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Peter, I've just started for surgical training. Um I did foundation while and now I've moved to Liverpool uh over the next uh 4 to 5 minutes to an hour. I'll be um giving tips about how to build a portfolio during your foundation years. And uh the aim of building a portfolio is eventually to apply for course surgical training. So this is uh what we're going to discuss today and we're going to go through the, the uh uh cement are tips uh not specifically related to the portfolio as in not uh specifically related to the uh CST application and also the MSR and the interview. And then at the end, we'll have some time for uh some questions. So this was the time now which I had um last year. Um So applications normally open at around the end of October and they're open for a month. Um during this time, you don't need to upload any evidence. But by the end of the application, you need to have completed um all of the um sort of tasks or parts of the application. So, in your evidence, you need to make sure that the date of the, for example of the teaching which you did or of the presentation, which you, which you gave needs to be before the date of the application. And then at around uh mid December, um you get an invite to see the emissary exam, which is normally sometime in January and then uh around the first or second week of February, the evidence port will open. So then you can upload all your evidence. And uh also at the same time, the MSR score um is released. So basically, once the MSR score is released, um uh some people will be invited to uh sit for the interview and some people will unfortunately uh not cause the interview application uh is based uh only on MS R scores. So then yeah, as I said, so same, same time the interview invites uh are sent and the interview is normally at the like mid to end of February. Um and then uh the, the rest isn't really important for for now. So this is uh a small graph over the last 10 years showing the competition ratio to get into course surgical training. So as you can see, it's been going up slowly, slowly due to multiple factors. And this is the case, not just for co surgical training, but this is the case for almost every specialty um including medicine, radiology, anesthetics. Um So things have become slightly more difficult to get into specialty training of the foundation. So let's get into the self assessment. So it's uh it changes every year. Um Over the last two years, it hasn't changed much. And I will explain later on towards the end. But when I applied last year, there were five domains and the maximum was 52 points. So I'll be going through every domain. Um I'll show you a photo of like a screenshot which I took from, from my, a application where I chose uh where I self assessed. So II assessed myself based on the evidence which I was going to provide. Um So the first part is commitment specialty. The screen II don't know whether the words are are too small. Um But you can find all of this online. I will provide a link at the end. But basically, so there are this uh domain is subdivided into three. And um the number of points you get depends on what level you take for each. Um And so you can get a maximum of up to eight points depending on how many theater cases you go to. Um You can get a maximum of three points uh depending on how many conferences and a maximum of three points depending on whether it is an elective or a taste or week. Um So my tips would be that this domain. So we said there's a maximum of 14 points. Um ideally you should get 14 points in this domain. So what, what you guys need to do is um if you've not already, um you can set up your log book. So this is something which all trainees throughout the UK use and which is something, uh it's the only form that they will accept as evidence for your portfolio. So there's the, um there's a, a link there. If you type ebook and Google, it will come up straight away and um you need to plan ahead. So if you're starting fy one, there's no, no rush. You've got 52 weeks until the, well, more than 52 weeks until the, the close of the application. So if you aim to attend one case a week on, on, on average, you'll be, you'll have more than enough cases. Um if you've got a surgical job, um and the ward is quiet, you can try and go during your, during some down time on the ward if you're desperate and only if you're desperate, don't do this. Like from now, if you're starting a one, you might need to go on your days off. Um But if you plan ahead this, this uh shouldn't be an an issue, uh try and attend shorter cases. So cases which are done under local anesthetic cause there won't be the delay of getting the patient to sleep, getting them to wake up. Um So either local anesthetic or else if they're done under general anesthetic, they would be relatively short cases which are done under general anesthetic because they are quite painful. So this would be cases like for example, creating an avi fistula excision of skin lesions. Um examination on the Estess of the rectum hemorrhoidectomy. Uh But you can also uh attend the bigger cases as well. If you, if you like um regarding taster days, um try and find a current trainee in the department, you'd like to do a taster taster weekend and ask them like which consultants are quite good, are quite eager to teach if there is maybe a designated consultant that takes care of the taster days and then for the conferences. So there are, there are different types um organized by different organizations. They can be either in person or virtual lasting three days or three hours. Some are free, some are quite expensive. So try to have a look around and see what's available. Um Sometimes you can also apply for funding from uh less part of your uh study leave and also make sure um at least bef before you apply that they will provide you with a certificate of attendance. Um So good common and very popular courses are uh conferences are those organized by AO G and ASG B, but these are normally in person conferences. So the next part is quality improvement and clinical audit. So this is against to two. It depends on um what uh the amount of involvement uh in, in you you put in, in the project. Um And uh whether it's, you did one cycle or two cycles. And then the next part is if you presented it. And where? So in my case, II led uh an a, an audit which was surgically teamed and it's important that needs to be surgically teamed. Um And I showed that I showed change. Um So in my case, um we uh we brought about an increase in the number of um patients presenting with upper gi bleeds who had the Glasgow blood for score calculated and recorded when they came into ed. So even though upper gi bleeds are sometimes will often come under the medics. Um it is still also a surgical problem. So that was accepted. Um And then I presented the uh the uh the audit results at the local uh restaurant meeting and run by the department. And so I got one point out of that out of the five points. So it's not the full five points, but at least it's better than nothing cause every point counts in this application. Um So my tips with this would be so this is also an area which at least for the first part, the part where you conduct and lead an audit and the one which has eight points, I think this is an area which you would need to get uh full marks. So try and find some, some other junior who would be willing to work with you on this, on this audit to distribute the work and you need to find a supervisor as well. You can either propose your own project, maybe you've thought of something or you think you could improve in some area. Or else if you, if you're not sure what, what you can do, you can always ask if they have something in mind or if they have a project which they need to get done. Um, I think in most trust there is like a local process where you need to register the quality improvement or audit and then they will provide you with a certificate once it's done. And sometimes um you might not be able to actually go ahead with the audit if you don't have local approval. Um And then uh the next section is presentations and publications. So you get either maximum points, either if you have a first thought of publication in PUBMED or else if you, if you present at a, you give an oral presentation at the national or international meeting. So in this case, if you are an AN F two and you're applying for the next round, um it's quite difficult to achieve a pub, a publication from scratch at this point. Um It may be achievable if you're, if you're still in F one, you might have time to be able to um write a, write a paper and have it published this section, the, this presentation publication. I think most people don't get like a large amount of points because it is probably the one of the most difficult to achieve. Um And then as you can also read, read for, for yourself. And when I send the link for the self assessment, there are different levels of achievements that you can show and each will get different points. So most people will get some points which because they will have done something in this domain, either a presentation or publication. Um So even also you need to make sure that if you're, you're, you're not gonna just write a paper just for the points. Um It seems to be something that you would enjoy doing a topic which you enjoy and find stimulating and you need to also find a good supervisor otherwise you'll end up being miserable and you won't produce a good piece of work or you won't even produce anything at all. Um And also, even if let's say you're, you're in a fight to, even though you won't be in time to produce a pre a presentation or publication by the next round, um there are still points to be awarded um when you then apply for higher training and acidity. So it's still something to bear in mind and maybe start thinking about. So then uh teaching experience. So again, there are different levels. So as you can see here, um I got eight points out of 10 in this domain because um similar to, to uh to what uh Melanie Alex and Daddy are doing tonight. I organized a series of four teaching sessions. Um And I got eight points, not 10 because I organized them online virtually. Um Because I also felt that it would have been quite challenging to attract and people from all over the region to come for four sessions in person. Um without even knowing who I was or who, who my other colleague was. So I decided to just organize online sessions which were also easier to organize and free. Um So, with regards to this, I think it's, it sounds difficult to organize. And certainly when I organized mine last year, so it was probably in September of last year. It was quite last minute. I thought it would be much harder than it actually was if you find uh other colleagues or friends, um especially if they work in other class or other other regions would be quite easy cause you could distribute the workload. It's important that you find a supervisor who would be happy to sign a document for you as evidence that you provided the teaching sessions. Um It's also important to request feedback um through uh through some sort of form um at the end of the session um as a sort of stimulus to then uh provide certificates to those who, who, who apply. Um And you can either or uh give the teaching yourself, which is what me and my other colleague did or else you can invite um, speakers to give the sessions for you. It doesn't really matter as long as you're organizing some sort of teaching. So then training qualifications. So this is, um, this is rather, it, it can be a bit expensive because so the top one which you can see, we just said, um, unless you get funded, maybe you're doing the uh specialized foundation program, um, you would have to pay for that yourself. And I think it's um something which you need to think and think whether it is worth its pain, um that amount of 14 or five points. So in my case here, I self assessed myself wrongly um by mistake, obviously, because I chose that I had uh teaching, which was over two days in person, but mine was not the whole two days impar. So I actually got one point in this domain. But if you manage to um attend two days in person of teaching sessions, you will get three points out of five. So that's quite a, quite a good amount of points for this particular section. Um So is I attended, I think I attended the IC medical course. As you can see, it's not, it's not free, it's not cheap. Um There's also another course by me body, they're organized quite frequently. They're organized online. You might need to do some um self study and uh um like sort of an e learning before the course, both of them are one point. So if both of them are one point, I think you can sort of guess which one is more right doing. And then there's this online PPD in medical education. So, um, I know people who have done it and paid, paid for it out, out of their own pocket. Um, I guess if you, if you're really passionate about medical education, um, it might be worth thinking about and it will also get you points also when you apply for C three and even for, for a consulting job, so it won't be a waste of money, but maybe at this stage, maybe your money could be better spent on something else. So as I said, um there wasn't much change between the self assessment when I applied compared to the previous year. So these are just some small changes which I sort of um wrote down by comparing the portfolios of both years. So, um with regards to the commitment of specialty two years ago, you would get three points if you did an elective and two points. If you did a taste a week, this has now swapped. So now it's three points for a taste a week, two points for an elective. And I guess this was introduced because at week is free to organize and elective is not. So maybe people who maybe were in a better financial position were being privileged, sort of because they could find find an elective compared to others who could not in the quality improvement, audit and presentations or publication section, there is, has been no change in the teaching experience. Um Two years ago, if you gave the teaching, either face to face or virtual, it didn't make a difference. As long as it was regional, you would get 10 points. But last year it was 10 points if you gave it face to face eight points, if it was virtual and the training qualifications. Um nowadays, uh a master's and the P GC will both get you five points. Whereas two years ago, um a master's would get you five points P would get you three and other teaching would get you one. Um So if you manage to get onto a two day face to face teaching session, um you would get three points and I think that would be uh I would be happy with, with that um for this section. Um So also beware of the definition of region and for the teaching. So if, for example, you're working in Hull, for example, where I was working, if the guests are him students. So even though they'll be working at York, uh Scarborough Grimsby, and even though they're quite widespread, it won't count as regional because they're all under the same medical school. So you can either try and collaborate with some other doctors from a different, like a, a different part of the d or from a different dry in order for it to count as being regional. Or else you can also count it as, as um national. If you get, for example, people attending from, if you're based in Hull and you get people attending from London Manchester, this would count as national because it's been open to everyone from the whole country. Um So, um my tips, uh especially if you're a fight to and you're gonna apply in the next round would be to focus on audit conferences, operative experience training and teaching the and teaching. So, um I think uh exactly a year ago when I was in, in, in your position, I was quite weak in my portfolio in all of these areas except maybe the the operative experience. Um So it is still feasible because I managed to get quite a good amount of points just in the last month, month and a half by trying to be wise and, and focusing on the areas which were weak and which were quite high yield for, for not too much effort. Um So these are also optional, which you can do if you have time and if you feel like so research, as I said, it, uh it's it, you, you need to be committed and dedicated, you need to find a good supervisor, you need to find a good project. So it's not easy to do, but um it won't be a waste, waste of time. Um Both for your personal CV. But also when applying for AC three, um, if you're quite certain that you want to do surgery, you can start thinking about setting some exams. So I've done both of them during my foundation years cause I was quite certain that I was going to do surgery and I wanted to get them done first of all, because the pass rate, especially for EMG S pa part A is highest during foundation years. Um and the longer um you postpone them after medical school, the harder it becomes to pass. And also because I wanted to go into training, having done my exam. So I could just focus on actual training. Um Other courses which you can do um basic s surgical skills. It is quite expensive. Um The prices can vary um around 400 to 600 lbs. It is a very good course, but it's quite expensive. Um Eight A LS, this is only for 52 and above the advanced trauma, life, life, life support also a very good course. But uh I think it's like 1000 lbs, I've not done, done mine yet. And then um as I mentioned, the PG and PGP medical education, um if you think that uh it would uh it would be beneficial for you. So these are specifically for us on doctors. So, um you've just started work, you've been working for a month as of as of today actually. So there's there's no rush. Um take it slow and steady. It's a marathon, not a sprint. The most important for now is that you make sure that you settled into your new job, maybe you've moved to the city as well. Um Once you've done this start slowly by focusing on the log book cases, um try to maybe find some confidence, um which you, which you might find interesting also, maybe try thinking about doing an audit or a quality improvement. Um Research, as I, as I mentioned, um if you go to theaters, try and learn some basic technical skills from, from your seniors like suturing and not tying and make sure you go home and practice. So that next time you go to theater, they can teach you something new and something more advanced. Uh But uh last and uh most importantly, at this stage, the most important thing is that you learn how to be a good doctor and also achieve a good work-life balance. Um Otherwise, um if you start too hard and too fast, now it's very easy to burn out and you won't reach your full potential. Um Had you maybe taken it more easy um and uh progress at a maybe slower rate. Um So another note on research, so as I said, not compulsory to choose a, a supervisor wisely. Um Most people at the start, they're quite keen to, to get involved and it is good to seek out opportunities however you need to be careful of people who, um, we just want someone to do a project for them and you might end up getting over rounded, overburdened. So you also need to learn how to say no, if you've got too much on your plate, if you don't like a project, if you don't like the supervisor, um, make sure you, if you're gonna going to get your yourself involved and team up with, with other juniors to distribute the work, I would avoid case reports because they're quite difficult to publish and you do not get points for them when you applied to three. So they're not really worth it. Um, and regarding the supervisor, so what you can do is, um, you can go on PUBMED, you can search for their name, see, um, what their research interests are, how many papers they publish every year you can also ask around maybe other trainees have work with them and see what they think, whether they're a good supervisor, whether they provide them or they just let you, um, work on your own with our three limit support. Um, so now I'm going to, to talk very briefly about the, uh, MSR and the interview. So everyone needs to do the MSA exam. Um, if you're applying not only for surgery but also for most other specialties. At the moment, I think medicine is the only specialty which doesn't, uh, need a necessary exam. So the format of the exam is, uh, two papers, both 50% each one has clinical questions. The other is S JT similar to, um, to what you might have done when applying for, uh, the foundation program. And the emissary score will make up 10% of your final score when it comes to getting a job. But it is the only thing that will determine whether you get an interview or not. Um, personally, I think this is quite unfair because um people are being chosen to get into surgery based on an exam which has very little surgery in it if anything. Um But unfortunately, that's how the system is. This has been in place for the last two years. Um The summer had in January and uh it's held at the prison view center. So once the emissary booking window opens, try and book a place early because um each city has limited slots and they might uh end up needing to travel even sometimes quite far to sit the exam. Um So with regards to the uh clinical paper, it's quite straightforward to prepare for. There are many question banks online. Um The part is a bit, I found it more difficult because in my exam and from what other colleagues told me, um the questions in the actual exam were quite different to questions which were available on question banks. Um So it's the exam, the that part of the exam involves quite a bit of luck as well. Unfortunately, it's a bit difficult to predict as well, what sort of questions are going to come out. Um And then, um, if you get a high enough score in the M sra, you will get invited for an interview which is in February. It's online, you get uh two stations, one is clinical and one is management and you get two scenarios in each, each station is uh 20 minutes long. Um So very briefly. So in the management station, you would get uh you would get sent a topic beforehand, which you need to give a three minutes presentation on and then they will ask you some questions for two minutes. And then the next part of the station, you will be given a scenario and uh it's you will get asked questions about how you would manage it. So scenarios like for example, um bullying on the ward, uh maybe you notice that uh that a colleague is struggling, maybe a senior is coming intoxicated in the clinical uh station. Um You get two cases as well. One of them is a, is a trauma uh case. So you say that you would approach it using the ATL S principles. And the second uh scenario would be uh a ward based emergency. So maybe someone who maybe is unwell after surgery or might have a, a DVT or AP. So you would be asked to assess them um and to prepare for the interview, very important to practice both with colleagues who are going to sit the interview and also with seniors, especially maybe those who have been on the panel in recent years because they could also guide you on how best to answer certain questions. So we're almost done. So as a summary, so try and start early but also be realistic on what you can and cannot achieve. Unfortunately, all of this is a sort of game like a tick box exercise. If you have 100 p publications, you will get the same amount of points as someone who has won. So try and distribute your efforts equally across all domains to try and get as much points as you can out of all of the do the the domains. Um Even though I showed you the competition ratios at the start, um it's still important and helpful to collaborate even with people who you might actually end up uh competing with. Um it's important to also find a mentor early. This is not just for CST, this is um for uh comes with the job in general, uh find a mentor who can guide you both on a personal, a professional and an academic level. And when applying for CSD, when um gathering all the evidence and writing up the letters of evidence, make sure that you read the instructions in the website and the definitions, well, because they are quite specific and if you don't comply with the instructions, um you will get down marked. And also sometimes if they think that you have um deliberately mark yourself up in the self assessment, they might be um uh ban you from attending the interview. And I've II think there, there could also be more serious consequences like a GMC referral. So it's, it can be quite serious sometimes. Um So I've got these links here. I think I can share them in the chat. I'll try and find how to do that. Um, and in the meantime, I think that's the end of my presentation. So down there, there's my email. Um, if anyone would like to send me an email with any questions.