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Good evening doctors. Please let me know if the sound is clear. I'm going to start like within few seconds, just a confirmation in the chat box. If the sound is clear, the video is clear and the slides are visible as doctor has already confirmed that the slides are visible. Ok, perfect. So it's clear. So good evening everyone. Uh we are going to be starting our session today which is basically on teaching and LGBTQ. So in the group, one of the doctors actually mentioned that teaching is something that uh is not usually covered by a lot of lecturers initially when they prefer uh some sort of fresh courses or some sort of lectures in terms of the basic uh uh basic structure or basics about the pla two teaching is something that has always, that has always been ignored by all the co uh teachers. I'm not really sure why, but I'm going to give a basic idea about how teaching works. What are the things that we have to do and what are the things that we have to avoid in terms of teaching and how we have to structure because this is kind of different. I would say it can't be counted as a combined station because you might be having some sort of dummies inside the room, uh some sort of examination that you have to demonstrate to one of your juniors or it can be something else as well. So please make sure that whenever you enter the room, you take a quick glance as I have always, always, always say this thing and I would not, you know, stop myself from repeating this thing again and again, that you have to make sure you take a quick glance and you have to decide whether this is a combined station, whether it's a history taking station. But if it is a teaching station, the um a piece of paper that will be stuck on outside the door, it will be written over there that you have to teach the juniors. You have to make sure that you actually demonstrate the whole procedure to the person and please make sure you do not try to over teach one of the uh whether that's a student, whether that's a colleague, whoever it is. Um you know, it can be the patient's relative as well. Uh For example, if it's an EpiPen structure, you have to make sure that you do not try to explain things in a way uh that can be, that can sound a bit complicated to the person because he or she is not uh a medical person. So you have to explain things in layman terms. OK? To make sure that they are getting what you are trying to deliver to that person, right? Moving on to the next slide. So teaching, what is the basic structure of teaching? There are a few steps you have to follow in terms of teaching. OK. So the first thing when you enter the room is always you introduce yourself to the examiner. You give your name, your G MS registration number to the examiner and then you come back to one of your colleagues or maybe one of your uh patients relatives or it can be a medical student as well. So they might be there to learn a few things, right? So what you have to do is you, first of all, you introduce yourself, you cannot say that I am one of the doctors. You cannot say that you know, um I am one of your seniors or you can't really have that approach. So what you can do is you can say that, you know, I'm nomi, I'm one of your colleagues and I'm here to teach you uh whatever you want to learn. So I'm here to help you with that. OK. So this is how you introduce yourself in terms of teaching at first so that they don't feel like they are inferior or you are superior to them. OK? It's very, very important. OK? What is the next thing you do? You have to make sure you build up some sort of rapport with the person. So what is this thing? You try to communicate with that person first? You have to say that. OK, so what is the rotation that you are in currently? If it's one of your colleagues or if it's one of the medical students, you ask about their exams, you ask about their studies or you can ask about their work as well. But um uh is it, is it like, how is your ward going on? Have you, how many patients have you seen so far? And how is it going on so far? And is it your first year? Is it your uh third year or which year are you at or which department are you working in? So this is how you build a Rle and when the person says that, OK, you know what, it's kind of cool and you know, um kind of uh trying to cope up with all the situation and environment around me. So thank you so much doctor for asking me that. So this is how you build that rapper up so that you can have some sort of comfortable conversation after that. OK, you directly do not jump into the topic that you are supposed to teach. First of all, you build a sh a very beautiful rapper and then you start talking in a manner that you are there to help that person. OK. Right. What is the next thing? We do. The next thing is we appreciate that they have made or they have sorted some time to make sure that they can be there to learn. Ok. It's, you're not doing a favor by teaching that person. Right. They have also made up some time on their own out of their busy schedule. Maybe they are one of the busiest, uh, like, this is one of the busiest words they are working in or maybe they are in their final year, the final year medical students, they are very busy with the exams, right? But still they have made some time to make sure that they can be there to learn, right? You're not the only person who is helping, they are helping themselves as well. So what you do is you try to appreciate that they have made some time to help themselves, of course, but then of course you appreciate them to help, uh, uh, help building the conversation or help, um, uh, help you, uh, making things easier for them, right? So you try to appreciate that person that, ok, I really appreciate that you have made some time, uh, from your busy schedule. Uh, and, uh, you know what I'm going to try, I'm, I'm going to try my best to utilize the most of your time. Ok. So this is how the appreciation goes on right after you have appreciated that person. What you do is you offer some help or support as Well, ok, for example, if this is one of your colleagues or if this is one of the juniors, what you do is ok. Uh I can see that you uh you are working in this department or this might be one of the busiest wards. So if you need any sort of help in terms of, you know, seeing the patients or, and so in terms of anything, like maybe uh some sort of investigation, some sort of examination or whatever it is, just let us know we are here to help you, ok. So we are going to be there if you need any sort of help or if you think that your ward is short stuffed as well, we are always here to help you. So this is how you offer some sort of help or support because you have made up some time to teach them. Uh meanwhile, they might miss out on something very important. So when you offer that thing, they will be very comfortable to ask for some sort of help if they have missed out or on anything that uh you know, during when uh during they were learning the things, right? So this is the time to trying to teach the person and they might be missing out something. So this is how you offer the help or support in case they feel overwhelmed. Ok. So this is how it works, right? Safety netting. What is this thing? Ok. Safe trading. Is something that you have to make sure that. Ok, you know what, just in case, uh, I'm, I, you know, I work in a ward that I might be, I might get bleeped so I might have to get back to work. But you know what I can obviously and definitely arrange another session to make sure that you learn about this topic properly. Or you learn how to use this particular specimen very, very carefully or you learn how to complete the whole procedure, OK? It can be anything. There are a lot of teaching uh stations that might come up like it can be a speculum examination. It can be E CG, it can be about EpiPen. EpiPen is all about patients relatives. It's not really important that that's um uh one of your colleagues, but it can be um a cancer pathway. So how this pathway works. So you have to make sure that you assure the person that um even if we are short of time because what happens at the end is sometimes you cannot really finish talking about all you are supposed to talk about, right? So you have to give that safety netting uh at the very beginning of your teaching session that you know what you might get bleeped, which is basically the end of your time. So you can, you have to, you can say that this way that you know what I might get bleeped in between our teaching session, but we can definitely arrange a another one according to your convenience. And also please let me know if you feel like you haven't learned anything, I'll be there to help you. So this is how you safety net, the person that even if you miss out something, there will be another session that can be arranged very easily and I'll be there for you. Ok? So this is how you safety net and this is how you assure the person. OK. Right after we have talked about all these things, we have introduced yourself, we have built the W rer up, we have appreciated, we've offered the help and we have talked about the safety netting. What we do next is if the topic is about ECG, for example, we assess the knowledge first. OK? We don't really start teaching right away after we have built the rer we have to ask the person first that you know, um can you please tell me a little bit about ECG like how much do you know? Even if it's like the slightest amount, you can just tell me, how far do you know about the ECG? So that is how you assess the knowledge of the person that OK, this is the limit they know till OK. So this is how much they know about ECG. So I don't really have to waste time explaining about all those basic stuff they already know about. So what you have to do is we ask the person that ok, so, uh can you please tell me that, how much do you know about ECG basically? So they are going to talk about? Ok, you know what doctor, I know the basics, I know how to read these things. Um, I know about the ways as well. So, but the problem is I can't really count the heart rate in terms of ECG. So then you know that all of your focus has to be based on heart rate counting, right? You can't really waste time in terms of the basics. You, you don't have that much time, right? Teaching is a station where you have to make sure it seems like you are teaching things but you're not rushing. Ok. So that's how you do it. You have to make sure you assess the knowledge in terms of saving a lot of time in terms of all of the uh teaching that has to be focused on which topic. OK. So you take a lot of time in terms of heart rate counting, you focus on that particular specific topic uh rather than explaining all the things about ECG that student on that colleague might feel a bit overwhelmed if you talk about a lot of things altogether, right? So that's how it goes in terms of assessing the knowledge. OK. Once you know, uh you know about the as uh knowledge assessment, what we do is we talk about the patient's safety. Ok. Ok. How do you do it? Patient safety is not about, you know uh how many discharge you have done or how many patients you have seen? It's not about that, it's just about that. Ok. Um you have come to t uh to learn something, right? So can you please tell me that? Is there anything important that you have left in the middle of something? Ok. This is how you make sure that all the patients, especially in terms of the colleagues that they are uh working in the wards, they might leave one of the patients because they might feel that, OK, you know what I have to learn this thing. Um This is so much important to me even more important than patients. So they might feel that way. So this is how you make sure that there was uh the patient's safety is there and they have not left something very important in between their work just for the sake of learning this particular thing, whatever it is. OK? And this is how you double check with the patient's safety. OK. The last thing is I have already mentioned this thing though, but still I would like to repeat this. Do not over teach. OK. The key to not over teaching is basically the step um 23456. OK. Step six is the key to not over teach the person. OK, assess the knowledge, you know how much they know, you know, how far they understand about that topic. And then, you know, that this is the limitation of my teaching today. So I have to make sure that my teaching is limited within this circle. So I do not go out of this circle and I do not over teach, which is actually uh something very, you know, uncommon according to their level, it can be a second year student. OK. You are not supposed to teach them in uh something very complicated that is supposed to be, you know, um learned by someone at a very senior level. So please make sure you do not over teach then no, your knowledge is not something you have to deliver. Ok. This station is all about how you teach. This station has nothing to do about how much do you know? Ok, please keep that in mind. So make sure you do not over teach that student or colleague or whoever the person is. Ok. And I have written something very important at the right side of my slide that please make sure you keep assessing the understanding of that person in every step of the teaching. OK. The moment you start teaching a particular topic after every like uh like I would say two or three sentences, please make sure that you ask the person that am I making this clear enough to you? Are you getting my point or are you being able to understand what I'm trying to teach in a very nice way. Ok, please make sure you keep assessing the understanding of the person. Otherwise, what happens is when you start practicing initially, um, because we have practiced so many history taking stations that it's always on our mind that we have to reach till the end of the station. Teaching does not work this way. Ok? You have to make sure that when you talk about a particular topic, you give pauses, pause in between the topic and you keep assessing how much they are getting the topic, how much they are understanding about what's going on here. So that they also do not feel overwhelmed. Ok, for example, um B LS basic life support with a dummy in front of you. This is a topic where actually there are a lot of steps. Ok? It's not very complicated. Once you read the notes, you will actually understand what, what will be uh, in there. So what happens in there is when you try to teach that thing, step by step after three or four steps, if you do not check the understanding of the person, they might get lost, even I myself would get lost. So this is very important. If you do not check the understanding, they wouldn't be, sometimes they won't be saying that, you know what doctor, um, can you please repeat that thing? They will be feeling shy, might, they might feel shy, they might feel embarrassed they might feel reluctant to ask about certain topics. They might feel dumb out of themselves. They might feel like, ok, uh if I ask the doctor, they might feel like I am such a dumb person. So sometimes they might feel this way. So please make sure you keep assessing the understanding of the person every now and then. Ok, and at the very end of the teaching session, you, if you have enough time, what you can do is you can ask the person a few questions like every here and there, like the things that you have taught that day, you can ask a few questions about a few of those things, like just to make sure that they have learned enough to be on the safe side. OK, for example, we are done with the basic Life support station. OK? At the end, what you can do is because uh this was one of my station in my lap two exam. So there was uh one of the medical students and she was very young and this was a basic life support station. So what I did is I actually made sure that I uh completed, completed that station uh like within 6.5 minutes. And then I had enough time to ask the person to demonstrate what I have just taught her. So what she did is she started doing the things that I just taught her. And at some point when she was supposed to give CPR, she was bending her elbows, which was intentional. Ok. They are, they are actually, um, you know, um, taught that way that you have to make some mistakes so that, uh, we can see whether the candidates can, you know, pick the mistakes up. So what she did is she bended her elbows while giving the CPR. So I had this opportunity to correct her. I said that, you know what you are doing amazing. But you know what um when you are giving CPR, you can't really bend your elbows. It has to be straight like a stick. So please make sure when you are giving CPR your, both of your hands are straight this way. So this is how I try to make sure that this is just not a one way teaching. It's a two way conversation or two way communication is there OK. So this is how we make sure that they are learning, you are teaching and this is going in a very nice way. OK. Right. Any questions so far, OK. I think we can move on to the next slide then. So this is all about teaching. Uh just make sure that you keep smiling throughout the station. And um um this is a very big myth. I would say that people don't really get enough marks in terms of teaching. But um I know a few colleagues of mine who already started working in the NHS and they have been working for um for like many years I would say. So there are a lot of teaching stations or teaching sessions that uh that actually, uh you know, takes place every now and then. So what they have observed is in the UK, I'm not sure about uh what happens in like back home in your countries. But in my country, what happened, what used to happen is we used to get criticized a lot. So what happened is what used to happen is the teachers used to be there and they would be like, even if we make the slightest mistake, they used to be like, ok, you know what, this is not how you do it, no matter how many good things you have done, all of these things get ignored and they only focus on the mistake that you have made. So what happens in our country is they actually focus on your mistakes rather than appreciating enough what you have learned. Ok. In the UK, it's completely opposite. You have to make sure you keep appreciating the person again and again. Ok, even if it's the slightest reputation that they have made, for example, if you ask the person, ok, you know what, um, this is how it goes on. So can you please repeat that thing for me or how much do you know about this thing so far? Even if they say the slightest amount of basic things, you have to appreciate like he, they have said something amazing. So this is how it goes, you have to say that, you know what this it is amazing and I really appreciate that, you know, this thing, but you know what I'm going to teach you a little bit more so that you can be a really good doctor in the future. So this is how you appreciate. This is how you inspire. So you have to be positive throughout the teaching station. OK? They do not like criticism. This is how um I think a lot of people have said that they mark the candidates. So um it's better to keep that little thing in mind that you keep appreciating, keep uh supporting and keep, you know, praising the person that wow, amazing. You have done. Amazing. So have that attitude in your behavior. It's a good practice in the UK, right? So we are done with teaching. We are moving on to the next slide LGBTQ. OK. This is a topic which is I wouldn't say complicated. A lot of people find this topic a bit complicated because of the variations. But uh my main goal is to make sure that I can simplify all the variations in terms of this topic so that we don't get confused that much. OK. Right. So what is the full form of LGB DQ plus? OK. L stands for lesbian, G stands for gay B, stands for bisexual, T stands for trance, Q stands for questioning or queer and plus is something else or other than that, if there is, there are some other varieties as well. OK. If like, I think uh we already are pretty much familiar with these terms, but still, if anyone is not, you can just leave a chat, uh leave a comment in the chat box, I can explain that. But since this is a very basic thing, I'm not going to explain in details what these things are and what these things mean. OK. All right. The person comes up to you with some sort of problems related to LGBTQ plus topic. OK? You cannot say that I am sorry you are feeling this way in terms of other history taking stations. What we used to do is we used to say that I'm really sorry that you're going through this. I'm really sorry that you are having this pain. I'm really sorry that you have been feeling um depressed for a very long time, but this person is going to portray her or his problems like this is some sort of severe sadness they are going through or this, they might sound like they are depressed but you, you cannot be tricked by this thing. You cannot say that I'm sorry you are feeling this way. The reason is this is not a condition, ok? This is not a disease, this is them, this is very normal, this is very, very, you know, not an uncommon thing. This is a very common thing. OK? So you cannot say I am sorry that you are feeling this way because this is not a feeling. This is how and what they are OK? Like a normal person, like you can't really make them feel that this is not normal. This is absolutely normal. So please make sure you do not use this phrase. I'm sorry that you are feeling this way or I'm sorry that you are going through this. This is not a phase. You can't really act the way that this is a face. This is just what they are. OK. That's it. So please make sure you keep a note of it, right? OK. So sometimes we actually get confused between these two terms. Uh One is homosexual person and the other one is transgender. So I think this is pretty much common. I would say some people I used to practice with a few people who didn't even know what is the difference between these two terms. So this might sound or look a bit silly that I'm explaining the difference between these two terms. But still, I just want to make sure that if, if you do not understand and you don't want to speak about it, I explain the difference between these two things because when I used to practice, there were like uncountable people who didn't know the difference. OK. Trust me, I'm not even exaggerating. OK, so OK, what is the difference between a person who is a homosexual person and a person who is a transgender person. Ok. When it comes to the homosexuality, the person is actually not having problem with their gender. This has nothing to do with their own gender. They are perfectly fine with the body they are born into, ok. They have no confusion about their own self. It's just the preferences that they are confused or maybe they are sure about, ok, there can be a pre who might say that, you know what I'm feeling this way. I'm confused at why I'm having feelings for a boy. Me being a boy myself, ok? They might be confused or they can be sure as well where they might come. Ok? You know what I'm a person who I'm, I'm a girl and I have feelings for a girl in my class and you know what I get bullied because of this thing. Ok? There is a person who's a bit confused. There is a person who is pretty much sure about their homosexuality. So homosexuality is basically the person's sexual preferences. So this basically reference to the gender you are attracted to, ok? Nothing to do with the your own gender or the person's own gender. It's just the reference to the gender that the person is attracted to. Ok. Right. What is a per a person who is a transgender? They actually feel that they were born in the wrong gender? OK. Ok. They're biologically a boy men. They are men but they're feeling like they are women. Ok. They are, they feel like they are trapped inside a body of a man. But inside they feel like they are women. So they don't like their voices. They don't like their hair, they don't like their masculinity. They don't really like how they are. So what they do is at some point they try to make changes in their gender or their appearances. OK. So make sure you know the difference between these two terms, a very common and basic thing and a very common and basic mistake people make at. Ok. Ok. So please be careful. OK. Right. In terms of person with a person with LGBTQ problems, you always always have to make sure that you ask about these things, ok? You can note it down or you can say or you can take a screenshot, but please make sure that uh you ask about all of these things when it comes to the person who is, who has something to do with the LGBTQ, OK? It can be homosexuality, it can be a transgender person, it can be gender dysphoria as well. So please make sure you start the questions by asking about the person's mood, ok? Because there is some sort of changes that they are going through or this is very uncommon that they might be feeling, this is something, this might be something new to them or they might get bullied of a bullied because of something they are feeling ok, they might be teenagers as well. So please make sure that you ask about the mood of the person like ok, um uh you know what, uh I can totally see that you are go, you are uh having some sort of sadness because of this and what you are going through is really bad because bullying is something we do not allow in this country or there are some, you know, rules against bullying in this country and schools as well. So um can you please tell me that how has your mood been these days? Uh And then you can ask about the mood scale as well, like out of 1 to 10, 1 being the saddest and 10 being the happiest. Can you please rate your mood out of 1 to 10? So please make sure you mention about the mood first. Ok, second thing that we have to make sure we ask about is drugs or alcohol. Ok? Because of all the things that has been going through in their life, there is a high chance that they might get involved in drugs or alcohol. So that's a very important thing you have to ask them about like, ok, so this is a sensitive issue. As in my previous sessions, I have already mentioned that whenever this is a sensitive issue, like drugs or alcohol or um suicide, please make sure you, um, safety net first. Ok. There should be a heads up before you mention these things straight away and also make sure that you, um, give an example of a third person in terms of the sensitive issues, like you can say that, ok, you know what, sometimes when people go through this sort of, um, um, you know, these sort of feelings or this sort of condition in their life and they feel a bit low like the way you are feeling, um they might get involved in some sort of, you know, um alcohol or some sort of addiction in terms of drugs. Is this something that you have come from so far? So please make sure you a third person and make an example of an a completely different person rather than asking them directly that are you involved in drugs because of this? So this is triggering, you can't really do that. Ok. Ok. The next thing comes up is bullying, ok. This is a very common thing I would say uh in a lot of stations, if you have read the notes, you can um notice that whenever it comes to a teenager in a school or in a college or high school, whatever it is, they actually get bullied because of their sexuality because they don't really know about that thing that this is very common. This is completely common, not very common, this is a common thing in the UK or um, some other countries as well. So at a very early age when they see something different other than the regular things they start bullying. Ok. This also happens in our country as well. And in terms of some other things as well, whenever Children or teenagers see something that's a little bit unfamiliar, unfamiliar to them, they start bullying right away. Ok. So I used to get bullied a lot of times because of, um a lot of things like I used to be a nerd. Sometimes I was, I'm not a nerd anymore, trust me, but I used to be in my school life. So they used to make fun of that as well and I'm a single child. They used to make fun of that thing as well. So bullying is something that is um a very, you know, um easy and available scope people always look for. Ok, so they find a joy by bullying. So please make sure you talk about bullying in terms of LG CQ plus because the person is going through some phase, they're having a low mood and they might also get involved in some sort of drugs or alcohol because of this all of this situation. And on top of it, the Chry on top is the bullying of other students around them which actually makes everything worse. So make sure you talk about bullying, ask this thing and you come up with a solution at the end, it can be anything we can talk about the policies, we can talk about talking to the teachers or we can talk about reaching out to the parents anything it can be anything. Ok? All right. Don't just, and my point of saying this thing is don't do not just ask these things come up with a solution at the end, ok? It can be counseling can be anything just come up with a solution. Ok? We are not just asking for the sake of asking, right? The next thing is stress how much stressed they are because of all of this situation. OK? What happens sometimes is they are not being bullied. This is not something new to them but they already have a partner of their same gender. So what happens is they go through a lot of stressful situation in terms of family members. OK? What happens is one of the patients might come up and say that you know what um me and my boyfriend have mo moved into a separate house recently and my parents are not very happy, happy about it. So what we can say is OK? Is there any particular reason why they are not happy? So you act the way that this is not normal for them to act in a different way because this is normal to her or him and this is normal to you as well. And this is a normal thing in general. So you ask that OK? Is there any particular reason why they're not happy instead of saying that? Ok, I can see that you are gay and you have moved in with your boyfriend. So yeah, this is very normal for them to react this way. Now I can do that. You have to say that. Yes, I can see that you are upset and is there any reason why they are, you know, upset with you or your boyfriend? So then they can trust you and they can start talking about some other perspectives of their parents and themselves. So what they say is, you know what um doctor, thank you for appreciating. Um I have been uh I have moved in with my boyfriend recently and this is something my parents didn't know that I am not a straight person. So they have reacted very badly and they are now they do not talk to me and you know, this is also affecting my relationship with my boyfriend as well. Can you please tell me what to do? So this is a stressful situation, right? So please make sure whoever the person is you talk about the stress. Is there any stress that has been going on lately? Are you stressed currently? And how is your mood when you talk about the mood? The stress comes up on its own way? It makes its own way. OK, so, so then you talk about the stress immediately. You don't wait till you're talking. You have done talking about drugs or bullying or anything else. Whenever the stress things comes up, please make sure you elaborate and you talk in details about the stress. Ok, because this is something that actually puts a very significant impact in terms of the person's, you know, lifestyle. Ok. Right. The next thing is sexual history of the person. Ok. So please make sure you ask the person that are you sexually active? Ok. Because this can actually affect a lot of things. This can actually have effect on a lot of, uh, you know, um, uh, uh, habits of their life. So, and also, you know, sometimes a person can come up with some sort of problem that is actually very, not common in terms of LGBT people. But then when you mention that thing, you clear that thing up, that, you know what it is very common both in people, uh, who are straight and people who are not straight. So, uh, you can't really ignore this thing even if you are not straight. Ok. So sexual history very important, right? And the last thing that we have to talk about is the support system. Ok. How do we talk about the support system, family, friends, relatives. And if the person is really lonely and if the person is actually getting abandoned by their families and their, their friends have stopped talking to them. And there are a lot of people who don't really want to get along. With them anymore because just because they have found out that the person is not straight anymore, they might feel lonely. So then is the time when you actually talk about some other support groups as well. So there are a lot of support groups who actually, which actually have members of the similar situation. So they can join the group and they can discuss and talk about their own problems, share their problems and have actually, they can actually make some good friends in the group as well. So please make sure you ask about the support system and if they do not have support from their family, friends or relatives, you talk about these support groups as well. OK. That is very important in terms of these people. OK. Any questions so far? Ok. So we can move on to the next slide. Then right, there is a term when the person comes up with some sort of gender dysphoria. OK. How do we recognize these people? This is basically a sense of some sort of, you know, uh feeling uncomfortable because of a feeling that, you know, that the person is not in their, in the, in the, you know, form of what they are supposed to be in. Ok, a female, she thinks that she is not a female and uh she is more comfortable in men's clothes. And sometimes, you know, when she goes to the gym, she actually likes making muscles, ok? Rather than you know, um working out on some other aspects as the women should usually be wanting. So what she feels like is there is some sort of mismatch between their biological sex, which is basically uh women, a woman that she is and their gender identity that she would like to get introduced with. OK, for example, if a person is very young, ok, she is a teenager but she is not really sure that whether she's comfortable in her own body or not. OK. This is what we call gender dysphoria, but there is a but she is very young. Gender dysphoria is something we cannot confirm at a very early age. We have to wait till she actually gets developed physically and mentally. And then we can come to the point come to the decision that whether this is an actual gender dysphoria or this was just a phase. OK. So there are a few things that we can talk about in terms of gender dysphoria, whether to be sure or whether to be not to be sure. OK. So what happens is in terms of gender dysphoria, we can actually talk about referring the person to a certain department. OK. So what happens in gender dysphoria is if the person is less than 18 years old and we know that this is a gender dysphoria uh uh case, what we do is we have to uh ask that. OK. So is this something that is uh you feel uh you are feeling recently and or this is something that's just, you know, that has been going on for a very long time normal acid card. Well, no, that, that no apologies. These sessions are going to get recorded. You can also watch uh at your spare time as well. Um uh Doctor Noa has an actual means. Organic, actual means organic. I'm not sure what you're talking about. Uh Doctor Noa, can you please elaborate a little bit so that I can explain that thing, right? So what, what was that? OK. So person is less than 18 years old and she or he is confused about their gender and they are talking about OK. Doctor, you know what um I feel I'm not really comfortable in my own body. I'm not a female. I think I'm more comfortable in a in made clothes which my parents hate and you know what? I try to keep my hair short and it's not something that I'm very, you know, um comfortable with. Do you think something is wrong with me? OK. What is the first step that we have already talked about in terms of LGBTQ? Plus, we do not say that this is a condition. We do not say that you uh something is wrong with you and I'm really sorry that you are going through this. Please forget about these terms when it comes to an A person with N GPT Q issues. So what we do is. Ok. Yes, I can see that, you know, you're feeling uncomfortable but if we are not sure about the, you know, gender dysphoria thing and if the person is less than 18 years old, we can refer the person to well, gender identity and Development clinic. If you have to write it down, please write it down because this is the exact words you have to say in terms of referring the person. OK, if the person is less than 18 years old, OK. But there is again about if we cannot refer that person immediately, we can actually refer that person to some other place. Meanwhile, they'll be waiting to get referred to the Gender Identity and Development clinic because there is a long queue. Sometimes it takes a lot of times, maybe five months, maybe six months. So they are not really that much patient to wait until they get an appointment to be referred to the gender identity and Development clinic or what happened. What might happen between these five or six months is they might actually feel that, ok, this was just a phase. Now, I feel much better and I think this is not something I feel anymore. I am a female and I want to stay this way. So what they do is while they will be waiting for getting referred to gender identity and Development clinic. Meanwhile, we can refer to them to some other place which is actually what we call Children and young people mental health clinic because the access is easier, the axis is faster. OK? We are only talking about the people who are actually younger than 18 years old. OK. What happens in terms of people who are older than 18 years old? OK. What we do is if we are confirmed that this is a gender dysphoria situation, we have to refer the person in gender dysphoria clinic. But again, there is a lot of time a a long queue might be there. It might take five or six months or maybe more than that. So what we do meanwhile is we refer that person to a counselor so that they can go through some sort of counseling before they get referred to the gender dysphoria clinic. OK? Because we can't really make that person stay at their home just for the sake of waiting to get referred to gender dysphoria clinic. OK. So that uh we can refer to that person to the counselor and they can get some help. Meanwhile, they are waiting to get referred to Gender dysphoria clinic. I know this sounds a bit complicated and it sounds a bit confusing sometimes. So please make sure you if you are confused about these referral systems, um You leave a message in the chat box so that if needed, I can explain this thing again. OK. Right. Any questions so far, right. OK. I can see some people have joined a bit later. So I would like to repeat this thing again, just to make sure that you don't get confused. Less than 18 years old, the person is having some sort of dysphoria. We refer the person to gender identity and development, but it can take as long as 5 to 6 months. So meanwhile, we refer to them, refer them to a certain place called Children and young people Mental health clinic. This is only in terms of less than 18 year old people. Ok? And if the person is more than 18 year old, we refer that person to gender dysphoria clinic. But again, it can take a little bit long to get referred to that uh space, that place. So meanwhile, we refer that person to a counselor so that they can have some talk. Meanwhile, they are waiting to get referred to the actual gender dysphoria clinic because you never know their mental health might get worse or they might feel in a different way. Meanwhile, we're w they are waiting for uh they are waiting for it to get referred to the actual place. Ok. So this is, this is the purpose of referring them to a certain space. Meanwhile, they are waiting to get referred to us at the the actual place where uh you know, they actually get treated basically physically, mentally or whichever treatment is needed, they get treated. But the counselor and the Children and young people in mental health clinic is only for the sake of their mental health so that they can talk, they can share, they can actually get counseled or they can actually, um, like, basically talk about anything. It is all about talk, talking like a CBD session. It's all about their mental health. It's nothing to do with their physical health. Ok. Right. Any questions so far? Ok. No, Hasan doc doctor. No, Hasan. Are you um, yes, you can explain it again. Are you clear so far or am I making some sense in terms of the referral system? I repeated that thing. If um you are getting what I'm trying to say, please make sure you, you know, leave a chat in the chat box that this is kind of clear. OK. If we are done with the the gender dysphoria referral system, I'm moving on to the next slide then. Ok. Uh This is a very important station in terms of LGBTQ plus stations. So what happens is this is just one station but a very common station. Um At least when I was uh preparing myself for my PAP exam, this was a very common station that I used to notice every now and then in the recalls. So what happens in this station is a lesbian couple comes up, they show up and they ask you that, you know what we want a baby. So what are our options? Ok, definitely they are lesbians. They can't really uh conceive on their own. So what we do is I have made uh these boxes just to make sure that you guys do not feel confused about the things that I used to feel confused about because this is something a little bit tricky and a little bit uh I wouldn't say complicated, but you have to really understand to make sure that you know, you are offering the appropriate solution to the person. OK? You ask three questions to the person. The first question is, do you want the baby genetically related to you? Ok. It can be either yes, it can be either or no. So you know the answers, it can be uh like the person might say that you know what doctor I want this baby to be genetically related to me. Ok? What do I do? We are lesbian couples so we can't really conceive on our own. So please help us with this. So what you have to do is you have to say that yes, there are options if you want the baby to be related genetically. So the only option is donor insemination. So what we do is we can get a donor, it can be one of your friends maybe or it can be an anonymous person as well if you want to keep that, you know, anonymous, that is also an option. But we do have a person who will be donating their sperm and we will be having some sort of you know uh in vitro fertilization or what we can do is we can inject the sperm directly into your womb and you will be able to get pregnant with the baby. And this is how it works. So we get a donor, we inject the sperm inside you and you grow the baby, you have the baby as well. And this is how the baby is genetically related to you because the baby has your OV. OK. You have fertilized that baby. So that is related to you might not be related to your partner. But yes, there is some sort of genetical relationship. OK. This is how we offer in terms of um if the person asks that, uh can I get the baby if uh is, is there a way to uh for the baby to be genetically related to me? Ok. Right. Another question. Do you want the baby genetically related? But is there any way you don't want to get pregnant? Ok. There is a solution to that thing as well. What happens is what we can do is we can fertilize the ovum injected into some other woman. OK. It's not uh necessarily has to be your, it does not have to be your womb. It can be some other women's womb so that they can grow the baby inside them and when they deliver the baby, they do not have any parental, right? And the baby comes to you and you have the parental rights legally without doing anything. OK? But that's how the surrogacy works. OK? We fertilize the ovum. Of course, there's, there has to be some sperm, we fertilize the ovum and then we inject that into the womb of some other woman. OK? But the ovum is yours. Of course, we do this thing outside your womb, but the sperm is someone else's, the ovum is yours. But we do the fertilization in some other woman's womb. Ok? I hope I'm making enough sense to clear this thing, right? This is the second option they can have if the person wants the baby to be genetically related but no pregnancy. They, they do not want to get pregnant, neither of them. Ok? Right. The next thing is the person says, you know what, I don't want the baby to be related genetically. I just want a baby. That's it. I just want to raise a baby. We both do. Ok? So what is the third option? The easiest option is adoption. Ok. You adopt the child and you become the legal parents of the of the baby. Ok. The second option is foster, fostering the baby. Ok? What happens in fostering? You are the the baby's foster parents but you do not have the entire right legally as parents to that baby. Ok? You are just being the foster parents, you're taking care of the baby for the time being and you know the parents get, get changed after every while. So you are taking care of a certain child for a time being. And what you can do is you can take care of the child as long as you want, but you have to change the rights at some point. You don't have the lifetime rights legally on that child or baby. Ok. And the third option for not uh wanting the um genetically uh genetical relationship is co parenting. OK. What happens is coparenting is you are you are talking to the per patient, of course not the patient, the person you are talking to the couple basically. So you say that you what you can do go for is you can do coparenting. So you are one of the parents of that baby and there are some other parents as well. So there are like four people taking care of the same baby or maybe the same twins. OK? Or maybe the same siblings. So what happens here is you are just one of the parents, you both are taking care of the parents but f you only have 50% of right legally on that child and the other 50% legal rights are taken care of by some other couple. OK? So you are taking care of that child or baby combinedly. OK? You are not the sole parents. OK? This is how it works. So what are the options, adoption, fostering and coparenting these are the easiest options without even talking about the you know, um, um, donor insemination without having the surrogacy issues or without even having some sort of, uh, you know, um, problems with conceiving as well. So this is the easier options, be easier basically. But sometimes people actually talk about the genetical relationship so they want to get pregnant or they might not get one to,, get pregnant, but they want some sort of blood relationship to that child. So that's when you have to make sure that you are delivering the information um in the clearest way possible because thi this is something that sounds a bit easier for us, but to the patient or for a person who is not a medical person, it can sound a bit complicated. So you have to make sure that you don't only use the medical terms. You have to explain the terms in um the layman terms as well. Basically. So we, we can't say uterus, we, we have to say womb. OK, so that they also understand that what is supposed to happen with them. OK. So this is how the lesbian conception station goes on. This is one of the uh topics of LGBTQ plus and one of the most important I would say, OK, any questions so far? All right. So today we have talked about uh teaching and LGBTQ plus. So let me just summarize a few things in terms of teaching. We have to make sure that we introduce ourselves not as a doctor as one of the colleagues, maybe, sometimes we can say that I'm no. And I'm here to help you with this, this and this and uh the second thing is ro build up, we have to make sure we have enough uh rer with that person so that things get a bit lighter and it doesn't only seem like a teacher, student relationship. OK. The next thing is we have to make sure that we have to keep appreciating the person again and again, we have to, uh keep, basically, I would say, literally applauding the person again and again, that you have done a very good job and avoid criticizing, of course, in the UK, they like it when they, you appreciate the students or appreciate the colleagues as much as you can, even if this is the slightest appreciation, even if they have said the slightest and the most basic things. OK. Right. Uh In between the teaching sessions, you have to make sure you keep assessing their knowledge as well, like how far they have learned so far. So that's one thing and make sure that you do not over teach. OK. That's one thing. And we have talked about LGBTQ plus today. Um to summarize this thing, I would say that, you know, um there are some basic difference between transgender and a homosexual person. So homosexual is a person, uh who has something which has something to do with their, you know, sexual preferences. And the transgender is a person who is a bit confused about their own gender. They feel trapped inside someone else's body. This is how they actually feel like literally they feel this way. Oh, this is terrible. I know. Ok. And in terms of gender dysphoria, please make sure that you talk about the referral system according to their ages. If the person is 16 years old, you have to make sure you talk about the gender identity and development clinic. And meanwhile, they're waiting for that, you have to talk about the Children and young people mental health clinic. OK. So that their mental health can be taken care of within that period of waiting time. OK? And if the person is more than 18 years old, for example, 21 50 60 whatever the age is, make sure you talk about the gender dysphoria clinic. And meanwhile, there should be a counselor who has to take care of their mental health again. OK. Right. Any questions doctor Nosa Hasan, you make it very clear. Thank you very much. It means a lot to me because this is something that is um I used to find it very confusing at uh initially when I started preparing, there were a lot of terms like, you know, gender identity and develop development clinic, gender dysphoria clinic and you know, um counselors. So when to refer that person, where, where should we refer that person? And what is the place that they should be referred to at the very first place. And what is the task of the counselor? So I just try to make sure that, you know, you don't get confused in terms of these words and places, any questions. And if anybody wants to practice any of the sessions with me, they can also mention um willing to practice one or two stations with any of you. Only if you are interested. Doctor Nosa Hasan. Thank you very much. I didn't know half of these terms. Neither did I when I started practicing. Uh I actually came to know about these terms. Um I would say one month before my exam because these are the topics that I actually started preparing um at the second half of my preparation uh preparation period. So I started with uh history taking stations. I started my preparation with um the counseling stations and what I left for the end, which is a big mistake. I would say, please make sure you actually have a good idea about all of the things you don't have to go through all the topics in details, but at least have some sort of idea about what the stations are about. So, excuse me the most, I mean, I would say the biggest mistake that I did is I spent two months just reading the notes of history taking stations, which is I would, it was something I would never suggest to anybody, you know, to no candidates. So then after two months, I was left with like one month and I was like, ok, uh I have so many things to do. I have so many things to understand. There is ethics that is breaking bad news. There is of course the practical stations, I have to go to the academy and I have to learn semen, I have to learn procedures. I have to learn teaching, I have to learn N GBT Q plus. So because in the notes, the N GBT Q stations seem very small and they seem very few in numbers. So what we do is we ignored them. What we feel like is OK, there is plenty of time. I II think five days is enough for it to be honest for each of the categories. One month is necessary to understand the concept, the basic things of thing like the topics. It is very necessary that you actually keep practicing. You don't really, you know, limit these things to certain sort of topics. If today you are practicing history taking stations, please try to make sure that you at least have two or three ethics stations as well. If you are practicing teaching stations tomorrow, please make sure that you at least have two or three breaking bad news or maybe uh the non accidental injury cases in terms of your practicing so that you have, um you know, you have practiced enough in terms of all sort of unexpected situations because in the exam, this is not supposed to be just the way it is written in the notes, it can be anything. So please make sure you prepare yourselves how by practicing a lot. Ok. So if nobody wants to practice today, uh I think we can call it a day and if nobody has any questions and nobody wants to practice any MS um I am supposed to end the session then. Ok. Thank you very much doctor we have joined and thank you very much for watching whoever is supposed to watch the recorded sessions. It was a pleasure teaching these stations and we have one last day tomorrow and it will be held at the same time six pmu K time. And I hope to see you all tomorrow at our very uh last session. So take care and uh have a very good evening ahead. Bye bye.