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Good morning, everyone. Um Welcome to the preparing for a Korean Surgery Day. I'm Michael. I'm the Director of Education for Asset. Um I would like to thank everyone for being here today and uh we are very excited to gather all aspiring surgeons in such an event. So as, you know, surgery is uh more than a profession and it's a commitment to lifelong learning as you can see, that's why we are all here at the weekend. So I hope today it will be a productive day for everyone. And um first of all, I'd like really to thank uh the faculty uh who dedicated their weekend to teach uh the future surgeons. And um definitely, I'd like to thank Jono for helping, organizing such an event. And uh let's dive in. So Jono the mic to you. Thank you very much for the warm introduction of Michael. We'll catch up with you a bit later. Um So, yeah, hi, everyone. I'm Jono. I'm a second year course surgical trainee. I'm just gonna start setting up my slides so I can share best with you. So I'm gonna share my to screen. Can you guys? I assume you'll all hear me? Ok. Yeah, it, but I'd also like to apologize very much in advance. I have quite a persistent cough. So, um, I'll try to mute where I can. Great. So, the slides back from the top. Mhm. Great. So, yeah. Hi, Yvonne, I'm Jono. I'm a second year course surgical trainee based in Norfolk and no, in the east of England. Um, I also work alongside the association of Surgeons in training as the core surgical training representative alongside this. I'm also part of the course surgical training advisory committee for the joint committee on surgical training. But what this all boils down to is I very much care about surgical training, trying to make a difference and trying to improve it as best as I can for you guys because you guys are, are feature surgeons. What I'm gonna cover today will hopefully share you a bit of advice and guidance and things that I wish I knew it'd be about 20 minutes long. But if I'm dragging, then I do apologize. Just tell me to hurry up. I'm gonna cover my journey, how to apply to course surgical training, what to expect, whether it's your first time in theaters, a clinic or whether you want to know the CST experience and some general tips along the way. So where did I start? I started in a place called Edd. Uh That's where I was born and raised. Uh My mom is Polish and my dad is mixed. Italian. Ukrainian Bedford is the land of the famous Dinky donuts which unfortunately have now shut down. As you know, with the Korean health, they move you around a lot. So for university, I was quite lucky enough to go to South London, had a lot of fun and memorable experiences, dressing up in all sorts of random attire, going for a year, representative for a number of years, you know, I wanted to support colleagues, but it's where I started to develop my interest in surgery up through so many different phases, cardiology, radio gpi know me. So I coordinated and events went through my surgical society. I was quite lucky to get to um the South Tens scenery for my foundation training and in top left the bathroom that was greeted hospital accommodation like my room like, but it was a time whack to applying skills that I learned through and learn new ones such as asset conferences are great for this and back into London. But I noticed that all of my friends were getting married, all of my colleagues were going through different progression in their career. Someone I went through the CST process or again, I was moved to the East Coast. A relocation, greeted with another hospital been cleaned in probably 100 years. It was by the thought was pleasant. But as with that one, Hill FDI I, ok. This time, he said much busier hospital different. A lot of independence. And a lot of on your feet with, but certainly operating more as a core surgical. So why have I just told you about my this or take away from? And that training is a very good process. Life events will happen, whether it's family gets sick, whether it's a minute, you're not getting your annual leave to go and progression is very different to those of other careers. So it's really important that no matter what journey does, whether it's surgery, medicine, something else, enjoy it. Enjoy the journey. You've got one life and your wellbeing is your priority. Ok. It's not just a race to become a consultant, you'll get there. Trust me, consultancy has their own lot of issues and a lot of paperwork. So just enjoy the journey. Uh And of course, operating is really fun and rewarding as well. So now on to the next part of talk, how do we apply? Ring your foundation year two doctor or if you've finished foundation training, then on the Aureol website, you'll be able to apply and actually that deadline this month closes, I think on the 21st at 4 p.m. once you're on the website and you've filled in all of those details and how to apply. You'll then be invited to sit the M SRA. Now the M SRA is a multispecialist recruitment assessment, a test done at a Pearson View center, the same place where you do your driving tests. Uh The theory one, this assesses two things. Firstly, it's another SJ TI know you thought you were over and done with it. But unfortunately, it's back again. And the second part of the test is a clinical problem solving test. This is very similar to what you have in your medical school finals. The top 1200 candidates for that test will then be invited to interview where you'll sit three stations, 10 minutes each in front of a panel on your computer. It'll feature a portfolio station where you'll be questioned about things on your portfolio, which I'll talk about just after this leadership and management station where you have a three minute opportunity to talk about your leadership skills and address a weird management or ethical conundrum. And then finally, you'll be given two clinical scenarios that test your ability to think on your feet. We also apply everything you've learned about surgery on the right is simply a photo of me at a conference applying for my interview time because they had just been released after your interview or during that process, you'll be given, you'll be given a whole host of jobs to rank about 750 to be exact. Now, you don't have to rank all of them. It's best to choose the ones that you'd actually be happy to do. And just with foundation training, we like to think things in two ways. Firstly, choosing a job by location. But secondly, choosing a job by specialty. I would strongly recommend you go by specialty if you know what you want to do going forwards for an ST three. For example, if you want to do general surgery, it's absolutely crucial that you have general surgery as part of your rotation. Because without it, you won't be able to get the experience you need to progress. And then if you're lucky, you get a job offer. Now you might not hear back the first time in that same recruitment cycle because not everyone accepts the same jobs. And if that happens, then you can still keep waiting on their platform for about a month or so. Cos every 1 to 2 weeks, there'll be a re avert and you may be allocated a job that someone else did not want. So how do you apply? What is this portfolio that everyone's talking about? If you guys type in that tiny ear link, you can take a photo and then just paste it. You'll see exactly what I'm talking about. And this is the portfolio that everyone talks about on how to get into core surgical training. You'll see different specialties, talk about some of their own portfolios, particularly cardiothoracic neurosurgery and oral and maxillofacial surgery. They have their own course surgical training pathways. However, this is the general one. So if you wanna do any other specialty, then typically this is the one you have to follow. It comprises four domains. The first domain shows your commitment to surgery. This goes through your operative experience and your surgical experience. Your operative experience is essentially how many operations you've been involved in the way you log. This is through a website called the log book. So if there's something I want you guys to do today is to register with this because it doesn't matter where in the world you are. This is the website you need. And this is the only way that you can correctly showcase stations you've been involved in the ones that count at CT application are those that you've either assisted in, been supervised doing or performed. Unfortunately, observed cases that you've done do not count. What I mean by this is if you've observed and done nothing, it won't count for portfolio. However, it's absolutely crucial, you still list it because it will be a reflection of your commitment to surgery, surgical experience. Now, this can be an elective if you're a medical student or a taste week, if you're a foundation doctor. So how do you get involved in that stuff? Well, if you want to operate, you've gotta be really proactive. Unfortunately, no one's going to particularly look out for you at university or on the wards and say, hey, do you wanna come to the theaters? The best way to do it is just to be proactive, go to the hospital, find a consultant or a registrar, speak with the junior doctors to see which uh, resident doctors to see which doctors are approachable and tell them that you've got an interest in surgery and you'd love to get the experience. Trust me at your stage, they won't say no. In fact, they'll really want to try and educate you. You can practice some surgical skills either at home. There's a lot of youtube videos out there, a lot of courses and especially your university should offer some of these experiences. Take this time to explore the different specialties. I can't stress that enough. It's gonna be difficult when you get to my stage and there's still specialties that you want to explore, but it's just a bit too late. I'd strongly recommend Washington University of Foundation training, take a day or two, go for a couple of days to find a department that you wanna get some experience in and just go for it. You literally just need to speak with them and just make the time. That's it. So at least two weeks plan, these early electives are typically typically done in your final and ultimate year, choose a specialty or experience they're interested in and just let the team know, set your objectives early. So you know what you actually want out of it. Sometimes people go abroad, sometimes it'll stay, people will stay in the UK or go to an institution that's really well known for producing lots of doctors or surgeons in that particular specialty and training them. Well, these are all things that you should bear in mind. The second domain is about clinical audit and quality improvement. Now, an audit, I've just put on the definitions I found on Google. But if I were to say it in a bit more simple terms, an audit is essentially when you're comparing your own healthcare practice or your team's practice to that of the standard, like the standard. The reason why we do this is to try to see if, where our department is doing uh is performing at the level expected better or worse. Now, an example of this is, for example, the best practice tariff for hip fractures, which states that we should be getting them done within 36 hours of patients attending to hospital. So if my department's taking 48 hours to operate, clearly, we're not doing that great and something needs to be done actually putting in that improvement and then re auditing to see whether we've made any difference is an audit cycle quality improvement project slightly different in the sense that you're just trying to improve part of your service. Now, the top marks for the portfolio go to people who have designed a or la surgically themed order or quality improvement project, which we call quips that has demonstrated a positive change. You also have to have presented both the cycles. So how did you get involved on the top? Right. I've shown you what I mean by the audit cycle this is you identifying a problem defining the standards that you want to compare to collecting the data, data analysis, implementing the changes and the re auditing lots of departments will have an audit cycle ongoing about something that they want to improve. So if you're just getting started, you can help with any of those parts of the cycle and just speak with the team and see how you can get involved. The more parts of the cycle you get involved in the more you'll learn. Perhaps you'll find a mentor who will go from start to finish with you. Once you've got more and more experience, you can start to think of your own and start designing them and implementing them. The third domain presentations and publications, what I've listed is what you can get points for on your core surgical training application. Top marks will typically go to those who have got a first prize in an oral presentation. Now, what do I mean by all these presentations and publications? So there's a lot of types of research that exist out there and there'll be a talk just after this on a career in academic surgery. Well, I'm sure they'll go into that in a bit more detail. So I'll save it for that. However, just to touch on the basics, you'll see a lot of things about publications, people going to conferences to present. Now, all of that is what gets you all of these points you can get prizes for presenting. You can get prizes for publishing good pieces of work. But how do you get involved in research? Now, you can either find a local mentor or research department who can get you involved. You can learn about research in a bit more detail. For example, star search website has a great online module called Incept where you can learn a bit more information about it. Start getting involved in different parts of the process and then applying it and take more leadership as you go along before teaching experience. Now top mark, go to the people who have worked with their local tutors to design a face to face teaching program and delivered four or more of those teaching sessions. How do you do that? If you're starting from scratch, I'd start volunteering. Perhaps for some medical school societies see how you can involve yourself, maybe take part in a teaching session. You could deliver a lecture, you could teach someone how to suture. It could be anything. But from each point, get feedback from the people who watch you teach and from the people who you teach, take on board what they say and learn from it and implement it into your own practice. There are train the trainer courses which will tell you a bit more about teaching theory and then going forwards, you can design some of your own teaching initiatives. When I was part of my surgical society, I designed a number of conferences and surgical skills workshops that I'd used for my own kind of development. But also to teach. So down to the final part of my talk, what to expect if you've never been to theaters, then don't worry, stay calm brief and just remember that every surgeon has been through your shoes, has been in your shoes. Make sure you introduce yourself to the entire room. You wanna make sure that everyone knows who you are and that you're gonna make the most of it. And trust me, if everyone knows who you are, they'll treat you much, much better learn to assist. Now, the art of assisting is a bit different to actually doing an operation, but it's a crucial one because you need to start thinking about what your operate, what the surgeon needs to see and what they'll need to do next. You have to sort of think before they do. It's a time where we can start to learn more about the operation steps and your anatomy is very different to the books, but 100% eat before you go in. Make sure you eat and drink. Otherwise you might feel a bit faint. I've been guilty of this once before, even when I was at first year course of surgical training, cos I hadn't had my breakfast. So what are the learning points that you guys should go and research after this? Definitely read up on your anatomy. Look at the who surgical safety checklist. I can assure you it's something they'll ask about the first time you walk in, learn how to wash your hands properly, learn how to put on a gown and glove properly. Start looking online as to what typical surgical equipment is used. AAS techniques. If you're a core surgical trainee aspiring and you're perhaps a foundation doctor during your theater days, you'll be in early, you'll be checking the consent forms, whether they're fit for surgery, chicken B or any allergies and where they last a eight and drank, you'll then go to theaters, do a brief where essentially go through a list of the patients, you're going to operate on telling them what operations we're doing, what side what positions or antibiotics are required, learn your anatomy and learn the operation steps before you go in. There'll be an opportunity to assist most likely to start with, especially if the surgeons never met you before. But later as you build that rapport, they'll start teaching you and hopefully start performing it yourself. Once you perform the operation a few hours later, review your patient, the quality indicators. Which mean, what are the best practice for your training is that you have at least three theater sessions a week. Sometimes people get better than this. Unfortunately, sometimes people get worse clinic if it's your first time and every time to be honest, dress smart, introduce yourself, start observing about how the interactions work what empathy skills are being used and what the point of the clinic is later, you can start taking a history or examining the patient. Perhaps even both when you start becoming a bit more fluid and get feedback from your supervisor. So you can learn from this. When you're a course surgical trainee, you do the exact same thing except have your computer set up, get your dictaphone ready because you'll be dictating some letters, perhaps typing them. You do your history and exam, you may even need to consent them for an operation and they may need some bedside investigations or management. For example, if you're an ent, you may need to do a flexible nasoendoscopy, a small thin camera tube that goes through the nose. So you can see the a, uh, the back of the mouth or the back of the nose or even the top of the larynx surgery. You might need to do a rigid sigmoidoscopy by the bedside and you can even ban some hemorrhoids whilst you're there. So you're actually doing a history exam investigation and managing all within probably the space of 10 to 15 minutes. You should have at least one clinic session per week. What, what to expect if it's your first time and as always dress smart if you got scrubs, go for it. I love my scrubs. I hate you wearing anything else. It's easy to put on, easy to put off and it's very comfortable. Most of the time. Introduce yourself to the team. Tell them what you wanna get out of your experience on the wards, observe them to start with, know where everything is, where the notes are kept, where the computers are, get your logins to the computer systems. And then when you're feeling more confident, get involved, see patients assess them and check with some of the resident doctors to see if you're doing the right thing. If you're a final year medical student, make sure that you start acting as an F one. It's much easier for you to start preparing now than when you are actually in F one and you're by yourself. Um I know this because I did that and it was quite the experience you only learn by doing if you're a course surgical trainee. Now's your time to start trying to act like a registrar foundation doctors and Sh OS will treat you like one. So sometimes you're performing the ward round, you're reviewing the patients independently, you're making discharge plans when it's suitable to discharge the patient managing ward emergencies. Documenting as you go along, speaking with members of the wider multidisciplinary team for advice and guidance on call and I'm almost there. The on call shift is your standard 12 to 13 hour shift. You can have four in a row. Some places may have longer or shorter your clark patients in A&E what I mean by that is you're doing a history an exam, you're creating the investigation and management plan as well. What happens from this is you either decide to omit the patient or you have to fill in all the admissions booklets. You have to put in all their regular medications, speak to their family and start implementing your management or you refer them to a different specialty because they referred to the wrong specialty or you discharge them home because they don't need to be there and because you've treated them there and there when you're on your night shifts, you may be alone. I was, when I was a course surgical trainee, my first year in orthopedics, my registrar was at home, but I could call them if I needed. They can be very busy portfolio. You have to make your own portfolio when you're a course surgical trainee, it costs 260 lbs per year. There's a number of things that you have to reflect on mini texts. CBD. S. All of these are different parts of your learning to prove that you have learned what you say you have done. If you've done an operation, you need to reflect on it. If you've seen a patient, you need to reflect on it. We advise for more than 100 and 20 cases per year, the MCS exam in order to pass course surgical training, this has to be done before you finish co surgical training. You do not have to do it before you start core surgical training but it may help. Part A is 625 lbs. It features a five minute uh multiple choice question with 300 questions and part B it's a tho 1099 lbs featuring 18 Oscar stations, 19 minutes each. It's quite long. So what's after CST? Well, the whole world is your oyster. You can use plastics, Ortho vascular. You'll learn a lot about that. today. You could go abroad, you could even leave medicine. Who knows? But I hope that today you'll be able to find out the answer. So just to summarize my final tips, build your portfolio earlier early. But don't sacrifice your wellbeing, seek mentors and ask questions, attend surgical conferences and keep curious. Keep inspired. Keep a sense of humor. Surgery is tough, but laughter always helps. Surgery is not just about becoming the consultant, it's the journey and everything that follows. Feel free to reach out to me if you've got any further questions or you know, if you just wanna get to know me. Thank you very much for your time. So I'm happy to, I know that we're, I kind of overrun there a little bit. It's half an hour. I see 43 messages. I'll try and whizz through a few and then we can start the next one.