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good stuff. So I'd like to introduce you to Anastasia Herman, who is an ent registrar beast in Manchester, and she's going to convince us Why is the career for us? Thank you. Yeah, Cool. So I'm Tasha. I'm kind of an s C six in Preston. Um, and welcome to Ent. Uh, so when I was preparing for this talk, I was thinking I'm asking myself why Ent, um, and really comes down to this kind of four. Things for me is the case is the type of patients, the surgery, the procedures, themself, the people. And I would argue, I think probably more important than the rest. But I'll come to it later. And the job itself, you know, the date today timetable running of things. So as a general review, uh, most ent in D. G. H will just be general ent and encompass all these four subspecialties. But in some bigger tertiary hospitals, you will get some further self specialization to say for a urologist, if you're in a center with neurosurgery, you get to do kind of lateral skull base. Anything trans labyrinthine access all the hearing implants rhinologist again in a neurosurgery department. If it's available in the in the hospital. Really cool stuff. You do transsphenoidal access to your pituitary Covina Sinus clivus. Great. And without an incision, you know, how great is that? Um, and then also to the facial plastic sites. That's your rhinoplasty, These kind of facial skin flaps and things like that for cancers. Throat mainly. It's kind of like oncology, which is basically just all vocal cord stuff. Um, and then head and neck and head and neck, you know, benign. Could be things like your thyroid protects submandibular glands. Malignant will be kind of your big reactions. Uh, laryngectomy, orbital exoneration, things like that and then pediatrics. And I think I would argue that we operate on markets than the pediatric surgeons because the volume honestly of just tonsils grommets, Um, just massive. But of course, if you're in a tertiary PCMT center, they are further than subdivided into, like, pizza, technology, technology, pizza and ago, Actually, pizza airway because you get a lot of subglottic stenosis and things. So the cases I was trying to kind of just look through my previous kind of photos of the things that I've kind of come through come across I guess in the past few years. So this is the one I had on the left Midnight sulfur Day and there was like a car crash. And these guys are like a C spine collar. His pin now is completely detached from his ear. You can see that you're just off the ear canal, but he's in the C spine collar and you have to kind of stitch this up without having to move his head. And I still find that quite challenging, but also quite stimulating, Um, and very rewarding afterwards. And we could finally put it all together. Um, that's a picture of the Internet. I'm sorry, but it is quite cute, basically because on the other side of Otology, there's a lot of elective implant work. Um, and that's a little kid with a cochlear implant. And I think in general, the implant patients are just one of the most rewarding group of patients because they're very grateful, even kind of in the older generation of the older kind of population. I've had people come to clinic with me on the follow up, saying they could hear their grandkids for the first time, and now they can play with them and babysit with them. I mean, isn't that just, you know, just make your day? Um And then in terms of technology, uh, that's a little girl. I think she was about two and she kind of fell over a butter knife when she was about to eat her lunch. Everyone just panicked in any. And then it's great because it's not just pulling things out of people's noses. I guess you've got to think, Oh, my goodness, Is that going to the orbit? Is that going into the skull base? You've got to do the scans. You've got to ask the right people to come and help you out as well as needed. On the other spectrum of kind of technology, this is someone that I met the middle of the pandemic destructive lesion in his nose. Um, it was so necrotic and smelly that he wouldn't even take off his mask even at home because his kids got scared of looking at him so sad. And we were so sure this is going to be something like a T cell lymphoma aggressive, going to kill him. But actually it's vasculitis, and it's so rewarding when you finally get the diagnosis and television we can actually cure this can actually treat it. Um, throat. So this is a little baby. When I was in my pizza rotation, Um, that swallowed a pin. A safety pin, but it's open. So, like the shot, But it was just under the tongue base. That was a bit tricky as well. Panic everyone out. I've got a little video here on the other one as well. This is kind of what you get scared of when you first become an ent s t three. Uh, so, as you know, your vocal cord is supposed to be dot and dot uh, this one's not really moving at all, but it's one of those, I guess, defining moment as a ent surgeon. I feel because it's very challenging. You get even anesthetist right anesthetists who are always the calmest person in like a rascal. Trauma calls and messages will panic looking at this and they will look at you and you've got to be the source of calm. No matter how panic you are inside, you've got to be a leader. Um, and you have to be able to leave the team swiftly from resource down to theater, do a crash tracheostomy there and then but then just relieve the patient from having to breathe through a straw. So rewarding, Um, the surgery themselves so varied. And I just love it because it's just it challenges you every single list. You are using a different part of your brain. Almost so in oncology, it goes from one end, which is just a local anesthetic. That's a bone and good hearing aid. And that's just done in 5 10 minutes. And the patient can just go home and in a few weeks later they can. The audiologist can put the Baja actual kind of, uh, implant there and they can hear. But the main workhorse of Otology is microscope work, and it's just completely different skill. And I was just putting a little picture of a mini shell grommet there compared to a 10 lbs coin. How small is that? And then the drills. We use a big as a six millimeter tip, but usually we started about four millimeter, Um, and it's just microscope work. Just take ages for me to get my head around, but it's also really cool because what you're viewing and where your life is coming from. You just got to know your three d anatomy and your access of instruments, but not, you know, um, in the way of where you're operating completely different skill as compared to radiology. So that picture on the left is an endoscopic Sinus surgery. Um, and usually your nondominant hand, which is what most people will be your left. We'll be holding the camera, and you have to pivot it somewhere to stabilize it. And you're basically operating 100. And it's amazing because you have to almost create a counter traction for yourself because you're operating 100. Um, and then, on the other hand, it's facial plastic. So you're rhinoplasty completely different, right? Gonna put on your headline, put on your loops, um, and then start this really precise movement with six Oh, seven nose. Um, it's almost like a sculptor. Put it like a little picture there because you're sculpting the nose. You are carefully lifting everything off this weird shaped cartilage. Um, the throat. So the one at the top is kind of your typical oncology work nowadays, very much outpatient clinic basis, and it's great because you don't need to fool around with pre op post stops. Anyone with the vocal cord falls a lot of time. You can just do the injection in clinic and you get instant feedback because the patient will start pollinating and you know whether you need to inject more or less. Um, if you ask any head and neck surgeon, they're probably going to start talking endlessly about They're robots because they love it and it is cool. You know, it opens up kind of new, um, dimension to two things, and we currently use robots for tongue base and tonsils. But I have no doubt that they will start branching out to different places, but mainly head. And what I find really kind of satisfying is just kind of your traditional open surgery. Traction counter traction, not tying dissecting big vessels, removing kind of tumors out of like tricky corners. It's great. So the people I wish I had taken more pictures, but it was coded, so it's very difficult. But honestly, I when I was kind of final you med school towards foundation years, I was hard going to plastics, actually, and then I had an F two n e N t. And honestly, just Yeah, I never looked back, and it is really just the people I think. And And this is where you've just got to do the job, do the test today, tastes a week, do a project with the specialty that you're curious about so that you know what kind of personalities, um, are attracted to that specialty. And I generally believe that, you know, especially as a surgeon complication is going to happen to you one day. Um, you're going to have a bad day and maybe make a sub ideal decision and you want the right people. Try Troop. Whatever. It is the right colleagues to be by your side to back you up and help you to get back on your feet, the job itself. So it is a large outpatient volume kind of job, and you can see it in good or bad ways. Uh, some days I I do kind of complaint sometimes not with the clinic, but actually, I would argue ent clinics are a bit different. We do a lot of practical hand on stuff, so you do lots of suction biopsies, um, cauterizing and as you can see even if you're in a kind of specialized like voice clinic, you do all sorts of injections and things. So it's not your what you would, I guess, Imagine as your traditional, quite mundane, boring clinic. The procedures are short, and I think if you've got slightly short attention span like me, it's great. I love it. I don't think 16 hour operation for me. I think most anti procedures I can think of are less than two hours. Um, and if you're one of those that just need to itch your nose, go to the toilet, have some snacks, really consider ent um and you get to sit down. So especially when I was a lot younger, um, maybe she was my age now, um, but I remember being a short, slim Asian woman. I have quite a low BP, so I get very lightheaded very easily when I'm like retracting in long surgery. You know, bright lights, hot downs. Um, it was a bit annoying because everyone was like, Oh, you probably school with your blood, but it's not. It's because I'm lightheaded because my BP is low. And you can imagine how amazing. It was coming to an ent theater and everyone sitting down so definitely a park. I think, um, I put 8 to 5 there because, yes, most of the time as ent we do get to go home one time. But please don't go to work thinking like that because that's my next thing, which is surgery is like a crop apprenticeship. So if it is skill base, you've got to be there to see the pathology. You have to be there watching and learning from your seniors how to assess those difficult patients. You have to be there to see the surgery, see how they deal with it. See the procedures, Um, and they happen out of hours. Um, working life balance. Um, so I'm very big on it. And probably that's one of the reasons why I want to do ent. Um, but yeah, I think the culture I find an ent is slightly different. And you get this choice. Um, so I have a consultant who does only 2.5 day a week and can get to all of their kids rugby, training, swimming, training, whatever it is and also have an amazing kind of outdoor activities and hobbies and also on the other spectrum. You, if you want, you can be a hard core, usually head and neck hardcore head and neck surgeon, doing all of these massive reconstruction work be the president of all sorts of societies, be the keynote speakers and like all this international meeting, and that's fine as well. And I think just having that choice, it's I think I think it's great. Um, we're culturally quite diverse. Maybe I'm biased, but I think we are. We are close to gender parity. Um, these latest one I know from 2020 e n t. Registrar wise, 48.2% of females so close. We are the second rate. Not that not you. Actually, Consultant wise, I think people surgeons are second at the moment, but training wise ent second pizza fifth. But anyway, not that I'm a competitive or anything. Um so lastly, what can you do if you want to get to the ent and you're completely changed your mind now, after listening to me S f o u k. Very important that that you're kind of student and foundation. Um, branch of e n t. U K um, sign up to ent audiology news because that's where you know all of your courses, meetings, all of the different places that you can get your points for oral presentation and posted presentations. Have a look at the sed recruitment and I know maybe for some of you, it feels like a long way away. But honestly, I've had projects where it doesn't count for my CSD, but it actually counts for my s t three. So definitely, you know, don't don't get too disheartened if it didn't for your c s t e n t s h o dot com is basically how I learned ent the first time. Or if you've got an ent rotation coming up or you just want to survive a cross cover e n t e n t s h o dot com is the way to go. Um, and finally, you know, actually, an ultimate your local ent department were usually very friendly. So come and chat with us and get a taste a day and, you know, just hang out with us a little plug. So I'm part of the a O. T. Committee and were having like a conference next year in Manchester. Um, just like a little hint. We will be quite lenient at scoring your posters. Um, so please call me if you want to get a point for your poster presentations. Um, but that's it. That's me. Oh, there's lots of questions. I'm sorry because I had my things. Uh, sharing. Okay. Yeah. Can you provide any information about the dance exam? And it's beneficial for twenties to also complete MRCs puppy. Actually, at the moment there were talks that they may get rid of the dance exam. Um, but for now, you probably have to do dance. Um, it's up to you. I only did MRCs a and then dance part to to get MRCs e n t. If you're still unsure. Obviously there are people that did MRCs a and then MRCS be, um purely from a financial point of view, I would argue, Why do you want to spend a grand on MRCs be And another grand for dogs part too, if you know, you definitely want to do ent. Um but I'll leave it up to you to decide. Oh, there's another one I've heard from a CT to an ent think Post. They don't get enough theater time and end up doing ward work. How does one circumvent this problem? To acquire the skill set, they need to apply a C three e n t post. Good question. Uh, yes, it's a problem. I think you can look at them both two ways here. Um, sadly, if you want to play the game, um, they don't actually give you extra points for being able to do independent tonsils or independent kind of basic EMT emergencies as an S u three. So you could argue. Just play the game, get the point that they want you and then learn more when you've got the three number. But yes, of course I get it. You want to feel like you're a Reg, or at least somewhat ready to be a Reg when you're starting at C three. And I guess maybe I have to say, when I was doing this, you just have to Come on, you're off days. You have to come on your zero days, you've got to develop a relationship with your Reg and your consultants and just be there, you know? And I think now that I'm a Reg. I always feel kind of more bad, I guess, for S h O s. That if they've always been there enough not given him anything to do or her. Um then at some point, I'll be like, you know what he or she is always there. Fine, Fine. Let's spend another half an hour and then let them close up everything or something like that. So you just got to be there. But also find the right people to kind of tag along with basically to give you those opportunities. Can you do run through ent training? Yes, that's very topical. Um, that's been scrapped from what I understand. Uh, since this year, I think since last year was the last intake run through E N T. Um, there's a lot of problems because I think the main problem is because the ent run through isn't run by the ent. Um uh, kind of national recruitment themselves is run via CSD recruitment. So there's been lots of problems with that. So not at the moment, unless academic. I think there's been some still some academic ST one ent post. Uh, and what are they supposed to? Yeah, they go are you aware of academic? Yes. There's something in Yorkshire. Uh, I don't think there's one available in Manchester dinner at the moment, but it is one of those things that they'll probably published. So keep a look out on the, uh What was it? The l A London and Southeast kind of post graduate degree. Cool. Thank you very much dot So that was really informative. And, uh, we're glad to have you. And we're here today to give a talk on your specialties. I hope you have a nice rest of your Saturday. Thanks. Thanks, Ryan.