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Trainee in Kent and I will be just taking you through with sort of the interview. Um These were the learning objectives that were on the middle thing, which was great for me by A I, which is quite fun. But essentially what I'm going to do today is just give you an overview of the format of the interview. I'm going to talk you through some salient tips, um how to approach, preparing some small things that I've learnt and, and heard of through word of mouth and then just try and run through a couple of examples. Um I just wanted to put a bit of a disclaimer here that um there, this, the interview is not like exams or other bits of prep you've done and there's no one set or prescribed way to go about answering your questions or approaching your prep. Um Therefore, everything I say is my interpretation and, and what I've done and seen and learned and others have seen and learnt. But actually, there's multiple different ways to go about answering your own few questions. Um And I would encourage you to develop your own style and feel confident in your own style. Um And also this is not exhaustive in any way, shape or form there. I'll give you some resources that I think are quite useful, but there's quite a lot as we'll see as we go on in terms of content of these interviews. Um And it's, this is a bit of an overview more than the answer. Um So just putting this in the interviews into the context of the CST application overall, um they're important. So they um this is taken directly from the er hee website from this year and essentially the interview score um will be at least 60% of your, of your final mark um on, on the day. And that's also, that's not the entirety of the interview. It's actually some of this 30% of your evidence, your verified evidence and portfolio score as we'll see later. And part of that is toes the interview. So it's, it's more than 60% it's probably closer to 70 or 80. So, um despite all the work and effort, I'm sure you will put in in M sra and your portfolio. This is the thing that makes the difference. Um Your invitations to interview will be um sent out on the sixth of February. And the interview dates themselves will be sometime between February and March and you'll have to book on yourself to the interview. Um This is just a slightly worrying slide about competition ratios. Um As you can see, they're slowly growing as the years go on and not much to add to add that there. I mean, obviously the numbers speak for themselves. But um yeah, moving on. Um so this year, compared to previous years, there's been a change in the structure which is important to know and um this represents the portfolio station. So previously, in previous years, the portfolio was solely um centered but via just a self assessment where you put your numbers into a box and you said, I there's been publications presentations, a, et cetera. Um And there was nothing to do with the interview. Now. Um You have to rank your achievements from A to E as I'm sure you've seen on the um self assessment thing. Um And it means that your portfolio is assessed via both the quality of your evidence, but also how you deliver it. So it increases the importance of the interview. Um This is what it used to be like before COVID. So before COVID, people used to print off their portfolios in a literal laminated folder, spent ages organizing it, they'd bring it on the day the consultant would read or senior would read it and they would then ask some questions on the bit that they thought relevant and, and they quite liked that. Um however, that will, that kind of went away during COVID, but they're bringing it back um And in an online format and we'll talk through that later. Um So prep, how should you do it? Most important thing to do and it obviously can't speak for itself is practice, practice, practice. Ok? You need to practice regularly consistently. And with a number of different people in a number of different formats, obviously, your exam is going to be online, you're gonna be in front of a camera. So it's used to getting, it's worth getting used to talking to a camera. Um And one way you can do that and I know it sounds very horrible. And cringey is just to record yourself, record yourself and see, because I guarantee you when you do record yourself, there are do that, you probably won't even realize you're doing. And there are a number of habits people pick up and literally by recording yourself, you can look back and stuff and that actually I've realized I'm looking down too much or I'm looking at my other screen too much or, or I'm not making good eye contact or I'm not centralizing myself in the middle of the thing. Um It's worth having a B or two similar grades or people or mates that are also plan for co training that you can prep with um the importance of this fluency. So number one, just learning to roll off your, your A two E and, and your various different bits really consistently. But then also it's quite good with accountability. So it's, it's useful having someone who is there to to so that if you agree a time and a place to do your prep, it's not just on you and, and, and you can't get away with, with just not doing it and you're letting someone else down. I, in my opinion, the most important people to practice with are core trainees. All of the ones I know are super happy to be approached and, and asked for help with interview practice. We were all in your position very recently. Um And they've obviously gone through the interview most recently. So they have the best overview of the process, the structure. Um and what's going on? Obviously, you've then got your junior reads, who are gonna be good as well? Um Your more senior reads and consultants are people you should go to once you're really confident with your answers, um who could then critique your kind of presentation style but might not be as familiar with the interview structure. So for high fidelity prep, core trainees are your best bet. Um As I mentioned, virtually, er, you should practice in front of a um camera, get used to speaking in front of a camera and obviously that makes it easier and, and it's more accessible. You don't have to organize a place to be. Um I'm aware this is a little bit late but in an ideal world, you should be giving it 2 to 3 months to prep um don't panic or stress if you're just starting now, there's nothing you can do. It is what it is. But in terms of, if you want to be absolutely rock. So in all your content and your delivery, um that kind of 2 to 3 month period is what people generally say is a reasonable time to um get your prep in um resources. So there's a number of different formats. There are books, websites, courses and there are also kind of model, um an question answer banks. These are the ones I used, there are 100s out there. And so I'm only gonna talk about the ones I use cos I can give you honest reviews and I don't wanna commit to kind of any one company or, or service or whatever. Um, this green book, um Core Surgery Interviews by Alexander Logan is a used book, um, quite a popular one. And I find it, er, quite useful. It's a li little bit outdated but it's probably got the best overview of different styles of questions. Um, and it's also one of the only resources out there that has um quite a good section on the portfolio station. Um because obviously this was made around the time that the portfolio station was sort of thing. And there's medical interviews um by Picard, which is quite popular for structuring your interviews and um structuring your questions. And there's a few structures I'll mentioned later on which they do. They, they've got quite a lot of detail in. Um You're gonna need to know your ATL S er and your crisp algorithm inside out. Ask core trainees, ask people that have done ATL S if they can lend you their handbook. Um And you're gonna need to know this. It's, it's just vital knowledge, it's really important. Um I found the Medi Buddy website was quite useful. They had, they had two a subscription thingies. Um It's got quite a wide range of question bank and it gives you kind of a bit of an overview of the different countries you need. And then obviously um med all this website has quite a few different talks that are even I kind of like watched when I was just um making some songs for this talk and I found some quite useful talks on there and I think this talk will be recorded and uploaded as well. Um Courses I'm not gonna offer, I'm not gonna give you any names. Um Partially because I don't believe in them massively, partially because I didn't go on one. And therefore, I'm not really sure if you obviously hear of people, you, you can research and Google different courses. Um And if, if people tell you that a particular course was good, then by all means, look into it. And then the final thing II used was um fast forward, um which is an ace, a company called Ace The Interview. Um And they basically have 60 different prerecorded moral answers for DV, various different things. Um, for some guys that do really well in the interview and I found it, I found it quite useful. Um, but by nobody's necessary and a bit more expensive. Um, this is a paper I found. Um, so th this is there's a few points to make here and then one, sometime around the sixth of Feb keep a close eye on your emails. Um If you're going to be in different advice to interview, you'll be asked to um select a date and time and these go rapidly. It's a similar thing with the M sra booking slots. Try and keep a very close eye because there's obviously specific days you're gonna want, you may have on calls, nights, et cetera that you need to work around. Um, I was on a ski lift with no internet whatsoever when I got mine. And by the time I got to the end of the ski lift, I had about 14 notifications saying, have you booked? What time have you booked? So I ra like rapidly skied down to a chalet and booked and that was all very stressful, but I managed to get a decent spot. But by the time I got down to the bottom, the slope, mm, most of the spots I wanted had gone. Um, this paper, er, is quite an interesting paper actually. And essentially they looked to the 2022 23 cohort for the surgical interview and they found that there was a slightly, um, well, a statistically significant rise in the scores for candidates that interviewed in the morning. Now, I, this is slightly controversial. Um, and it's definitely not something that I would put too much weight behind. But people do say that as interviewers, if you're sitting there all day long, by the time you get to the end of the day, you've heard so many answers, so many similar answers, there's probably going to be some mental fatigue and it's probably almost a human nature to just stop listening as much. Um So according to this paper, the best time um to interview is in the morning and towards the start of the interview window, it, the difference isn't that big and it really doesn't matter. So I would encourage you to essentially book your interview around your own schedule and not worry too much about this. It's just something that I thought I could highlight in case you wanted to think about that kind of thing on the day you're gonna be put into. Um This is as mentioned, this is an online format and um ICP have said that they want to follow with go on with this online format going forward. So it looks like in, in person interviews for the time being at least a, a thing in the past. So you're gonna um get put into a, a, you're gonna go onto your keeper com.com link and get put into a pre kind of waiting room. You need to have your ID with you, so you need a passport or driving license. I need to show that to the camera um where a kind of invigilator will confirm your identity. Um And then you will be put into a waiting station which actually can be for ages as been a in mind for 25 30 minutes um whilst they're waiting for the person before to finish or if they're behind or whatever. Um, and then at some point, um, it says they're ready for you. You, you get put in, um, and you have usually two or three interviewers that don't tend to be consultants or senior regs. Um, and then you'll have, er, by, um, people that flit in and out the call that basically are meant to keep the process fair and make sure there's nothing untoward going on. Um, your environment when you're talking. So wallet room really important. Um, make sure you've got a neutral, Uncluttered background. Ideally white wolves best, make sure you dress smart. Um, these are things you can control. These are simple things. Er, it sounds obvious but some people don't do this so it's important to as well. Um, and eye contact. Obviously, this is a whole lot of difficult when you're, when you're in the online world but you need to get used to looking at your camera. I've highlighted these bottom things cos they are by no means necessary but worth mentioning. So some people found it useful to invest in a cheap microphone or microphone um and have a ring light behind their um or some kind of light button that, that you can kind of get off Amazon for 510 quid or whatever it is behind their laptops. Like I said, not, not at all required. Um If you do want to go down the route of getting these things, the argument you can make to yourself is you're gonna use these things in the ST three interviews, which are all online anyway. And, and who knows by the time you get consultant interviews can use them. So you're probably using the S and er, they probably won't be just for their stay. Um So just a quick overview of the formats of the interview. So there are three, sections of the interview, there is a management section, a clinical section and a portfolio section and I will um go into further detail about all these three sections. Um The management section consists so all of those 10 minute slots are split up into 25 minute slots in the clinical section. It's just 25 minute clinical scenarios and I'll talk about the different types of scenarios. They can be um, in the management section, there is a three minute presentation um that you'll be preprepared. It's an oral presentation. You do not have any slides. Um I should have mentioned, by the way, if anyone has any questions to pop them in the chat and I'll answer as I go on, um, you do not have access to any slides. You're just literally giving a speech. Um And then you get questions on that on your presentation. They say that it's in relationship presentation, but usually they're kind of preprepared and, and there's a, there's a list of questions that on um, those resources that I mentioned, um, that they basically ask every year. So the, the questions are unknown. Um, and then you get a management scenario which is like an S JT type type scenario and I, and I'll run through that a bit more later. Um, pretty much all your questions will follow these main surgical areas. So TN O vascular general surgery, urology, and post operative complications. There aren't really many, er, questions that are outside of this, of those kind of remits of specialties. So, moving on to the format, er, and into the actual authorizations themselves. So, first of all, um, we'll do clinical. Um, and the first thing I'm gonna talk about is trauma. So you're gonna get a stem and I'll show you an example of a stem on the next slide and it's gonna be an acutely traumatized patient, someone that has done themselves a disservice and, and has hurt themselves your structure that you're gonna apply to. This question is going to be an ATL S structure because they're coming in. Um, and usually it'll be a case of, er, you'll, you'll be told that they're coming in in 15 minutes or they're on the way like you do get in real life. Um, the primary, the focus is on resuscitation. So you're gonna retreat, resuscitate as you go along through your ATL S primary survey and you're gonna reassess, this is important. You're gonna reassess after every time you do an intervention as the ATS guideline states you're gonna reassess. Um, and see, did your gu intervention work, you're gonna follow AC ABCD E structure. Um And then you're gonna do your primary survey and resuscitate the patient within around 3.5 minutes, maybe four. And then you're gonna give the interviews time to ask a couple of questions. OK? Um, a note about, oops, a note about the timing, the, it, it says five minutes, I've in my experience and a couple experience here, they, they are a little bit flexible and it has gone on for longer than the five minutes, but I wouldn't at all bank on that. You need to keep to your five minutes and when you're prepping, be very, really, really strict with how you time yourself, always five minutes. So I'm just gonna talk through ATL S briefly. I mean, um A TL S itself is a massive topic, huge. I could do an entire talk on just ATL S. So this will once again, be a whistle to, as mentioned, you're gonna have to be really familiar with these concepts. I'm just pulling out a um, a few things that I think are really relevant and really important that I sometimes miss. Um, but at a very high yield, um but this is obviously not exhausted by any way, shape or form. So the main, one of the main difference is with your ATL SA to E is that there are some circumstances in which airway and sea spine are not what your airway is not your first priority. If you have a patient coming in with a catastrophic hemorrhage, that would take priority and you would try to get hemorrhage control before you actually went onto the airway cos they're gonna die from that first. Um This is something that you can just mention very briefly in your kind of um opening spiel. And I, and I've got that written down on the next slide. But um obviously, when you're looking for your sources of hemorrhage, um blood blood on the floor and for more, which I'll go through later, um Also the kind of ATS algorithm for dealing and trying to control hemorrhage goes with your first. In your first instance, you're gonna get direct pressure on the bleeding site. If that doesn't work, you're gonna try and get pressure on the proximal artery. If that doesn't work, you're gonna put a tourniquet on. If that doesn't work, they're going to this airway. Um So you're not expected to have advanced airway skills um as a core trainee. So this is all the the other thing of relevance is all the relevant level of core training. So you're accepted, you're expected to be able to use simple adjuncts. Um And if you have any concerns, it's really worth mentioning, involve anesthetics early. Um One of the main, the main thing your interviews are looking for is is this a safe core training? Can they go to this next level of training safely? And if you're saying that there's an airway concern and that you would involve anesthetics air early whilst using s adjuncts and things like jaw thrusts. Um Then, then you're demonstrating that you're safe. Um When you're gonna talk about your CS by immobilization, really important part of a of ATL S. Um You're gonna talk about triple immobilization with collar blocks and tape. Um Breathing a really common question they like to ask is triangle safety. You're often putting chest tubes or um put the needle decompressions of your ATL S patients in this interview. So you need to know your triangle safety and that's really, really common follow up question. Um There's some controversy, I don't know why they shouldn't be, but some people are a bit afraid to put on oxygen in acute um vignettes, always airway a any, any kind of chest or breathing concern, just pop more 15 L of oxygen, not by a number of breath, um, circulation is particularly important. Um In HL S, there's a couple of things I've put, put out here, this picture on the left is a fast scan. Um So that's a particularly important part, part, part to raise and the part that it's something that would be part of your primary survey in terms of identifying a location of a hemorrhage or a cause of a hemorrhage. Um When we're talking about hemorrhage control, which is the kind of one of one of the ways that the A three examination is adjusted in ATL S. Um you need to know the four different um categories of hemorrhagic shock. Um And you need to know how you would deal with them. So for example, category one and two, you might treat with fluids with some warm, say um warmed hearts, whereas categories three and four you need to replace blood with. But, and this um this photo is just a algorithm for a major hemorrhage. And, and that's one thing that you would be expected to do in your um primary service put, be able to know that you need to put a major hemorrhage. Call out. Um pelvic binders is a nice thing that people often forget and it's really worth mentioning any question of hip trauma or instability and you don't know the source of the bleeding. A pelvic blind is a really sensible thing to do. Another thing that's commonly missed is um urinary catheter monitoring urine output. And then the other thing is obviously you're gonna be pouring volume and blood back in, but then you're also gonna be aiming for source control, ok? Um Disability. So the main thing to mention here in trauma is head injuries. So you need to just men mention it briefly that you would look for signs of obvious head injury or even things like um signs of skull fracture, um basal skull fracture, like your pander eye sign. Um And then exposure. So also super relevant in your primary survey in ATL S. Um You're gonna say that you're gonna do a four person log roll technique, ex examine their back and in the meantime, maintain dignity and normal therm. It's a really nice, quick, simple way to say that um whilst you're demonstrating that you're safe and you're completing your examination properly, you're then gonna escalate. And if you haven't already, if you haven't already, if, if you've got someone who's unstable and you're intervening, I would ii would say that I, when you're doing your answer, you would escalate at the point of your intervention. If you haven't already make sure you escalate, talk to a senior, one of the things interferes really, really don't like are people that escalate too late or not at all? You're demonstrating that you're not a safe qua trainee. Um If this patient is unstable, you're gonna take him to theater, if they're stable and you've intervened and, and new interventions have worked. You're gonna take them for act scan. All of this has to be done in 3 to 4 minutes. Now. It's a lot to get through. So I will take you through some tips and tricks for how to make it smooth. And this is ev everyone, the one thing point I'm gonna make is everyone's got the knowledge to run through these. You should all be able to do an at ATS A two E but it's actually the, the people that do well in the interviews are the ones that are really smooth and slick with the way they present it. And the only way you can get that is literally by just repetition, practice, practice, practice. Um and just going really hard with that. So this is a stem that you may get, um see you're a CCC on call for TN O and you er are informed by A&E there is a 26 year old who's come in um in 15 minutes after falling 12 m from a ladder, he's complaining of chest pain. What do you do? So this was a scenario I had in my interview. Um So the way I like to structure it is uh first thing you need to do is a bit of a set up. OK. So you're gonna talk about what you're gonna do before you even go to assess the patient. And that is gonna be, I would assess this patient as a priority. I would inform my senior on the way to seeing this patient. I would um I would, I would inform my senior on the way to seeing this patient that I'm about to see them. I would ensure a tr call put out and all the necessary equipment is made available in appropriate areas such as research. So in a this really brief sentence, you managed to escalate to your senior, you've understood that this is a major trauma incident and needs to have a trauma team. Um You need, you, you're, you're aware that there's gonna need to be in intensive monitoring and appropriate and and you're making sure that you're in the appropriate area like like research and you're also identifying the fact that this patient is a potentially significantly unwell patient that needs to be seen sooner rather than later. You don't com commence with your primary survey. Um Oh, so I brought the patient and also noted by any catastrophic hemorrhage. So in that one sentence, you kind of got rid of that whole sea thing. If this patient is catastrophically hemorrhaging, your interviewers will probably interrupt you at this point and tell you actually, you've identified a massive gushing arterial bleed from his sever's leg in which case, you would then deal with that and then move on and, and, and they would as long as you do the right intervention in the first place, they're gonna let you crack on with your structure, I would issue all c spine protection is in place for using triple mobilization with Carlos and tape. You're pretty much gonna say this for all your ACL S patients. Um There are some patients you probably don't need to. For example, if someone's got an isolated injury, stab wound, no obvious trauma to the abdomen, probably not the end of the world, but you're never gonna be marked down for saying it. So I think it's just safer to say it for all all trauma situations. Er, patient, if the patient's talking in full sentences, I'd be happy with the airway. Otherwise I would inspect it, revolve this obstruction and consider simple adjuncts or escalate to anesthetics early if concerned. So that's nice quick, 1520 seconds, you run through airway, you've demonstrated that you can use simple adjuncts, you demonstrate it, you know how to escalate. You've demonstrated. Um and, and obviously in the stem, it's saying that he's complaining of chest pain, indicates he's talking and probably has an intact airway. I mentioned um a couple of slides ago that it's really important and this is where a lot of people go wrong in the interview to tailor your clinical assessment and your A two E to their body potentially in involved body system. And there's always gonna be a bit of clears. This gentleman is complaining of chest pain, so we can maybe go on out on a bit of a limb and say actually there might be something intrathoracic going on here in the world of a LS pneumohemothorax. They, they really love. Um So that's probably pretty high up on my list. So I would inspect the chest, obvious external wounds, paradoxal movements and tracheal locations. So you're um basically saying in that sentence that you're not missing any obvious stab or, or terrible chest wound, trauma, bruising bleeding, um You're looking for AF segment and you're making sure that this isn't attention. You before actually looking at the location, I precurse, palpates and auscultates. So you don't have to talk about how you would do all those things, you would say that you would do them and on to oxygen saturations. Any concerns I initiate oxygen therapy to fif by um fif fif no, by a 15 L by a normal breath. Um I would be particularly concerned about chest trauma given the presentation um and should signs of attention to pneumothorax be present, uh depress this, decompress this immediately. And I and I, you could also add on have a high suspicion for hex. So what you're doing there is showing that you're actually thinking about the question, er rather than just um reeling off your kind of A to H bill, which is what most people will do. Reeling off your A th bill is fine, it's safe, but it won't necessarily get you your kind of top end marks, which is actually tailoring your, your question to the, your answer to the question I would observe for P diaphoresis, I would assess central peripheral cup refill pulse, take an EG and BP. I would insert to your whiteboard currently and take full drawing bloods and you need to say which ones. So I would take full blood count using these group and safe clotting. And I also take a BBg to access for lactate metabolic status. If concerned about hemorrhage, I would commence resuscitation with warmed Harmans. Um and search for a source and I would mention the source as being the chest abdomen, re pre and long bones and external bleeding. If no response, I'd put out a major hemorrhage protocol aggressively ate with blood products or simultaneously attempting source control um and monitoring fluid status with a urinary catheter and input output charts. Um As mentioned, see is really important. He's really important. Um I got two hemorrhage scenarios in my interview. I got a this chest trauma with a hemothorax and I got a upper gi bleed um for the other s scenario. So um you need to know your um hemorrhage protocols inside out. You need to know major pro major hemorrhage protocols inside out. You need to know what blood products you use in what order. Um Like I mentioned, you know, there are different types of hemorrhagic shock. Uh That's very important. The so your life threatening injuries in your vast majority of, of sections are going to be an a to C and it, and that's where you can do most of your interventions, as mentioned earlier. If you do intervene, you're gonna rein you're gonna um reassess B eight. For example, if they've got, if, if, when you say that I would just inspect their care and your examiner says, oh, it's deviated. Oh, when they've got hyperresonant chest, oh and they are desaturating or when blood pressure's dropping, you would then decompress them with a nale throes. And then you would say once done that I would then reassess, reexamine the patient recheck, the oxygen sats. Um That's just an important thing to mention. D is only gonna be super relevant in your A TLS as if you've got a head trauma. Um Otherwise I would keep this nice and quick. Your DNE should be done in 15 seconds. And I would consider, I would seriously consider when you're practicing your ATL S to to time how long each of your ABCD E take and make sure that you've got them down to at. So I examined their neurological status for initial P formal G CS, papillary reflexes and inspected for any head injuries. I exposed the patient fully, keeping in mind dignity in normal family removal dressings, examined their back using four person log rod technique. Done nice and quick all in one slide, eight a week you resuscitated the patient um and you treat it as you went along, you then escalate. Um So in conclusion, I've completed primary survey on 26 year old with the following significant findings. And um as I mentioned, the examiners will, will have given you a fund. Well, then I would inform my senior immediately if they weren't already aware, if they're in a stable situation, I would then consider further investigating for this patient such as full trauma ct um consult any relevant specialties, obviously like chest trauma, might cardiothoracic head trauma might be neurosurgeons, et cetera, et cetera. Um And I would complete um my examination with a full secondary survey. If unstable, they're gonna need to go to theater. Um So you, so you're not ever gonna take anyone to theater and it's never gonna be your decision as a core trainee, but you need to be able to identify the patients that will go, you need to be able to identify your role within taking patients to theater. So for example, I prepare this patient for theater. Discuss the case with the onco anesthetic team, discuss the case with theater coordinators, book an ICU bed for them as well as completing a secondary survey. So by, by doing this, it's really nice cos you're demonstrating, you're aware of the job role, you're aware of your responsibilities as a core trainee. Um And you're aware, you're thinking of more of just the acute scenario, you're thinking about long term. What is this patient gonna need? What level of care are they gonna need? What's the rest of their journey in the hospital gonna look like. Um, so that's trauma, that's your kind of approach to trauma. Um, these are, this is the website I found and the, these are some key, er, injuries and common things that come up. So you do sometimes get airway issues and you do need to be able to know about um front of neck access and surgical um airways and er, what you would do and how you escalate. But you're always gonna say how to escalate to an anesthetics. Um They can er ask about head injuries. Um and tension pneumo thorax is really common. Pelvic trauma is a really important one. And like I said, all these things are separate toxins. Are you doing the entire few hours on pelvic trauma? Um Main things to know about your, your um pelvic binders, be aware of the importance of um maintaining normal anatomy um and maintain high suspicion for vascular injury and pelvic trauma. Um hip trauma, you could always get enough. Um There's, oh I was gonna ask questions but this one in that last se scenario, we had you, if you were really thinking and, and if you wanted to give some differentials at the start, you could have mentioned. Um and if, if you get, for example, someone with um a hip fracture and chest pain, you could always talk about maybe this is this a fat embolism syndrome just saying that literature saying the word fat embolism shows that you're kind of thinking about what could be going on with the patient. Um and then also traumatic renal injuries um in your interviews. So these are more talking about follow up questions. Now, there are some definitions that you need to know just off, how you need to be able to reel them off. Um straight away. And so things like this and you need to know the definitions for major hemorrhage. You need to know definitions for a definitive airway including a G CS requirement. So, for example, definitive airway, you need to be able to just reel off, say that this is going to be a cuffed endotracheal tube with the balloon sitting below the level of the vocal cords. And that's enough. Nice and quick, you're demonstrate, you know what definitive airway is. And I would say I put this in just GSS and a usually though, as I mentioned, the class of hemorrhagic sharp chest rain landmarks, triangle safety. Um and there are often times they'll, they'll ask things like what examination findings would you expect in attention? Pneumothorax. And you just need to know, you need to be able to reel them off straight away and just say you're hyper reid deviation, um et cetera, et cetera. Um And the other thing they like to do is after you've done your primary survey and, and rolled through it, they've said, OK, so you've now seen your t your, your um you stable patient, they're now unstable and obviously trauma is a evolving process. It's not a one off thing. What do you do and what they're looking for is escalate, first of all, and then being able to know in your, your next levels and higher levels of treatment, which will nearly always lead you to an operating theater in the course I training interview. So the next er, part of the clinical station is another five minutes station and it's an acutely unwell surgical patient. Um This might be their initial presentation to A&E but it's more commonly a POSTOP presentation. It's usually a patient on the wards. Um where, where ATL S is more focused on their primary survey in resuscitating them. This is more focused on post recessive care and your management um uh sensibilities. So your key thing to know about and your key structure to know about here is the cris algorithm. So cr standing for care of the critically ill surgical patient, um You're gonna start off with your A three, like always you're gonna start off with, oh, really circulation dear, et cetera, et cetera. Um But this is gonna be a bit more of a brief one. You're not gonna do as much intervention as you did in the previous one and they're a lot less likely to, to interrupt you. So this is when you just need to know, reel off your a week 2, 2.5 minutes job done, ok? You're then gonna do a full patient assessment and this is where you start to get into your getting good and getting higher marks. So this includes things like doing a full chart review and you're gonna have to talk specifically about what charts you're gonna look at. So you're gonna look at this patient's drug chart. You're gonna look at their clocking, you're gonna look at their daily progress notes, you're gonna look at their operation note. Operation note is really, really important in these patients, especially your POSTOP patients. If you go through the entire scenario without saying you haven't, you've looked at the operation note, you're not gonna do well. Um you're gonna examine them and examine systems more specifically. So in your vascular patients, you're gonna do proper vascular exams in your surgical patients. You're gonna do proper abdominal exams and then you're gonna think about what results you have available, what bloods, what bloods, what cultures you're gonna think about. If you've had a patient that you've, you've taken a cancer or you're going to look at their pathology. Um And then once you, you get to the next step of this algorithm, it's about a as always, are they stable or are they unstable and their daily management plans? So all your iras that you're with on your surgical ward rounds are using crisp on a daily basis. This is how they make their decisions and it's um all those different elements there that are, that are listed. Um, and these are all the things that you would have been, um, seeing on your surgical ward round. So, what can they eat? What can they drink? Are they for free fluids? Are they for TPM? Are they for whatever? Um, how they, are they getting the proper antibiotics, pain relief? Do they need PTO T, when are we taking the drains out? Do they need further investigations? Do we need to refer to a specialty? So these are things you do in your stable patients, then you have the luck of being able to do. So if they're unstable, you need to know what? Ok. So part of that is your diagnostic work up. Um And there's a structure I can tell you that, that I think that's quite good for that. And then you're gonna move on to definitive treatment. It's important to mention here that definitive treatment is not part of the station so much. You're not expected to be able to take the patient to the theater and do it right? Hemi on them. But you are expected to be able to escalate to and know what kind of route they're gonna go down. But this is the cherry on the cake basically. And so another stem uh you're on the CCC on call for general surgery called by the nurses for the surgical ward. A 68 year old gentleman. Despite the temperature, three days post hemicolectomy for un obstructing cecal tumor, set up. Same thing again. So these are the really nice things that you can do at the start of your interview. Just to get a get across a load of points. I would assess this patient as a priority. Inform my senior on the way to seeing them. I would ask the nurse to carry out a full set of observations and like what I might do today is and also get all the charts ready for a review on arrival. I'll carry out a rapid assessment with this information. If unstable, I'll put out a double two, double two emergency call. Any case I would manage the patient as per the cris algorithm as part of the cris abdomen is A two E in resuscitation. Anyway, so that, that's what the MetCare team is gonna do. But what you're doing is, is quite a nice quick way to show that once again you're a safe call, trainee, you're identifying the deteriorating patient and you're putting in the emergency call out and getting the relevant expertise there. Nice and early and this is what you should be doing for all your acute surgical reviews. Er A three, I'm not gonna go through it again. We've been through it, you know how to do A three now. But by now, obviously, this is, this is a, any old medical treating can do an A 33, but it's just about how fluent, how consistent how confident and how smooth you are with it. Everyone who's doing that interview is gonna be able to do an, a two week but not everyone who is gonna be able to reel it off flawlessly and you have to be flawless to, to kind of be with him getting a job or getting the upper ends. I would take a brief focus history for this patient. So you're actually gonna take your history most times. So you're gonna do a very, very brief, humble history. And for this patient with this particular issue, things you may think about asking are pain. How long has it been known for? What's the character and nature of the pain? Are there? Are they febrile? Do they feel febrile? Do they have any symptoms? Are they having any shortness of breath? Any hemoptysis? Are they n nauseated? Have their bowels opened? Um What's their appetite? You need to get a bit of a picture of what's their postoperative course been like? Um you ca and I would carry out a full chart with you including the operation note, clerking, daily progress note in the output charts drains. Um and a drug chart of of importance in the drug chart. I would like to have a look at the antibiotics, their VT E status and analgesia. So we're thinking what we're doing here is your, your signposting to examiners, a two interviewers that you're aware of the various different differentials you have for this patient. Um and we, and I, I've got a um a few, I have some notes about some differentials later. Um and it's probably worth telling them what you think the differentials are. But by doing this in your assessment, you're kind of taking them through the process and showing them that you're thinking about the case and you know what might be going on. I would discuss all my findings after your A two E. This is um, and your brief focus history and your chart view with your senior. If any further diagnosis are required, I will then move on to investigations and I'll split these into three categories. So the three categories that I think is quite nice to do this in is bedside tests to start off with. So I would think about er, pregnancy status, um, urine, urine investigations, er EC GS and cultures V VGA V GS. Any others you can think of are great. I'm sure there are others that I'm not really thought about hematological investigations. So I would take a full set of blood to this patient, um, including plotting football current using these LFT S and A um, any any other relevant blood as well. Um And if they need a group and say to go back to this, so that's relevant as well. And then I'll um then consider imaging. So, um abdominal X rays, erect, chest X ray is very popular in the exam. People. They really like when you say that it's a nice, super quick investigations, you can get out in your, in your surgical patients that might rule out some pretty significant, um, issues. But what you're really gonna do is a CT with contrast, um, that's gonna be the important thing. Other things to think about are ultrasounds and A C TPA. So you need to give an idea, you need to have an idea about what your thinking is going on and you don't have to get it right. You just have to, it has to be reasonable and defensible. So, in this patient, I'd be concerned about sirs inflammatory response syndrome, which is what you have. It's a temperature POSTOP. Um, you're then, so, you know, you know what's happening, you're then thinking about, ok, what's caused this, um, my top differentials would be an osmotic leak, POSTOP collection and a, an infection somewhere, a sepsis. Um, and we'd want to search for a source and obviously with your history and your investigations, you could get closer to that other, other things to think about would also be a Basalis and a pulmonary embolism, which you can get a temperature with. Um, this is all relevant and you can see how the different er, history elements and the chart reviews might lead you towards that one way or another if they've been having the right antibiotics. Have they not been having their VT E? Um, how, how have they been doing POSTOP, how they've mobilized? Um Are they lying in bed? Are they more at risk of an apsis and a chest infection? Um Your Yes, like I said, as long as you're thinking about it, um you're then gonna move on to management. Um So if stable and it's, and it's a diagnosis that you think doesn't need urgent investigation, you would then move on to your kind of wall based care. I would conservatively manage the issue and tell you can tell them how you manage it. Enter a progress. No deal to say that my plan for level of care and all those things we mentioned. Um And if if if unstable, I would just um proceed to management of this patient. It consulted him with seniors and relevant specialties. So is it a collection? And then they, one of their follow up questions is gonna be like, how would you manage this collection? And you're gonna talk about a radiological drain or if needed surgery. Um If if, if not stable to go for a um regular Children and then you can talk for like we talked about before. All those things that you would do in preparing patient for theater such as talking to sea pod and the booking the patient on for sea pod, booking an IE bed, speaking to theater coordinators, et cetera, et cetera. This is obviously quite a wide ranging area and there's lots of different things you can be asked about. So you need to have knowledge of all these areas really and these, if you work surgical jobs, you will have seen all these things. Um Like I said earlier, this is not an exhaustive list and, and there's definitely more stuff that you need to know and have confident so um confidence talking about, but what, what you need to know more than anything is, is your structure and your crisp and you need to stick to your, your crisp structure. Um And that will get you through most of these scenarios. You need to know about wrist stratification. You need to know what the P possum is. What, what the nulla is, things like cocker scores for septic arthritis. Um and cancer staging, you just need to have a bit of an overview of how different cancers are staged and what the relevance of that is. Um possum and Nel are particularly important and obviously that's your work up for your surgical patients um and identifying risk for, but oops um I II don't find their risk of morality, mortality for um surgery. And then like I said before, with trauma, there are some definitions you need to know. Ok. So sepsis, septic shock or sir, are you need to know um on AK is and the different categories of AK is um the for example, so just as an example, sepsis is gonna be your dysregulated your host immune response in the, in the presence of infection, you need to just know it, you need to be able to reel it off. There's no, it's not on a course. It's just, it's what it is, just learn it, moving on to management. So we're th way there. Three minute preprepared verbal presentation. Ok. Um I said, usually something like reflects on your experience of leadership when working as a team member and how it would be useful as a co trainee. I think it's been that question for the last six or seven years in a row. That's not guaranteed to be that question, but it most likely will be this question. OK. Um Your structure is really important here and the way you're gonna structure, this is via camp. You've probably heard of camp Clinical academic management and personal. My tip top tips for your presentation are put your best quality example at the top. So if that breaks your camp structure, doesn't matter if you've got a really amazing management scenario and you've managed Manchester United to a dynasty of five premier leagues in a row or whatever, that should be top of your list. Even if you've got loads of um dop S and C mini cases in your clinical. That failing that signpost show show your um sh sh show your best examples first. Um and things mentioned, but obviously no non exhaustive that you can mention in in the clinical was ward your your theater log book um different feedback, you've had um, academic, er, so obviously, publications, teaching journals, et cetera management. Have you been on any committees? Leadership in the workplace, on calls, the scenarios you've done? Um, and then personal, what, what have you done in your personal life that, um, is gonna make you a good leader and a good team member. I'm sure you've all got really good examples. It's just about how you structure it. Everyone's got good examples. And then obviously, if you've got anything particularly good, you need to signpost it because you want to have their ears prick up if you make some, um if you've done really good things and you, you're gonna wanna just use some buzz words um that, that the, the interviewers are gonna listen to follow up questions to this. Um So there will be two minutes of follow up questions. There's a massive list of them if um in that er blue book I mentioned um they called surgical training but II really advised the book. It is really good. They've got a really exhausted list of all the different questions that are commonly asked. Um a, a really common 11 that I got was what, what is the difference between a manager and a leader? And this is a lovely question because you can just because the, these are definition questions again. So a leader is someone who sets out a vision and a manager is someone who enacts upon that vision and makes it happen. OK. So you as a core trainee and as a surgeon want to be a leader, not a manager. Um Another common question I'd like to ask is describe good leadership examples you've experienced in the NHS and what have you learnt from them? OK. You need to have answer to prep for all these questions. There's no excuse not to. The questions are known. There's a limited number of them. They're all, all the resources that I mentioned. Um But they will like you to tailor the question to your presentation specifically what you said and kind of back on that. Um There's the also the scenario. So this is um I should also mention as well. There's a structure for your specific examples star which I'll run through later, which is quite important um which is situation, task action. And um so management challenging workplace dilemma. So this, this is um similar to your SJ at that you said did the M sra um I don't think you do S JT S now when you apply to foundations. So you may not have done one then. Um And the format we're gonna use for this is spies. So there's these acronyms you just need to learn and I actually find them really useful for structuring your answers. And the interviewers like to see you structuring your answers. They like to think that you've thought about it that you've prepared, they're expecting you to use these structures to use camp to use SPS to use D. So next step, your ct one in general surgery, a patient has been waiting. So this is the one I had in mind too as well. Patient's been had waiting for three days to have an abscess. I he's extremely high rate. Um I already having been canceled twice. Your registrar has told you to inform him his case appointment will be going ahead. So, due to emergency workload, how are you going to approach this? So once again set up, oh, sorry situation. So this is gonna be the s in your spine. So this is a highly challenging scenario. On one hand, this is a justifiably dis patient. He's been starved, he's in discomfort. He's a waiting for his operation which he needs. However, this has to be balanced against the clinical needs of emergency. So all emergency of the emergency workload and the cpod theater. So in that sit situation, what you're doing is you're signposting to your patient that your um whoops um that you're on your, that you understand the dilemma you are, you're understanding the question they're asking, you're understanding what's going on and it's just a nice way to start the question. Um A lot of people would read this and their first thought would be to the, the kind of almost the thing that's staring you in the face is the angry patient, but actually dealing with the angry and the angry patient comes pretty far down what you would actually do and and I'll run through that. So the next and most important thing and the one thing that you always have to say in all of these scenarios, nearly all of these scenarios is my, my priority would be patient safety. I would review and reassess this patient urgently carry out full chart review and clinical examination to ensure clinical parameters haven't changed, altering the urgency of his booked procedure. Obviously, if this guy with an abscess is now septic and in shock and about to die, that's really relevant cos that changes his urgency on the on the operating board. Um I would review the other p patients on the er books emergency procedures, review their clinical il are they more and well, basically, I would ensure ensure the patient receiving optical medical care, antibiotic, fluid analgesia whil they're a wetting surgery, be surprised at how much time, how much in real life this doesn't happen. So this is showing this, this is the common scenario one that if you work for general surgery you will come into. And so it's actually quite relevant to your work as a core trainee initiative. So what are you gonna do? I would take uh take steps to attempt to resolve the situation. This would include discussion with theater coordinators about theater capacity. So your understanding, you, you that's you demonstrate your understanding of the multidisciplinary team, how they work. Um I will talk about theater capacity and the possibility of opening a new theater using, utilizing free space in other theaters or even canceling elective work. If things get particularly bad, if I say I had the skills and I had an appropriate supervision available, I would see if I could just do this procedure myself. It's an abscess. Can it be done on local? So this is you, you're not committing and saying that you can do this or, or that you would, you're saying that it's an option and you're showing that you're thinking about it and you're actively trying to find solutions I would discuss. So the next, the ian er spies is escalation. I would discuss findings with um with regard the association with my senior register and an on call consultant who's ultimately responsible for the list in this case and, and just, and talk them through my potential solutions and offer them up and then support. So then we move on to being nice. So once all the information is at hand and you're fully aware of the scenario and what needs to happen. I would discuss the situation with the patient, I would assess their on. Th this is what I've done here is a little bit of spikes, which is another um another kind of thing if, if you just Google that um it's breaking bad news and it's just, it's just obviously you're setting your patient's understanding um and just being nice to them. I would explain the current scenario, the reason with delays and you would apologize. I would offer up solutions that I thought after discussion with seniors. And if not, if there are no solutions for your Children and surgical team and seniors are aware of the predicament, I working hard to find a solution. If they want to make a formal complaint, I would signpost them to pals and follow the local complaints protocol. So this is you showing your understanding of good surgical practice, such good medical practice and just being a nice bloke woman. Um And then to finish off, um these are where you in my opinion, get your extra marks that can show your quite your thinking. It's quite good. I would document thoroughly all my discussions and actions. This is really nice. Your consultant wants to know that you're gonna be a medical, legally safe court trainee because they are gonna talk and do a lot of things and they need to know that you're gonna document properly. If there are any patient safety concerns, I would submit a day or incident form and, and discuss this with seniors. I would reflect on my experience in my portfolio and consider what changes could be made to prevent similar issues in the future with a view to carrying out a potential audit or quality improvement project. So that's you showing your breadth of understanding of um of governance um And understanding how and just basically showing your commitment to a number of different areas in that self assessment that we've, that we've talked about what this question really hinges off. And, and if you ever get a question like that, inevitably the follow up question will be is what do you understand by NC POD? So then that's when you need to reel off NC POD was a national audit. It stands for the national confidential um inquiry into peroperative deaths. It looked at surgical outcomes and their relations to um differences in outcomes up and down the country. It changes made by NC POD have to significantly improve surgical outcomes and reduce overall peroptic mortality by X percent and all that's on their website available, you need to learn it, you need to know what C po is. You need to know what the C categories are. So they're here. So one A and one B are life, um are immediate surgeries that need to happen within minutes to hours. Um And they are limb or life too is, um and that's within hours to days of o of deciding to operate and you need to know what these might be. So for example, compound fractures, um people with bowel obstruction and perforations, critical limb ischemia, et cetera, certain injuries, expedited procedures. Um So things like heart gallbladders, cancer operations, tendon injuries, um stable or nonseptic patients. People that are either on the emergency list or on the expedited er, elective list um, usually, um, and then everything else fits into four, whether this is your elective or planned, er, procedures. Er, another thing to be aware of is a wh o checklist, you need to know what it is when it came about, why it came about, you need to be able to, to, you know, the definition of a never event, um, and understand that wh a check list exist to prevent them. Um, like I said, there's a lot, there's a lot of content to be aware of for this, for this er interview. And that's why it's really important to start your prep early. So that you can um you can have a when, when they answer the question, you can pull out relevant examples um and show that you have a working knowledge of these really important things. Um and then consent is a really common and important question. Um And you need to know or be able to name, drop the relevant literature um and legislation. So this is the MCA 2005 and the children's act, you need to know other different types of consent forms. So you need to know that a form one is for capacity to form two. It's for kids. Form three is never used, but it's for procedures where consciousness is not impaired. So things on the local where they're awake and talking um and then form four is a replace capacity. If you're gonna do form fours or talk about form fours. It's nice to talk about a class act. It's nice to talk about um the and, and in that blue book, there's loads of really nice stuff around form floors and that's super relevant to know what you're gonna document, who you're gonna talk to. What's this one you're gonna carry out? Um You also, I think a, a another way to separate yourself and, and to do to be really nice is um that a lot of, a lot of this, obviously, it comes out of the legal world and the medical, legal world. So there is la landmark cases. Um One of them being gonorrhea Lanre Health Board, which essentially was saying that surgeons weren't consenting properly. So, the one of the reasons we consent is because what the findings of this case in the following inquest saying that we weren't consenting properly, we need to consent properly. Um And then G er versus gel versus er West Norfolk. Um Council, obviously you've heard gel competency. There are others and they're listed in the resources I mentioned. So your management station um is seven key areas and these are your kind of your pillars of governance. That's another definition. You need to know, you know what governance is and what the pillars are. Um And it's management, leadership, teamwork, communication, training, audit and research, complaints, consent. So these are your pillars of governance and these are the common questions that come up. So, what we just sign is on this delays DNA R discussions. I've added on cos I didn't mention it on this list. Um That's really important. Um Never events, you know about wrong site surgery that got us last year. Um confused patients. It's all that these are all typical S JT scenarios, but with a bit a bit of a surgical twist. So that's the management station. Um and then moving on to the last station is the portfolio station. So this is gonna be 25 minute questions. Um So as I mentioned, all in five minutes about one of those four domains that you self assess. Um So that is um surgical experience, Q I and audit publications and presentations and teaching the structures. You're gonna need to know here are star and prem you're gonna give your CV, you're gonna give your portfolio as self assessed with your A two E er to the examiner or it's gonna be email to the examiner on the day or it's gonna be saying ahead of time, but they're gonna have access to it on the day. They are then going to read through your full portfolio. They're gonna pick out most likely the two best examples, the two strongest categories and they're gonna pick those two to ask about. So if you're putting something in front of them, you need to know what you're putting on inside out, you need to know everything about it and you need to know how you're gonna talk out how, how your experiences and your um and your quality of evidence in those four categories make you a good core trainee. Um And how you're gonna say that in your interview um star um I haven't got an, an example for this one, so I actually didn't do the portfolio station myself, but there are um online examples. Um start is really important and you can use this in your management scenario as well. So whenever you're talking about something that you did, if you're talking about the teaching er scenario, you l or the um audit, you did or anything that you an example that you're providing, that you can demonstrate that you did in real life, you're gonna use a um And this is the situation. So for example, I identify the fact that during the pandemic, there was a paucity of teaching for medical students on the topics of hematological malignancies in Children. This um it's an important area and one that is poorly understood by medical students and I felt it had to be addressed. Therefore, such situation. Therefore, task I set up a national teaching program um via this organization. It was online. Um we had, and we had this many people joining. Um This was my feedback um et cetera, et cetera, et cetera. Um This is how I managed to make it work. These are the steps. So as part of my teaching series, I coordinated people. I booked rooms II um paid online um subscriptions and, and financed them. I ad advertise the scenario. I helped set up and prepare teaching resources and deliver some of the teaching resources. Us these experience demonstrate how I would be a good, good core trainee. As I have demonstrated breadth of ability in leadership management teaching. Obviously, I'm just making this up as I go along, but you can see how you can link your experiences and always bring it back to how it's gonna make you a good core trainee and how it's gonna make these consultants listen to you want to have you as their colleague and then the result, what happened, how did it come out of it? And in a, in for example, in the scenario that I was talking about, you're gonna talk about the feedback you got here, you're gonna talk about if you do it A it or Q I out of it, you're gonna talk about if you're teaching, you, you published the results out of it. So this, this is just you showing your understanding and your um overview of, of the things you're doing and how they're relating to your quality co train. The other um er acronym I came across found was quite good was pram and this is for audits and research specifically. So um it's the same thing as D essentially, but just tailored to audit and research. So your P is gonna be your purpose. Um So you're gonna state why the publication, you did, why the audit you did had to be done. Why it was so important. You did it, how it was gonna make a difference? You explain what you did. So in this audit, I did data collection coordination and analysis. These demonstrate skills in these specific areas which I would bring to my time as a core trainee when I'm managing operating list or when I'm on call, et cetera. Um And then you would describe what the methodology. So this is gonna have to be brief. It's gonna have to have a good understanding of your methodology. And if you do mention a methodology, you need to be able to answer questions questions about the method. If you did a systematic review, you need to know about systematic reviews, you need to know what Prisma is, you need to know about, about levels of evidence and that kind of thing. Um And then the findings of, of what of what your paper found. And if you're ever gonna do a pram for an audio research, expect to have follow up questions about your audio research, about your methods, et cetera, et cetera. Um And this is obviously gonna be come out of when they're reading your um different bits. Um So obviously, the questions in in the portfolio station are probably gonna be more questions and more intense. Um These are questions, the top four questions that have been asked previously in the portfolio station. So tell me just literally, just tell me about your Q I teaching. So you're literally just gonna have to know your, I'd like I mentioned, know your CV inside out and just reel off your, your answer. Um You've got questions in your log book, but you've only performed a few. Why? Which I think is a bit of a nasty question, but there's a lot of you can do, you can dig into there with talking about working within the limits of your own competence developing through a surgical career. Um and how it, how it demonstrates you're keen and interested and good to move forward. Um And what is an audit? Um That's a definition question. Um What is it? It's research and audit these four domains. So obviously this is the different mains of surgery. This was actually all generated from Chat GBT. So these aren't previous questions. This is just what A I thinks, but I thought they were quite good. Um I didn't do the Chat GBT, someone else did. Um this guy called it. There's a, there's a talk on the portfolio on this website. Um that as I did by a guy called Georgios, um I found quite useful reading through. So if you do wanna um give that talk or watch, it's quite useful. Um So these are all there. Um And obviously with your portfolio, it's just about knowing your experience and knowing how you're going to talk about it. Um as mentioned. So summing up key points, it's all about practice. It's all about how smooth and, and how fluent is your um are, are, are your answers if you're confident your interviewers are probably gonna switch you off and to be like, yeah, that's what we're talking about and then just wait for buzzwords. So nearly everyone who's sitting in this interview has the knowledge to get there. They've all done F one F two, they've all got medical degrees, they've all sat the exam and they've all done well enough to get an interview. So it's about how you set yourself apart. And as mentioned, fluency, signposting to particularly experiencing buzzwords being succinct and not waffling on and they want to see structure in your answers. They want to know you've prepared. And the structures we talked about today are camp stars, spies, spikes, pram your a structure atls and crisp. Although there are more, as I've mentioned, use your own personal influence and twist stillness. Um And then good luck and hopefully around um I can't remember when it was March sometime you'll receive something like this. Um And it will all be over and that feels really nice until the next thing comes along, which is called training. Um That is my, my email. I'm happy for anyone to contact me if there are any questions or queries. Um And if anyone has any questions, please chuck them in the chat and I will, um, answer if not.