it wasn't as urgent and colorectal team and lower gi team was more suitable to take care of them. So morning like Monday mornings, if you do a surgical um attachments are quite busy, the ward rounds are really, really long. Um And just you get like you go home on Mon A Friday and you come back Monday and you have the list of patients who just doubled up. So that's what post take is essentially. Um You can see um surgeries as well, so you can definitely go in theaters, um watch surgeries, I think cos I was in E GS. Um So emergencies, general surgery, I saw like a few cholecystectomies and close hernia repairs, but there were so many other ones um which I did not take like when offered, I did not like kind of go in because I was like, I would rather see like something happening on the wall like an er N GS er tube insertion because you could do that more as an, you know, junior doctor, no one would expect you to hold a scalpel and operate, but people would expect you to kind of know how to take bloods, um know how to put a catheter in and all these things. So just have an idea of what you need to do in the time given, but also don't pass any opportunities that could also help you learn. So it's having the balance of birth. Um I went and so we had a thing called se as well, which is same, um, same day emergency cases and ed clerking, which is emergency um department. So patients would come in typically through emergency department. Um, you know, and they would be seen first in the Ed. Um, you'd, and then obviously the sho would go down there. Um, and they would kind of do a full history taking again, they would do an examination that are necessary. They would have a plan going in of like what's wrong with the patient, which is like a, an impression of what's going on. Um, and then they would get admitted into an admission ward. Um, and then obviously once they've had their surgery, they can go into a surgical ward as well. Um, and they will make a plan of what the patient needs. Um, if you're on surgery, a lot of the patients would need a group and save. Um, uh, this is just so that if they need bloods, you can have the appropriate blood. Um, it's not unheard of and uncommon for patients to lose blood in surgery. So that's something that you do differently in surgery and you wouldn't do as much in medicine. Um, you can sit in clinics with consultants as well and observe consultations. Um You'd have lots loads of patients come in with different complications and different problems and you just see how the consultants navigate those issues and how they do with it. Um You can go and attend loads and loads of meetings and teachings. Um There's one, I think they have like um f one teachings which is like lunchtime, lunchtime teachings. Um and they do like a different topic every week. Um So I think when I was there, they had like a, they did a, a teaching on sbar handover. So that's why I'm gonna kind of go into a little bit and talk to you guys about a, a handover as well, but they also did a teaching on like um septic management. So patient came, comes in with sepsis. How would you manage that? What is the micro guide? Um What does um the hosp, what is the hospital kind of like guideline on how to manage a septic patient and all the rest of it? Yeah. Um The other thing that I wanna highlight, which I think is really important um is that there is a potential to get a job from a clinical attachment. It's not unheard of. Um because you are putting yourself in front of a consultant who essentially if they know of a vacancy or if they know of a gap in the program, they can think of you as someone who could fill that gap. So if you carry yourself well, if you kind of, you know, show up on time. If you're eager, you're engaged, you're learning, you know, you kind of show your knowledge and you're professional. You know, that's like, you know, you're essentially making a good impression and you are just, if they do think of you, you can get a job and honestly, it's kind of one of the really good ways to get a job um aside from track as well. So, um if you are rounding off on an attachment and you are finishing up, you can actually go and give your CV and contact details to the hr and recruitment managers, you know, you can pop in and be like, hey, II am an international medical graduate um or I'm a student, I'm like, you know, a few months away from graduating, I will be looking to get a job. Um Keep me in mind if there is something that comes up and they can always get in contact with you, they can even give, give you a heads up and be like, hey, um a vacancy is coming out in this department that you did an attachment in. Do you want to apply and then just send us your track number? It can happen. So I'm just telling you all the opportunities that can come up in attachment and you know, it can increase your chances of getting a job. Um and also when it comes to references, um it's good to have a consultant as your reference, you can have other um references as well from different referees, but a consultant is a good one to have um because they can give like professional a reference on, you know, how you were on your attachment. And this will give a good, I this will give a good idea to the recruiters of what they're looking for. Yeah, and the last one is network guys, network because you never know what you can like kind of land on if you kind of network and say, hey, um I'm looking for a job, you know, this is like I'm an F one or MS ho um you know, I'm looking to get a post, they can always hook you up with someone else as well. They'll be like, actually I know someone in the other department um who kind of could get you a post, you know, if I recommend you and support you and all these things. So network essentially it can be your best friend. So going into a um ays is a common method of assessment for medical students and healthcare professionals to use. Um It's a objective structural clinical examination used to assess clinical competencies in medical education. Um So, and it's something that's tested in pla as well. So I think it's in PLB too. But um so even foreign medical graduates have to kind of um undergo an examination to see how they do. Um So OSC includes clinical examination. So you perform a clinical examination either on a dummy. So a simulated patient or a real patient. Um You can do history taking, they'll look at your history taking format, um how you kind of structure your history taking, how you give information and how you break bad news to patients. Um So it's all about communication skills, about empathetic being, um having sympathy and all these things and interpersonal skills, um Data interpretation as well. So, can you recognize um what's abnormal on bloods? Can you recognize that a patient has hyperkalemia? Can you recognize the patient has hypocalcemia? Can you recognize the effects and how urgent he needs to treat these? And what is the cut off for giving blood to a patient? So, it's all about being familiar with all these things and interpret, interpreting them to meet the clinical needs of the patient. Um simulations and 88 E assessments. Um I'll talk about eight E assessments in a minute, what it is and how to use it to uh manage an acutely unwell patient. Um But that's something that they do a lot in the NHS and something that you would do when you see a patient who's unwell, regardless of what they come in with, regardless of what their problems were, regardless of what they're diagnosed with. You'll always do an eight E assessment of a patient who's unwell who has deteriorated or is going to deteriorate. Um Well, it's a clinical procedure as well. So they will show you how to, um, sorry, not show you, they will assess how well you carry out a clinical skill. Um They'll assess how well you can, um, do a speculum exam, how well you can, um, take bloods, how well you can do an ABG you know, all the core competencies that you would need as a doctor, um especially as an F one or F two doctor um eight E assessment. Um So 18, what is an eight E assessment? It's a structured method used in healthcare to evaluate a patient who is very, very unwell, who is identified to deteriorate, who is going to essentially get more unwell and you want to get ahead of it and stabilize the patient before that. So the A to E assessment is by design meant to be from A to E and that's because the airway is more important to stabilize than E for example, which is everything or B because if the patient's airway is obstructed, um they won't breathe. So you need to deal with airway before you go into be and before you go into see, there is a reason why it's at E and kind of doing that in that order is important as well. Um So airway is kind of making sure the airway is clear and patent is the patient um able to speak and make sounds, um check for any obvious obstructions, look for signs of um airway compromise and um gurgling. So, is the patient um is the airway compromised? So what you can do is if the airway is compromised, you can do a jaw thrust. Um if they have ac spine injury or you could do a chin lift as well and you can shine a light in the air just to see if there's any obvious obstruction at the kind of at the tongue level and all these things these for breathing. So um the goal is essentially to assess the patient's breathing, check their um efforts of breathing. Um is are they breathing? Um are they making a lot of effort to breathe? Um What is their respiratory rate and the depth of their breathing? Um Look for any sorry one second ta. Ok. Mm mm. Yeah. Check for signs of respiratory distress. Um Any obvious uses of their accessory muscles and their cyanosis and any asymmetry in their um chest movements as well. At this point, you can also um measure the oxygen saturation and listen to their breathing sounds as well using your um stethoscope. So when you do the SP O2 levels, you could check um is it below 94 is this patient ac O PD patient who is retaining um what are their target saturations as well? And um you can also um take an ABG at this point as well to kind of um you can do an IV access, take a BBg, run it by the gas machine and you can get a measure of their oxygen levels and their carbon dioxide as well. Um Circulation, you can assess the circulation and their perfusion by one doing their vital sign checks, um checking their heart rate, their pulse and their BP. You can look for signs of poor perfusion. So when you do the cap refill time, if the cap refill time is more than two seconds, that gives you an indication that the patient has poor, poor perfusion of the tissues and you know, they might be calm down. So you might wanna consider IV access and think about stabilizing them with fluids and medications as well. Um D is for disability at this point you want to consider is the patient orientated? Are they alert? Are they responding to you um check their people's sizes and their um reaction to light as well? So when you shine the, the light on their eyes, is it equine dilated or is it fixed? Um look for signs of neurological impairment, looking for um any kind of like confusion, newly confused patients anyways, um looking for any seizure activities, any weakness in their limbs. Are they kind of like limping to one side? And um you can also take a blood glucose measure as well at this point to get um if the patient is diabetic and if they are going into hyperglycemia. Um Yeah, so you can do something called a A DPU scale. Um This is kind of a score that you do and I'll go into it um a little bit more when I do the new score. Um I'll talk about how you can check the scores for a BPU. Um It's a quick kind of assessment that you can do and it'll give you a score if the patient is unresponsive, then you wanna alert um the medical team or the um the emergency team just to be like the patients unresponsive. Um you know, I might need more help and that is a criteria for met call as well. So I'll go into it which is medical emergency um team. So if you were to put out on met call, you'd have a team in the hospital that is um kind of there they're put together. Um and they're kind of just all they're there for is just to manage medical emergencies. And there are a group of doctors, um nurses, it specialists, um CCO nurses, all of these things and they will come in to help you to manage a patient that's deteriorated or, you know, is kind of urgent like you need more help, you know. And uh yeah, and the Glasgow coma scale as well, which is a more formal um assessment to assess a patient's consciousness as well. Yeah, is for exposure. So if you do your a to d and you can't still find what is wrong with the patient. You can essentially do a, a head to toe assessment of the patient. Look for any new rashes, any injuries, any signs of trauma is the patient bleeding? Are, are they in obvious hyperthermia? Are they warm to touch, check their temperature? And also, um, you can essentially um evaluate as well what is around the patient? Um Is there any hazard around the patient? Did they take any medication? Um Is there anything on the table that would indicate like they, they've taken a type of medication that could contribute to their drowsiness. Um So just kind of getting the bigger picture here. Yeah. Um going on, sorry, going back to see as well. Um You can put in an IV access. So that is the time to put in a canal, a large canal. Um because at this point, you'd wanna give the patient fluids or any medications or just painkillers, anything like that, they would need to stabilize them as well. Yeah. And also when you put in your can a lot, you can just draw blood from the canal and quickly send that off as urgent and you can get the results back within an hour or less. Um That could give you a more accurate i image or picture of what's going on as well. Um Sbar handover, this stands for situation background assessment and recommendation. This is a tool that's commonly used to um kind of hand over a patient um between healthcare professionals. Um So basically, when you're at the end of your shift, you will go to a huddle and you will hand over your patient and be like I had um you know, so, and so who came in and they had, they were, you know, two day POSTOP hip repair. Um you know, I'm worried about them because they had a new oxygen requirement. Um I've sent off bloods, I've done the at e assessment. Um you know, I'm at the end of my shift. Um but can you just review the bloods? Um This is my impression of what's going on perhaps and then um kind of tell them what you would like them to do as well. So be like, you know, can you just chase up on the bloods number one? Um And can you treat them for, you know, if they have a clot or anything like that? I don't know, for example. Yeah, so just going in and the breakdown of uh sbar and what it is, it's situation. So essentially giving them the description of what's happening. Um The reason why you're contacting them as well. So who you are essentially give your name? Um Give you a role as well be like I'm an F one. My name is, you know, um Foza, I'm an F one. give the patient's name and location, which bay they're in which bed they're in. Um, you can also give hospital number as well, which is a more accurate information and this would help them to just look, kind of locate the patient's information very quickly. And as you're doing the handover, um, they can essentially just draw up the patient's information and kind of follow through properly as well. Um Tell them the, the current problem right now. Um So the patients, you know, kind of deteriorating, they've got a new oxygen requirement and, you know, that's it really highlight the issue as well. Um, background. Um So what did the patient come in with? Um, were they, did they come into hospital? You know, they had a trauma on the kind of hip, they had an operation? Um, they're two, they're um, POSTOP right now, two days and that's a relief. Yeah, tell them any investigations that's been done, any treatments, um, any kind of medication that they're on and give them any relevant medical history, a background check of anything that's relevant that, you know, would help the per patient. Sorry, I mean, the person to understand the case better so that they can conclude a, a clinical judgment as well at the end of it. Um So a is for assessment. Um, you know, you what do you think the problem is? Um, so essentially highlight any parameters in the vital signs that were off. Was it the pulse that you were worried about or was it kind of a combination of like more and if so why were you worried about it? Was it high, was it low? Um, and just highlight that concern as well? Results of any recent tests and observations? Um, anything that came back that was abnormal or anything that kind of made you think this patient is getting unwell, um, any clinical concerns or symptoms as well? Anything that's come on right now and be like, yes, this patient has got worsening chest pain or they've got abnormal drops or anything like that. Yeah, abnormal troponin, troponin. Yeah, um recommendation. Um This is the last section and it's kind of essentially what you, you tell them what you need them to do and what you expect them to do. Um, so highlight to them, any intervention that they, the patient needs, does the patient need medications? Do they need um, fluids do they need? And what kind of fluids do you want them to go on? Maintenance fluids or, you know, um kind of a bolus of fluids which is resuscitation fluids, um, and the urgency of the situation as well and be like, I need you to come within, you know, as quick as you can. It's quite urgent. I need you to review the patient. Um you know, that's, you'd highlight that as well at the end and be like, yeah, a good tip that I got when I, when um they did the session on um sbar handover was to highlight what you're concerned about as early on as possible so that the person on the other end of the phone can kind of already know what it is that you're calling about and kind of, you know, essentially make a plan as well. They'd be like, ok, so you're worried about potentially a pe like the patient might have pulmonary embolism. Is that what you're worried about a clot in their chest? Right? You highlight that and be like, actually, yeah, so new oxygen requirement, POSTOP, you know, um this patient was a high risk for um kind of um you know, when we looked at the world's criteria, this patient was considered high risk of developing a clot later on. So it could be that um they have a pe and I've requested a chest X ray and I've done the bloods and I've checked ad dimer and all these things. So just kind of highlighting that as early on as possible in the conversation, um sepsis. This is something that um they did a talk on um which um is kind of a big thing in the NHS. Um when a patient comes in with sepsis, especially if they have kind of like, you know, not mild but like kind of, they're quite unwell um you know, their parameters of their oxygen and the heart rate and temperature is kind of like off it's, you know, they're febrile, they've got a high heart rate, they're tachycardic. Um they're um desaturating. This patient is quite unwell. Um They're now, you know, not orientated, kind of confused or maybe drowsy, you wanna kind of um if the new score is high, you want to alert um and start the sepsis six protocol and this is a management protocol which um kind of is essentially based on um six things. Take three, give three. So if the patient is new scoring high, you're worried about sepsis, it's on the top of your differential, which should always be if you, the patient's scoring high on a new score, um then you wanna go through sepsis six and you want to take um their lactates, you want to take um you know, um urine output, you want to catheterize the patient and see if you know one thing you can check is a perfusion and um if the patient is um having a urine output, then that's fine. You're not that worried about, you know, perfusion and diuresis and all these things. Um put the patient on oxygen um give the patient a bolus of fluids and um yeah, so take three and give three essentially. So take three would be um lactate um urine and uh was it on other um blood? I think it was. Yeah, and give through his antibiotics. Um oxygen and fluids. That's a three. Yeah. Um So this is something called a new score. A new score is a national early warning system. Um It's something that the NHS uses a lot. Um So when you do the vitals um observations for the patient, you have to log them on the system. So on their um E pr or health records or whatever it is, um It would have like um so in my hospital, it has something called a power chart where you can log everything about the patient, it's all digital, so you can log their vital signs. And when you log the vital signs, it would give you a score which is a new score. And based on that, you can kind of um think about the next step for the patient's uh plan of care. So if the patient new score zero, which means they're fine. So that means all everything in the parameters from temperature to pulse to respiratory rate is all fine. It's within range. I'm not worried about anything. So kind of the new scoring zero means that they're not getting unwell, but if they are scoring a bit higher and you know, they're scoring like three for oxygen, three for pulse. Um Patient is on oxygen as well. Um And I have an kind of clinical idea that the patient is getting unwell, then couple that with what I'm seeing about the patient and also the new score, um you'd wanna escalate that and you wanna escalate it as quick as possible and as soon as possible. Yeah, and highlight that as well. So when you're kind of escalating to the person on the phone. Um you know, you can be like, actually, I'm worried about the patient. Um they have a really high pulse um pulses, you know, over maybe 120 like it's over or whatever. Um And I'm also worried about the saturation and they're like, you know, scoring um a three in oxygen because they're like um 88 for example, and this patient isn't AC O PD or an asthmatic patient with exacerbation, they're just getting worse so high like that as well. So that is a new score um in a nutshell, essentially going on to the last slide. Um I've kind of compiled like um logos of like different um apps that I think are useful to use when you start off as a doctor training in the UK. Um So the foundation program book guys that is amazing, like it's literally the Bible like of, you know, what you need when you go in, in. Um it essentially runs you through like um tips and tricks of like what you need starting off on the wards. Um you know, interview preps. I think it's got information about interviews. It's got um kind of ranges of like investigations and like what's normal, what's considered abnormal and all these things. And it gives you like in details about chapters of like, you know, specialities and like, if you're starting off on gi you can read a bit about like what a junior doctor on, on the ward and Gastro would do, uh, et cetera. GME is a good one. Ay, I think someone recommended me as a vision guide for Acies as well, which they said was useful and they used that when they were, um, kind of entering their, um, f two role, uh the B NF micro guide meal, um, and a few other ones as well. So, yeah, that concludes my talk today. Thank you so much doctor. That was definitely very helpful. IP I learned a lot. Um I think everyone else did that as well. Um Before we jump into the Q and A session, um I will be posting the feedback form in the chat. I think it's up in the chart. If everyone can take a minute and fill the feedback form, we would be extremely grateful. These are really important for us to um improve ourselves and it really helps the doctor presenting the talk. So please please um fill it. Um And we will start the Q and A session in uh five minutes, I think five or 10 minutes. Oh, I can see. The question is already, yeah, we'll go for them guys, the ci and guys when you're also doing like now as well, if you think of any questions you can jot them down. OK. The drug, I think so. Yeah. Let me know when to the qra Yeah, I will, I will call you. I, yeah, if everyone can just take a minute to fill the feedback form, um, please, um, and we'll start the Q and A session in two minutes. Ok. I think we can start answering few of the questions that in the chat box. Um I'll have a so sorry. Yeah, I'll have a look at the questions and good stuff. Ok. You can, uh should I read them out for you or do you wanna read them? Ok. Um So the first question is, do we need to complete a degree in order to do a clinical attachment? Um No, you don't need to have you. It's not requirement for you to have your degree um completed. Um If you just highlight to them that you're a medical student. Um Yeah, it could be as early as second year. Um You can start doing your attachments, you know, if you want to do a few attachments before you graduate, it's better to start early. So get more experience, get, you know, more attachments in different hospitals in different specialities in different departments. Um It will help you to strengthen your CV um at the end of the day and it will only help you to become more confident when you start working in the NHS. OK. Um I think you answer to the second question as well. It um OK. Can we do it in it in like the internship here? 60 or so? Yeah, the answer do you mean it as do you mean it as you do your internship as a clinical attachment, if that makes sense? Um I think there is some requirements in six year um that you need to do or be signed off for which I think you would not be able to achieve in a clinical attachment. Clinical attachment is just an observer. Um So you're not, you're not handsome with, with anything. So if you're trying to get um your stook kind of signed off, it may make things a bit hard to get your kind of your um rotation signed off and things. So I would say do your um my experience, just me alone, in my opinion, I would do the internship in the, in Bulgaria. Um I wouldn't try and do it anywhere else. Um Just do it in Bulgaria. Do your a um do your state exams and all, all the rest of it and wrap up quite nicely. Um Yeah, but I think in some universities, I think in my one, they do give you um uh an elective um an elective period. I think they give you a period of time where you can do an elective, you can go away and do it anywhere if you wish to do an elective um and do an clinic attachment in the UK. Maybe that might work, you know, you just, it could work. I don't know, maybe you can just have a look into it speak to um you know, kind of a university about it and see if it can work. Yeah. OK. Um Is this recorded? Yes, it is recorded and we will look into posting it uh on a med page for you all to refer it back. Um And the next question is t ta Yeah, that's, yeah, so that's an abbreviation. It's a medical abbreviation, essentially what it means is to take away. Um So you, you'd hear a lot like abbreviations um when you work in the NHS and this is just one that they give you. So the patient going away, they go away with a discharge summary and att A um which is medications to take away. That's all that means. Um How long were your attachments? Um So my first attachment was about n not that long actually when I did it in Gastro, I think it was about a over a week, not that long. Um Because again, I was in uni and I was thinking some of my uni so I was ha the time I got the attachment approved, I had to go back to start the semester. So I couldn't been that long, but as much as I wanted to, but the second attachment I got a decent amount of weeks in. So I did it for a bit longer. I think I did it for 33 weeks. Yeah, three weeks. Um Yeah, but again, it's basically just like kind of sorting them out and getting them in when you have the greatest amount of time. So you can de dedicate a lot of your time to it. Yeah. How many attachments do you usually need to do to get a job? There is no number, there is no number of attachments that you need to do. Um Essentially just the reason why they ask for age is just because they want you to be to become like to be familiar with the system that you wish to train in. It's not that you need to be an expert. You don't need to know everything about the NHS. Even when you go and become an F one, you're not gonna know everything you're gonna learn throughout the number of years that you work in the NHS. Um But essentially it's just for you to have an idea um of what it looks like and what you kind of, yeah, that's it really, it's, you can do one or you can do 78 Y you, it's up to you and up to how many you wanna do. Which hospital did you complete your attachment at? Um I did it in my, not a local hospital but I did it in a hospital in North East London. Um So it's a really small hospital. Um Should I say the name? Uh um So you said north East London? Yeah. North east London? Yes. Hospital to North East London. Um And I'll tell you. I'll be honest how I of how I got the attachment. I think it's a good idea to talk about how to get the attachment. I got the attachment because I worked there as a healthcare assistant. So I just kind of kind of the consultants down and I said, hey, my situation is that I'm, you know, one of them, I was a medical student and I was like, I'm a medical student. I'm going to work in the NHS. Can you help me? And they were like, yeah, take my email, pop me an email and essentially just kind of being persevere and then be like, you know, um if they don't respond to emails kind of go and see them again, be like I dropped you the email. Can you check? Um but usually if they know you, they are more than happy to take you on like they will help you like when people, when you are in the NHS, you'll see just how healthy people are. They would actually kind of be willing to give you an attachment. Yeah. And um I think I would say to you guys if you know anyone who works in healthcare, get them to hook you up with it like a consultant. Um you know, and there are some um kind of hospitals and trusts in London and outside of London that do have a program where um a period of time where they give attachments. So make sure you check um the times that they provide and offer attachments to people, it's not all year round. It's specific periods of time when they don't have as many medical students as well. So yeah, would there be a possibility of getting a job where we do our attachment? Yes, I was talking about that earlier. There is definitely opportunity to get a job and that's why I say be mindful when you're on attachment and make sure that you be aware that actually if there is a job available, that you wanna be the person that they think of. First, you don't wanna be the like you don't wanna be like not showing up on days like, you know, you're arriving late or you just being sloppy like you wanna make a good impression so that you are the first person that I think about when you make an attachment and have those good connections and those good relationships with people because they will help you out, which hospitals provide clinical attachments for Im Trees. Um So there are some hospitals that provide um clinical attachments. Um They are known as observers sometimes as well. So you might see the two names being interchangeably used. Um But I think most hospitals provide attachments, some of them provide af e um I'll be honest, I'll give you guys a secret. If you sometimes work in the hospital in a different role, they can give it to you without a fee. That's the truth. Um So, but they can take a fee and you and you are giving up your time. So just factor all that in as well. Can you devote as much time as you'd like? Um Are you able to pay that fee, you know, to get the attachment? I think. Um Eastbourne does attachments, some hospitals in Sussex and sorry does attachments. So I MG friendly as well. So hospitals that are I MD friendly typically offer a lot more attachments and the fee is smaller. Um If you go outside London, I think there's more opportunities to do an attachment and it costs way less to do an attachment as well. So they take like 50 lbs to do an attachment whereas some hospitals could take 250. So just kind of weigh up your options and see which one you want to go with. Where can we get that oscopy book? Um I think you can get it from Amazon. Have a look. I don't have one, but I was told that you this is a good book. Um So yeah, check on Amazon. Um they could have that book. Yeah. Um what was one of the most challenging things you face transitioning to an fy after medi med school, whether practical or otherwise? And how did you gradually? Ok. So um I'm not in a post right now. I took time off um between my school and trying to get a job. Um but I know a few of my friends who did get a job and they said to me, like, one of the biggest challenges that they faced was just, it was not really a set challenge. Like they didn't say that coming from Bulgaria, set them back. They just said, wherever you go at whatever level we enter in, there's just gonna be a steep learning curve and you just have to adjust and that would come with any job. So, you know, when I was on attachment, it was the same time that um kind of UK doctors were starting, new doctors were starting and they were nervous, they were anxious. They also did not not know what they were doing. They needed a lot of help and a lot of jobs were getting like left undone and that's expected they expect that from you when you join the trust, no one expects you to have everything down. So don't think about like, you know, you coming from Bulgaria gives you a disadvantage. It doesn't, you're going to learn and you will become the competent doctor and you're gonna become well rounded doctor at the end of all of this. So it's fine, but it comes with time and again, confidence comes with time as well. So don't worry about it. The next question is um usually how long would it take to get a job? How is the current situation in the UK or you would say to look into other countries. Um So getting a job, it depends on how early you start out applying. Um If you started out applying and you were on it every day, like you would like, kind of like and you made sure that you um did your attachment, you kind of did extra things like A LS, you know, some hos, some um job posts require advanced life support. You did your B LS, all these things, you made your CV better, you weed on it really hard. I think you would potentially like make yourself um you would, you could, you would get a job, you know, eventually and the job market at the moment is a bit saturated. I'll be honest. Um There are people coming in with more experience and because the NHS is currently facing a budget, um they are taken on people that have X number of experience of years or whatever compared to fresh graduates doesn't mean there are not jobs for you. There is definitely a job for you and it comes with time, but it's just about applying, being diligent with it and making your CV um better so that you stand out as a candidate, as an applicant when you're applying. Yeah. And using, using kind of like your networks like, you know, if you know anyone in a trust, you've had good relationships with them, ask them, are there any posts available? You can ask what years did you do? Your attachments. What? Yes, I did my attachment. I did one when I was in fourth year. So um two years ago now, three years ago. Uh and I did one just recently now as well again. So I did 12 years past. So, yeah. What kind of things do you think look good on the CV that you could do during med school? Mm. Yes. Definitely a good question. Um This one I think I would suggest maybe doing research if there is any research um opportunities available, guys, grab them, you know, make the most of, you know, what you have available to you in terms of resources. If you have teaching opportunities, take them, you know, teach um kind of uh more junior students. Um you know, be part of like societies um be proactive, show leadership skills um take some training courses um which shows you that you are a doctor that is concerned about patient safety. If you take your um you know, if you wanna do a, you can, if you wanna do your BLS to basic life support and advanced life support, you can because at the end of the day, it will show the recruitment manager that you can handle a patient um who's very and well um in an emergency, you can essentially do what needs to be done. Um And it's all about just patient safety. Can you demonstrate that you are a safe doctor who can practice safely? And show all the skills that you need to be like, yes, I want to get ahead on my career. Yeah. Do we need recommendation letters from our Bulgarian professors while applying for the attachments and jobs? Do we just email? Um So they will um let me remember. Do they need references? I think they do. I think they do. I think they do need a reference and yes, you can get a a reference from your um teachers in Bulgaria, of course, um just chase them up. So once, once you do get the email in, chase them up and be like actually, hey, I think the person I'm doing attachment with has dropped you an email. Can you respond? Um Yeah, so you can use an attachment from, I'm sorry, you can use a reference uh of any of your teachers, you know, it it is a suitable reference to use. OK, I think you answered the question. Do we need recommendation letters? Um The next question is sorry, go on some uh clinical attachments. They they operate, they were sorry, they need different things. So depending on what trust you decide to do your attachment in, they might need certain um documentations. Um So I think one attachment that I was looking to do, they needed a letter of good standing. Um So I was like, I've never practiced in another country before like as a doctor anyways. So I said that's I can't get that for you, you know, so just they, if you are reasonable and say actually, I don't have one of documents that you're looking for, I have everything else, they will waive it off is fine. Um The next question is, did you have to pay for your clinical attachment guys? I'll be honest. Um I did not um I uh because I um had another role in the trust center. I work that I did my attachment in. I essentially just asked and they just sent me a letter and I mean, an application form filled that out and I was able to start. Um but they, some hospitals do take an um they do take fees and I do believe my one takes a fee as well. Normally if you're an external candidate. Um Yeah, but yeah. Does he experience come towards your CV? Absolutely. Yes, it does guys. Um If you can get your hands on uh any work available in the NHS, it demonstrates that you are familiar with the current um structure of the he healthcare system. Um It will help you with your CV. If you don't, it's fine. It's ok. Um But I think it's a good thing to have on your CV as well if you can do it. What is the name of the hospital, please? Um So it's Homer Hospital, that's I work there as a healthcare system. Yeah. What department can you contact Reda regarding a clinical attachment? Uh like Ok. So, um it's not really a department like I wouldn't say specific to a department, you can do a clinical attachment anywhere. Um If you wanna do a clinical attachment in dermatology, you can um it's just about having someone who will supervise you. Um who's a consultant, who's an educational supervisor from that department who again is willing to take you on. Um, but there is no set requirements, sorry, there's no set department or speciality that you need to have. It's all about just getting any exposure um to the NHS and that's it. You can have a preference. If you feel like you prefer surgery, you can kind of go towards surgery. But I would say don't kind of um be tunnel vision on it. Like don't say I just want surgery be open to any specialities if you get medicine, go with it because at the end of the day, you are demonstrating on your CV, that you know about the NHS. Is it hard for non UK residents to get clinical attachments? No, it's not. Um, it's the same level like difficulty as, as home residents. I mean, home students. Um So a lot of the time I think when you do um a um a kind of reach out for an attachment to a consultant, it sits in their inbox for weeks and you don't hear back from them. So that's a challenge that everyone faces and you just have to be perseverant and just if one door doesn't open, go to the next, go and go to another consultant, go to another department, um, just be diligent with it, kind of keep going at it. There will be doors that will open eventually for sure. Does. Right to work affect your chances of securing a job. Um, I don't know that question very well. I don't, I don't think it does. I don't think it should. Um, Yeah, II don't know. I, II don't wanna give you an answer because I, I'll be honest, I don't know too well about um what the NHS kind of has on them just to answer you some, you'll find that some jobs will, some job applications will say if they, if you'll be, if they're willing to sponsor you and some jobs will tell you if this role is suitable for um the sponsorship visa. So that's what you should look out for because if you don't have the right to work in the UK and the job doesn't offer you sponsorship, then you're probably not gonna be able to have that job. So do look out for jobs that do offer um the certificate of sponsorship. Yeah, thank you. Um How about if you have worked in a care home? Yes, guys, care home is, is an experience. Um It might not be a hospital setting um that you get experience in. Um I would say go for a hospital setting, go for um kind of like work in acute care setting or um in a ward that is the best thing, but any experience counts. Um because working in a care home essentially shows that you're compassionate, you're empathetic, you care for people. And it's a good thing to have. You see, you for sure, are attachments at multiple hospitals advantages over multiple departments in one hospital. Um So uh let me see. So you said say multiple hospital advantages over? Oh, sorry, I didn't catch catch that. Well, I think what they mean is like if you do um multiple uh attachments in different hospitals is better than uh doing like multiple clinical attachments in different departments in one hospital if that made it. So guys, it doesn't matter if, if you do like eight attachments in the same hospital, it, it's, it's the same thing you essentially you've done periods of attachments in and that's it. That's all they're looking for. It doesn't matter if you just do it in across the country and you do a number of attachments across different countries. I mean, across the country, it's fine. You just need to demonstrate that you have an attachment and if you have more the merrier, but it's not specific on hospitals. If it's at different hospitals, it, it kind of shows, hey, I've got exposures at different places at different um departments as well. Yeah, I think that was the last question. Um I'm just gonna put the feedback form in the chart again in case anyone has not filled it. Um But yeah, thank you doctor for, for that. Yes, it was, it was indeed very useful. I've learned a lot. Um And I think I want to say thank you to everyone who attended. Thank you guys. Thank you guys for taking the time to attend this talk. I do hope it was useful. I do hope that you guys have done something. And um yeah, and good luck with everything guys. If you guys are at uni or if you're close to graduating and you're thinking about the next step to take a job, it will be fine. Um The process uh you know, just trust the process you'll get there. Um It will be well, yeah, you're welcome. Yeah, thanks. Thank you. So coming in in the chat. Um Yeah. Thank you guys, everyone once again for taking your time um to attend this talk. Hope that this has helped you even a bit. Um We, I posted the Instagram link to account. If anyone wants to reach out for anything, please feel free to drop a message um on our Instagram. Um uh You and also you can see the future upcoming talks um that we will be doing um on our Instagram page. We're always here to help you in any way we can. So please feel free to reach out to us any time. Uh I think I'm gonna just stay for a minute and then um I will end the talk. Thank you so much, Doctor Foza once again and thank you guys. I hope everyone has a good evening. Thank you guys so much for having me and likewise. I hope everyone has a good evening. Huh?