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And okay. So next in our program we're handing back to Rock and DJ. I think that's, that's good. Yeah, this is where the fun starts, right? This is where you all want to do research and I'll do one session. Mccaskey's going to do another one on how do you get research degrees sorted within the region? A bit of uh Yeah, a bit of uh if you've got an idea, how do you develop it further and take it to the next stage? So I'll share with you a few slides on, on our experience and what I think about all this. So warm welcome to all of uh the SG fellows. We had a slide, couple of slides for you in the morning, but I think you all were still in bed. So we'll play it again tomorrow. You've already been to uh to the Eagle pub. I, I take it from, from Twitter. So I took a, took a picture from there. Okay. So everybody wants to be a good surgeon. But if you dig deep down and I think most stock had it as well to an extent, what is a good surgeon? And these are all the attributes which probably go towards making a good surgeon. So you obviously need to have the surgical skill. Uh That's how you are a surgeon. You need to be operating in theater and compassion. So you need to be good in the our patient clinic with your patient's. Uh you need to be a good thinker and researcher. Uh And that's what this day is all about. Uh You need to be a good writer and orator. You just can't be thinking uh and researching because you need to convert your ideas into appropriate papers so that everybody around you can understand. Uh and you need to be able to speak about those ideas and convince the audience that this is a good thing. You need to be a good teacher and then finally need to be a good manager and leader and whether you're a registrar or you're a consultant in your early years or in of your consultant years, you need all these things to actually make yourself a good surgeon. And if you look at the aspects of your training, these are the gaps that we're trying to actually fill and, and push you on. So let's let's focus on thinking and researching. So why is research important uh as institution as individuals? And we'll talk a bit about higher degrees as well. I think it's just a necessity if you look at the national budgets all around the world, whether you look at it in the US, in the UK. Even with the declining economy, we've got a huge amount of money that is actually going into R and D. Um And the maximum number of Nobel Laureates actually coming from this area as well. That's the government side of things. If you look at the corporate sector, this is what some of the companies land up spending on the research budgets per animal rush was 8.7 billion, either is 7.4 billion. This is what people are spending on research, obviously for therapeutics uh point of view. And then uh from the point of view of orthopedics, Johnson and Johnson is still spending a fair amount in research and development. And Cambridge is Cambridge because of the research that it does and the impact that it has and it puts out and also does all sorts. Exactly because of that reason. And you saw what Sarah is up to. So it leads to top institutions, leads to international standing lineage elite, personal and definitely has unbeatable deliverables. So that's from an institution, a country and economy or uh of the corporate sector point of view. What about an individual? Your academic career would depend on your publication list as you start off whether it's uh F one F two ct one ct 22 ST three ST three to getting a good fellowship, everybody's going to look at what have you published? What have you presented? Unfortunately, that's the truth. Even when you go for a consultant job, if you're applying into a teaching hospital, that's what they're going to be looking at. Not competition is so stiff. Even in district general hospitals, the only way you can distinguish yourself from your colleagues is your publication list. So it is a necessary evil to get a job to move up the ladder. Something is better than nothing. Avoid definitely publishing crap and start, start soon and have a strategy. Publish what baird at what pace and with whom I think that's important. So it all starts with uh asking the right question. I ask them this in the morning lecture. How do you get the right question? The more time you spend in the clinic with your patient's, the more time you spend in the operating theater trying to solve problems, that's where the real questions will come. So you really need to do that or rely on your consultant or expert colleague who's been there for a long time trying to solve these problems and get the questions from them. So start by defining the question right down a clear aim. What is it that you're trying to answer and then divide the problem into smaller answerable questions, which may be that you've got three or four papers actually coming out of it. And then the second bit is the methodology that you're going to use to answer that question. I used to talk. So based on that I won't dwell on that too much. And if you look at all the multi center randomized control trials that UK has at the moment, all of these actually come from the questions from the clinic, whether they are relevant questions or not is a different debate, but that's where these trials are actually coming from. So how do you stop a small research project or a pilot study as we discussed in the morning? I think if you have a big randomized control trial in mind, you definitely need to start with a smaller study. Uh get your mscmmchm sure or MD pieces, findings uh into a journal, get them published uh critical review of the literature on the topic. So if you're actually thinking about how the warmer season may affect the infection rate and joint replacements, you start with a systematic review and it may take somebody three years to actually finish a systematic review, but that's fine. They do it and, and then some it to a good journal. So that's a good way to start uh critical analysis of a popular concept. That's what you can do as well. Uh discussion forum or book reviews for journals in your field. So that's how you basically get started. And now I'll sort of invite questions from you. So a lot of people come up to me and asked me, what is the right time to actually get involved in doing research or a higher degree? And my answer to them is whenever you're inspired, don't do a research degree, you can do research and write papers, but don't do a research degree because you as a means to an end because you have to do it. A research degree should be done. Only when you're really inspired to do it. Okay. So that's the first thing. And then we'll ask you, what do you really need to do a degree? What are the requirements? And I have very simple for requirements to take a student on substance. Be anybody knows what that is? Passions. Exactly. Unless you've got pash in, you're not going to actually finish it okay. You really need to be passionate about what, what you're going to research. So hustle a good example. I take, take that example again. So he did an mcs with us and he was really passionate about this idea that the warmer seasons are going to affect infection rates. I didn't believe in it actually, to be honest, but he just convinced me, he was passionate about it, right. He went to 10 other people, epidemiologists, he got everything and he just convinced me that there is something in it. And finally, if you look at 1.5 million joints around the world in this systematic review, there is something in it. So unless you've got the pash in, you're not going to take it through. So you really need that okay. You need to be passionate about what you're doing. Then come, then come the two Ds, you really need to have the discipline and the dedication because you are going to be doing, acquiring clinical skills, surgical skills as you go along in your training and to be spending time doing research, you definitely need dedication and discipline for that time, management skills for sure. Because the last thing you want to be doing is being a poor surgeon at the end of your training and having 20 papers, you don't want that. So you need to make sure that you spend enough time in the operating theater and also clinically at the same time, do research. So time management is important and then commitment uh to actually making sure that you see this project to the end and that's all I look for. If you've got these for, I'm taking you on for sure. Ok. That's all you need to do a higher degree. You don't need to have the neurons of Einstein or Newton to do a phd or a higher degree. That's all you need. Okay. And then how do you choose now? We are so lucky in our region because we've got all these opportunities. We've got the m ssure with the University of Cambridge. We've got MCH with the, are you, we've got em fill in both places. Are you, you e A uh University of Cambridge MD phd? How to decide, uh, where do you go to? And, and what do you do? Lots of options. So people have done it in University of Essex. There are people who are doing it in a are you people are doing it in UE A and people who are doing it here as well. So lots of options available. I think the bottom line is two things. What is each university good for? So if, for example, we wanted to look at muscle strength and the psychology of sport, then are you was very good at that? Two departments? Very good. So we've taken a phd students and place them in there because we've got good supervisors in their Cambridge is excellent for basic science, physical sciences. So if you're wanting to look at uh robotic aspects of CAM osteochondral plasty, we've got a very good robotics department. So whichever department is, is stronger in which university you look at that. That's one aspect. And the second thing is supervisor because eventually you're going to be working with that individual for the next 57 years, potentially or longer. You need to make sure you get on with your supervisor and he or she is on board, try and take you through this journey. So those are the two things which will matter which university is stronger in the field that you want to research in and I'll give you my experience as well. And secondly, your supervisor, are you going to get on well with them? And are they going to mentor you and then be your, your true supporter to take you through the next stage of your career and beyond and then lots of funds available. Um You need to tap into the right ones, obviously, whether it's an invention, whether it's an evaluation, adoption or a diffusion type of study that you're doing and different aspects will uh whether it's, if you're going for invention, then you need to think of MRC and welcome. Obviously, if you're evaluating new ideas, new things, new Deck Creeks, new approaches, and you're thinking of applied research, which is NIH are adoption things. We don't really get to as orthopedic surgeons, but a fair bit of money as I'm beginning to realize uh with the state and insurance and commissioning groups as well. Uh and finally patient care providers uh in terms of diffusion. So depending on what you're researching, there are funds available for you to do that. So now about my journey. So I started a phd well into my consultant job, probably three years into my consultant job. And people thought I was mad, why, why, why am I doing this? And I did it at the University of Ghent. And the reason I did it at the University of Ghent is because uh this guy Emmanuel on garage, uh he was the smartest Chapin town looking at forces uh within any joint. Okay. So looking at statistical shape modeling, how shape effects forces and all my work was on Femara established impingement. That's the clinical work that I was doing. And I really wanted to look at forces and precision surgery. So I, I chose him as, as my supervisor and then he worked again. So I basically went again because they were very good. It's mdeas, uh and all that and I've never looked back. It's been a great journey. Yes. It took me about five years to complete because there was a full time consultant job that I was involved in. But then after that, just through the phd in those five years, we had 35 publications, five grounds, 14 Might, a lecture, three awards to eponymous lectures just on that phd, right? A huge amount of work that actually came out just just from their culminating into a phd. And then that allowed me further on to develop a full fledged young adult hip research program focusing on optimizing outcomes in patient's having hip arthroscopy. So you're looking at surgical risk factors, uh stratification, disease and outcomes. The name filling A phd got money for that. Looking at fate to with biologics for earlier way. We're applying for a bigger Nitra grant for that surgical precision. And now in navigation, robotics that continue uh with a phd student and then non surgical list factors that is optimizing muscle strength almond, who is a consultant is actually doing an MD uh soon again, who is a consultant who's, who's doing a phd uh rehabilitation and I just got the NIH our doctoral fellowship for that, looking at the effect of rehabilitation and then mental health, we're working on uh probably market Aragona who's probably going to be doing a phd on that as the North surgical risk factors. So that, that's developed into a full fledged research program and research fellows as well. Uh It's probably an output of over 20 papers per annum coming from this and over 3.5 million in grants. And yes, I started my phd after I'd like to become a consultant because I was inspired by that. That's the area that I wanted to research and I found a good supervisor and that's what we're looking at. So it's all about personalized and accurate camera sections, not based just on morphology. So yes, we have the X rays, we have the CT scans. Uh We can get dynamic analysis on those CT scans, but it's also about contact pressures. That's what it's all about. And the contact pressures is what we're trying to adjust and lower in these patient's so accurate resection of cam and pencil lesion's so that we prevent arthritis in this cohort is the eventual game. And I don't know whether Iggy spoke about his project. Uh Not yet, no, but essentially Iggy's phd is looking at the biology side of things and, and the genomics. So Sarah who spoke earlier, uh IG is going to look at the single cell analysis of patient's of Premarin established impingement. So we're actually looking at the genetic side of things as well uh in collaboration with Oxford. So that's uh I guess phd. And then again, we've been successful in getting grants from all these places uh over the last five years, this is what uh Sarah talked about. This is the project that I got involved in. We got uh 2 million from the Chance Hackenberg Foundation. And then for a G we'll be applying again uh to that foundation for looking at singleton analysis for uh Ibrance tablet intervention then and loads of awards from there. The other thing that came out and again, this is where choosing the place is important. So we wanted to measure the force is obviously in the native joint, but in the replace joint, how do you measure the forces that's never been done? So uh came across uh Professor show Nikon Orion from the materials department to uh specializes in micro fluid IX. And we've come up with sensors which are like so which are conformable thin and we're putting those sensors into the liner's of the acetabulum or the knee or any joint whilst you're doing the operation to actually get exact pressures in that joint when you move the hip or the knee to balance the joint appropriately. And that's the first time you will actually get objective data and you marry that with the computers, which is what you're trying to do. Now, with striker. So you've got accurate positioning of the implant plus, accurate data sensing in terms of the forces being going through the joint, then you can position and balance your joint appropriately at the same time. Now, this definitely couldn't have happened at University of Essex or are you off for that matter? You e A because the expertise for this kind of stuff actually lies in Cambridge. So it depends on where you want to do and what you want to do, which you will choose the place from. And I'll leave you with these two thoughts. Uh Success is not only doing extraordinary things, but it could just be doing ordinary things extraordinarily well and actually digging deep down and successes, the ordinary things that you do extra really well at the right time in the right order and that's important. So your research question that you ask first is very important, okay, I'll stop there and then I'll spend about 15 minutes answering your questions. If you're thinking of doing a higher degree. If you have any questions open ended, then this is a good time to actually ask. Thank you. All of you are satisfied. Yeah. Survive. Um You don't actually, you are what? ST three you don't. So at ST free level, uh I just had uh fashion because I wanted to. And there were lots of questions that I was asking and the initial papers that I wrote were actually on shoulder surgery because the guy who I was working with was a good shoulder surgeon and he had questions. So that's what it, and what did it do? It allowed me to start doing systematic reviews, appraised to check carefully. And that's how you started this surgeon, right? But you need to have that comfort to be wanting to do this. I think that's important. So in short, the answer is no, you don't have to be absolutely clear when you started that disrupting one question you want to answer that will come only uh only data. And that's why I think you shouldn't, you shouldn't fear doing a higher degree later on, like as, as you, because your question would be much more mature and then it's probably a different way of doing it. Uh Visas degree may just be the energy level and you don't want to finish our course. That's fine. But once you put them in your question, then there's uh that, that fashion and the one thing to get that answer is a lot more, very matter question which is generated by it. We've had a very similar question on the chat, Mr Candy Asia. So can you please ask Mr Kinesia, what is the best time for someone to undertake a higher degree in research for someone starting ST three and how to go about it? So I think we've pretty much had that haven't also pursuing passionate. The right time is really what it's about what did y'all do? Let's ask our HCG fellows. Have you all done hiding these guys? MD phd? What, what can you advise on our young service? Still good. It's uh yeah. Well to one have pleasure it. Hello, later on uh discussing obvious today, later on the economic. So basically effects that I work ph over or nothing. Okay. There's nothing in the screen. It's not very individually tailored you uh Yes, she five rounds, seven years probably coming back here. Uh No, at the end of uh one year, uh early on, uh together we're creating is somehow uh g which is like we go on training and uh time works. I don't think it's uh you need to go down. Uh That's the requirement, go on to become member. Uh And your uh two of the old village in med school as well as a part of that program or among the data. Uh Obviously, I think research in medical school, but this was uh not, you have to do it right. And I started doing research and my second resident year and it's not called Black phd Germany. It's like we call it habitation program. It's a bit more I think than a phd than so it's like to become a professor. If you do this program usually takes you at least four, sometimes eight years. Uh to get it, you have uh you must do like applications. It's 12 in my department. Uh You must do certain teaching skills, like lectures and all the stuff. Uh, that's a pretty, it's, but it depends on which department you're working in. So, it's different. Um, but, you know, it's all about research and it's like we said, it's almost the same, it's all about fashion. You know, you really have the must want it, you know, just meeting because it can make fun and then it doesn't matter how many words you have to do many applications because as you said, one more or less, it doesn't matter if you could have written another 10 because you were questioning about it just will run if you are running just good. That's what I think. So. I did, uh, two years of research of the right. Yes. And I was supposed to do it again. I really night it was a question. Mhm. A younger generation with that stage because we need to research with exclusively, uh, agrees making much less money. I think it's much harder when you've already had a model salary as a resident. Uh, and then go down to less than 50%. That's the reason I think, uh, make it harder for me. So I really like to do it for America. We all don't have, um, proper, internationally accepted each time we wanted to live. I think that's part of the Bologna process. All right. Um, and we had to, but when I started, I have to do a proper time going to great effect for the phd school and school as well. And that would have been only basic sign 3 to 4 years. And I didn't want to spend so much time on that and not being trained, uh, as a certain. Now it's easier because we have all these new M PTSD programs that you can do it during new claimants work as well. That's a, that's a nice, uh, nice possibility and that I would think but nothing uh that can do both like a protective research time during mechanical time, but also progress in my training becomes it. I think one thing is very clear and I say this to everybody that you got six years of training home ST three USP A and that's probably the time when your hands need to be working pretty well because you need to require that should be surgical skills. And if you land up spending that time for a part of that time in the lab, then you miss out on that. So you as a surgeon, you really, I strongly feel that you really need to be for protection from getting your cervical skills right in that timeframe. And even if you're taking a year out, make sure that you have a program that you get at least a day or two of operating that you keep it happen. Like because you're not, you're not going to be sitting on attention and you're gonna be serving at the end of the day and you need to be able to talk for research is important. So you need to balance that appropriate or you decided right from the beginning that you're going to be a professor boobs when you're eating, eating, uh facing socks on, think that's it. It will be a surgeon and an academic. Then I think it's important that we make sure that your programs have uh the opportunity for you go to uh even that you have to prove that you take out, which is what pe was uh cool. Any other questions? Good. Excellent. Thank you.