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Hello. Good evening, everyone. Hello. Good evening. Um, Bernard, can you kindly, um, Newt yourself? Yes. Yes. Hello. Can you hear me? I can. Yes, I can hear you. Yes, I can hear you. Love you. Let's wait for, like, five minutes. Orders to join. Okay. I'll be through the worst day Life. That's great. Hi. Hello. I can hear you. I'm gonna see you as well. Welcome. Great. Welcome. So, um, um, we we plan to give a few minutes for people to join. Um, yeah. Before we start, I think we're about three people. Um, on the I don't know. I don't know what to call. It is It's waiting room. Okay, So she will wait till, um 5. 10 before we can. Okay, that's right. Right. I think we have about, uh, six people, All in all who are present at the moment. Uh, okay. And my my discussion is going to be interactive. I would, um I would really appreciate if other people are, uh, involved as well. Oh, no worries. Who are you? Um, should I, like, upload my the idea? No, no, no, no. Okay, good. Okay. Yeah. Okay. Um, Good evening, everyone. Um Bernard. It's 5 10 already, so I think we can start. And anyone that joins can always, um, catch up, if that's okay. Okay. Yeah, that's fine. Uh, thank you, Obinna, for having me. Uh, my name is Benard. Um well, technical fellow with Ganguly General Hospital in Wales with trauma, not diabetics. Uh, we're here to give, like, a discussion, basically, on the challenges that international medical graduates face which regards to cut surgical training, application? Um, it's going to be a discussion as much as possible. Um, so I would try to do is I would ask questions from, um, those in attendance as well. Um, I won't be presenting, like, a slide, Uh, because I want to be as interactive as possible, So I would, uh, you know. Sorry. Sorry to go T shirt. I use that house after your presentation. Uh, not yet. No, I'm just trying to set up. Okay. All right. So, um, let me just introduce everyone So everybody understand what's going on, and then we can coordinate it better. So my name is all benign anymore. Um, so for today, um, I think Bernard immensely for having trying to organize this and trying to get a lot of people to make presentations. Um, a lot of people have to make last minute arrangements and make sure that this happens. So, um thank you, Ben and foreign izing this, um, we have actually have three presenters today, So Baynard is going to give a presentation on challenges of, um I MGs when they're making applications and and, uh, from what I understand, he's probably going to give his own perspective. Um, we also have Shirley as well, who has kindly organized a presentation on Kodi Faina. So, uh, it promises to be a very exciting presentation, and we should all look forward to that. And and the last presentation, um, will be given by Dr Chinedu. I don't think he's here at the moment, but hopefully he's going to join us in the Utah, uh, and then give us his presentation and he is going to give us a talk about, um, koala surgical applications. And he's a CT one and probably is going to give us his own perspective and give us an advice on what to do. So, um, I think we tell them what I do. I think we should go. Go right into it and have been urged. Give us his stock and Yeah, Bennett, you have the floor now. Okay? Yeah. Thank you. Thank you very much. Up in. Uh, yes. So now I would just be running us through. What? I I feel, uh, my challenges or what I feel, uh, challenges. Most other international medical graduates have, um, gone through, um, within this period. Israeli within the u. K. I think the the the most impair. Uh, the most pressing of them will if, in my opinion, is understanding your role and understanding the system. Basically, how the system works. Uh, because a lot of times, most of us coming from other countries from other systems already used to how things are done, they already used to What is obtainable? We know how. Yeah, expected to, uh uh, it looks like your mic is, uh can you kindly that. Thank you. Okay. So, um, sorry about that. So, um yeah, I think as international medical graduates, the first chat injury we face is, um, understanding our rules, understanding the system, how the system works, or the system wants of us as junior doctors or as, um the city was CT to s H O s. Um, understanding our place in the system, understanding how we can use that place to own advantage. Um, we can all agree to the fact that initially when we came in, the first few months were like a very crazy period. You didn't know what to do. You didn't know what was right. Um, it's like you were thrown into, uh, my notion and you're due to swim basically without, without understanding how how to swim or without understanding what to do. Um, uh, in my to my experience, I I feel that's the greatest limitation that we face initially when we come in, Um, yeah, we have to relearn basically how to practice medicine. Uh, we learn how how to interact with our colleagues. Relearn what, uh, would consider important things are important aspect of medicine. Uh, we can most of you agree with me that before coming into, um, the country, um, things like audit. We're not a very big part of our, uh, medical practice. Uh, most of us did them, but not as irregular, routine, active thing that you do here. And that's another thing, because when you come in here? You realize that the medical practice in this setting is not only focused on, um, how you do your job, it's You have to show proof that you're doing your job. You have to keep active information. You have to keep your logbooks active. You have to actively, um, sort for things example like, uh, something like this. So all these things that I feel, um, uh, challenges that we face, Um So if if I may ask surely to you, what do you What was your greatest initial challenge in terms of understanding your role and the system When you came into the UK, I think for me, um, it wasn't that difficult, because when I walked in Nigeria, we had so many UK doctors or doctors who were trained in the UK and practice in the UK and then came back to kind of give back. Let me put it that way. So in the certain where I was then they kind of brought all of that, um, experience. Uh, you know what we're doing? What they were doing their Then they brought it back to where we were and implemented it. So I'll say some of the things we're not new to me for instances Audit. Yeah, I know. We we do some things, like audits back home, but I think the first time I did it, I didn't know it was called an audit until these guys came. And then we did another one. That was when I knew that. Okay, so this is an audit. But I had done something like that before, so I think one thing is the practice here. I will not say that we have to relearn medicine. I think this is These are the things that we know. Uh, it's just that if I say knowledge wise, yeah, we have the knowledge practice wise. I think we have the we we practice well, but there are some some other things, like so the oddity A it wasn't compose ary, but here you have to do it. Teachings wasn't compose ary, but here you have to do it. Um, what else? You know, it wasn't so like, uh, 3 60 feedback and all of that. That wasn't a thing back home. But here you have to do all of those things. Keeping portfolios. There's some things that I know that most of us have done in numbers back home, but because we didn't have this culture of keeping evidence of things that we've done, and so nobody keeps evidence. So you come here and you start from scratch. Yeah, very right. Shirley. Sorry. Uh, sorry to cut you short. Um, you're right. Um, all this, uh, true. And you've rightly said everything. Um, it's You see, that culture of information gathering and keeping proof for that information is what we don't necessarily, um, comments. And we have to learn a good one. I think this the second challenge we face is building a good network. Um, uh, we all agree that you can't go about this application cycle or this application process alone. You're bound to struggle. If you do that, you would be deficient with with regards to information gathering and information sourcing. Because most of the informations we have almost of the informations we share amongst ourselves, Uh, things that we get from other people. Not necessarily from ourselves. Um, so you I think it's very important from the get go Once you step into you, the contrary should have been to the setting. Are trying to get into Cassatt ical training to build a good network. That is I I can't I can't overemphasize the importance of that. You need a very good network. You need a good, vast area of people who are willing to provide you with information and who you're willing to share information with. Um, it's also you can start you. I would recommend you start at your local level, be your consultants, your colleagues, your junior colleagues, other people who have just recently got into training other people who are trying to get into training. Um, so and that's why platforms like this, like the surgeon kind, um, train interest groups. And I'm sure a lot more other platforms that a lot of people have are important. You need to in and I say something about that, you know, finding, networking and all. I think one of the challenges that international medical graduates face is we I think maybe now it's coming up. But when I started searching for information about course surgical training, I didn't have people with the same background as myself. So UK graduate, of course, is things are different for them, but it was difficult finding people that have come from back home that did. How's your back home and come here and entered surgery? But I think recently that is changing. Changing, But yeah, Before it was very difficult to find someone with a similar background with you that you know, you can, um, pattern your own method to Yeah, that kind of thing, Which is true. So, uh, Victor, I don't know if you get if you can hear me. Um, to you. Um, what do you think? In in in terms of, uh, information that rain and networking. What would you say? Are the challenges with you guys to that? Can you hear me? Yes, I can hear you. Yes. Well, I'm not I'm not I'm not practicing in the United Kingdom yet. Uh uh, Maybe that's why I said I need to introduce myself too. It's to you. I joined this, um, webinar, uh, in order to be able to gather, uh, information. However, I'm currently for graduate students at, uh, Glasgow Caledonian University. I'm taking my master's in public hate. Okay. But before I came down to the United Kingdom, I'm a chronic medical officer, a federal medical center. ButI metta Lagos. Uh, all these audits, they like Helen to me. I don't even know what it is. Uh, you know, you see, if you're speaking in tongues and it is very, very unfortunate that I was discussing with a nonmedical friend of mine some days ago and, uh, we don't know how you put my phone and he says So many things on my phone. I said I was in neurosurgery for a whole year. We did a lot of salt. A lot of surgery you should have lost. Can't have lost cans of how many schools doctor handle oral use. A neurosurgeon at Fed America Center, but a meter high and doctor, If you have opened, we have receptors. So many. And Rakhine a two more, you know? Hardly. Is that it? You can point to that we use in Rosalie that I don't know. Yoga is record. None ought. Appendix. I was there for, like, six months. Many reduction. Or if that we did Sure. Many hip replacements. Where is the record? None. I was until I saw you for a whole year. Where I'm where I'm going is when you talk about how this how do I give how this personally I am confused. I'm not only confused, I don't even know where to start from. So that's and I'm just like, maybe this, uh, capital UK is like a brick mistake. I'm not going to get myself good, you know, in between, because I I don't even know the way forward. And that's why I, you know, propose they might have that I must join so that I can understand what you mean by hold it. What can I do? Where? You know? In the condition, Maybe. I don't know. Maybe it's in a tight condition, which I box myself into. Now, how can I be able to get out? How can I survive it? But I don't even know what to do. Going forward. Yeah. Okay. Yeah. So, Victor, uh, can I respond to that? Sure. Sure, sure. Um, So, uh, thank you, Victor, for, um, for your comments. Like I can release, I can relate because, um, I moved to the UK just maybe around two years ago now, to make approximately two years now. And when I came to the u. K. Um, I also struggled. Um, the thing is, when you come into the UK and start with practicing in the UK You realize that a lot of things you must You must have done something similar back home, but it probably did not have that name. So the more you're practicing you Might you You realize that I've done something like this before, but maybe it wasn't called an audit. Okay, so UK call their things. They have different technologies for that. Um, So what? Our advice is that you've come to the right platform and you have to watch out because there will be more programs to discuss that in the future. Uh, but discussing audits is beyond the scope of this, um, lecture today. So hopefully, uh, in in the in the coming weeks, Uh, probably organize something else. Talk about that, and maybe you'd benefit more on that. So, uh, let's stick to what we're discussing now. Uh, Bernard is going to finish this presentation. Shirley and needles are presentations. After that. Maybe if you can email Ben urge or me. After this, we can also have another discussion and maybe let you know what audits and things like that look like because some, of course, actually actually still learning what these things mean. So But, um, certainly if you send emails or reply us, we can put it to, and then maybe at later dates, we can organize another teaching to discuss month. That Is that Okay? Okay. Okay for me. All right. Thank you very much. Yes, thank you. Uh, thank you for answering that question. So, yeah. Um, yes. I've dropped my email in the chat box. Please feel free to send me an email. And, um, I would help with any questions I have now the next. The next plan is haven't faced the challenges or the next things having to face the challenges of the system. Uh, you actively try to build a good network information gathering and information sourcing. I think the next thing you have to do is planning. You have to plan. You have to look at your current experience. You have to look at your current standing of things and structure out something that works for you. Now I'll give a good example. Um, myself, I didn't have a surgical background from Nigeria. Um, not at all. Um although I've always loved surgery, but I never got into a job where? I would say I was doing a surgery job and I didn't get into training. Now, once I go into the UK, um, I knew I wanted to do surgery. So from the get go from there, say Stead making my plan. So I was in a private hospital. I was in the N H. Any years. I spoke to a few consultants, I think the orthopedic surgeon and some some other guys. So I'm like, Okay, I'm interested in to get getting into surgery. Please. How can you help me? This is what I have. Well, I want to do this. I want to do that. I want to get this. I want to get that. I want to do this. What eventually happened was okay. They They gave me a bit more information in terms of experience to help me activate to To help you help me structure myself a bit more to help me plan more. So I I knew that. Okay, because of this, this and that, I would like to write my m s. Um sorry. Um MRCs At this particular point in time, this would be the best time to write my MRCs. Um, this would be the best time to do my audits. This would be the best time to do my conferences. But so some simple things And we all know Well, no, sorry to say that about as you begin to get information as the process begins to unfold. You, you know, pick periods where they do a lot of conferences or pick periods where they do a lot of things and that can help you plan. Because sometimes some of these conferences are life conferences. You may need to present posters. You may need to do a few things, so planning is important. You have to plan right down to the very minute of things or to the very basic things and for for me, I think if you have a good plan Willstrop dried out. Um, I feel you've done most of your job. Now it will be challenging for me to say okay in terms of planning, this is how you should plan because we are different and I can't speak for everybody. But this is what I know. When I plan my things right, which gets to the surgeon surgical, um training application. I write it down on a sheet of paper. I put on the war everything I want to achieve and the time frame that I want to achieve these things that I have tick boxes that I just take two. It's like a self gratification thing, but it really helps if you have 10 things on the list and you're able to plan them out and you have a structure and you're achieving them, be them and you're taking them as you find that as the day goes by, you would feel a bit more courageous. You'll be much more happy with yourself, and everything will continue to flow. Yeah. Um, now the next thing I'm going to talk about is sitting for exams. Um, we all know well, before now that be if you needed at least an M r C s pat A. To score some points. Um, that's no longer the case in Australia with regards to CT training. Um, however, they've introduced the M. R S A. Exams, which is a general exams. Everybody writes So, General, um, GPS trump. Um, I think most of thumb ology o N g, and the most other departments writes these exams. However, there are other exams that I would say important for people seeking to get into, um um, course surgical training that you don't necessarily need. Not anymore. As for the current guidelines, however, we know these guidelines change. So the m r M C s, but, um part B. Now, these exams are very important exams. Um, well, yet again, they take a lot of time to practice to practice for a lot of time to read for, and they're quite expensive. So if I could ask Shane Shirvani, um, if you could just give us a bit of information on your your how rapid it. Now, your plans was writing. Um, these exams. Are you planning on writing? Have you decided to, right. Oh, Shivani, are you there? Okay, I guess I'm not. Okay, fine. So would would move on. Uh, okay. Try to switch on my microphone. Okay. So while while I'm waiting for Shivani, I would continue, uh, now a few other things as well. Um, building your portfolio. When you start this journey, there's something you need to have or there there are some goals you need to set for yourself and the most important of them would be too have a portfolio that is comparable to a lot of other people. And as international medical graduates, we struggle here largely because we don't have all the information. We are not very, Uh, um, we we do a lot of these things, but we don't give them the names and we don't document them. And that's a challenge. Because when you're now eventually come into the UK, you're not struggling to account for X years of your practice, maybe all the time. Like Victor has said all the time he spent in Nigeria practicing doing a lot of things coming down here and because we don't necessarily keep all the informations like I will admit like we should. We we struggle and boudin, your portfolio is a null and compassion thing. So you have segments for audit. Have segments for your surgical practice your segments for your teachings. You have segments for your conferences. Um, we have cigarettes. Leadership. I would say that most of us have had leadership positions, rights through school, even after school during uh either n y s c as, um ahead of these n. C. D. S groups and things like that and first other things. A lot of us have had leadership positions, and we've done a lot of things and don't positive change. But because we didn't document them at the time, it's a it's a challenge was going forward. So building your portfolio when you come here becomes like a daunting task because you're trying to get all the necessary information, you're trying to see what other people are doing. Um, I would recommend in terms of using your surgical portfolio, there is a very good tool. It's free. It's the log book. Just go on. Like if you don't have that already know most of us here have them. But if you don't have that, there's this, um, um, stuff called the log book. It's very good. You really sound like and you can put in all your, um, surgeries that you've at least done assisted, observed and all that. There are also segments for you, too keen, other things like, um, other things. You've done other reflections and things like that. So, uh, to tell all your your application itself, I suggest that you get the, um the person person specifications for the just past year for your for the city, Uh, social applications. And you look at that and try as much as possible to tell you what you're getting to meet that criteria. It may not be the same thing as at the time you're applying, but I'm I'm very sure that it should be very helpful. Um, this the last set of, um um, Chinese I'm going to talk about largely I'm running short of time is, uh, and specific. Um, so things like age, family backgrounds. Um, I have a lot of friends who have surgical backgrounds in Nigeria are still interested in surgery. But by the time you're coming into the UK, they're adding their mid thirties, uh or oh, yes, mid thirties approaching forties or there about and they they look at the whole, um, time again. I need to take them to practice and all that and also that the end of the just said it's not what distress it's not. What's the challenges? At this point, I would just find something that I would do over a short period of time. Um, commonly G p or any other thing, G p is the shortest three years and most people have done. And that is a challenge because because most of us have graduated at X number of years of so number of years. Um, practice, maybe eight years, five years old. What about in Nigeria? Coming here and starting basically from scratch is a big challenge to a lot of people. And it's something that many people struggled with. Not everybody. Some people coming at fairly early period, and it's not a problem, so you will come in at a much later age, but they still decide to continue with that. So this is specific to the individual. Um, also short, like we talk about family background. We cannot under um on the emphasized the importance of family in the UK, and a lot of people have made changes. Especially international. Medical retirees have made changes because of their family backgrounds. Either they're finding it challenging, um, with the kids or they are finding it challenging, doing a few things. So people change their plans and people change their intentions and what they intend to do. So, uh, this again is like I said, it's a personal thing, Um, but it's something that most people struggle with, um lastly, um, I was talking about mentorship. You need to find you a mentor. It is very important, as a mentorship goes both ways. It not only gives you something to aspire for, it gives you a feeling that I can do this because most of the time with where you get a good mentor and use the world Good. Uh, what, you get yourself a good mentor. They would show you things that you can do without necessarily stressing yourself or without necessarily putting a lot of, um, a a lot of hours a lot of times because this would have been in the system for a very long period of them able to break down the challenges, they're able to break down everything to a level that you we all can understand. Um and also, uh, what I struggling recommend as well is be a mentor to somebody as well. So it's not enough to get someone leading you through the path as you come in into the country. Try as well to find one or two people. You could lead either where they're still back in your home country. But they're still back in Nigeria. or when you're here and you're just trying to struggle and find out how things Because at the end of the day, you have experienced, no matter how small, no matter how minute, no matter how, um, how little you might think your experience is, I'm sure there are a lot of people who would really appreciate, um, this experience. So, um so, yeah, that's in a nutshell. Um, those are the challenges. I know if we if we can continue talking about this for a very long time, but I think within the scope of our discussion today, I want to limit it to this point. I think in the coming times we could pick specific things and have a good discussion on a good conversation about these things and try and see how we can help each other. Now the goal. The goal of this discussion is to, you know, free our minds to get us to understand, truly that even with these challenges, all these things are doable with these challenges, and even much more have they have not mentioned. I'm very sure about that. Um, the cost of medical training application is still very possible. Lots of people are doing it. Lots of Nigerians are getting into surgery training, and whatever trainings they decide that they want to do is just all about good planning, good information gathering good networking, good portfolio puting planning yourself, planning your exams and getting a good mentor. So thank you very much. Please. If you have any questions, I'm happy to answer. Open, uh, please. Over to you? Yeah. So thank you very well for for, um, nice, cheap, chatty toes. So, um um, so let's give about five minutes for people to do it some Q and A. So if you have any questionnaire, if you're free to commute yourself actually, Christian, um, if you feel more comfortable chatting, you can only send the question three chat person. Um, Bennett might see that can also respond to that. Thank you. So, uh, I've tried to add everybody to stage so that we can listen to each other talk. Um, and actually, which is well, like open has said, if you're much more comfortable dropping a message in the chat box, please do. And I would pick that up. Um thank you, Doctor Banana and Doctor Obina. At least I personally have been able to derived some vital information, and, uh, i'll be able to put it down without even being told. I realized us everything started from building a portfolio for you to be able to get into cause subject a tree. From what you're obsessed so far, be able to, uh, extrapolate down from what you have said, uh, and the ability portfolio O N T e s o d. Teaching negative position. And there's some horror things, uh, that would have you we should have mentioned. But you may mention of something which is also very important. You said, uh, h is. Maybe I just want clarification on the Is it on a personal grand, for example? Well, we just maybe someone fed. I'm already 35 36. And if I'm gonna go into psychiatry and it's going to take another 67 years of my life, but it tells them how how many years do I have to really practice, you know, to be active in this, uh, surgical, uh, Terry, before I'm going to call it a quit Or is it that the the college just look at, uh, it doesn't want it investing on someone who's disorde. So I don't think we can be able to get you a slot for you to start your cost. Logical training. So I wanted to clarify, uh, you know, if you understand what I mean. Is it on a personal time? Maybe somebody just resolved It doesn't want you taking. Let me just go for G P and do three years and get out and start making money. Or is it a college that you just look at you and said you're too good You can't invest time training you. You're, uh, just mail with, uh, three years, Uh, start a long test of practice. Thank you. I think I I think I think it's, uh I think it's it has, uh it is a personal thing, because when I said when I talked about family, background and age, I think I stated that that these are personal challenges. The college would not restrict you. I I don't think the college has any plans to put an age gap on on on it. What I know is the college would not let you apply at city level. If you have an extensive surgical background, usually more than 18 months before you come in. I'm sure you do. We'll talk more about that. I'm not going to focus a lot on that. Um, but in terms of in terms of, um, um the the college restricting you that's unlikely to happen. It's most likely people who come because I've met lots of friends, lots of people with old school backgrounds, and they've practiced four years in Nigeria. Yeah, I don't meet thirties or approaching forties. So all some of them, even in the edited they just decide this is no what it anymore. I'd rather do something I can quickly do and be finished with. Yeah, that's uh, right. Um, thank you very much. So just I would just add to to that. So, Victor, uh, I think what Bennett is saying is own personal opinion. So, um, you're also very You're also, um, welcome to make your own, have a lot of information and make an informed decision or whatever you want to do. Um, yeah. A lot of people will have a lot of things that that's the factor before making any any choice for any training they want to do. Um, surgical training, specialty training either medicine or other specialties not is not short at all in U K. Training is usually very long, so it's important for you to know how long it would take and then put that into consideration into your own personal situation and circumstances, and then make an informed decision what you want to do. Going forward. Um, I believe Chinedu, when he's giving his stock, is going to chew more light on how long surgical training is and how it works. Um, but like in summary cost, surgical training is like two years and then higher surgical specialties at least five years, so also get about seven years and above. So, depending on if you take breaks or if you just go through at least seven or eight years, and it's not limited to surgical training, medical medical training is also very long. Pediatric streaming is very long. Emergency training is also very long. So, um, I understand you're not in the UK now, so but get your information, make a choice based, you're on your own personal situation. And then, um, the opportunity is yours. You disguise your limits to make any anything you want to have and make it happen. Um, I don't believe age personally. I don't believe it should be stopping you from doing whatever you want to do. So yeah, because my this month is now believe I believe that if if you want to do medicine, even when you're 40 you'll probably still be doing the job. So I I always encouraging everyone to do what they want to do, regardless of their age. Yeah, so but thank you for your question. And if we don't have any more questions, um, I believe we will invite Shirley by six. PM to start. Uh, no, I don't I don't know if I can. I'm actually in the UK. I'm taking my master's in public eight at Glasgow calagel a university, uh, in Glasgow, and I I I don't just want to take plan. Actually, I don't know. I just don't like it. So, um, you you must not take plaque to get a license to practice in the UK. So if you feel confident enough, um um, you can also like, right the MRCS, part A and part B. And when you pass the full exams, um, membership of the reality of surgeons of England or Edinburgh can grant you, um, g m c registration. So, um, like, like I said earlier, um, discussion on GM. Gm. See, registration is beyond the scope of this. Our discussion's, um so yeah. So, um, your masters also gives you a lot of points when you're doing Cassatt ical training and higher specialty training as well. So just know that what you're doing in the UK now is going to count eventually if you want to apply for surgical training. So I think you are on the right path, so but I believe you need a little more a bit more information to, um, streamline your, um, what you're doing, and then when you have it, understand, you can plan yourself better. Um, for whenever you're going to apply for any training, not just historical training, any train you want to do in the UK Okay, I'm sorry for doing you back. I'm actually I started looking for, uh, MRCs agitation of taking it by him free. Okay. I don't just you know, I'm just, uh, doing things on my home. Know, mentor cheap. Uh, okay. I'm unorganized. So do you know what? Let me just I don't want to take club. I don't like, uh, that's fine. Very honest. That that's okay. I completely understand. Uh, I think I need to hear Chinedu. Um, is he is currently a course surgical training. I believe he will probably have information on MRCS exams and probably possibly some groups that preparing to write the exams anytime soon. So, um, um, I think if you can message him after the stock, um, I believe he should be able to help you. Okay. Is that okay? Uh, I don't know if you, uh, if you should if you if you should, uh, but they will probably guide you again in two to do for okay, if you need more information. Thank you very much. Um, surely I don't know if you're ready, or should we give you, like, five minutes to get ready? Hello? I will just upload my my slides. Yeah. Okay. So while while while you upload your your slide show, um what being that said who sit in his own talk was very important. Um, most of the times when people men I mg my my great. The problem is not that they have not done a lot of things. The problem is usually D formats, Um, in which it's it's done. So, for example, uh, when I came to the u. K. I realized the practice is something called reflective practice. So when I first started coming, I was doing a lot of things, but I didn't I don't understand what reflection meant. Okay, so it's something that is different. Okay, Do we reflect in nine in Nigeria? We do, but yeah, we do. But not in the level. They do it in the UK. So in the UK, once you learn anything, you're supposed to reflect on it. If you do, you're posting is supposed to do a reflection on that. So it's all about trying to put your own experiences from what you got from wherever you're coming from and then try to streamline it into what the UK systems wants and then getting, um, let us people that can see that you can do this again. Another problem I encountered was, uh, um, it's evidence, so you could have had a lot of leadership position. You could have been like leaders presidente of So so so. But do you have someone that can write a letter to you. I had a situation where I had to chase consultants to give me letters from Nigeria, and they were not even replying their emails. They were not replying their messages, and it was difficult for me to get these letters. Um, we're at most of these consultants in the UK here. They realize the importance, and they are very willing to help you. So it's always about the balance between your experiences and, uh, trying to feed back in towards, um is acceptable in the system. You are currently, so, yeah, those are experiences. But like Benadryl already said, get a mentor gets very good groups that help you with information. And then, yeah, you should be able to be pointed in the right direction, which will help you achieve whatever you want to achieve. And we tells for that. I do. I think, um, Shelly give blows, has a presentation up, And if she is ready, I think she can start. Yeah, I'm ready. Yeah, Good for it. All right. Good evening, everyone. Uh, like Vanessa Yamani Micheli, Um, currently ST one in a any. And, uh, we're just going to use this opportunity to just quickly refresh our minds on this very important topic Code equina syndrome. Uh, we're going to use this outline. Uh, yeah. So all of this, we're just going to walk through this and yeah, so enjoy. Uh so, by aware of definition, this is basically a test book definition of quetiapine a syndrome, but in very simple terms, Code equina syndrome is just the collection of symptoms and signs resulting from, um, compression of the kata equina from any cause. Um, so we're just going to go through some anatomy of the coder equina some epidemiology as well. So we know the spinal cord, which is a continuation of the medulla. It ends as this taper structure here, where my arrow is, uh, called the Conus medullaris. This is usually at the level of l L. One in most adults and then below this, uh, structure, the Conus Medullaris. You have the code equina. So it's a collection of nerve roots from L1 to s five. And then compression of anywhere along this area gives you the syndrome called Code Equina syndrome. Below that, you just have the phylum terminal. That is the fibrous extension from the News Media Diaries, and it has no neural elements, so I don't think he has any significance. Um, so the code equina syndrome is a rare condition. Uh, studies have shown in the UK it happens in about 1 to 3 people in every 100,000 of the population, and it will cause more in meals. Um, the most common age group is those in the four decade of their lives and commonly are caused at the level of L4 L5 vertebra. So, yeah, talking about the pathophysiology now. So there are some factors of the kata equina itself that make it susceptible to injury. So one of them is a poorly developed a pin ery um, the opinion is basically the outermost layer of connective tissue that includes is a nerve. And the function of the epinephrine is to protect the nerve from compressive forces from tensile stress. Uh, so being that the cauda equina is lacking in this with compression of it from any costs, you have, um, decreased blood flow to the code equina decreased CSF deficient as well. All of these leading to decrease nutrient delivery to the nerve roots there as well as nerve root ischemia. Um, the second factor that increases its risk to injuries Increase vascular permeability. Normally, uh, this is supposed to supplement nutrition to the nerve roots, but in injury to the nerve written the cauda equina, it encourages intraneural edema leading to intraneural compartment syndrome, which will further give you reduce proficient and the scheme of the nerve roots as well. So all of these are the factors that's combined to make this injury possible. So in terms of etiology, like we said in the definition, so code equina syndrome is basically compression of the cardiac wanna from any course at all. So you can hear you have the degenerative courses like this condition, and this condition is the commonest cause of code equina syndrome. So in the MRI image here, you can see the disc bulge. I think this is L5 s one, um, compressing the, uh, nerve roots there. Um, you also have spinal canal stenosis here is just clear here in the image as well. Um, another course degenerative courses here, degenerative spondylolisthesis where you have, uh, like a sliding of the vertebra relative to the other ones. And here is also compressing the lodipine, uh, other causes. You could have tumor's. This could be primary to most of the spine or metastatic tumor's. Um, you have ineffective causes as well. Like epidural abscess, usually epidural abscess. Usually, um, in IVD, used as intravenous drug users when they have Qatar Equina syndrome is usually from epidural abscess. Um, another effective courses ports disease, which is basically TV of the spine. And that's what this image here is showing, um, TB of the spine here, causing compression there, um, also have traumatic causes. So if you have this location of the spine, that could give you a compression. If you've got spinal fracture with the fracture fragments also compressing, just like in this image here, I think this is L2 fracture. I hope you can see this clearly. Um, L2 fracture causing compression here. So if you've got spinal fracture with the fracture fragments compressing that, you can have that as well. And and in this case here, you have a spinal epidural hematoma. So this could be from, uh, post procedures, like lumbar puncture like epidural anesthesia. Um, uh, it could also be spontaneous in those who are taking, um, anticoagulants um it could also be post surgery. So you have spinal surgery, and then they develop cardiac wanna syndrome is most likely due to spinal the epidural hematoma. Um, so in terms of presentation, here we go through the history so patient, but have a history of lifting heavy objects with the spine flex. They might have a history of anti coagulant use. They may have a history of being IV drug abusers. Uh, history of post procedure or even trauma to the back. So all of these will, like, kind of give you an idea of what the possible cost of this could be. Then the symptoms. The most common symptom is back pain. Uh, lower back pain. Then you have sciatica or bilateral leg pain. You have sensory changes in the legs. Uh, this could either be tingling sensations or numbness in the legs. Uh, there's also weakness and the legs bladder dysfunction in, uh, terms of during retention with overflowing continents, they could have constipation or bowel incontinence as well. Um, decreased sensation in the perianal area where we call saddle paresthesia. And in men, you could have impotence as well. Or sexual dysfunction. Um, so yeah, still in terms of presentation. So these are some of these designs now, you as the doctor when you're examining the patient. So first of all, yeah, you see patient in distress due to the low back pain? No, not always what they might be. Then, when you palpate the spine, you could have midline spinal tenderness, lumbar spinal tenderness because it's most commonly, of course, in the lumbar region. Um, the urinary blood are also maybe power people if the if there are urine symptoms. So, in this case, the palpable urine blood. That would be because they are retaining urine. Um, neurological exam. You have lower extremity weakness. There could be abnormal sensation in the legs, like numbness, tingling like you mentioned earlier on and also, um, reduce the absence sensation in the saddle area. So, as shown in this picture, the saddle area is this area marked in red is, um s 22 s four. So involving the back of the thighs, the Parini, um, and the perennial area. So usually in this area, they have either reduced or absent sensation. Um, sometimes, what have happened? Sometimes when you ask the patient if they feel like when they go to the toilet when they wiped, can they feel the toilet paper? Some of them will tell you that they don't feel the toilet paper when they wipe. So that tells you there's also, uh, saddle paresthesia there. Uh, they could also have decreased or absent lower extremity reflexes. Another thing that's significant is that they've got, uh, increased post void residual volume. So normally you do a bladder scan before they avoid, so that's prevoid. Uh, then you do another bladder scan when they ask them to avoid, and then you do another bladder scandals, the post void and, uh, normal post void residue. Volume is usually less than 5200 meals, but in code Equina syndrome, the post residual volume beast or the post void residual volume is usually above 200. So you do that. Then you find there's a significant post void residual volume on bladder scan, um, on rectal exam, you have reduced in el tone and also reduced or absent anal wink. So usually with this, when you do a pinprick around the inner area, the external sphincter is supposed to contract in a normal person, but with cut equina syndrome that is absent or very weak. Then, in Mills, you have reduced or absent, um, global Covenas reflex. Let's go. So in terms of work up, we'll just start with the most important one, which is the which is the MRI. So that's the imaging modality of choice for code Equina syndrome, and this should be done urgently. Usually, we didn't want two hours of presentation the year you're supposed to have this MRI done. Um, plain X rays and CT scans not usually done. Except if you're suspecting a traumatic cause of the injury, for example, fracture or dislocation or spondylolisthesis is, then you can have a CT scan done. Uh, city MYELOGRAPHY. Is indicated when, um, when there is any contra indication for MRI, for example, um, if they've got, uh, MRI incompatible implants or they've got pacemakers that are not compatible with MRI, then you can have city myelography or when you don't have MRI at all. Then this comes handy, and this involves injecting a di, uh, contrast into the spinal space. Um, if you're suspecting an effective course, then like post disease epidural abscess, then you're f b C crps are comes in handy the bladder scan. Like I mentioned earlier. This you usually do this by the bedside when you're examining the patient is one of the things. I think it's part of examination, not like investigation per se. And like I said earlier on usually do is record equina syndrome. Post residue Post void. Residual volume is usually above 200 meals. It's quite significant. So the management is emergency surgical decompression. So ideally, uh, they should have surgery done within 24 hours of onset of symptoms, but no more than 48 hours. Because anything after 48 hours is carries a very, very poor prognosis. They might not be able to regain function, uh, like, regain power in their legs or regain normal sensations in the legs or regain normal bowel or bladder control. So for to give them better quality of life, they need to have surgery done within 24 to 48 hours. Uh, yeah, so that brings us to the poor prognostic indicator. So, like I said earlier on so delaying diagnosis because when you delay diagnosis, then of course the treatment will be delayed. So delaying diagnosis gives you poor prognosis. You have surgical decompression after 48 hours. That also pertains poorly for the patient, um, presence of saddle anesthesia or bladder dysfunction. In this case, this is if this is present and it's called the complete Course Equina syndrome. So that also carries very bad prognosis for the patient. Um, so these are just some of the conditions that mimic, um, code Equina syndrome. We're not going to go through all of that now. Well, I think it's important to just have this in mind so that you will be able to exclude all of these when you're evaluating a patient that has presented with some of the signs and symptoms of, um, code equina syndrome. So in summary, um, Kota Equina syndrome is basically diagnostic and surgical emergency, and we should know that delay in diagnosis and management can lead to very devastating lifelong mobility for the patient. Um, if you've got symptoms in a patient like bilateral lower extremity weakness, sensory changes saddle paresthesia with blower back pain. This should raise the suspicion for the, um condition and also note that MRI is the diagnostic modality of choice. It should be done within 1 to 2 hours of presentation. The other, uh, investigations you can do if you suspect, um, any other cost for the for the condition. And also, it's important to know that treatment here is prompt surgical decompression. So either done by the neurosurgeons or the orthopedic surgeons? Uh, we have different, you know, different centers is yeah, is handled by either of the two. So once you suspect is it just promptly referred to them. And they should have surgery done within 24 hours, but no more than 48 hours. Yeah. So this way where I got my materials from. Thank you very much. Any questions? Yeah. All right. Yeah. Thank you. Thank you. Was there any questions? Yeah, Well, that was a fast one. Thank you, Shirley, for your presentation. That was quite socks. Uh, yeah. Um, again, Any questions? If you want to ask any question, your fridge anx ax. And if you bit shy like me, you can drop. Um, it's on the chat box and certainly surely should be able to respond to your questions. Yeah, just to mention please, I've put the link to the feedback form in the chat box. Please, please, please try and fill it up. please. If we're talking about gathering evidence for the things that we've done, sometimes we do things that we don't have. Evidence. Please. This is all of them. If you will just fill this out, I would really, really appreciate it. Thank you. Yeah. So everyone kindly feel, um uh, feedback laon Know how she's done. Make suggestions for improvements. Yeah, Feedback is very important. So, um, very important. Everyone go and click on the form and give a nice feedback. Thank you. Thank you. Victor said, how do we elicit bulb? Oh, cavernous, Reflects. Actually never had to do this. I just know it because I think the inner wink and the director tone is enough for me. Inpatient. I don't go to that area. Veena, can you help us a big You're muted. Oh, sorry about that. To be honest, I'm not very sure about how that works because it's not one of the very common reflex Six people check. Yeah, so yeah. Sorry. We don't have a it's about You have to, like, squeeze the glance Penis. Yeah, I think that's why people don't actually do it. Yeah, you have to squeeze the glance Penis or if they've got an indwelling catheter. Then you have to talk at it. Um, I don't know what's supposed to happen, but yeah, I think the so I think why it's not done. Because if you do the rectal exam in that many people will let you do a rectal exam on them, but not that one. So if you do a rectal check for the rectal tone and check for the inner wink reflects, yeah, that's usually enough. Yeah. So, um yeah, you are So allow Elise have responded with some answer. I believe so. He said here. Yeah, yeah, I'll just read out his response. He said, You put a gloved finger in the patient's in us and gently squeeze the glance Penis in meals. If you you feel the sphincter tighten on your finger, That's quite is even uncomfortable for you as the Examiner and also for the patient. I mean, you have one finger in his in his rectum and then the other one squeezing his glands. That's like, So, um, what what I need to say is that, um, a lot of these reflexes are for academic purposes. Um um, in real life practice, um called a I wanna syndrome is is an emergency. Um, if someone presents to the any of its lower back pain which red flag symptoms? Um, we have very popular test to make a diagnosis. So things like post void bladder scan things like in our tune, which are more easily accessible. Um, and those things are more objective to assess and easily available to do in the emergency room. Certainly. Uh, in terms of definitive diagnosis, your MRI scans, um are the gold standards making such diagnoses? Um, I'm not saying that people should not know about all these. They are very, quite good for academic purposes. But, um, I'm not sure how often it's being done in the any or by the orthopedic, uh, neurosurgical teams, but certainly something for you to read up and then just No, I don't think it's even done because most hospitals have this pro former, uh, like a form savior doing a referral to the neurosurgery team or to the orthopedic team. You have a form that you fill out, and there is a part for you to fill out your examination findings. So you have a path for sensory exam motor exam in a rectal exam or the anal tone and all, but I've never seen for Bubble Kavanaugh's reflect not not routine in my in in my experience. So, um, it's something that is good for you to know. Um, I think it's for academic purposes. Basically, um, I don't think anyone would advise you to do that in the any Yeah, so, um, thank you, Um, all hourly for for your response and helping us out. It's this one. Um, I think there's another question from Victo if you respond what degree of spondylolisthesis can cause by now called compression. Well, I do know in terms of quantifying the number now, but I think if you've got any, I think if if if they've got it to the extent that they are having symptoms, then yeah, but you could have spondylolisthesis. And it's not causing compression, but I don't know if there is a particular value. Do they measure the degree? I'm not sure about that. I'm not sure about that. If there is there a degree or something, I haven't heard anything about that before Or read anything about that. Yeah. So again, I don't think, um yeah, so there are values. Well, really? Okay. These letters now. So you're so if you can mute yourself, then we are. You are free to make your comment. Thank you. So if you look at the bottom of your screen, you'll see, uh, the mic is the first, um, icon there at the bottom of your screen. Um, so Victo, if you go to the bottom of your screen, you will see, like, five options of things you can do you see or not. Not there. Uh, is he using the mobile phone? Are you using a computer like a deck? Stop? A laptop? What? What device are you using? Two. Um, participate. Laughter. So, um, I think the problem is, um, like from my experience, people that use chrome had difficulties with doing that. Are you using Google Chrome Victor? I using chrome. Right. So if possible, it can use another browser. Our our comment edge. Um, then you can restart here because I don't see any option too for you to do that, I'm afraid. Sorry. Do do do do you do there? So we are still waiting for, um, more comments. While I was about this, um, by the way. Um, Doctor Kenny, do if you are ready, um, do let us know. Let me see if we're coming. So, yes, while while So we have to sort out that, uh, I need I think we can I think we can have your presentation, and then we do all the questions and answers at the end. Yeah. So, um, you need to let me know when you're ready. Hello? Can you hear me? Yeah. Loud on clay. Okay. Hello, everybody. I hope we can hear and see me at the same time. Uh, my name is Chinedu. I stated on the party slides, so I'm gonna give as much as I can make it a very quick and brief presentation on what it entails in terms of trying to begin your surgical training or surgical practice in the UK. Uh, I'm just trying. I'm gonna Most of us must have heard some of these topics before discussed, but at the end of the day, there's always something new to get at the end of each presentation. Um, please feel free to ask questions if you want. Um, I would put, um, I'll paste a feedback form at the end of the presentation, I'll just place it on the chart. So please do me a favor to try and, uh, comment. Go on feedback and feel the feedback form and just let us know what you think is your feedback and what we can do better in the next subsequent presentations. So basically, um, preparing for surgical training, It involves a lot of processes, but breaking down into three parts. The first part is the portfolio part. Second part is the documented part. And the last part is the interview. Um, permit me to introduce myself again. I'm changing. Uh, like, um, currently a course surgical training. See CST one in university hospital. Sell something. That's why I'm doing my cst. My course surgical training. Um, so I'm just gonna explain what exactly I went through, What things I did, uh, while preparing for court surgical training as well as things that I have learned over the last couple of months while in Costa liquid training. That probably if I knew it would have really helped me during my application stage. But anyways, um, I'm happy to be where I am today. So, um, so the portfolio stage as we know the usually released at the towards the beginning of the the requirements or what they call, um, self assessment criteria is released towards the beginning of the application application process. It starts by November of every year, right and spans from I think November 2nd or first or third to the second of December was the first of December. Now, during that process, you are allowed to look at what you've achieved over time and then score yourself based on the self assessment score and why you score yourself. You are allowed to, like, score yourself any number. Basically, they don't really care. But at the end of the day, they just let you know that whatever score you're giving yourself, you should be able to have, um, documents that would support that score. And if you are scoring yourself too much much, whereas your documents does not, your documents do not support or do not be at this evidence, then you are actually putting yourself in a very difficult position because you probably would be, uh, not just your application might just be disqualified completely. So we know of the portfolio stage and we it's divided into different segments you have for this year. This current application, the segments are basically, um, you have commitment to some specialty SEC section, which has to do with surgical cases, your conferences and surgical experiences experience now for surgical cases. Um, my advice would be based on if you're coming. If you're an immigrant coming from another country, I would advise those some people do try to bring in if you've had a surgical experience in their previous country, whatever. And they try to keep it into the like into the UK system or bring it in when you're applying for this for their cus article training. But my advice would be to completely abolish that and start a new application while you are here Now. Usually there is, uh, what they call a log book. Uh, log book. You can use it anywhere in the world, Bob. Uh, the only problem is, if maybe your consultants are, um there are people who are very, um should I see very keen to use the computers or stuff like that. So you log books. You can use it to compile all the surgical cases that you experience in outside the country. but preferably it is good to have them within the UK for surgical cases. Now there's something you have to know about surgical cases. There are ways that you can go about it. You know, the the scoring system on this slide says, if you've had 40 cases and above, if you've had 30 to 39 there are different scores for that. But sometimes, uh, you can have one case and record it as two or three cases, depending on what? How complex the surgical cases. For example. Let's say the you are in a theater and or you're you're in a surgery scrub for the surgery and then they're having a anterior resection, right? Let me say this patient has a sigma, UH, two more, uh, two more of the Sigma the colon. And they want to do a primary restriction, and they want to do a resection and primary anastomosis of the sigmoid colon two more, and then probably do what they call a D. Functioning cool, uh, ileostomy. So basically, because they're joining the bowel parts together, they want to free, remove less stress or remove most stress from that bowel segment that we're joined so Therefore, they bring another part of the bowel outside. That's like a D functioning. It lost to me to help and take out all the, uh, basically the products avoiding food content or whatever to move down to the Sigma Cologne. So allowing that bad part of the body to heal properly. If you're going to score or record this theater kids, you can record it as two. The first part is the bowel resection with Premier Anastomosis. That is, once that's one surgery on its own. Then you cannot record, um, formation of sigmoid of information of, uh, the functioning Alou's to me as another separate operation. So in that way, you already have two from one surgery, and it it works. This is not what just they do for surgical application. It was to also do in CAS surgical cut surgical training because in Cassell, RECULTURING, we are expected to have 100 and 100 surgery. In fact, in the total of two years to have about 250 surgeries, record ID under your name, of which you are supposed to do some percentage of it. So if you want to go bye, everyone surgery that you see record is as one. You might end up not really having enough time to get enough cases to record. I don't know if you're following me. So this idea helps you too. Q more some numerous beds with one stone. So if you have a some people even end up reckoning. Three surgeries under one theater. So if you had, um, like, uh, like, for example, you're doing, um, you're involved in, Let's say, a Whipple's Whipple's procedure. And after the Whipple's procedure, you want to record the surgery. You sort of just using Whipple's as one surgery, you can say, Oh, um, um, you record the surgery. The first one, maybe, uh, a gastro jejunostomy is one part of a Whipple. You can record it as one. You record, right? The entire D surgeon, whatever, Whatever you go and write another one. Uh, pan critical, uh, news to me connecting the pancreas to the gym. Um uh, you write that one as the second part of the surgery? Mhm. So all this you just break it down like that, Then, judge, you know, jejunostomy or whatever connection they are making in the theater, you just pilot right. All these surgeries, you split this one big surgery into three or four different sub surgeries and write it as each one has a surgical case. So in that way, you'll be able to build more numbers even within a short space of time instead of counting Whipple operation and then look for another one and see, uh, evaluates operation. These are big surgeries that have many processes involved in many stages involved, so you can record them as two or three different surgeries. So with that, it helps you to get your numbers and surgical conferences. I would also advise in terms of surgical conference, always make sure that you go for conferences that are, I wish affiliated to the Rail College of Surgeon. If, for example, this this particular platform we are using to for this presentation if you go on, if you register on this platform medal, they have several types of, um conferences ongoing. You can. Most of them are free. You can just go and, like, register for each of these conferences and ensure that when they when the when, the conferences, sure that you attend the conference and then you can certificate. But make sure that these conferences that you register for are recognized by the real College of Surgeons. So it doesn't count us. You You might have a conference, but it doesn't count. So you can. You can have conferences that either you attend both virtually or in person to face to face. But just make sure that they are all affiliated real college of surgeons. And then in that we are able to get your maximum score going to surgical experience. Uh, in my case, you can use your If you're coming from outside, you can use your house job. That's from a from be whatever I use for your house job. You can use it because if you look at the explanation here, it was stated. I have undertaken a surgical placement. Um, see additional notes below, say, during my foundation training or equivalent minimum of 12 weeks. Foundation training is basically house job, so if you have your form, be whatever you can, as far as it was signed by a consultant and stamped, you can use that you can also use. If you did a surgical elective, you can use that, but most most people would just use. Uh, how's job? That is what I used as fast. It's signed, stamped that can. That has its weight and it will be enough for you and then, um, surgical experience. We've talked about electric placement yesterday and test us so we'll go to the next part of the representation when we talk about audits. Now audits somebody. I remember when, During the first, uh, presenter Dr Bernard was talking, somebody asked about audits. Um, it's quite new to most of us when we come here, because the access for all this and we've never done audits before. But it's a very simple thing. And audits. What you basically do is you look for a situation and problem that you notice in the hospital. For example, let me give my audit. I did a very basic auditors, and that has to do with documentation. So I took the document because they have a clerking performer in the UK for you to take history. So the performer just has all the questions that you need to add these sections of the history. Rather, So you ask your question on those on those parts of the section on the history now for the audit. I just basically looked at the performer. I looked at how people clerk on the performers. Some people, they just jump some stages. They don't even bother to ask those questions. Some people, um, ask the question, but not as detailed as they should ask it. And I just basically looked at the performer gathered several performers about 15 20 compared it had a like a what you call it. Is this a Microsoft sheet? I believe yes. To tick, to just have a table to take. Okay, which sections were answered properly? Which sections? One APRA answer properly. So I just call them as yes, answer properly or no, not answer properly. And then after that, you collect your your stuff. You know your data, you put it into a graph and then you just present it. Now that is the first step part of it on audit. So you notice the problem? I think that there's a problem with people who take history, not documenting the history properly. You take you look for the problem you presented in that situation just basically like that. And then after the presentation, the next thing you do is the in your ideally, in your first presentation in in your in your audit, you have to state what are your plans? Because you've noticed the problem. The next thing is, what are you doing about the problem? So you will ask that maybe. Or I have planned that after this first audit, I am going to maybe teach the junior doctors on how to use, um, the the performer. Probably properly, Or I will probably have to attach a small piece of paper or a small form to that will direct the doctors on which aspect of the performance they should feel properly. And you just you state that you you attach it to the you either organize a small teaching for the general doctor, just get them to show up, talk to them about the importance of documenting properly, and then the next thing What you do is, uh, after you've taught them, you give it like maybe a week or two, depending on what? How much time you have. You give it about a week and you take another data sampling data you take. You take another data from what you have from the, um from the performance like the clerking sheets that you've that the the doctors must have used after the teaching has been organized. And then you just after doing that, you basically go back and you go to your your sheet, your Google sheet or whatever you're using right out the data. Yes. Know for people properly field or not. And then, um, take the data, put it into a graph and then present again. Now, what you should know is that for audit, you don't have to. You don't have to be that it doesn't have to be that your, um But after your teaching and whatever you must have done to bring about a change that it change must actually happen. It doesn't have a change. Mustn't happen if a change happening. Maybe, maybe, like you notice that 80 at the first time you did an audit. 60% of doctors feel the performer properly, and then the next stage 80% field properly. Good. But if you did the first stage and then the next Stage IV, unless it doesn't matter. The fact is that this is your attend. This is what you noticed and this is what you try to do so. An audit is usually that easy. And usually before you start the audit, you must speak to a consultant in the hospital that would teach you or guide you on how what you should do because you need a consultant to stand on your behalf to say, Oh, this doctor actually did this audit. He did this and this and he either made the positive change or there was no, there was no change involved. But it doesn't matter. The fact is that you did an audit. So with that, you cannot have a presentation. The part of the this year's perform this year's, um, application. They split. Or they added the presentation for audit together with, like, they did it separate from the audit. Before they would say you did a local audit and then you presented it. But this one Now they score you for just doing an audit, and then they score you separately for doing a presentation. And one of the ways to do a presentation is it mustn't be an oral presentation. For example, I talked about this platform that we are using Medal. You can go there. There are many, uh, all the conferences going on like conferences that they're looking for people to present something so you can take your very small audit that's not really big stuff and just put it into what you call a poster. A poster is like a summary of what of the events that was involved in the, uh that was that happened in the audit, what you did, just a small summary and then submit it to these conferences, and some of the time they would just take it. It doesn't have to be whether you over you, you stand on the podium or you talk to people like the way I'm doing. No, you might. It might just be a poster presentation, so they just put it on their post. I'll hold you go there. You can see different people who submitted their audits like that, and that counts, so that makes you score the highest point. So if there are ways to go about these things, you might think that it's a big deal. But actually there are ways to go about it, and you you get your best, your highest score. So that's for the audit and the presentation part of it. So we go to the, uh there's also presentation and, uh, publication. This is quite different from the audit, the audit section. But if you have two different audits that you have presented in two different places, then each of these you can use one for one for the audit and the other one for under presentation, and that covers you so they usually advise you to do at least or have at least two audits. So one you use for the under the audit section and the other one you use under the presentation section. So that's the idea, because you cannot use one stuff for two different sections. In this application, you must use something different for each one. So for this presentation, if you have another audit, good for you a publication. Nobody's going to kill you if you don't have a publication. But the idea is if you have friends or colleagues or you have anybody at all who you know is into publications, and you can basically just have a discussion with the presidency. Please, can you please help me? I'm I need to publication. Can you just add my name but anybody can help. And maybe they give you a small section of for something that you have to do about the publication that they are trying to get published because your publication must be on pub made for this for you to be accepted. So if you have any friends, any colleagues or even lecturers, you can actually let them know that. Oh, this is the issue. Um, and this is the issue, and you need this assistance and they would if they are keen enough, they're willing enough. They will help you for you to get the publication. All you need is your name, and it gives you a score on the publication section. Then we go to teaching experience. Now, what most of us don't know is a teaching experience is easy to get. You said you were involved in a look at, um, you have you worked with a local educator to design and organize a teaching program? A series of sessions defined as four or more to enhance, organize, teaching for a health, healthcare, professions of medical students. Basically, what you're saying here is that you basically assisted in teaching medical students or even junior doctors now the best way to go about teaching is to speak to a consultant. That's why you, as they said, you need a mentor so you can speak to one of your consultant in the department if you are in surgery or if you're in medicine. Even if you're not in surgery, you're not in a surgical specialty. You're in a and E or you're in medicine. You can speak to a consultant and say, Oh, please, that you want to apply for surgical, uh, training, But you want to do, uh, you don't have any, like you want to get involved in teaching, and this is the idea that you have. You want to organize bedside teaching for medical students that come to the hospital? Perfect. All you need is somebody a consultant. That will be like, Okay, no problem. If this is what you're doing, fine. I would. So I would, um I'm I would support you basically. So what you do in that situation is after you just get medical students. When they come to the hospital for their posting, they usually come around. You can make one or two. See, I'm organizing Suzanne, so teaching and I would like you to be a part of it. Most of them would oblige as much as far as you make the teaching very brief and interesting, so you can take them to the best side and teach them abdominal examination. Today. You can take them another day. You organized maybe in one week time, organized another one and teach chest examination. Or you teach a particular condition. Maybe a patient that has chronic liver disease and has all the stigma. Tres of chronic liver disease can just say Okay, this is you just have a brief discussion. That alone is enough teaching. Now after every teaching, it is good to get a feedback from those students and then make sure that you let your consultant who's standing for you see those feedbacks because that's the only way. The consultant. We understand that. OK, this doctor is actually getting involved in this teaching. He's doing what he said he would do so make sure that your consultant sees those feedback. That's the most important thing. So when you do that, uh, and if you can, if it's possible for you to have, for example, if let's say your hospital students from different universities come around beautiful. So let's say students. Or like in my previous hospital, I was in King's Lynn. And so we had students from Cambridge Com where students from knowledge come around and basically that was a region because the region where my hospital is students in the universities, universities in that region where basically, Cambridge and, uh, knowledge. And by that it made it look like we're doing. We're teaching students within the region. So if you do bedside examination, best side teaching for students that come from different regions, right or different hospitals. Maybe this one comes from this, uh, this particular hospital. And there's another teacher and I'm sorry, this category university, and there's another university within the same region. It already makes it a regional teaching. That's it. Now, with that way, you can actually get your highest score in the teaching that you're teaching students in a particular region. That's it. You have come. You have already got an original and teaching another way to do regional teaching without you without stressing yourself. If you are organizing an online platform, what you can do is within your university within your hospital. Send an email to the to the medical education. Just say, Oh, my name is Doctor. So So, So so from this department we're organizing. So so and so teaching on this This on this day, we would like, um, doctors from within this region to get this message and be involved in the teaching. That's all you do. Once you send an email to the medical education, the medical education department would then send that email to all the doctors within that region. Whether they are trainees or non trainees, they will send it to all of them. Now, once you get that confirmation from the medical education that the email has been sent, it doesn't matter whether these doctors show up for the teaching or not that teaching is already in regional teaching. If they send it to all the doctors in within, the within the within the country, it becomes a national teaching. It doesn't matter whether those doctors come around or they don't come around within the teaching or for the teaching as fast. You have few people that are there whether those people show up or not. You have gotten your national teaching or your original teaching. So these are ways that people use to get the highest score in teaching. So you don't have to think about it like how will I get people from different region and get gather all of them in it, please and teach, Or how would I know? You can basically do it bedside teaching from different medical students from different, uh, different universities within the region. Or you can just do it online teaching and tell them to send broadcasting email to different people. Do the doctors within the region, and they will do that, whether those doctors show up or not. It's not your business that teaching is already automatically regional teaching, and you can get a letter from the Medical Education Medical Education Department that you organize the teaching. They're aware that they sent the document out. They will give you whatever you want at that point, so that covers for regional teaching. So that's how you can get maximum score in this section. So we go to training and teaching, training and teaching is something that you can't honestly, you don't have to beat yourself about it. What I would advise to do is to go for what you call the, um, teach the the one that gives you one point. Teach the basically train the train. Now, um, train the train out. Whatever the teaching of teach the teachers organized by Oxford Medical. Um, so in this one is like a two. They they they have a They have different courses that they do. Some of them are two days, some of them just one day. So depending on what the cost you want to keep into if you key into the two days course you get two days for that. And I think this one is different now. They've changed it in teaching methods lasting at least two days. So this one is two days before it was five days, at least five days. So if you have one teaching course with T t T T Oxford Medicals train, teach teacher Perfect. That covers you for this. These other marks are quite difficult to get, except maybe you're already doing a master's program. Like somebody I heard I think was Victor saying he's on a master's program. So this is where the masters come in. And if you got a master's program, it gives you five points, right, But to be honest with to you, a lot of people might not be able to get it to this. Get this maximum five point, but there are people that will get it. So what you need to focus on just to get as much point as you can to get a P G certification is quite very expensive. In the UK, some people pay as much as 3000 lbs 4000 lbs 5000 lbs just to get a P G certification certificate for application of surgery is not like you're going to get the surgery. So if you have the money, good. But if you don't just go for the basic, uh, Oxford teach teacher, that's what I did in my year. I didn't have money for, uh, Post P G certification in education or whatever. I didn't have that. I couldn't think of spending three or 4000 lbs for a certificate that doesn't really still guarantee if you're going to get a training or not. So, yeah, if you can just get the least every one point in this application counts every one point, and, um so that's basically portfolio stage Now we're going to go to document stage after the application process. When the application ends by December 1st, they will now Khalid everything. Look at the different scores that people have scored themselves. And with that, they were able to plot a graph and get their cut off. Now, the cut off mark that you get during the portfolio stage at the end of the portfolio stage is the cut off mark that we use throughout the application. Open till, uh, what you call it when they start to give out jobs. So that same cost of Mark There's a reason why I'm saying that when I get there, I'll explain. So for the documentation stage, these are the points that you must not have at heart. And make sure your documents satisfies the requirements are stated in the safe assessment score in guardians. Now, if you go back to those self assessment score in guardians, you see all these notes that they give here, like under the notes, part says Uh, not even for, uh, not for training if you go back to like teaching experience, it says. For example, he said, I have worked with local educators to design and organize the teaching program blah blah blah blah, blah to the end. Now your letter that will be issued by your consultant to support disclaim most pick basically must have all these words in it. They can't just say, Oh, you you taught in this hospital from this period to this period and you have feedback. No. It must have all these words that describe what you are saying you have done because if not, you might not get the full mark. So make sure that when you get the document that supports that claim, then the document basically the document basically has all the information that was stated here. Right? Sorry. So the document has all the information that was stated here very important, very, very important. So let's go back. So make sure that all the documents that you have this satisfy the points that your state or they satisfy all the requirement that was stated on that particular assessment. So nothing more, nothing less. Usually they will actually to create the document yourself. Your your consultant might say, type the letter and they will read through and then sign it. So make sure that when you use the same wording so that you don't lose your points. So and then one thing is, you know that documents from abroad are accepted. If you did a two day teaching program in Nigeria, let's say in a in a teaching hospital, let's say you walk at, uh, University of Abuja Teaching Hospital National Hospital Abuja and you thought some doctors or you did a teaching there or or you thought junior doctors there in Abuja. All you need to do is make sure that your consultant who is signing it from Abuja like he he signs everything and the this thing is the letter with which you you you type out this stuff must beer the hospitals, what's heading the hospitals, details and everything so they can. They can accept those kind of teaching whatever. If you say that's the proof of teaching or you didn't teach, you have not taught in the UK, but you taught in Nigeria, and why in Nigeria, this is who you thought you thought students from blah blah as far as you have. A letter that supports that cream and the letterhead is is a renowned letterhead, so it's the hospital letterhead Perfect. That should cover you So notes that some documents from Nigeria can be accepted. It mustn't be everything, but however enable to have a mix of documents from put the UK and abroad don't just have everything from Nigeria or from wherever you are you're coming from. So have a mix of boat, then put as much documents that you have to support a particular score. So if you need to put two or three things just to explain one particular documents, one particular score, then go ahead. Actually, in the document stage, they will go the once you pass through the portfolio state, like your score that you got is above the cut off when I send you a link to where you're supposed to go and upload your documents. So that place you can upload more than one document, two documents or three documents for one section so that you're able to explain yourself. Some people will add some notes. There were types of notes and explain because, you know, it's not a face to face that you can actually ex explain to the person looking through the documents. So this one is this This one is this. This is when this will happen. This one, this will happen. Know once you submit the document, nobody's there. They will look at it and if they are not convinced, they will not take your score. So you can even use some words to type a little small attached and words or letter and include it. And to explain the score, anything at all very important. However, use documents that score you the highest. So, for example, if you have, uh, let's say you have you have your house job form. You also have, um you have your house job from you also have, um let's say you didn't test that week. You don't have to combine the both of them. You just use the one for the house job. You might not say Oh, I did a test a week in the UK now, and I'm also I also have a house job from Why not just just Just what? Why not? I just combined both of them. No, that's wrong. That will give you a bad scoring. So use the document that actually gives you the highest score. And then he said, if possible, let the document be as straightforward as easy as easy as it is. So yes, if you can make it less cumbersome, less complex, Better. But if you can't then give as much documents as you can give to support that particular score ng. Because at the end of this portfolio stage, a lot of people might people that made the first they have made the cut off. They will take out some points from them and see, with this point, we don't agree with this point. We don't agree with this one, and then they would down score them and some of them will lose out. Fall back. Um, they fall out of the the race basically. So the Nascobal oh, cut off because remember the same cut off that they used for the portfolio at the cut off the continue to use to the end. So when you get below cut off the last set you are, you cannot progress. And then we go to the last ege of this presentation which talks about the interview stage. Now my advice would be once you get once you pass the portfolio stage. If you pass the portfolio stage, don't wait until you get to interview before you Now go and or, you know, be sure that, Okay, have interview before you go ahead to start getting the materials that you need. This book is being sold on Amazon so you can order it. And you really would you see free copy so you can order it and go through? This book is very useful for surgical interview. Very useful to you. Just go on Amazon and type cause surgical interview cancelled your interview and this book will pop up. And you expect it's good to read this book back to back masters everything in the book. So don't wait, because most of us, even me I had this issue where I had to wait to you towards when I was sure when I was very sure that I got interview slot that I was invited for interview. That's when I went to purchase this book. So the only like I had was that I booked my interview towards the end. So I had a lot at some time, Like Almost like a week. Really? Good. Uh, I used to go there. Yes, yes, I'm still here. Can you hear me? Hello? Can you guys hear me? If anyone can hear me, please, just can if you can type any smile on the check box, please. I can't hear. You can hear all of you. Okay, so, um, I will go ahead and say for the interview. Don't wait. Once you've passed the the entity portfolio stage, there's a very high chance that you, especially if you know, you have your good documents. There's very high chance that you would move to the interview stage so quickly grab this book and start to study. And the the the inter, visually broken into three sections, they have an oral presentation where you give you three minutes. Talk about leadership. Basically, they will ask you, um, state to time in your past, lie on your past. Experience basically state how you have how what leadership role you played. And how do you do. I think this leadership rule would be of help to you when you get into Cassatt ical training. So just a matter of, uh, reciting poem and then just saying stuff you don't have to Anything that you feel will make you sell yourself, put it into the representation and just just sell yourself. And but the only thing that you have to be very spontaneous when you talk, you can't be saying, um um um um, you just as you start talking, you have to be fluent throughout the conversation or throughout the, uh, presentation until the end and try as much as you can to cover all your points because honestly, three minutes would look very short before you know, they're like, Oh, time is gone. So try as much as you can to air all your points. Don't need to talk too much. Go hit the nail on the head and then that's it. And then they give you a management scenario, Like in the hospital, they tell you or, uh, you are walking in the hospital or you're probably in the theater. And then you notice that the registrar is your drinking alcohol. And what will you do in that situation being that the the patient is already on the on the on the theater table for surgery? But, you know, notice that they register I smelling of alcohol, that kind of thing. So there are ways to answer this question. By the time you get this book, it will tell you you see the formats that they used to answer the question, and you have to follow that form and to answer this question. And finally, they will not ask you to clinical scenarios that you have to go through. And then you can answer these questions. They'll ask you this clinical question. Ario. Most of the time, it's still similar to what they have in this book. They might change one of two things. It usually acute. Emergencies that is. Ask you so emergency. So you just if you read the book, you muster the book. You'll be able to understand the the clinical scenario. Give your diagnoses and give how you manage the scenario. So there's always also a way to answer the question that stated in this book. So basically, it's a very straightforward thing. But as you as we go on with the with the, uh towards the surgical application, if you get to the interview stage, you let us know, and we can also try and get organize a platform where we can all like, get involved, test yourself and and we just more like a like a an exam form, uh, forum where you can actually have the opportunity to just be involved and see if you are well prepared or you need to do more for your preparation. So basically, it's the end of the presentation. And thank you so much, everybody. So I'm going to put my thank you. So this is a feedback. Please, please comment. Make your feedback. Could you please feel the feedback form and just I really appreciate that. Thank you so much. Um, so thank you, Tina. Due for a very interesting um, um, topic is giving us, Um, certainly, um, we appreciate you giving us your own personal experiences. Um, please. Everyone trying to give them feedback. So Shelly has just posted her feedback from our again. Give our feedback, and she need you as you're giving me feedback. Um, now, back to question and answer. So Chini do If you look if you go to the chat box, um, a four psa has a question for you, so if you can respond to that question and child box. Okay. So, uh, thank you for your questions. Surgically themed audit surgically thing. Or do you just mean anybody that you do that is within the that has to do with the surgical department. So, for example, it was a proper proper documentations in the surgical clerking booklet. That was my audit. Proper documentation in surgical clerking booklet. That's all. So, as far as this Audie audit has to do with the surgical department is a surgically teamed audit. So if you say oxygen prescription now in the on drugs charts for patient. Very good. Who actually to undergo surgery? That's a surgically teamed audit. So it counts as a surgical retained audit as far as it has to do with the surgical department. Right. Um, So, um, um, if your PSA the only thing I need to add is that just like Nelly mentioned when you're getting your, um, your evidence try to, um, write the letter and puts that this year all this has is surgically team. Just copy whatever is written in this space person specification and then post pasted there and then give the consultant to sign for you. Um, any do If if If I'm correct, please, If I'm wrong, correct me. Yeah, yeah, yeah. You're very correct. Just make sure that just as you said, it's surgically team. Make sure that you state that this. Make sure you put attach a surgical name to that, just as you said. Prescription of oxygen can be for any department can be for medical doctors, medical department O and G Pediatrics. So But once you say prescription of oxygen for patient's yet for preop patient, it's already it's already covers, uh, surgically team audits. It makes it a surgical team audit, and then you get a surgical consultant to sign it, That's all. So you don't have to just make sure that the audit is within the surgical department like it just covers anything or touches anything. Surgical. So oxygen prosecution. You want to look at, uh, intravenous fluid giving postop if it's accurate, but not please. I thought I forgot to ask this for every audit that you must do always remember that there must be a like a an existing guidelines for that audit. So eggs, for example, if you say oxygen prescription, you must be able to find out maybe from the Royal College of Surgeons side that anything that has to talk about prescribing oxygen and how it should be done, uh, the same thing even for documentation. If you get about, if you go to the play around in Royal College of Soldier on site, you will see where it is talking about how it is very important for doctors to surgeons to document properly blah, blah, blah. This and that very important. Also, Vte is. You can even do audit on vte appropriate, uh, prescription of Viti for patient's in the surgical department because not the surgical patient that needs VTs. That's, uh, things like Ted stockings or collecting, so that can also cover for a surgical audit as fast it's done within the surgical department. Uh, for Ahmed, I saw your question. It says it's the 18 month surgical experience essential for CST. Very, very important, it stated in the person's education. If you've done more than 18 months, then you can't apply. But, however, notes that the 18 months does not include your house job. So if you did house job, uh, he did surgery for three months. It doesn't count because their own 18 months they're talking about Post Foundation. So after a foundation years, if you've done surgery for another 18 months, then accounts more than 18 months. But if you did house job for three months and then, you know, have you know, basically start doing surgical job for less than 15 months in the UK It doesn't. Doesn't mean that you are more than 18 months. You're still 15 months. So are there any other questions? Is there any other question? Um, so I don't think you're, uh I don't think there's any other questions, so maybe we live for a minute. Uh, if I present a letter to the consultant to sign, how would I get it to have just with the letter? Lester letterhead. Very easy. All you need to do is, um, normally, what they do is you send the letter the form of the letter performer to the consultant. You follow up. The consultant usually has a secretary. This is the secretary of the consultant that will print out this letter in the hospital head letterhead. So you don't have to go and look for the letter and print it. You just type how you want the letter to be written out. You type it and send it to that consultant. Then all you need to do is to follow up on the consultant because, you know, they can be quite busy. So you follow up on that consultant, And once they have the once they have the the response. Once the consultant have responded, they will give it to the the, uh, secretary and secretary will print it out, and then you can take the consistent, usually will sign it and stamp it out. The secretary has done everything, and they will just call you to come and pick it up. Or you need to just send send the letter, the performer. So, please, guys, can you would you please feel the feedback if there's no other question? And, um so in the absence of any other question, I believe, um, we've come to the end of today's presentations. Um, kindly feel the feedback funds for both present, as is very important to tell them what you feel give suggestions for improvements. Um, uh, presenters also need, um everything that they are doing presentations. We can really help them. So they help you. And then you help natural and everybody's happy. Thank you very much. Let me see. Thank you, everybody. Thank you. Okay. Yeah. Mhm force a feeling now.