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Gonna start now. So, first of all, thank you so much for coming today. Um I know it's a Saturday evening and people have plans, but I'm really glad to see that we have some audience and we have a turn out for, for an amazing talk tonight with our guest. So I'll introduce myself. So my name is Hansa, a fan. I'm a year three medical student at U Klann and also this year's Presidente for the Ukraine Cardio Thoracic Society. So today's event, as you all know, is around electives and cardio thoracic six. And um, we're gonna start. So we just have some housekeeping rules, just make sure your cameras and mics are off. If you have any questions that you'd like to ask, please type them in the chat and we'll go through them towards the end in our Q and A time and towards the end, we'll also have our feedback forms that you have to fill out. So this will not only allow us to improve our future events but also give you a certificate of attendance. So, yeah, I'm gonna introduce my speaker for tonight. We have show be Gupta who's a year five MG be a student at the University of Liverpool and she has a passion for congenital cardiac surgery. So show be the floor is yours. Uh and uh we can't wait to you for you to present. Thank you. Thank you can do um like Kansas said, I'm, I'm should be I'm one of the final your medics from Liverpool. And today I'm going to be talking about my experience doing an elective, so congenital and adult cardiac surgery elective in India. Um over my fourth year summer and that was for a couple of weeks. Um Yeah, so just to start off with in Liverpool, I don't know about you Klan and where all of you guys are from. Uh We have our electives in the summer of our fourth year. So it's after our finals and I decided to do mine in India. I'm ethnically Indian. Um And that's one of the reasons why I chose to do it in India because it'd be nice to, to go home. But it was also because um, like cancer said, I really like congenital cardiac surgery and you see a lot of patient's um, who are being operated on a daily basis in India. So it's a lot of exposure that you get. So I, I did my elective in the Norrena Institute in Bangalore. Um and it was like a joint adult and pediatric cardiac surgery elective. I did have to pay some money. So when you do go international. There are um certain institutes where you have will have to pay money to, for an absolve worship or to basically do your elective there aside from all the costs of travel and you know, accommodation costs and such like that, stuff like that. So I had to pay around 10 lbs a week uh for three weeks and my accommodation costed a total of 50 lbs um for the whole stay and it was a one bedroom apartment with a kitchen. So it was quite a nice um stay. It was a five minute walk from this um institute and there was a free shuttle service as well, which was really good. Um Now why I chose to do a an elective in this in student, in particular, um like I said, the volume of patients that you see in India is immense. So, I mean, over here, I'm, I'm based in Liverpool. So my congenital unit is an older, hey, and if I stick to one consultant, they probably operate on maybe two or three kids a week. Whereas um the consultants that I was shadowing in bomb a Sandra and Bangalore, they were performing four operations a day. Um And that's, that's a huge difference. Um The amount of patient's that you had on the ward. So they're around 40 patient's that I could go to take histories from auscultate Mama's. Um There were so many different findings. So obviously going from one country to the other, especially going to a developing country where the health healthcare infrastructure might not be as strong. You will see a lot of healthcare inequality. So there were a lot of babies who actually had Epstein normally because during their antenatal care, no one told their moms to stop lithium. Let's say uh a lot of moms who were continued on sodium valproate, which is so teratogenic and their babies had congenital defects um as a result, a lot of late presentation. So, you know, adults who were actually presenting with um tetralogy of Fellow because early signs weren't picked up and they had mild disease which just eventually uh presented as congestive heart failure when they were 25. So there's a lot of weird and wonderful things um that you can experience if you do consider doing an elective abroad, things to consider, you always have to start early. So I started planning my elective um around Jan. Um and I pursued my elective at the end of July in August. So you do have to give yourself a good couple of months. And I mean, that is for India. But if you're considering other places like Australia and America doing Observer ships in America, some people apply a year in advance because it's a lot of money which goes into play and you might wanna um you know, apply for any Bursary schemes and stuff like that. So always start off early and there's other things that you also have to consider when you're planning the elective. So it's not only about the hospital, but it's about the location, whether it's easily accessible and whether you can actually find accommodation because the place that I was in, uh it was basically um quite far away from the main city of Bangalore. So the accommodation that I was in was hospital accommodation. Um There was another student who used to commute an hour every day in the morning to come in. Uh And that's quite a long time, especially for a surgical elective where you're already starting at, let's say seven or eight AM. So you always have to choose and think about your accommodation and, and funding visa requirements as well. So um whether you need a visa or a special uh letter of acceptance to actually do or do this elective abroad and you can also consider things like medical liability insurances, medical insurances and schemes like that with things like with companies like Wesleyan, they're quite good at providing insurance for students were uh you know, basically doing the electives abroad and they're a good company to check out. I would say if you are considering to do one abroad. Um Also things to consider our health wise, our vaccinations uh if you need to take any medications beforehand. So malaria prophylaxis with, let's say Chloroquine. Um so there's a lot of things to consider before you're, you're basically planning an elective. Now, why I recommend the place that I went to. So I'll just talk you through a day and just a warning shot, it's very intense. So in India it's one day off, which is Sunday. So I was in six days a week, not five, I used to start at eight AM in the morning and end at eight PM. Um So it's very long days, but like I said, there were around four operations occurring the day and you could just hop in between operating theaters. This institute had 20 operating theaters which were always active. So every day there were operations happening there because there's so many CABGs which happened in India. So I used to be able to scrub in uh either be 1st, 2nd or third assistant. Um I got to participate in saphenous vein harvesting skin closures, suturing external closure line placement. So, like your I J V line, central line placement with the anesthetist, I learned about different echocardiograph views. Uh I helped an intubation. So placing I gels and L M A s uh one day a week there used to be the outpatient department. So I used to go and um go to the Cath Lab. Um look at the angiograms. Uh And I'd examine these patient's with a lot of mama's which was really good for my clinical experience. Uh I also got to experience the Cath Lab. So um I saw a lot of tv's um sinus venous mother. Was it sinus or valsalva aneurysms. Um So it was, it was a lot of very good exposure in both pediatrics and adults, which is why I definitely recommend Bangalore and Norrena Institute. Um And another really good thing about obviously traveling abroad is you can go with friends and make a trip out of it. So, although my elective was a bit intense, you get less intense, you can make it as intense as you want it to be. Uh And you can discover new places. So I went to nearby cities like my sore, I had really good food bangalore has a really good nightlife. If you want to start, it's a university city. Uh and the weather is rather pleasant. So it's not a very, very hot that you can't survive and you get heat stroke in summer. So it's a, it's a good place to basically um consider uh if you're considering India uh and just some advice about electives and how to make the most out of it. So in terms of research output, India is really good because they have a lot of rare cases. Like I said, there's a lot of adult presentations of uncommon conditions. So things like um uh or take arch uh interruptions. Um You don't really see them in the younger population and adolescents and kids usually see them in adults. I saw quite a few of them in India. Uh You can write these up for BMJ Open as a case report or you can present it as a case presentation as a poster. So I'm presenting a case um in these S C T S conference as a poster. Uh So it's quite good for that. You can apply for prizes. So there are some cardiothoracic section case presentation prize I I won that last year just presenting a case. So it's low effort, high output and high yield. Um you can network with all these international uh and very, very knowledgeable uh and skilled sergeants. And obviously in India, there's a lot of dry and wet lab experience, there's a lot of lab research going on there as well. Uh There's a lot of audits that you can do, especially if you're interested in global surgery. So global cardiac surgery, you could try to compare the differences in outcomes, let's say like court outcome sets of morbidity and mortality for certain procedures, let's say like intracardiac prepare for Toffs in this institute. Bus is your local institute Institute. It would be fun to see what the differences are. Um So that's something to consider clinical experience. So I got to scrub in four times a day, six days a week, which is amazing. I'm not saying I did that every single day. There were days that I, I definitely did take a chill pill, but um it's it's great experience. Um I got to also participate in a conference. So the Indian equivalent of S C T S and I got to do a lot um a live dissection. Um I did buy an anatomist and I got to learn about transits a vigil echocardiograms and you know, the views and basically simulate them on models. And another thing is you can get Bursary awards. So these are good because obviously traveling abroad is expensive so it can fund your stay there. But it also looks really good on your C V um for SFP applications if certain dignitaries don't accept them. But certain sceneries do so for SFP applications for a CF applications for specialty training applications, they always look good. Uh And where you should look for these Boss Rhea Wards. Well, your local university, that's your, the first place I would suggest to go. Um There's other places like our CSE D R S M A sit, they all do these Boss Rhea Wards and some of them are quite nice because you get to write a little blurb. So I, I got one through SPNS and I got to write a little reflection piece and I got to publish it on their website ass it, they get to you to present um your elective experience in their conference. So that's quite nice. So just some things to consider when you know, you want to make the most out of your elective and what you should do to secure an elective. So contact the hospital admin team uh and surgeons individually. So I personally contacted surgeons individually. I used to stock them on linkedin because Linkedin is actually quite a good way of getting in touch with people who are active on linkedin. There's usually a application process I had to fill in some forms, send in some um passport copies and stuff like that. Um Payment apply for funding. So I applied for my boss Serie in March, I think and I got to know in May um accommodation That was a real stress out. So I sorted that out a couple of months before I, I traveled and occupational health. So like I was talking about any vaccinations or medication prophylaxis you need. And I've already mentioned these but things to consider during your elective. So transport like I've already mentioned. So just knowing the lay of the land and you know, whether they have Uber there. So there are a lot of Ubers and Olas in India. So it wasn't too much of an issue. Um International travel cards. So a lot of people use revolution or mons. Oh um and like, you know, like those travelers checks that you can take as emergencies, sim cards uh and you know, just planning your state, I would recommend going with a friend. Um It's really fun that way. But yeah, that's, that's all I have to say. Short and quick if you guys have any questions. Uh please let me know now and I'm happy to answer anything. Yeah. Thank you so much. You'll be for an excellent presentation. Um, there's a lot to unpack in there but definitely key information for us to take for our electives in the future. So, do any of you have any questions, can type it in the chat or I think you guys are able to even, uh, put your mix on if you would like to. I actually have a question though. She'll be for you, um, out of all the different sorts of experiences you got on the place in which one would you say is your most memorable? And why is that the case? Okay. I think my most memorable was the amount of time that I was given to improve my surgical skills. So over there, it's usually the nurses who will basically do the saphenous vein harvesting and um they'll do the skin closure for, you know, your calves, your hands, wherever you're harvesting for C A B G S. And for the first week because I'm handed. So it was a bit of a struggle to finish. Like, you know, if someone started stuttering, it's very hard for me to continue on because I go the other side. Um For the first week, there was literally this nurse who spent like a good 2030 minutes with me patiently whilst I closed um all these wounds and I really appreciated that and I did that for four surgeries. So four operations a day. So that was a lot of surgical exposure. Um I got to be first assistant, you know, they let me palpate the heart several times, kid and adult hearts. Um I got to like proper look into the anatomy. So, you know, like the proper, like, you know, like branches of your internal thoracic and memory, you know, arteries. And there was just so much teaching which I was really appreciative of because there's so much time and there's so sergeants to one from. So I think even more than the research experience, I would say just the clinical exposure that I got. Um I'm cheating here because you said one thing. But like, you know, like when I used to be bored of bot, um I could go to the wards and literally just ask everyone whether I can hear their murder because almost everyone did have one and it was just so good because diastolic murmurs are so hard to hear and you know, the more experience you have, the more you lawn. So imagine, you know, auscultate in 20 patient's back to back. It's just so much clinical experience which you won't be able to experience here, I think. Um it was just the sheer volume of patient's which I really appreciated, I think. Yeah. Um and is it due to the fact that you weren't electives or in placements uh that you got that exposure or was it because you chose to go to India? And like you mentioned that you got an exposure to a lot of patient's. What do you think could be the reason? I think it's two fold, like it's both things. So when you are on an elective, you are attached to one doctor and they make sure that you're okay. So, you know, I have like weekly meetings with my, my doctor, my thought. Um, but so I think there's that aspect where you are getting given a bit more preference, but I definitely think it is India because like I said, so in Alder, hey, we'll probably have like around 67 patient's um you know, new patient's, let's say a day. Um Whereas in India, you have like around 2030 patient's checking in every day. So it's sheer volume of patient's I would say uh which is quite specific to India, especially for congenital heart disease, if not for adult. Yeah. Okay. Um Does anyone else have further questions? Um I have a question? Sure, go ahead. So um with regards to other than the volume regards to history taking and your experience on awards, what do you find is different from here when you went to India? So one of the things that I didn't mention is obviously language barrier, so I can speak Hindi. But there were a lot of people who are from Kolkata in Bangalore and they were speaking Bengali. So there was a language barrier uh when it came to history taking, which was a possible hindrance. Uh But history taking is the same. Like if you can speak the local language, um history taking is the same clinical examination, findings are the same. If not, you might see a typical things like I mentioned. So, you know, like listening to diastolic mama's for tough and adults, um something that you might not find here because, you know, the babies are usually operated within the first year of their life. Um But aside from that, I think, you know, the questions that you are asking history and the examinations that you do will be the same wherever you go. So I think in terms of communication skills, it is different there as well. I think communications are given a lot more importance and priority over here are compared to India just because you have less time. So let's say in clinics, um they probably have around like five minutes per patient, which is just not enough to diagnose a patient, be empathetic and you know, tell them the management plan and everything. So sometimes it can get a bit stressful. Um So it is different. Um but there's a lot alone. Yeah. Thank you. Okay. Um Any further questions? Yes. Um If not, then what I can do is I'll put the feedback form in the chat for you to fill out so you guys can fill that out. Um while we wait and also to let you know that um you know, once you fill the forms out you'll automatically get a feedback uh feedback form and a certificate to it's the end and just make sure to give us a follow on our social media. So on Instagram, and you're also on the Student Union's website. So if you want to follow up for more member exclusive events, that's where you can go. Thank you. Thank you. She'll be.