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And does this mean it's live? I don't, I'm not sure, I'm not correct when it says red, when it goes red in the corner. Ok. Ok. I think it's live. Ok. Um, hi, my name is Rebecca Vanvleet. I'm the Vice pre president of the Anesthetic Society. And today we're really excited to invite Doctor Aziz to come speak to us about anesthesia. Um, just a quick background, he trained as a GP um and he switched to a career in anesthetics later. Um He then moved to Edinburgh and he works between the Western and the Royal and he's very involved in undergraduate teaching and um mentoring as well. Um So I guess just take it away and um we'll just give him the four and then there'll be time for questions at the end if, if anybody has questions. Right. Rebecca. Yeah. Thank you for the invitation. Uh I'm glad we're able to talk about anesthetics because anesthetics makes up like about 20% of the workforce and people are really not too sure what we do as individuals because at an undergraduate level we get some sort of experience, er, but not a huge exposure to it, er, compared to other specialties. So hopefully today in the next sort of 20 odd minutes, I'll give you a personal whistle stop tour of how I ended up in anesthetics and I'll hopefully try and convince you that this is the career that you really want to be following. Er, if I don't convince you that hopefully I'll convince you of other few bits and pieces and perhaps, uh, give you the opportunity to look at yourselves and see what you think is the best career for yourselves. So, first of all, thank you for attending and thanks as I say for the can invitation. So my journey go was back to 1987. I graduated from Glasgow University and in those days, there was no such thing as a training scheme, er or very few training schemes as such. And we basically went from job to job handing in C vs er getting accepted, getting rejected and perhaps er eking out a career. And that's really where my journey started. I er left a medical school. I don't think I had a clear purpose other than finishing my medical degree. Uh I didn't have any mentors. I didn't really see a career beyond er finishing the medical degree. And it all sounds so naive when I look back 35 years later and I think how did I even get this far? So my journey started after a medical school, I went to do A&E at the, er, western in Glasgow. And that was followed by, um, I think I did some geriatrics. I did some pediatrics. I did some neonates and before I knew it, I've done enough things, er, and bits and pieces to almost have completed a, a general practice training scheme. So I thought, well, that if that's the case, that's what I really should do. But a friend of mine, so, although I've said I have no mentors, I had a few friends who were a couple of years ahead of me and they said, well, you've done enough stuff for general practice but you really should go and do some obstetrics. So I applied for a job at the Southern in Glasgow. And, uh, I went for my interview and they said at the end of the interview there's some good news and there's some bad news. I said, what's the good news? And they said we can offer you the job? But I said, well, that sounds like great news. What's the bad news? They said we can't offer you the job just now. Uh, we can offer you another year from now. So I said, ok, that's fine. At least I've got a job in obstetrics. So I now had a year to kill and in those days, er, the jobs used to run from the first of February to the 31st of July. And it didn't matter whether the first of February and the first of August landed on a Saturday or a Sunday or a Tuesday or a Wednesday. It didn't matter which day of the week everybody rotated at that particular time. So as the days got closer and closer to the first of February, I didn't have a job and I had a 12 month gap in my training or I did, I was without a job and I went from very, I went for a variety of different, er, interviews. I went to the homeopathic hospital in Glasgow. I went to the Beatson in Glasgow. I went for so many job interviews and I got rejected for everything. And eventually on the 29th of January, er, I was invited for an interview in a place called Greenock, er, or Gouker and I was invited for a psychiatry interview and of all the specialties I'd studied as a medical student, the one I had least interest in was psychiatry but needs most. And we're on the 29th of January, I didn't really have much choice. So I made my way across to, er, Greenock, uh, and I apologize for giving this long story but it'll, it'll hopefully make some sort of sense. I pitched up at this hospital which is a big massive building on top of a hill, you can see it for miles around. And I went to the Human Resources Department and when I went to the Human Resources Department, er, they said, er, yeah, you've come to the right, er, you've come on the right day, but you've come to the wrong hospital. And I said, what, what do you mean in the wrong hospital? They said, well, the psychiatry hospital is on the other side of the carriage, right? So I said, fine, uh, the guy who I spoke to said, look, if you have a car, could you drive me across there? I'm involved in the interview process. So I said, yeah, fine. And you get, so we drove across to this hospital, er, I had my interview, six applicants, three jobs and I was unsuccessful. Uh And in those days, there was no mobile phones, you basically had to stay to the end of the interviews and they would read out from a list and say either you've got the job or you've not got the job. And when, um my name wasn't read out, I was making way out my way out of the hospital and the chap who had driven across who was involved in the interview process from, er, human resources said, uh I'm really sorry, you didn't get the job. And I II being the type of person I am, I said to be honest with you, I wasn't really that interested, it was just a job. And he said, well, would you be interested in a job in anesthetics? I said, um why is that? He said, well, we have a gap at the other hospital. Do you fancy going for an interview there. So half an hour later, after having been just rejected for a psychiatry job, I was now being interviewed by three consultant. N so if there's nothing else II can think on my feet. And basically, I, in this half an hour gap I had, I came up with this, er, kinda for want of a better phrase, a cock and bull story about wanting to be a GP in this, in rural Australia or, or, or Canada. And II argued that I think these would be valuable life skills uh to have working in those sort of conditions. And these three consultant in this bought this and, er, they gave me the job for a year. So I had a year's anesthetics and I left anesthesia at the end of the year, I went off to do a job in obstetrics and then I lined myself up for a year in general practice. So fast forward, I've now graduated at the age of 23. I'm now 26 years old. Er, and I now look to see where the future lies. And this year in general practice is probably the most important year that I spent because it taught me lots of stuff about uh, primary care. It told me how to interact with people, et cetera. But when I was 26 I started thinking, if I retire at 66 I've got to do this for 40 years of my life. I don't think I could do it. I think I could do it for a few years but I don't think I could do 40 years, uh, going forward. So I started to think, well, what did I do that I kind of enjoyed or, and I couldn't really think of anything. And then I started thinking, well, what did I not enjoy at all, or what do I think I couldn't do? So, I went through a whole list, I think, thought surgery was out of the question. Uh, various other medical conditions. I didn't think I was very good at those lab work was certainly out. I couldn't look down a microscope. And then I thought, well, I quite enjoyed anesthetics. Why do I not just give that a shot? But there was postgraduate exams. But I, and that kind of put me off to some extent. But I'd already sat the MR CGP and the D RCO G and I thought, well, just another exam and I've sat exams all my life. What's the big deal? Uh, it's only a three part exam. Let's get it out of the way. Let's give ourselves a two year, uh, kind of window if I can get through the, during that period of time. Uh, let's see what the future holds. So I was successful with the exams. Uh, I got my exams as a junior in the, in Glasgow. And then I applied for a job in Edinburgh in 94 and I moved across as a registrar but commuted from Glasgow, uh, for the next sort of three years or so. And then there was a point of consultant in, er, the Western General with Sessions out at the Royal Infirmary. Uh, and I've been there ever since. And so that's 1998 through to 2023. So, the best part of 25 or 26 years and they've been the happiest years of my life. So the point of the story really is I had no interest in anesthesia as a medical student, I really had no interest in medical, er, in anesthesia as a specialty. Er, when I started working I didn't really know about it if it hadn't been that for that chance interview that went for psychiatry and ended up in a job in anesthetics. Uh, I would have been completely oblivious to the fact that there's this huge group of people that work in hospitals. Er, they, they're kind of Cinderella specialty. They're absolutely necessary but nobody really knows much about them. They don't know where they're involved or how much they're involved. And I'm what I'm trying to. I, well, hopefully it said to you is you should never, you should never let doors close in your face because you never know when they'll, you'll need them. Uh, you'll never know what specialties they are now. I, I'm fast forwarding now 35 years because the training programs have changed significantly because now you, I II feel envious in some ways, but I also feel w worry for you guys because you have to make a decision very early on in your careers, whether that be as medical students. And I, I'm sure some of the people who are listening here have already decided on a career in anesthesia and that's great. Uh, there may be some people who are thinking about a career. Well, hopefully we can encourage you and there's some people who are just attending here. And if you're one of those group of people maybe will shine some light on to you in terms of what an anesthetist can provide. So in terms of the bre specialties, we provide an anesthetic, which is some people will ask, what does the aist do? And the, I think the best quote that I can, er, r to you is somebody asks somebody, a patient asked somebody what the anesthetist do and his response was, uh, well, I try to keep you alive while the surgeons try to kill you. And that's more or less it. You know, we see people when they're at the most vulnerable, uh we look after them, we help them through their patient journey and we help them to try and er, get a better outcome from their diagnosis. And whether that be a benign condition like a hernia repair or whether it has to be uh where it's something like a cardiac condition or a neurological condition or a colorectal condition. The, the, the, the kind of scope of practice that we work in is absolutely phenomenal. And within anesthesia, there are so many specialist niches that people again are perhaps unaware of. You know, you may have an interest in er delivering babies or you may have an interest in looking after neonates. But all of these specialties, it's amazing how many times anesthesia processes that divide. So you have an interest in obstetrics, but then you get exposed to what the anesthesist does in that process of labor and how they can help the mother as she progresses through her labor. Uh, the, the, the, the opportunities abound, you may have an interest in intensive care and most of our training, er, has a kind of dual aspect to it. We have anesthesia and intensive care built into our specialties, er, or specialty training. And so all their, er, people will either come into our specialty because uh they really want to be intensivist and then we find that there's some people who've always wanted to be anesthetist, but as they progress through their career, they feel that the niche that they're really looking for is the one that intensive care provides. So the opportunities are huge, they're vast, they're available. Er, the specialty is great. I've got, I've got the benefit of hindsight. I'm in the twilight of my career. I look back and I look back at the 35 years or so, I've spent doing anesthetics all 30 odd years I've spent, it's been a pleasure, er, I say to the medical students when we first see them, when they come to see us, I say, look, er, if you're at first years, I love the first years because we all were at that stage. We, we were quite altruistic. We wanted to be great for patients, we want to help people et cetera. This is what we said on our personal statements. This is the type of thing we wrote in, uh, you know, when we were interviewed, this is what we said and I see an erosion of that as we go through the medical curriculum, uh to some extent. And also when we become junior doctors, er, we're influenced by the people around you and my, er, er, what I would like to say to you is associate yourself with people who enjoy their jobs, people who enjoy their jobs will speak with a passion about it. They'll tell you all the positives about it. There are negatives with every job but it doesn't matter whether you're uh working in anesthesia or you're working in hospital port or you're working elsewhere in the supermarket, et cetera. There are good days and there are bad days and as long as the good days are override the bad days, that's what's important. You need to, you need to enjoy your job. That's a crucial part. It has such an impact on your wellbeing. If you enjoy your job, you'll do it well, you'll care for the patients. Er, they'll appreciate that. Uh, and that's all that perhaps is where I should end and open the, the, the discussion up thereafter. Rebecca. All right. Thank you so much for sharing that. Um, you're welcome. We could start with questions. Um Yes, or we could talk a little bit more about maybe what the day to day kind of life is like as an anesthesiologist, maybe just to give people like a little insight into the actual or whatever. So maybe. Yeah. Yes, absolutely. So our first interaction with a patient really comes either uh we receive an email about them if they're complicated, but more often than not, we arrive on the morning of the procedure. Uh We have a operating list with a surgeon and we see the list and we then see the patient. So we operatively uh we see the patients preoperatively. Uh We have the opportunity to allay their anxieties to answer their questions, to discuss the anesthetic technique. Are you still there? Yeah, I'm still here. Oh, right. So my camera seems to have disappeared. Uh I don't know what I've done. Can you still see me or no, I can still see you. Yeah. OK. So for some reason it's disappeared on my screen. OK, if you can still see me. So we see the patients preoperatively, we assess for their anesthetic, we allay their anxieties. Uh We reassure them, er, patients on the whole, usually only have two questions. Uh They, they're kind of focused on what they're needing to have done. Uh, but there's usually two concerns that patients have. The, the main concerns that we see on a day to day basis are, am I gonna be awake during the course of this operation because they're concerned about awareness during the course of an anesthetic or am I gonna waken up at the end of the operation? These are the two biggest concerns that we face on a day to day basis. So we see the list preoperatively. We then go and prepare the drugs for the day. Uh We have a team brief in the morning to discuss the order of player at any concerns. We share that with the theater team and then the, the day to day is the induction of the anesthetic, the maintenance of the anesthetic and then the reversal of the procedure. So as an example, for our argument's sake, the patients have inguinal hernia repair, they're maybe 50 years old, they're fit and well, otherwise it's just a question of talking them through what we're gonna do in terms of uh cannulated them. A BP monitor, an ecg, a saturation probe, drift them off to sleep. They fast asleep for the procedure during the course of the anesthetic or their induction or after the induction, they'll get A I, you know, blocker to try and reduce their discomfort. After the procedure, they'll get their surgery carried out. The surgeons will infiltrate at the end and at the end of the day, uh, you know, at the end of the procedure they'll go around to the recovery room. Hopefully they'll be nice and comfy. They'll be kind of groggy for a period of time and then they'll be discharged out of the hospital. And if it's a case of a day case list that you'd expect most of the patients to be like that. Um My workload is basically at the western, the western over the course of the last 20 odd years has really evolved in many ways in terms of the specialties that it provides or or doesn't really provide. So it's really a cancer based hospital. So many of the procedures we do are kind of tertiary referral level care of patients with advanced colorectal cancers, breast cancers, uh neurosurgery left the department or left our hospital maybe about 2.5 years ago. And that's nows the role in and the other special that we have is so uh most of our work is really uh cancer r work. So they, they are long procedures er longer pro mean that there is perhaps more line. And so whether that be arterial lines, in addition to just an intravenous cannula, sometimes a central line for bigger procedures where you may expect significant blood loss. And then you have to work out a destination for those patients. If a straightforward surgery would go back either as a day case or back to one of the regular surgical wards or to a high dependence unit or emergency or urgent surgeries. Uh that involve a lot of blood loss or bigger concerns may end up in the intensive care unit being ventilated, er, postoperatively. So on a day to day basis, if, if things go smoothly and I also say to our trainees, if you go home at the end of the day and you're bored, well, that's a good sign because excitement is not good for you. It's not good for your coronary arteries and more importantly, it's not good for patients on the whole. Yeah, that makes sense. Um I guess we'll just open the floor to questions then. Um but I can start what's something like on maybe on a day to day that you find really challenging with anesthesia as a career? Ok. So anesthesia in itself is not a challenge, but it's uh the challenge perhaps is uh related to working within a team. Er, and th that can be a challenge if not everybody is singing from the same hymn sheet. So the, the purpose I II feel is that you want to deliver high quality care in a safe environment efficiently. Uh I think there's no, there's no kind of discussion. People do want to deliver high quality care, they do want to deliver it safely to their patients but they're not necessarily, uh, the most, uh, some people work less efficiently than others and that can be detrimental to the working of the team. So I think the biggest challenge is more related to team factors rather than actually on a day to day basis, on occasion. But, you know, if you speak to some people, people who are perhaps not in the know, er, they, they'll say anesthesia is about 99% just sitting around doing nothing and 1% is about pandemonium. And my feeling is you want to try and minimize that pandemonium to the barest possible m, er, minimum because as I say, it's not good for you and it's not good for the patients. So, on a day to day basis, the challenges are more about how efficiently the, the theater list is running or whether we're going to run late, et cetera, whether somebody has to potentially be canceled as a consequence of those inefficiencies. There's sometimes when things are gonna run late because things have gone on toward during the course of a procedure and that these things can happen and that can happen in any sort of work environment. Mhm. Ok. Thank you. Thank you. And I guess I'll just keep asking questions unless others wanna ask some questions. I just have a question to ask. So, is there anything that, is there any sort of research that you've been involved in? And anything that's like, really that you're personally interested in? Oh, ok. So you're, now, you're now getting on my achilles heels. Hey, because you have, so, um, when I was a registrar I had a, a real interest in a, in a drug called Xenon. Xenon is an inert gas. Um, it's in the environment, er, it makes up p 0.0003% of, uh, the, the atmosphere. So it's rare and it's inert. But the interesting thing is it has, er, anesthesia like properties and Boris Yeltsin. I don't know if you remember him, who was the president of the Russian Republic? Er, he had a cardiac anesthetic that was delivered uh by Xenon, er, and in the sort of mid to late 19 nineties and that's when I got involved in it. Er, I became a, in, for one for want of a better phrase. I actually became an international authority. I was here there everywhere. Speaking in Tokyo, speaking about this wonderful drug that was safe. It was, you know, brilliant, it was nature's anesthetic. Er, but then a newer drug came onto the market called Sloane, which was nice, smooth, pleasant to inhale. And then I kind of lost my weight in that sign of, kind of researcher. So that's where I was heavily involved as a registrar. And then laterally, er, the kind of aspect is one thing I've just touched on efficiencies of the work practice. Uh NHS Lothian have been extremely generous towards me. I was awarded a 50,000 lb grant to try and improve the efficiencies of NHS Lothian operating theaters. We managed to achieve that by introducing a new system of working er and er we we kind of looked at other hospitals, how they were doing it. We brought that into our hospitals across NHS Lothian and it's been a, a massive success. It's now part and parcel of the architecture of the theater suites. Uh nothing happen without this meeting being involved. Uh So they're the two main areas er that I was involved in, in, in, in terms of research or things outside of medicine. Uh Other than that, I also held the clinical director role for around about 10 years or so within our department and you see a different side of things because it's not just about delivering care, it's about making your team work in the best possible way uh managing people's expectations, managing your own staff, er making sure that people's wellbeing is well looked after. Er, so these are kind of little kind of side shoots to anesthesia itself but delivering the day to day anesthetic for a person for a procedure is what we do er, in the bulk of situations. Yeah, that makes a lot of sense as well. Um I just have a question about so I II understand sort of like the day to day, it's mostly procedural in theaters. Is there specialization within that is that normal for most anesthesiologists or do most switch between different types of operations and surgeries? Ok. Uh a great question and II kind of alluded to that when I said that the Western uh and now really all my sessions are based at the Western. So, um as I say, it's a mostly a colorectal, it's a colorectal urology and breast of the three specialties that we have as a tertiary or quaternary referral center. So that's the type of surgeries. But if you were to go for argument's sake to the royal infirmary, you've got vascular, you've got cardiac, you've got thoracic, you've got neurosurgery. Now you've got pediatrics, you've got, er, upper gi you've got uh a whole uh you know, you have this, er, obstetric suite there. So you have gynecology, you have obstetrics, you have the, the care of the, er, part lady in terms of, er, preoperatively assessing them or pre labor, assessing them where they are, are potentially gonna have difficult, er, deliveries for a variety of different reasons. So, within anesthesia, the, you know, as I said, it's like an octopus, it, it encompasses so many different specialties and until you're actually in it, you don't really realize orthopedics is uh sorry, something that I've also missed out, you know, the, these car, but they're a significant part of the anesthesia's, at least this workload to be honest with you. And it was so it really depends on where you are what we have in Lothian is, although I'm primarily based at the western, many of us have sessions in other hospitals as well, whether that be in the NHS or whether that be in the independent sector. But if you work, you know, if you go to Saint John's, they have a max maxillo facial stuff there, they have ent stuff there. So once you express an interest or you have a desire to look after those particular patients with their own peculiarities in terms of how you deliver anesthetics. Er, well, those can all be kind of addressed and as I say, the other offshoot of anesthesia in its broadest possible sense, some intensivist will argue against it is this other overlap that we have during our training with intensive care as well. So if you're in a teaching hospital, well, the intensive cares are really manned by, er, in, er, whereas if you go to a district general hospital, particularly in the peripheries, well, then you may have an anesthetic, er, you know, you're, you're mostly an anesthetist, but at night time you're also covering the intensive care unit. So it really depends on where you are in terms of what type of exposure to the types of surgery and what your own interests are and they can all be accommodating in many ways. And as I say, if you choose to go down the managerial road that those are options are also available to you as well. Thank you. Um, maybe we'll just wait to see if anything pops up in the chat. Um, but I think you can. Yeah. Ok. Someone's talking, sorry, I've got another question. I promise. I will interrogate you too much. Um, I just wanted to ask, are there sort of like any hot topics in anesthesia at the moment? Any sort of, uh, points of controversy, debates? Yeah. Ok. Uh, so the, the first one that springs to mind is, uh, yy, you, you'll be aware of it. Everybody is now. Uh, II have to be careful how I phrase this. Er, everybody bangs the drum of something when something controversial or something happens. So, if you've been watching the news over the last 12 months or so, er, www, you know, today has been an, er, a monumental day. If you've been watching the news today, Cop 28 has decided that fossil fuels are no longer gonna be used. Well, that's great news. Er, we're gonna save the environment, et cetera. And, er, about 12 months ago, er, one of the volatile agents that we use is a drug called Desfor. And its ability to destroy the environment was, er, a hot topic. Everybody was discussing it and it's been taken off the market or its use has been really limited and I was one of the people that used to use that drug. So it's a drug that's been taken off the market because we're supposed to be protecting the environment. But the amount of the drug that we're actually using is minuscule in comparison to the other bits and pieces. But in terms of sustainability, I suppose it goes back to the way in which we started, er, you know, recycling our waste products where we started separating all our junk into, er, things that could be recycled and things that couldn't be recycled to minimize the amount that was going to landfill. So these are the, that's perhaps the hottest topic that I can think of at the, the sustainability issue. Er, because if you don't use a volatile anesthetic, you have to deliver the anesthetic in some other way. Now you could provide a regional technique but that's not necessarily, you could use, use a spinal or epidural or a shoulder block or there's a number of ways in which you can deliver, but it's not always possible and the patients may not al always want it. Some patients just want to be asleep, they're not interested in being awake during the course of a procedure. Uh The, the, the question that I would have in terms of sustainability is we kind of, if we move away from the volatile delivered anesthetic agents that we currently use to a completely intravenous technique. Well, we have to look at the plastics that we're using. How are these drugs are actually being, uh you know, how are they being form? What are they being formulated in? And what's the impact of those agents on the environment because we're kind of disregarding them. We're just assuming that these are, er, you know, er, benign kind of drugs that don't, don't really cause a problem at all. But they, they've been manufactured and that manufacturing process has its own problems. I'm sure that's, I mean, poses own challenges but I think it's very relevant and you're right in what everybody's talking about these days. But, um, do you think that's just to do with anesthetics or do you think that's funneling in to a lot of different areas of medicine and different drugs that are not anesthetics based? Uh, no, no, I think we, as I say, I have the problem with many things is when things are foster, er, you know, they're put upon you, you kind of resist, there's always this resistance to change, but we have to change the way in which we do many things. So, whether we are using cars, whether we are using planes, whether we should be using public transport more, which is using energy in a green kind of way rather than fossil fuels, et cetera. These things, er, they need to, you need the early doctors to jump on the bandwagon and really beat the drum to get us all on board and we, you know, initially we'll be reluctant to change and then we begin to change. So all these drugs have a problem, er, in terms of how they're being manufactured, how they're being stored, how they've been, uh, you know, if they've been, er, processed for argument's sake in India and then we're transporting them all across the UK to the UK. Well, is this, the, you know, the itself may not be causing a problem but the fact that we are actually carrying it, er, 3000 miles by air, et cetera, it creates its own problems. But I suppose the first thing is we start thinking about these things and once we start thinking about it, we can start addressing them. So I think all the drugs have a problem but then in the theater environment, II see er, buckets and buckets of waste products for whether they be the drapes, whether they be the irrigation systems, whether they be er drug related items, whether they be syringes, er, there's so much waste that goes er out with each operation and because all these things are single use items in the past, we used to use. It sounds crazy now, but we used to use kind of cloth, er, drapes, et cetera, which were washed and that process, er, you know, has gone now and everything is paper based and that carries its own problems in terms of the environment. Yeah, for sure. Um Maybe to bring it back to a little bit more, just a career in anesthetics. So this is all very interesting. Yes. And maybe we could talk about some of like the great things about a career in anesthetics. Like what are some of the pros to you personally? Ok. Yeah. Ok. So I, I'll take it back a little. So I'm not, I'm not sitting here trying to say to you, er, that anesthesia is the only specialty. Uh, what I'm hoping to say to you is there are thousands of special when you're a medical student. I don't think certainly I wasn't aware of how many specialties are available to you because we're not, we're never exposed to them. But sometimes you'll just bump into somebody by chance who is passionate about what they do and they'll kind of open your eyes or they'll open your heart to something and you want to find out a little bit. Um, more about it from my point of view. What do I like about it? Uh, well, I enjoy patient interaction, which seems a bit strange because some people think, well, the anesthetist doesn't have anything to do but you know what we see the patients when they're at the most vulnerable, we can calm them, we can make them feel more relaxed, we can encourage them through the whole process that if they're super anxious, we can reassure them that everything will be ok. Or, er, so that aspect, that's the first bit, the next bit is putting them off to sleep. The challenges that may be associated with putting them off to sleep routine operations, the anybody could do those, but there's certain challenges, they may have a difficult airway, they may have cardiovascular problems, they may have respiratory problems. Uh they may have poor venous access, er, they may be a bigger size patient. Er, so venous cannulation becomes difficult. The challenges of the airway, the challenges of the obese patient, each of those patients potentially can cause you problems. But if you have plans, you can carry out successfully. That's the, the, the beauty of it, you know, and you're helping the patient, which, you know, if a patient has breast cancer, they come, they get their procedure carried out under general anesthetic, you're part of their, er, patient, you know, their treatment journey, you've helped them during that process and now you, they couldn't have got to the next stage of their treatment process. Uh, so they're, the pros cons are, these are personal, the, the bit of my job that I really don't like very much is on call. Uh, and I think it's the not knowing what's going to happen over the next little while and I'm sure I'm sure I'm not the only person when it's out of hours. Er, you may have a small amount of work to do but it's stretched over a long time frame and I don't really like that aspect of it. I'd rather, you gave me six hours of work and just told me to crack on with it and I can do that without any problems. But the only way I, II kind of can reconcile myself with doing on call is if I'm in the anesthetic room at two o'clock in the morning, there's one person I know that's in that anesthetic room that wants to be there even less than me. And that's the patient and our job is to try and get that patient who's comfort. You know, it's only supposed to be life and limb surgery, er, being carried out through the middle of the night, that patient doesn't really want there either. And so the, the best we can do for them is try and get them through the process as safely as possible through the sort of small hours of the night. So that's the only real aspect of my job. I don't really like, I, you know, you, you asked about frustrations earlier about inefficiencies. Well, you, you can overcome those but the on call has always been a kind of bug bear in mind but I don't think I'm alone when it comes to that. I think that makes sense, but almost like what you said, it's almost touches on that pro that you were talking about, about being with the patients at their most vulnerable as well. So, yes, I think that's really interesting, um, to do it, like maybe the training of it is there. Uh, you know, it was kind of just brought on to you. Do you wish that you had known about anesthetics? As a medical student. And do you think you would have gone right into it? Do you think it's worth being open first and then going into anesthetics? What would you recommend for people thinking about a career in anesthetics at the moment, I think. Um, yeah, I think if you're thinking about it, er, you wanna try and work out what personality traits you have, er, you need to be. So I'm just talking generally to begin with then I'll come back to anesthetics. Er, you need to know what your strengths are, but equally you have to be honest with yourself and see what your weaknesses are. And then I think you then have to work out the specialty that you're thinking of going to and whether you're a good match. So I, II take it whether it's, uh, match.com or Tinder or whatever you wanna match your personality with what you think the personality traits of the specialty that you're choosing to go into. So, if you find that you're an excessive ii, I'm just generalizing here. Er, somebody who worries an awful lot about a lot of things, er, doesn't like emergency sort of situations. Well, maybe anesthesia is not the career for you because as I said, 99% of the time nothing really happens but the 1% where it does, if you're the type of person that can't cope with that stressful situation, perhaps anesthesia isn't the right thing for you now, can Rebecca, can you go back and remind me what the question was? Because I've digressed so much because I've forgotten what the actual question. Um, I was just sort of asking, would you a couple parts to it? You know, do you think you could have got into it? What would you recommend for people? Like? Well, the first thing is I don't think any experience that you get, er, as a post once you've qualified is actually detrimental. I said to you, I think the year I spent in primary care, opened my eyes to many, many things. After that come, I really had only considered secondary care. I never had given, uh, primary care a thought. So a year of looking after patients with a variety of different medical conditions or surgical conditions, I think it just, er, broadens your horizons, er, every experience you, you imbibe some sort of information and that I think helps you going forward, er, when I was a medical student, I can remember being in the first year, the first class we, II was at Glasgow and they used to do biology in the first year and I remember sitting alongside somebody and he said he wanted to be a cardiologist. He knew before he arrived in medical school, whether what he wanted to do, I had no such plans at all. And so II think, I think the way in which it all worked out for me was the best because it allowed me to see things from other specialties that I would never have chosen to do, er, unless I'd wanted to go particularly into them. And the, the year I spent doing anesthetics, even then at that point I didn't expect to do it, er, long term, but I enjoyed it. Er, er, and I don't know if you get that much of a flavor of anesthesia when you're a medical student because, I don't know, I think the undergraduate curriculum is still only about a week or so. So it's not a huge amount of exposure. You get to anesthesia. Uh, you see a bit about this and you, you know, give a bit of fluids, give a bit of analgesia, here's a step ladder of analgesic requirements, et cetera. It's, it's a good foundation but you, you don't really get the flavor of how much information you actually really need to know about somebody because it's not just about putting somebody off to sleep and waking them up at the end, you need to know what their medical condition or how their medical condition or surgical condition impacts on the type of anesthetic that you're gonna deliver them. And I think some of that actually just comes, uh, with experience, er, and exposure, er, as a kind of example, when you're a medical student, er, when somebody asks you about diabetes, it, it can take you a while just to get your head round. Uh, what diabetes. But once you've done five or six years and you've looked on, uh, you know, you've been on wards and patients are diabetic and they have these problems, et cetera. If somebody then asked you to tell them about diabetes, you know, a whole heap of stuff. Although you've not read a book about diabetes for the last six years or so, it's just because that information has now become second nature to you. You, you don't even realize you, you've actually imbibed all this sort of sort of information. So I think if I'd actually been exposed to anesthesia, II was II, tell a lie in the sense that I said I had no exposure because I had three days of, er, anesthesia at the Victoria Hospital in Glasgow. And that's all I really remember about it. Er, I remember nothing else. Er, and as I say, it, it is a pretty, it was a pretty much a Cinderella specialty. Nobody really discussed it. It was considered to be a postgraduate kind of thing. But the problem with that is if you don't have exposure when you're a medical student and you don't see people who are passionate about it, you're not really gonna get a flavor for it. Whereas, you know, I, if I compare myself to the surgeons, whenever I listen to them, they're always passionate, er, they always appear to be passionate about what they're doing and whether they be colorectal surgeons or breast surgeons or plastic surgeons or orthopedic surgeons. They a, a and I think the medical undergraduate curriculum exposes you to the, to that group of specialties for a longer period of time. Thank you. I think that's really useful. Um, you mentioned also, you know, a lot of picking your specialties, a lot of figuring out what the personality traits of each specialty kind of have in them. Um, what would you say those or a couple of those might be for anesthetics? I II think prob er, I kind of touched on it in the sense of that. I talked about inefficiencies in the system, but teamwork, I think it's important that you, er, can be a tea, you can be both a team player, but at times when the, you know, when that thing that shouldn't really happen, happens, then you have to also be able to step up to be a leader in that sort of situation and direct that whether that be a cardiac arrest, whether it be a pneumothorax, whether it happens to be uh a brady cardio, you need to be able to step up to the plate. So being a team player, because you're involved with the, the scrub team, the ODP staff, the, the surgeons, uh the, the abortion staff, et cetera, you need to be able to be part of that team and not be somebody that, er, I is a loan shark kind of thing, er, or a lone wolf. I should say, rather than a loan shark that, that has a different connotation completely. Er, so you're a team player, but as I say, you, you need to have the skill set to be able to, when the situation demands to be in charge of the system and allow er, things to happen, that need to happen. Ok? But above all else, you, you need to have a, a calm head about you. Uh I in all situations. Yeah, thank you. I think that's really helpful. Um I've kind of been taking over for questions, but if anyone else has any questions, yeah, I just wanted to just um elaborate more on the the structure of the the training program. How do you personally feel about it? Like what was your personal experience with the training program? Did you like the structure? Were there any cons to it? You things that have improved? I know it's a pretty well supported training program in general. OK. Uh I'll have to give you two answers to this, right? The answer is the way in which I train and then the second answer will be what's of more relevance to yourself. So from, from my point of view, II basically was an sho in anesthetics in Glasgow, I was sent out to different hospitals and then I came through to Edinburgh in 94 and it was Edinburgh is, I can't rate it highly enough to be honest with you because they really had the Southeast Scotland school of anesthesia seems to have the handle on everything. Uh, you cover all the specialties, er, you know, you work in an environment. It's a relatively, in comparison to the west coast. You know, you've got a population of 1.5 million on the east coast, there's three different centers of anesthesia. You know, you've got Tayside and then you've got the Aberdeen area on the west coast, you've got a population of 3.5 million and they're all served by essentially the Glasgow school in Edinburgh. You've got the Southeast Scotland School of Anesthesia. They rotate you out to all these different specialties. Er, you get full coverage, you get exposure to all the specialties. Er, it's absolutely superb. I couldn't recommend it highly enough to be honest with you. So, mine was slightly different in the sense that at the beginning I kind of made up my own scheme but the system as it currently is, I think it, it, II can't compare it to anything other than what, what I was exposed to in comparison. Er, there is comparison. It, it's absolutely superb. I, and the, the beauty of it is if you, when you speak to the trainees, they all seem happy and comfortable in the specialty that you've chosen, they seem happy in the exposure that they get, er, er, the, the east coast of Scotland and everybody seems to be very friendly. I've experienced many of the hospitals, the only place I've never worked is the Borders and, er, er, Kody, er, but you know, the trainees, when they go there, the consultants that are based there, everybody is very friendly. The other thing I need to say about anesthesia in particular is because it, it's like it's akin to a novice or apprenticeship type model. You really are supervised heavily, er, particularly in the initial years of your training. Er, you're constantly being watched is perhaps not the correct phrase, phrase, but you're supervised initially, you're supervised within the theater environment. When you get a bit more confident, somebody moves out into the, you know, coffee area of the theater suite. When they're a bit more comfortable, there may be more comfortable going out to the, their office and then there'll be a point where, you know, you're able to deliver an anesthetic from start to finish by yourself. And that sort of evolution as it happens, it's a great feeling when you get to the point where you have the confidence, but more importantly, the people who are supervising you have you, the have confidence in you to be able to deliver that quality of care, the, you know, the quality of care that they're looking for. Ok, think back to me and thank you. Um, I think we've touched on a lot of different sort of things to do with anesthetics. Um, more kind of current research things and what a kind of career looks like. Um, I did wonder, I know, I kind of asked this but I don't know if we fully touched on it, what advice you would have to kind of medical students or fy ones who are looking towards a career in anesthetics. Like, what if you know what kind of things they could do to kind of get involved and get more experience with it? Ok. So, uh, you'll, you'll need to remind me in. So, if you really, if you, as I say, it's difficult for me because II wasn't that way, I wasn't that way inclined when I was a medical student. I had no idea. I had no purpose. I just wanted a medical degree and I never really thought about it. So, if I had a forum like this, it might have opened my eyes much sooner. But, but that, that's in the past. So I, you know, I did a Glasgow, we used to have two electives, er, the first time I went out to the States, er, without any real player plan. The second one, I'm originally from Manchester. I just did it in the local hospital in Manchester and again, I never really put any thought into it. Er, but, er, remind me in Edinburgh you have an elective, er, period. Is that correct? Yes, you do. And that lasts for 6 to 8 weeks or something. I think so. Yes, mine's slightly different. I'm on the Canadian program. So, mine's a little, I think in Edinburgh it's just four weeks for the elective, four weeks. Uh, well, I think if you're really interested in a care in anesthetics and you, you want as much exposure as you possibly can. So I think that your elective would be an ideal opportunity to try and touch base with a, a place that you wanna go. Uh, and a specialty that you want, you know, you want to consider as a potential career choice for you. So choose the country that you want to go to and find an anesthetic department that's happy to take and, er, spend four weeks, see what the anesthetist does on a day to day basis. After that four weeks, you might think this is the best thing that's ever happened to me. I'm sure that would be the case, but it may also be the thing that says, actually, I don't think I'm suited for this et cetera. And as I say, there's no experience that is wasteful if you see something and you don't like it. Well, you, you've just perhaps potentially closed a chapter of your life. It, it doesn't mean to be all and end all, to be honest with you and it may be that you go on and you're elective and you see somebody else doing something. Uh, I'm gonna just drift aside for one second because I know an interventional radiologist who was training to be a urologist and he said he did a weekend on call. He had a lot of interaction with the interventional radiologist that weekend. And the chap said to him, have you ever thought about a career in of it in interventional radiology? And he said that was what opened his eyes to a specialty. And that was just because the two of them happened to be on call at the same time, uh doing different specialties and suddenly this crossover occurs where somebody who has a massive impact on your future, you just don't realize your, your, your worlds collide at that one moment and it, it, it changes your direction forever. So your elective might be a good place to start. Er, similarly, if you in the Edinburgh area, if you're on the rotation, er, when you come to do anesthetics, it just like just let the anesthetist know this is something that I'm, you know, I'm considering doing and he or she will be more than delighted, er, to take you essentially under the wing show you what happens, er, the more enthused you, you know, it, it, it doesn't matter what walk of life you're in, you can have passionate trainers but you can also have passionate trainees and somebody who's really keen and enthusiastic. Well, that rubs off on everybody, then people say, OK, well, let's show you this, let's show you this. Have you seen this? Oh, let's go to intensive care. Let's show you this part of the, our potential job plan, et cetera. Suddenly your enthusiasm has opened up a lot of doors that were perhaps, uh, close to other people. Yeah. I think that's really helpful and I think that's very true. I think the more you put into your time at the hospital, in any specialty, the more you'll get out of it, I think. Yes. And honestly it really rubs off because it's, you know, we all have bad days, whether that be the, er, the student or whether that be the doctor, we all have bad days. But most of us, er, you know, when somebody's, er, keen to learn something, it's our duty as much as our passion to tell them all about it. Uh, so you, you, if you, the more enthusiast are a medical student because, you know, even when you go into theater you're kind of, er, standing in the corner, you're not really sure what you can do, you're not really sure how you interact with people, et cetera. Er, but if you try and meet people before they get to the operating room, it actually makes life much easier because they know who you are. Er, they know what you're here to learn. Er, they know that you're interested in, you know, whether that be, er, say you're in the operating theater and it happens to be a urology, operating theater and they're doing kidney stones or something like that. Well, you know, you interact with the theater staff, you interact with the surgeon, you interact with the anesthetist, et cetera, the more involved you become. And I know it's difficult as a medical student because you don't know where the boundaries are. You don't want to encroach on them. Er, but if you're polite and you're pleasant and you're enthusiastic that rubs off on everybody and then, then everybody is encouraged to teach you more and more and explain more things to you. I II think it's a two way street to be honest with you. I think that makes a lot of sense. I do agree with that as well. Just, just wanted to add my two cents on that. I think a lot of the anesthetists I've met in the, for example, in Cardiothoracic and G, they've always been very keen to teach, I guess you have to return that energy to them. As you said, you have to show that you want to learn and you have to ask questions, I think. Yeah, it's valuable to just if you want to be taught, you have to be keen. You're the best is when the, the, the best stroke worst is when the medical student knows a lot. And they ask you questions that you can't answer. But if, if you're honest and say, II can't answer that. But let, let's, let's find out between us. When you go for your break, you go and read up about it and then come back and tell me about it. And as I say, that learning process just because somebody is more genus to you, it doesn't mean that they can't give you information that you, you, you've never really considered or never really thought about. Uh, and suddenly that person has, you know, a light bulb for you that you've never considered. So it is a two way street. So the, and it's, it's interesting that your own exposure to the cardiothoracic people, the obstetric people, they are keen to teach and it's really, er, physiology and pharmacology are the kind of things that we know, uh, most about. And it's always really p when you get a medical student and they seem to have thought through the whole th you know, process whether that, you know, simple things like hyperthermia in a patient. Well, if, if you're asking questions and know, know somebody doesn't know the answers to anything, there's not knowing the answer to something and then there's the possibility of thinking about the answer. WW, why do patients get hyperthermic? Well, how can we prevent it? What can I, how can we measure it? There's a whole host of avenues that we can go down that you hadn't really thought about. And yet, you know that if you put you lie, somebody down without any clothes on, in an open environment, they're gonna go colder. But thinking about that, a simple thing like that, it can generate half an hour, 45 minutes of not necessarily questioning but discussion, er, that allows you to gain information and pass on information that you've got. Thank you. Um, we're kind of coming up to the hour but I wanted to ask, is there anything that we haven't touched on that you would like to talk about or mention quickly before we kind of wind down? Er, er, I, I've got a, got a summary here, er, Rebecca, which is, er, I've just jotted a few points down. This was my summary because I didn't go around, you know what they say about poor preparation, producers, poor, poor performances. I had no slides to show you. Er, but my summary is, er, you should choose your specialty wisely. Er, you should choose what you enjoy doing, er, work out what your own personal traits are. I know we've covered most of this, check out, work out what your own personal traits are and what may be asked of you if you carry on if you choose a certain specialty. And then lastly, but most importantly, whatever career you happen to choose, you need to make sure you have support structures in place, whether they be your family, whether they be your friends within medicine, whether they be your friends outside of medicines, whether they be your neighbors, whatever it is you need to have some sort of support structures because unfortunately it doesn't matter which specialty you choose you, there'll be good days there will be some, not so good days and there'll be some horrendous days and those horrendous days are hopefully few and far between. But when they happen, uh you need to have somebody that's there to support you because if you're not supported, then you can't deliver care to your patients to the best of your ability. So looking after yourself is as important as looking after the patients. Thank you. I think that's a really important reminder for everybody. Um Well, thank you so much for giving us a really good, I think, insight into current anesthetics and some other aspects about it as well. Um I don't know, maybe there was an issue with the questions, but I took over questions. I apologize. Right. No problem, Rebecca. If there's anybody who wants to get in touch with me, they can get through NHS. It's tell dot Az uh speak to me, they can come and join us in the, if they want, if they want to find out a little bit more, uh I do my own not to be grumpy on that particular day. I'll try and be as passionate as I can to try and infuse people going forward. And as I say, if, if people are coming up to their elective and they're thinking about this sort of thing, I think it would be a useful opportunity to try and take advantage of that four week period where you go away so you could go somewhere exotic. Go to their athletic department, you get a holiday out of it, you get some learning out of it and you perhaps choose a career for the rest of your lives. Certainly. Thank you so much for letting everyone open to that opportunity. If they want, if they want to take it, they're more than welcome. Thank you. And maybe we'll just make sure everyone has your email and we can circulate that after the session. Um Just to know I'm just going to send in a feedback form into chat now. So, um this is more for the audience. I'm sorry, just fill in the feedback form um because your feedback is very important to us. It helps us prepare future events and you want to know more about what you think could improve or what you liked about it. And yeah, and you'll get your certificate of attendance afterwards as well. And Doctor Aziz, you'll get your speaker. You're very, I, I'll be great. Thank you so much. No worries. Thank you. Yeah. Thank you again for the invitation. I really appreciate uh coming on and being able to speak about my, my chosen specialty, which was chosen for me in some ways. Um Yeah, thank you so much for speaking for us. I think it was really in my uh my pleasure. All right. Enjoy the rest of the evening. Thanks for making time for us. Ok. Thank you. Cheers. Bye bye now. Bye bye. Bye.