Day in the life of a Urology Consultant
Summary
This webinar hosted by two people from Aberdeen is a perfect opportunity for medical professionals to explore the specialty of urology and learn how to get into urology training. From learning the rewards of this field to understanding what tasks are involved, gain insight on all aspects of of this work and how to proceed with your application for neurology training. Learn what's expected of your portfolio, presentation, publications and management when you apply, plus gain tips on how to utilize your resources and put your best foot forward.
Learning objectives
Learning Objectives for the Teaching Session:
- Explain the two pathways of Neurology training in Scotland and England.
- Demonstrate how to score points for the portfolio in a Neurology training program.
- Identify techniques for creating a successful portfolio for Neurology training.
- Describe the technologies involved in Neurology operations and how to use them.
- Illustrate ways of balancing personal interests and Neurology career development.
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Computer generated transcript
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
Okay, so that's a slide right now. Are you both okay? We just give it another couple of minutes for everyone to join, and then we can go ahead and start. Sure. All right. That's fine. I'll just give it two more minutes. Right. Okay. So thank you, everyone, for joining us again today for another one of our neurology series Webinars. So today we have a special session, Um, joined by two people from Aberdeen who have kindly joined us today, and they're going to be talking about the more practical aspect of the specialty of urology. So, um, today Gianluca is going to start talking about how to get into urology training, and then it's going to be followed by a discussion about what it's like to be the urologist and what sort of things you're likely to get down to doing as a urology consultant. So I'm going to go ahead and hand over to Gianluca now. Great. Thank you, Zack. So lovely to meet you and my name's channel cameras. Come one of the neurology trainees in Aberdeen currently on S t four. And as I mentioned, I'm going to talk to you about, you know, the specialty training and how this is changing and some in some tips on how to do well in your interviews and school points on your applications. I wanted to start off by giving a brief introduction as to why I genealogy and the list is never ending, I would say, But primarily I like operating. There are days where I like doing minor procedures quick, you know, effective, done and dusted. Everyone's happy. Everyone goes home that same day, and there are other days where major surgery, which is what most surgeons have a very special calling for, um, take place So nephrectomies cystectomies prostectomy. These are all major procedures. Which brings you nice for a second point in neurology. We have a vast array of technology and new equipment, and it's a very expanding field of robotics. Uh, laser, uh, new technologies. Such a low dose for benign prostatic hyperplasia resume urolift. The list is never ending, really. And, of course, traditional laparoscopy and cystoscopy alongside open surgery, which is the mainstay of what being a surgeon is all about another important point. And I think a very important factor for my choice of Korea is the work life balance, particularly if you're a very family oriented person or you have other interests outside of surgery such as academia. Or if you have an interest in private work, then the career the neurology, even from it's early days as a cold, rainy or registrar allows you that little extra time to do those activities on the side. Which, to be fair, are also part of, you know, developing your career, your career as a surgeon so moving on to how to get into urology training. Uh, there are two pathways in Scotland and unfortunately, only one in England this year I'll start off by mentioning the improving surgical training pilot, which is still ongoing in Scotland. And that is entry at ST One level from my current understanding that is one post on the east of Scotland and 11 post on the West this year. And I'm sure you all know portion there are no I ST posts in England, but nonetheless, there is still the S T three and three root, which means you need to interview for course surgical training to start off with your first two years, which are as I'm sure you will you will know Quite varied. You do a bit of urology, but you also need to do a bit of junk surgery and potentially one or two other specialties. And then the interview for your ST three post so very briefly For those of you who are interested in the I s T project and are keen on pursuing training in Scotland, there is an entry level fst one and the training continues all the way to the end of ST seven. Um, there are, of course, weight points. There are check points from a portfolio perspective from an assessment perspective which you will need to achieve in order to progress. But these are seldomly different to what you would see in other specialties such as orthopedics for neurosurgery who have been doing run through for quite some time. As mentioned, there are no I see 20 posts in England. Unfortunately, hopefully this will change, and I already I already alluded to, uh, two posts in Scotland this year. So let's talk about portfolio, which I think is what people worry about the most, and perhaps needlessly so, particularly because the the guidelines on how to achieve a good score are always really available, and that link at the bottom of that slide is should lead you to what is expected or what the scoring system for your portfolios are. As of this year, here's a brief summary of the points and how these are divided. Obviously, some of you in the foundations have done their MRCS. Most of you most likely would have done that part. A few of you, almost like you've done that part, B. Of course, those of you in court training will have done that part B in preparation for your S t three interviews. So depending on which part you've done, you get points allocated maximum four surgical courses, and these are non specific courses such as basic surgical skills, course skills and neurology, advanced trauma, life support. They all count towards this section. And I believe, um, each course scores up to one point. So four courses and you're full points in that section as well. Surgical experience relates to taste the weeks which are usually done in the foundation whereby you attend department in our case, urology for a week, the shadow registrars and consultants on the day to day activities attend theater and keep a log book, as well as evidence of reflection, which also comes into the next section. Surgical Taster and Reflection. So these two sections combines a surgical logbook, surgical taste a week and reflection. Carry six points, which are extremely easy to achieve, provided you are organized from from the staff. Similarly, for those of you who are still in medical school, a surgical elective ideally in a foreign country, although this year there will be a bit more lenient. Given the Cove ID situation, which reflection of activities undertaken during that elected can score, you're a maximum of three points. Presentations and publications go hand in hand, and I'll come back to this shortly. But speaking to registrars, the consultants within the relevant departments can easily get you involved with a project, which, as a minimum nine times out of 10, will lead to a presentation at A at a national or international conference. Publications are a bit of a more long term commitment, but certainly over the last year I had to have a foundation doctor and the C D f Together. We came up with two publications and we are working on a on a third one, which is going to be quite a big one. So it's not impossible to do before your interviews on the right hand side post graduate degree. If you have this, you have this. If you don't, it's not a big deal. Most candidates will not have a post graduate degree, Um, so I wouldn't really stress too much about this. But by post graduate degrees remain M. S, C S and PhDs prizes anytime from medical school through the foundation and core training, all prices count and all. To get prizes, you have to do extra work and to present your extra work, usually at conferences or within a medical school or foundation training, setting, quality improvement and audit. And the presentation of this, as you can see, carries a significant amount of marks. And these go hand in hand with presentations and publications because, let's face it, if you come up with a really good quality improvement project or an audit, which can be reproduced across other departments or within other hospitals, and that is something which will be easily accepted for a presentation, scoring you points for that section presented potentially at a national or International Conference, which will score your points in the presentation section. And also I did this in my foundation, um published my quality improvement project in the BMJ, which again scored an exquisite amount of points in the publication section. So it's all about what I'm trying to say is it's all about being smart and choosing projects that will give you marks in more than one section as highlighted teaching experience. I mean exactly scoring millions of points in this, you know, is organized a good course. He's brought in speakers from various specialties, got various topics so showing that you are engaging in that kind of teaching that you have feedback from those who are delivering teaching, too, and also making a habit of teaching and obtaining feedback will score you a good chunk of points in your portfolio as well. From a personal perspective, I organized a very simple regional, uh, teaching course essentially once a week, for I think it was 12 weeks. So we had 12 sessions, one from from each specialty surgical, and also included are anaesthetic colleagues, um, and some of our medical colleagues who deal with peri operative optimization. For example, the geriatricians on the orthopedic wards, Um, or the renal physicians and the Urology Awards who help with optimizing patients post pre and post operatively. And I displayed this in my portfolio. I asked my, um, educational supervisor to just write a short letter explaining what I had done and, um, making it official essentially. And that's called me quite a lot of points in that section as well. The next one is training in Beijing. The way to score points of this is to go to training the trainers course it's it costs 600 lbs. It's usually done in London, although Edinburgh, I believe, run the course once in a while as well. Um, this is not an answer, by the way, but unfortunately from a real life perspective. Unless you have a post graduate degree, such as a PG set in medical education, in order to score points in that section, you need to sit that course or show that you've attended a similar course, which is validated by a recognized institution. Finally, the last section is leadership and management, and this is a very broad and very genetic section, which is very often rated based on personal reflection or references obtains during activities done in the hospital. For example, in my case, having organized and lead that teaching course for those 12 weeks also counted towards showing leadership and showing people management and time management in balancing my work, as well as my extracurricular activities such as that training course. But leadership can be assessed in other ways as well. From your make. Full use of your portfolio is both in medical school, in the foundation and also in core training. Um, so if you have, let's say a good uh, tabs or good feedback or good multi source feedback forms from trainers or peers, make sure you print those out and add them to your portfolio because you know, the Examiner's and people on the panels are there to give you marks. I think that's one very important thing that everyone should keep in mind. Use what you have to your advantage. Print it out, put it in a nice bound folder. My one still lives on my bookshelf, hidden away preserved, I should say, for future use and keep it up to date as you go. One thing people tend to do. Unfortunately, it's a lot of stress and panic is. Leave everything last minute and print everything out, and suddenly your printer is not working or you can't find that certificate your email people. But it takes ages to get these things through, so just start slowly. Everything you do document reflect on, if possible, get someone to validate and put into a folder. So by the time of your interviews, you obviously have everything there to score your points. And needless to say, you guys said they are interested in neurology. So remember to make your portfolio urology team, particularly if you are applying for the I see for the urinary training. It's not as important, for course surgical training, but it's you definitely have to show commitment to surgery and the willingness to go the extra mile to be the surgeon you want to be. Surgery is a very interesting, uh, specialty in the sense that it's an apprenticeship. You learn a lot on the job. You learn a lot by staying late. You learn a lot by using your free time to go the extra mile. Um, you know, if you're in the theater and it's something that you've never done, try to get involved. If you're in theater and it's something you have seen or you've done a million times and perhaps there are time pressures, then use that time to either get swollen or if you can't scrub in. Then why in theater not to the South, of course. Do something extra on the site. Read the paper and do some data collection. Just get your projects going. Make good use of the eight hours you are at work for 12 hours where it is, or if your med school if you have a free period between nine and 10. Yes, you can go to the canteen, but the library is there or the ward's See a patient. Have a chat, and this is how you get your points. It's it's hard work, and it doesn't really get easier. Um, but of course, as you progress things, you start enjoying things more, I would say, because it's it's driven into. It's something you want to do because you want to improve as a surgeon and as a person, and it's not easy getting into training, and I don't want to put you off by this, but this this is the reality. You know, for course. Surgical training, the competition ratios. Where for? Uh, let's say 4.5. But it's, you know, five candidates to one place. Where, as for urology, s t. Three this year it was three candidates to one place, which doesn't sound like a lot. But when you put in perspective, if there are 50 50 places you're competing against 100 and 50 other guys and girls who want to get into the specialty, it's even worse for into training. Um, there were two places in 2019, which was when I when I applied there were no place is the following year. That was one place in 2021. Sorry for the title, and I believe two places this year again. So it is difficult, and you really do have to up your game and get your point. It's a few tips. I won't bore you too much, but download the self assessment guidance early. Make sure you're familiar with it. Start taking those boxes. For those of you are still in med school. Now is the time. Don't waste any time. It's never too early for those of you and foundation. Make the most of your hospital time. As I said, if you're on a surgical block and you want to come up to urology and have a chat, see a quick procedure. As we mentioned, we do a lot of minor quick procedures. Just come to the theatre. Were most urologists. I would say 99% of the urologists are happy to to teach and happy to have you there because as a specialty, it's were very chill, and we're very happy to teach. Do it next week. Come join us for a week, Why not and attend your courses. And if there is something which you are I'm sure about or something you want to learn specifically, just ask. You know, if someone came up to me and said, I really don't understand what you know what, what the treatment for prostate cancer is. Can we go through it? We'll go theater. Look at the robot will have a chat. We'll take it from there, and you can also do do this on your study leaf. Of course, it's kind of frown upon, but if you have a reason to be on study, Leaf and let's say you're on a course which lasts midday. You still have the whole half of the rest of the day to go. So why not pop in and, you know, go to the theater, have a look, go to clinic. And importantly, use your education budget. For those of you in the foundation, it's It's a good chunk of money which you can spend on courses, some of them. Some of the courses you have to do a mandatory. Um, so I appreciate that, but I have a look around. You can sometimes work the system a little bit and get a little bit more funding for relevant courses. After discussion with the TPD, I did my core urology skills and foundation, and I got that paid for alongside my l s A T l s and all the other courses you guys are forced to do. Unfortunately, it's just the way it is. Um, so, as I mentioned earlier, speak to trainees. I have I've given this talk with Mr Tetanus. Shot is not too long ago, maybe a month ago, too, and I had a couple of medical students reach out asking for all the opportunities, and I actually have one, starting with me this week on a project which is a very big project, and I have another one lined up for a medical student is clean and lined up for a project which I'll be starting later. Well, early next year, So go up to someone introduce yourself and most people will have projects. I mean, I come up with Project sometimes after reading something or in theater. After I see something, there's always a question in my head, and I think, let me have a look at the literature. Can we do better? And that's how most of my projects tend to start. Um, easy points. Sit your MRCS. Just get it done. Um, if you guys are still in med school, once you qualify, get your MRCS part out of the way. Everything's still fresh. Your memory from your finals. If you're thinking about Part B and there are websites you can use their our trainees or even foundation doctors you guys can practice with. It's all about communication. It's all about confidence. It's all about how you answer the questions. Um, there is a knowledge elements to it, of course, but by the time you decided you want to be a surgeon, you would have that knowledge, of course. And I hope, well, my, my my very short presentation aims to highlight that. It's it's not easy. You don't just wake up one day and you're a surgeon. There's a lot of hard work that goes into it, and people do well when they're driven and when they don't lose sight of what they want to be. I from my days in med school, I think for my third year, I didn't know I wanted to the urology. But I knew I wanted to become a surgeon. And I always saw S t three as an important milestone. So from those from the early days from 30 in Mexico, I always thought, What can I do to get a head to get my points to to be prepared for S t three and one s t three finally arrived. Looking back, I've done a lot of things which have helped me, you know, be, uh, hopefully average s t three. As Mr uh I can vouch for I'm sure. Um, once you reach training once you're registrar, it doesn't feel like work anymore. It's more of a lifestyle, and it's important to have a supportive family, a supportive partner, supportive friends and supportive department because, you know, I come home sometimes from work, and I know the back of my mind that that project I want to finish or that paper I want to read or my wife board needs updated with the latest backs. I've learned that day, and it's it's just the way it is. It's it's a lifestyle. So that's one thing that you guys need to be aware of before you start surgery here. A few resources for you guys. Um, in case you're interested, uh, some website for the MRCS examination. The view are sitting in a part of your part B in the next few months. Of course, the Royal College. I'm a member of the Edinboro College Nancy Edinburgh website has great courses on offer as well as the house, the British Association of Biological Surgeons and for for you. For those of you who work in England because the British, the the English college websites there as well, I have to take any questions at all. Of course, if anyone's in Aberdeen or the east of Scotland and wants to collaborate on the projects. Be afraid to drop me anymore. Thank you very much, Gianluca. That was a great presentation. Um, I'm happy that you put your email down. So if anyone feels like they like to ask a couple of questions later on, maybe after the session, then feel free to send Gianluca an email. I'm sure he'll be more than happy to respond, but I think in the meantime, we'll carry on with our presentation just now. And if anyone has any questions, you can pop them in the chart box at the end of the session. So, um, the next part of our presentation today is going to be a chat from Mr Athanasiadis, who's going to be talking about life as a consultant urologist. So I'll hand over to you. Hello. I'll do is I'll stop sharing my screen of antibodies and you can take over. I will just start sharing my screen in a second. Mister Valencia, This is one of the neurology consultants in Aberdeen. Okay, so what am I I'm going to talk about Is the life as a urology consultant? That's right. So, as you know, the urologist the surgical specific specialty that is dealing with the urinary attack, the male and female and the male reproductive organs. So the big question is, what do I do? How do I spend my day? It is a surgical specialty, so there is a strong technical skills element. However, it's 10% skills and 90% work. I think Gianluca mentioned a few times already that it does require quite a lot of work. I could not. I could not agree more. There's also an element of non technical skills. So just because we do work in a very complex environment, we are leading a large team in theaters. We work quite often under pressure, so communication and team working is paramount. Okay. It looks like Mr Atomizer must have disconnected. I'm sure he'll be back in no time. Yeah, that'll be fine. We'll just give him a couple of minutes. Sorry, guys. Hello? Can you hear me? Yes, we can hear. I'm terribly sorry. There's power outage here. Unfortunately, for some reason, I know that that's my cell phone is still working. Are you able to put Oh, yeah, you are. Okay, that's fine. That's awesome. Slides for you you can. Thanks. Thanks. George Lucas. So I'm sorry about that. Everyone, uh, we're kind of in the dark here, but, uh, I think I can cope from my phone. So I was I was just mentioning that we often work under pressure, so sometimes we do need to improvise. So I was just saying that, uh, there is a strong element of, uh, you know, so communication and team working basically is paramount. We do interact a lot as a specialty by default by other surgical specialties. So we were quite often with the general surgery team. Sometimes we do work with the gynecology team or other specialties. So, uh, that is actually that that is actually one of the key elements for improving you as a surgeon and give even more interest in the work. The most important question, though, if you are to, you know, to choose your you know, urology as your as your profession is whether you can see yourself as a surgeon. Obviously, that does apply for all surgical specialist. So in urology, there is also a strong element of clinical medicine. So it's one of the few specialties that blends clinical and surgical the clinical aspects and the surgical aspect of our work, they're not too many. I mean, the one that comes to mind one that comes to mind is ent. That does to quite a lot. So the other thing that is quite important is, uh, quite interesting is that there is a lot of imagine involved. So a radiologist is a urologist best friend, as I like to say often so we work very closely with a radiology for diagnostics, also for intervention with the interventional radiologists. Uh, there is a lot of physiology and pathophysiology background just because there are many different organs involved and quite often in urology, we have the privilege, if I may say so, Uh, the differential diagnosis being relatively straightforward most of the time. So quite often in urology, one plus one does make too. Mostly, we do know what's going on within minutes. So, uh, I would I would think that if you are very much into differential diagnosis, probably urology main. I mean, probably neurology is not for you. Also, uh, what I find quite interesting for urology is that quite often treating cancer. We're treating cancer with curative intent. Uh, so so there are. There are quite a few. I mean, quite quite a few examples with regards to that. So testicular cancer? Uh, yes, that may be surgical treatment. Chemotherapy. Radiotherapy involved very major surgery. But at the end of the day, we cure almost everyone. Prostate cancer. If we pick it up early, it is we We we do apply our surgical or radiotherapy treatment with curative intent, saying with smaller renal masters staying with quite a few different, quite a few different conditions. Uh, you know, quite a few cancers. Also, we call it quite often are dealing with quality of life issues. So one might say that at the end of the day, we do have quite a few happy customers. Uh, there is One of the biggest advantage to me, though, of Europe is that there's a huge range of things one can do within the specialty. So, uh, the workload varies from, you know, can vary, you know, from office urology, very clinic based neurology. When we do exam in patients, we do our differential diagnosis offer treatment, sometimes do minor procedures to very major, uh, open or minimally invasive surgery. Very, very major laparoscopic robotic or open surgery and quite a lot in between of major or minor surgery. I think that is very important and links in very well with what Gianluca mentioned earlier about the work life balance within within the specialty. Because, uh, I do get a feeling that in medicine we do get a rush into taking decision after decision after decision into what will happen next. So I, for example, had to take the decision of becoming a doctor at the age of 15 or 16 years old and then finishing, you know, finishing medical school. Soon enough, I needed to pick up, uh, you know, the specialty I would follow to apply for it. And then the big advantage of urology that I realized is that I had still time to to decide what I will sort of becoming life just because of the huge range of things one can do within the specialty. So, uh, that, I think, is a very big advantage. So how does my leg they look like? So it varies a lot, So I have clinic commitment. So I do see patients in the outpatient department, mostly patients with general urology condition's I do See, I have a subspecialty interest at my subspecialty interest is, uh, robotics. Basically mostly in small renal mass is but also but in in, uh, you know, renal cancer in general. So I see my cancer patients in our urological cancer center is a charity based center. We are blessed to have a neurology in Aberdeen. Also, I have theaters commitment. So my main theater list is our in our Ms Be theater. The minimal, invasive sensory theater be where our robot lives. Uh, and, uh, also, I do my core, my general urology operations in our ward to to theater. Also, we do run on a weekly basis multidisciplinary team meeting, where our oncology colleagues, radiologic colleagues, pathology colleagues and obviously ourselves. Everyone who has an interest in urological cancer attends. And we discuss all patients with a new diagnosis of, uh, urological cancer or some other patients that we need to move forward with the treatment, which is an excellent, excellent opportunity for for for us to make sure that we are providing our patients with, uh, optimal care. There's a lot of admin. That is what I described sometimes the, uh, undying monster, the Hydra if you're familiar with ancient Greek mythology. So but But one is to understand that admin is at the very core of what we do. Is essentially reviewing the patient's case, is reviewing their scans, reviewing the blood results, reviewing pretty much everything and come up with a plan for them and then apply the plant. So let the patient know, Let the sippy no, uh, request the scans and, you know, essentially progress with their care. There's also a lot of teaching that is happening. A lot of teaching on the world we have obviously, our senior trainees like Luca, we have our junior trainees are quite two. We have medical students, pa students, uh, student nurses. We have nurses, we have specialist nurses. So there is, uh, there is a lot of opportunities for people to teach if you are, if you like that. And also there is an on their own call commitment. So the way it works in urology is that we it's It's eight of us participating in the in Colorado, so we're on call for one week and eight. As you look already mentioned, there's a lot of academic opportunities again. You know, I think we are blessed to have a very strong academic department, uh, led by professor. And, uh, So, uh, the academic unit has got very strong links with the European Association of Urology and in particular with the guidelines office of the of the European Association of Urology, which is one of the best function in organizations producing guidelines for urologists across the globe. Naturally, just because of the variability of the conditions with in the urology. And just because urology does take under it's shield quite a lot of, uh, quite a lot of, uh, different organs. There is a huge, huge range of academic opportunities. So as Januvia already mentioned, if you're interested, I mean and you're and you would be you know, even with us, you're more than welcome to approach is and then we can support you with this and obviously do get in touch with your local urology team, especially in bigger academic units. They're always they're always ideas that are, you know, that are, uh, that people have. There's a lot of technology in urology. I did mention image in already, but there's a lot of robotics, so we do most of our major operations nowadays with with minimally invasive and in particular in Robotics in Aberdeen and quite a lot of places, quite a lot of centers across the globe. Also, there is a There's a lot of laparoscopy. There's a lot of endoscopies. So we treat topically stones, various different humor's we do, uh, as I mentioned earlier quality life of life improvement operations like T. U R P s, you know, removing people's prostates. There's laser technology that we're using. Urology in general has been at the forefront of use of technology for decades and again, if you if you like working with technology, I think there's no better place than urology. And, uh, I think what again links perfectly with the quality with the balance of work and life is private your work. If you are interested in doing private work again, that would be time in urology. Should you choose to you should you choose to do that? I mean, I think I think both Gianluca and I discussed about this because we think that this is quite important. I mean, some people, I mean, we don't really see it when we are in our twenties, but we start thinking about it quite a lot when we're in our in our thirties or or older. Uh, the life work balance is quite important, and it's quite important that there is a surgical specialty that can provide. As with that, mostly we work office hours. That is a big difference from most of the other specialties. The on call, uh, pattern. It's a rare occasion when our presidents as consultants, would be we would be required to be on site, and it's it's even more rare that we would be called to be present ASAP. So that is, that is, that is quite important and link and also helps with a lot of flexibility with how you set up your own call timetable makes it very easy to have swaps with your colleagues and, in general, makes your life so much easier days in theaters if you choose. If you choose to, especially if you choose to do major surgery can be quite long. So if you choose, for example, to be doing cystectomies, which are quite long, quite complex operations, it's likely that you will spending a lot of time in your you know, uh, you know, most of your day in theaters whenever you have a you know, whenever you have a case as such to do, but you can pick and choose. As I mentioned earlier, you can pick and choose in urology how your life is going to be. I could not resist by putting this. I have a I have a love for what I just look, I know shares that It says that, uh, says that with me so I could not resist to put that I'm happy to take any questions back. Excellent. Thank you very much for the presentation. That was brilliant. And I hope it was as useful to you all as it was to me as someone who was hoping to go into urology at some point. Would anyone like to you put a question in the chat box before we end our session? Just give a minute for anyone who would like to type something up. So there's a question who? I'm not sure which one of you guys will be comfortable answering this, but, um, are there many trainees in neurology who trained less than full time? I think they look at probably would be in a better position to answer that. Yeah, I can always speak for the East of Scotland because that's the That's the reason I'm training in. But from my current knowledge, that is so. There are just comes very quickly. There are about 10 3 days in total. A little more. Maybe about 12. Um, there's a girl who obviously went away from a technically recently came back, came back to less than full time. So it's doable. It is doable, Um, and the the dinner at least the least of Scotland greenery. Sorry, the Scottish scenery, particularly east of Scotland, because that's all I can really speak about is usually very accommodating. There have been other people I know who have trained in England as well, who have taken time out for various other things or who have taken who have done less than full time training to keep up with other commitments, such as family or even academic commitments. So it is doable. Um, one important question to ask yourself before going for less than full time training in any specialty really is. What's your what is your What are your long term career goals? If you want to be doing high end difficult surgery. Um, that requires quite a lot of intense and quite a lot of prolonged strength. So doing something like that less than full time requires an even bigger commitment, because it will take you slightly longer. But the short answer is less than full containing is doable in urology. Yes. Perfect. Okay, thank you very much. Can I just ask, would you be able to pop the slides back on just the very last slide? If that's okay. Thank you. That's perfect. Right? So thank you very much, everyone for joining us again. And thank you. Both of you, for the great presentation. Um, So what I'll do is we have a link here for an email address that you guys can use. If you have any other questions you'd like to ask to send us an email, and I'll be sure to relay them to either Gianluca or Mister Africa. Say this, and I'm sure they'll be happy to respond. Um, otherwise, I put in a QR code here that you can use for feedback and you'll get a certificate from that. So I do go ahead and do that. I've also put the feedback link in the chat box in case you want to use that. And be sure to join us next time on a k I and Hypochelemia. So thank you very much. Everyone. Thank you so much for organizing this area And, uh thank you, everyone for joining. No problem at all. Thank you. Thank you again.