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Ok, guys. Welcome to the locum F three Talk. It's lovely to have you all with us. Um Today we've got Doctor Sergeant Bassey and Doctor Willem Fields, Jul speaking to us. Um They've both, one's doing a locum year and one has done a couple of locum years. So we've got a wealth of experience speaking to us today. Um And hopefully it will be really insightful um with lots of different tips, tricks um and advice on how to manage a locum year. So first we're gonna start with a lovely Willem who's gonna talk to us about his locum year, his experience and everything that's gone on with his locum year. Um This is run by the Portfolio Clinic. Um There's lots of different things that go on with the portfolio clinic. So please check out our website. Um We've got ventor mentee schemes, et cetera and we run this series twice a year to give you more information and guide you on your F three year. Ok, with them. Hi. Hello. Thank you, Holly. No. Thank you so much for coming. So I'll start your slides and then you can start presenting if that's ok. Absolutely. Yes, so good evening. Oh, I hope, I hope you can all hear me. So, um, my colleague said my name is Will and I'm currently a locum, more specifically, I'm a hospital bank locum F four as you, if you were to put a name to it. So, basically I've been asked to talk today about uh locum life and how this compared to my clinical fellowship where I was more hospital owned, er, how that compared to my foundation is and what local life is like. I'll also touch upon how you can stay local to a familiar hospital and look or perhaps look at er going abroad. I'll also look at the different ways you can also local as well. So, so yes, so before we get started just a little bit about me. So I am a postgraduate medic. So I did a medical science degree before I move on to er study medicine at Cardiff. I did my F one at the er University Hospital of North Midlands Trust where I completed rotation one in upper gi surgery, then rotation two was Jerry's and then a little thing called COVID came along, meaning we weren't allowed to rotate. So I was put on to uh an emergency COVID rotor as you were for about 88 months, meaning that I missed out on my last rotation. Um I'm sure you guys probably did interim or something similar F two. I also stayed at the University Hospital of North Midlands Trust, uh, where I did hematology oncology as my first one. Uh, my second rotation was up with A&E weekends on call and then my third rotation was General internal Medicine between December and, er February. Of that year. I was looking at jobs, er, I knew I wasn't quite ready to go into, er, training just yet. So I wanted to look at other pathways so I looked at becoming AJC F or junior clinical fellow or FY three. Um, and a really good job, came up at the University Hospital of Derby and Burton Trust, er, where I can pick and choose my rotations. It was 9 to 5, Monday to Friday one and five weekends, one in four weekends. So, applied for that managed to get it and then I picked rotations, neurology, geriatrics with a bit of COVID-19 ward cover, followed by uh CCU and cardiology. Um When I finished that I still didn't apply for training cos I still didn't think I was ready. So I thought, do you know what I'll give this locum in a go? Um, and it turned out to be a really, really sort of like successful, I guess job so far. Um I managed to stay on CCU for a month, so I finished my last blocker in August and then I basically carried on same job for about a month and now I'm currently on winter pressure wards. So, what I'm personally interested in terms of medicine is, I'm quite interested in sports and exercise. Medicine, being quite sporty myself, uh cardiology and to spice things up a little bit of aviation medicine as well. So, so why locum? First of all, I'll touch on what a locum is. So, for those of you who don't know, uh a locum is basically a nontraining position where you, your primary role is to fill in rota gaps and vacancies, let's say. So, the good thing about loing is the pay. That's one of, that's one of the great things that is attractive towards it. Um Is the pay, you get paid a little bit more, let's say, than you would do if you were in a training position. Um Another massive advantage is the work life flexibility. You can pick and choose your ro you can work as little as you want, you can work as much as you want. Um I found as well. Another reason why to local was to time out the training pathway, you get to pick a bit more variation, particularly, let's say if you missed out on some of your rotation such as I did. Um And if you don't feel as if you're particularly ready to jump on the the training treadmill, then you can take some time out and perhaps perhaps local, it gives you that time to focus on your portfolio. And I know we have allocated SDL time particularly when you are in training but sometimes you, you may feel as if you're lacking in a particular area of your portfolio. So you can have that time for clinical practice, but you can also have a lot more time to focus on portfolio. Let's say you're missing clinics or you want to do quips or audits publications, you have that time to fill it in whilst also keeping your clinical knowledge up to date. Um Obviously, another massive attraction is the traveling as well. Some people would do, let's say six months of lo coming and then for the remaining six months, they want to travel and experience other things across the world also as well, if you have a family, um it's perfect time to catch up on that as well. So another big thing I think particularly in this day and age in medicine um is, is attention to avoid burnout. We've all been there, we've all had tough shifts, we've all had good shifts. So I think it's a really good way to avoid that, that, that burnout feeling of, I just feel fed up and want to do this. I want to do that. But with, with low, you can have that time out while still earning relatively good money. So, so personally why I picked loing instead of continuing on my, my clinical fellow year. So as I mentioned, I was an F three and it was a Monday to Friday, uh 9 to 5 job that was contracted um for which I decided to pick one in five weekends for which I was working on call. So, as I mentioned before, the, the, the biggest attraction to me was this flexibility. I have loads of other hobbies such as running. Uh I'm an avid runner, footballer. So II wanted that time to focus on that for a bit um whilst also getting a relatively good amount of payment for it as well. So I was able to work much less hours uh for equivalent amount amount of pay if not a little bit more. And it allowed me to invest in things that I wanted in my life at that time, such as investing in a house or a car or or so forth. So that was the two biggest reasons that I wanted it as well. This th this year of low, I wanted a bit more varied clinical experience as well. So although I was ii like to think that my, my portfolio looks quite varied as well. Um It also gives me a chance to, to catch up on other areas that I perhaps missed during, during the COVID um experience. So I've done some on respiratory as well. I've done a couple of locums on, on respiratory as well. That was one of the rotations that I missed out on as F one. So it allows me to, to keep that general knowledge up to date as well. So a a table there just kind of is a very brief summary of just the differences or the the the main differences I wanted to highlight. So as I mentioned before, the hospital bank is is better flexibility with your rota. I appreciate the fact that a junior clinical fellow position, although it is a non training position, you are still contracted in it. You could argue that yes, it was more structured. You had more um structured teaching sessions that, that you could attend more structured clinic work that you could attend and the, the same wards are used to that familiarity. Um I still found as if the flexibility and the better payment was still much more of a, an attractive er, aspect of loing versus staying on the junior clinical fellow job. Um Yes, I was, I was contracted so it didn't mean that I had to worry about con er, sign off sheets. Um locus typically one on sign off sheet. So you do your shift and you have your sheet and you go to your supervisor or um sister on the ward and you ask them to sign you off and you typically have to get that in between a set time period, let's say the end of the month in order for you to get paid. Essentially, obviously with a junior clinical fellow job, you didn't have to worry about that. Um They both came or junior clinical fellow came with an appraisal which is very, very important in in the medicine world. And this, this locum in position also comes with an, an an appraisal as well. So that's the reason why I wanted to stay in those jobs. So well, I wanted to change to locum in versus moving away from a junior clinical fellow job. So just highlighting some of the advantages and disadvantages. So I'm gonna talk a lot about the flexibility of becoming a locum cos that, like I said, it's one of the fantastic, fantastic reasons to become a locum. So once again, the flexibility of your rotor, you can work nights. If you fancy, you can work weekends. If you, if you prefer that you could do 33 days, one week, five days, the next, it's, it's, it's great in that sense, the pay but, and I know everyone's obviously quite interested in the pay, but II don't want to spend too much time on that, but typically a grade that I'm at, which is an sho is typically around about 45 to 50 lbs an hour. That's normal, sort of like day working time hours. Obviously, it varies if you do a night shift or an evening shift and it obviously varies depending on your grade. If you're a registrar or a consultant, um like I said, variation as well, one day you could be asked to cover or when the pressure was the next, you could be pulled across to do cardiology, you could be pulled across to do respiratory or, or that, that I think is quite useful in keeping your knowledge up to date as well. I think, I think that's very important. I'll touch on a bit more about this a bit late later on, something called the Hospital Staff Bank, which I'm currently on versus er, hospitals tend to look at external companies such as agencies that can build vacancies. So I'll, I'll touch upon that on the bit later on in this powerpoint, like I said before, it gives you that extra time to sort of focus on your portfolio on, on the things that you think are missing, particularly relevant for training projects such as Q I PS audits, research publications. It gives you that time um to do that and I know lots of locums like it as well cos it allows you that extended periods for prepping for your exams. Let's say it's the M RCP or MR S or GP exams or whatever it is. With all the advantages, there are disadvantages as well. So availability sometimes it may not be a shift that you were initially looking at. Maybe you're looking at day, day shifts. Unfortunately, this week's all taken up. So you may have to look at doing night shifts. It does vary time to time and it, it generally a first come first serve basis sign offs and handing in your, your, your sheets on time. It's almost like feeling as if you, you go back to primary school and you have a register that you have to get signed off for each shift and you have gotta make sure you hand it in to whoever you need to hand it in to in order to get paid. And if you don't, you kind of missed your, your, your boat for that payment. So it backs up onto the next one. You could argue as well. Obviously, you're not in a training position. So your, your time teaching, you could argue, you're always learning, you're always being taught something. But the structured teaching sessions is, is obviously AAA disadvantage of becoming a locum. So you, you're not, you're, you're designed to sort of fill in the gaps of the training positions rather than to, to attend the structured teachings. Although there is the options to do that. Once again, with the variation, as I mentioned, there could be that lack of continuity one day, it could be cardiology one day, it could be respiratory or whatever. So some people enjoy that some people don't like it cos of the continuity. You get to know your patients and you get to know the team surrounding you, particularly how that ward works as well. Let's say some people find it quite isolating in that sense. So you work by yourself kind of thing, even though you could be part of a team, you're only with that team for one day. And uh locus typically don't um in their payslip. They, from what I understand, some of them don't contribute towards the NHS pension as well. So that you could argue that that's one of the good things about working for the NHS is the pension. But locus um some, I believe some trusts might so something to look into. So I've touched upon this briefly. So there's two broadly speaking, two types of locums, you can be a hospital bank or you can be an agency. So hospital bank is what this slide is about. So it's typically a trust pool of doctors. Uh many of them who have rotated throughout that trust and are able to pick up local jobs. You, you typically may have to sign a form when you first um join, join, join a trust saying that you want to work against the the working time directive. And that typically means that you can sign up to the local staff bank. So that's typically what what that is, it means that you directly work for the trust and they're in charge of all your compliances. So whether or not you're doing your e-learning and you're you're registered and and so forth, just breaking that down, looking at the advantages and disadvantages, let's say working with agencies who are more external companies. So the advantages of becoming a hospital staff uh bank doctor is the flexibility, the familiarity, particularly if you've gone through that hospital or through that ward or you know, the different, you know the different systems, you know how the, the structure works. You, you have that familiarity about it. Uh You don't have to pay agency fee because you work directly for the hospital. You don't have to worry about paying a consultancy fee, which I'll, I'll come onto in a bit which you typically get when you sign up with an agency. Hospital, bank staff typically have the first access as well to the shift because they'll send the email out to the locum. Uh the locums who or the hospital staff bank prior to the agency, it's not always the case, but that, that's typically what, what happens. Um It's a better way of building relationships as well, particularly, let's say in my position when I was a CCU J CF for four months and then I could continue on building those relationships for another month when I was a locum. So I think, I think that's a fantastic way of, of building relationships and keeping that, that, that going really once again as well. If you work a certain amount of shifts with, with, with a hospital, they, they tend to offer you appraisals as well, which is like I said, it's very, very vital in the medicine world. You, you, you won't get far without an appraisal. So and once again, it's that better support, particularly if they know you and you've worked through that hospital versus the agency disadvantages are once again availability. It's a first come first serve basis. Um It can be quite isolating in that sense. You may, you may not see colleagues, er, for so, for some time and if you're not used to the team, you can find yourself in a quite isolating position, cos you're not paying somebody to look for the work. You're, you're constantly on, on the lookout for that email or that text message saying, oh, there's a shift coming up. So some people can find that quite stressful that they have to keep looking, looking forward to, to finding shifts really. And they do get snatched up sometimes quite, quite quickly, particularly some shifts oo over others once again talking about times sheets as well. So looking for sign off, looking for getting that times sheet in um in prior to um getting paid by the end of the month, let's say, um if it is run poorly, the hospital bank, it can be very difficult to, to arrange shifts and, and, and get paid and, and so forth. So, all right, moving on to the agency now. So that was hospital staff bank and now this is agency. So agency locums are typically an organization that specialize in filling vacancies uh with these locum doctors. So typically when you sign up to an agency, you get uh all allocated a recruitment consultant. So this job of the recruitment consultant is to make sure that you're up to date and you are compliant uh with looking at the, the jobs that you'd like. So let's say you want a job in cardiology, their job is then for, to try and find a job for you. Um, so, and obviously they, they want, they want you to get a job because the more you sign up for, I believe they also means that they get paid as well due to the agency fees. So they, they typically charge trusts as well, er, for filling in the these gaps and vacancies and typically the job of the agency to make sure that you are compliant with what the trust wants of you. Um, examples of these are holt and NP er health care as well. So the advantage is, is they want you to get registered quickly and they, they want you to have long term placements because it means they get a better agency fee. They're really good at finding work for you. Cos like I said, you're essentially paying somebody to find some work for you. Um, once again, they, they, they quite enjoy making you get paid promptly as well. So sometimes they can do weekly payments instead of monthly payments as well. You could argue it's a bit of a wider opportunity of work as well. Um II don't know how true. This next, this next one is about negotiating rates. So II won't spend too much time on that. But II, do I do know that sometimes you do get referral bonuses, let's say you sign up with one agency and you get a colleague to sign up with it and they do a certain amount of hours. You typically get a financial reward for that. Some of the disadvantages of obviously you get paid less is less, take home money because you have a little, a little bit of that fee goes towards the agency. Um Sometimes it is the second selection of jobs. So as as as I mentioned, the first lot of jobs typically go out to the hospital bank staff and then the if those aren't filled, then they typically go to the agency. Not all the time, I appreciate that, but most of the time it can be quite location specific as well. So it depends on what company you sign up with. So that's, that's agency work in a nutshell. Really. I wouldn't spend too much time on this. Uh obviously staying local as a locum, but there is the option to go abroad. So, um I know lots of people like going abroad, Australia and New Zealand, very popular destinations for going abroad as, as a locum. So it's whether or not you want that familiarity of a trust you versus a new experience, let's say in Australia, in an a A&E department over there, you get to learn new, new concepts, new, new ideas of different healthcare system, you might be able to take that back with you if you do eventually move back to the UK or, or stay out there. Um I know that it's quite a lot of logistics. It's like anything particularly you, you might have gone on elective somewhere. So it's lots of logistics to arrange like such as visas, compliances, accommodations and so forth and particularly a job out there. Some might only have a three month post or a monthly post. So um there is, there is the option to go abroad. So, but it's, it's whatever you feel as if it is, it is best for you really. So in summary, I do really highly recommend you, you consider a lo year um due to its flexibility, I cannot, I cannot stress that enough. The the pay obviously is is brilliant in that, in that, in that sense, compared to training positions, let's say, and it allows you that time to catch up on portfolio. Uh There's different ways you can locum such as hospital bank versus agency and you can look about staying local to a familiar environment or going abroad and learning new ideas, new, new experiences and new, new concepts. So yeah, thank you very much there. There's a couple of useful websites um which I'm sure can go out a bit a bit later on. But there's there's loads of resources out there, loads of locus like to talk about their, their experiences and why, why they recommend it. So yeah, that's it in a nutshell. I'm gonna, I'm gonna hang around for a bit. So if you do have any, do you have any other questions, please fire, fire away or you're more than welcome to email us a bit a bit later on if you're, if, if you're shy over, over the website. So cool. Thank you very much, everyone. Thank you so much. Well, thank you so much. That was really interesting and I have a lot of questions to ask you myself. So I'm looking forward to the question time. Um, now, Sergeant, if you'd like to just introduce yourself and tell us a little bit about yourself, if that will be ok. Yeah, it, it's a bit odd being on this end. So, yeah, my name is Sergeant. Um I am one of the co-founders of the Portfolio Clinic. I did my foundation training back in 2018 now as well. That was in Nottingham and Derby. So there's a bit of a derby theme going on here this evening and following on from that, I also did an F three and an F four and I did a, a few things in, in that time period as well. So, um I think I've got a mix of everything that Willem has, er, mentioned, including agency and er, a junior clinical fellow role and, and er, a bank role as well and er, I did APG Cert as well. Um which is where I met Shiv, who is the other co founder of the Portfolio Clinic, er, without him, we probably wouldn't be here tonight as well. So, yeah, emotional time. So, yeah, a very sort of F three and F four. And I think that's really interesting as well because I think a lot of us actually don't necessarily do one pure locum or pure J CF year pure teaching fellow year. A lot of it, you know, for the viewers, a lot of it is quite dynamic so you can pick bits of each job that you like in your F three year and merge them all together to make something that works for you. So I do AJC F three days a week and then I locum the other four, if I decide I want to locum and I load them in various specialties where my J CF is in orthopedics. So sergeant, tell me what you did. Post F two. Yeah. So, um, post F two, I was sort of forced to take an F three in a way because it's, er, I'm, I'm a bit of a complicated case. So at, at the time when I was in foundation training I was quite interested in, er, well, before foundation training as well, I was quite interested in going, um, to see what work was like in the United States and I was sort of semi interested in moving abroad. Uh, well, you could say quite interested. Um, so I ended up. Yeah. Yeah, exactly. And then, so during my, my F two, I managed to take time out of the program to pursue a clinical placement in the United States. Um Just before COVID actually. So I was very lucky because when I went through the meetings and the process, they gave me a set period and I could have either chosen the end of F two and extend my F two further or the start of F two. And I went with the start of F two. because if I wanted to launch an application for the United States, it would have made more sense because I would have been more prepared with all the experience that I had and I returned a week before everything just shut down completely. So I was very lucky in that sense, I was able to come back and I wasn't trapped out there. Um So, yeah, so in that sense, my F two was extended. So I knew that I was definitely gonna have to take an F three and my F two finished instead of finishing in August, it finished in December of 2019. So I knew I had at least eight months where I needed to fill time essentially. And II initially went to do a um a junior clinical fellow. Um and that was arranged um actually through an agency as well. Um So I did that in Chesterfield for a bit in acute medicine. So that was a sort of a set block and a set rotation. Um But I also knew that that wasn't all I wanted to do. And actually, um, in the F three, I also pursued APG Cert as well. Um Amazing. So how did you arrange that locum work in your initial F three year? And how did you go about arranging that? Because I think that's what quite a lot of people find difficult is that starting process of, I'm going to be an F three A locum. How do you start that process? Yeah. And it can be quite daunting as well, especially when I think as medics and, and um as clinicians, we are people who like to follow a structure and a pass and you know, you go through medical school, you then automatically into foundation training, you automatically have what theory, particularly it's a bit more difficult these days, but theoretically is automatically have a foundation post. And then from there, it's the assumption that although a lot more clinicians are taking F three and F four S, it's the assumption that eventually you will get onto a training program and sort of climb the ladder in that sense. So I think that there's, it's always gonna feel daunting, but I think it's always good to step off the ladder. Um because as Willem mentioned, there's so many different experiences that you can gain and so many different avenues that you can take the clinical experience that you have. Um So initially, I came back to England and I carried on with my F two and I was sort of sort of ing and ahing about going into a bank post, um, which was sort of in the hospital that I was at, in, in Nottingham at the time. But I decided that II wanted something a bit more, sort of stable at that point in time because I didn't feel that there were persistent shifts. Um, which is something that is difficult when you're a local as well as to sort of think. Sometimes it can be really stress to think, oh, where's the next shift going to come from? Or I don't really want to work on this ward or I don't really want to work nights that I have to in order to keep some sort of stable income coming through. So that's one of the, that was one of the advantages of, of, of coming across an agency. And actually the agency that I joined, II gained that through word of mouth. So I just sort of asked around and a colleague of mine said, oh, there's this agency that's really, really good. Um Why even try to contact them? And what was that process? Like, the process was fairly smooth, to be honest, I feel like most agencies are quite keen to have individuals because then they get paid as well. So they were very sort of direct with all the forms that needed to be filled out in terms of signing on with them. And they also were very interested in the mandatory training that you've conducted. And because I've been out of the sort of, out of the system and my, my training was extended, there was quite a bit of a mandatory training that I needed to do. But they were very good. Do you mean all the e everybody always says is the first one, the most sort of distinct training that we have to do potentially. Um but yeah, fire safety, all of that sort of stuff. It's really good in that sense, joining an agency because they will make sure that you have done all of that in order to on board and get you across very quickly and very swiftly. Um The other thing about pay, I know that Willem mentioned that sometimes they take a fee from your pay. Some agencies actually will take the fee from the hospital instead. So when I actually did my, my J CF post in chest, my pay wasn't deducted at all from what a bank local would receive because they actually added that to the hospital and the hospital. So that does actually happen with agencies as well. Yeah, so that's something to consider. They don't necessarily always take the fear away, but they were very good at putting me in contact with the hospital. And then from there, I started my role and it was a bit daunting because there was a new hospital and I was in sho So I was a bit more experienced and I think there's a greater expectation sometimes when you're in sho who's, who's had a bit of experience. And I remember on my first day there was nobody there. It was a snow day. It was, it was snowing so heavily and chest feel sort of very hilly. And, um, I was the only one that was there who made it on time because I was coming from a different direction. I think I remember this day, I think I worked this day. We were there and it was quite stressful. And I think that's one thing as well is you don't get a formal induction as a low sometimes because the flexibility is great. But you join at random times. So this for me, I joined in January and it was a very random time. Um And I just sort of slotted into a role. Um but depending on the type of person you are, I feel like if you're somebody who is quite forward and charismatic. Yeah. Well, I don't know, maybe, but somebody who's like is keen to get involved and ask questions and learn. Most clinicians are really receptive to that despite not having sort of a training post or a training role. So I learned a lot from that experience, but it wasn't what I wanted to do long term in terms of local, but it was sort of a good reintroduction back into the NHS, especially that silence. So going on to your PG cert, then you mentioned about APG set and I'm quite interested because I know that now with a lot of your applications to your course, your um I MT S et cetera, they like APG C. So when did you decide you wanted to do APG CT? Yeah. So I think that when I was, when I came back to the UK, I felt that um my experiences in the US were great, but it wasn't sort of the direction that I wanted to go into. And I think that actually working in the UK in internal medicine was the direction that I was going in. Um I felt that having the initial experience of the locum at chest field was a good opportunity, but I didn't want to just leave it at that with my f three year. I wanted to try and build upon that. And so I remember initially, I was, I was thinking APG Cert would be a good sort of alternative thing to do, especially if you can do it part time. So mine was part time and I also got the opportunity II wanted to work in London. Um But I wanted to, it to be flexible. Um And I wanted to learn skills with regards to sort of leadership and education as well. And I remember Googling those specific things, Google is absolute magic when it comes to improvement as well. And I came, I was very fortunate to come across the PG, so which it was in healthcare, leadership and innovation and was also linked with working at Imperial Trust as well. So um I did that and it was also where I managed to come across Shiv as well. And it's also where we started the portfolio clinic through the work that come about then. So that was an issue as part of the, the P GC, one of the leadership modules was to come up with a, an innovation, an innovative idea in order to benefit healthcare workers and the field of sort of medical practice and clinical practice. Um One of the things that we wanted to focus on was wellbeing. And one of the things that we wanted to focus on in particular, which related to us as F threes was career uncertainty and career guidance because we both of us were in a position where we sort of, we knew what we wanted to do. We didn't have all the information and there's so much information out there and there are so many information about what you should put in your portfolio, but it's not really sort of tailored and it's not really sort of personalized and we felt that we could create a service. Um I guess we did at the end of the day where we could provide personalized and practical support. So it came from one of the modules and then it sort of just expanded um and we took it beyond the PG cert. So actually PG CTS are pretty good cos they can, they can, you can use the skills and they can take off. Um So I'm, I, we, I remember I applied for that in January. So II started my locum job actually in chest knowing that I didn't want to carry on with this um as well. Um So I applied in December, sorry. And we had interviews in January and then it was to commence in sort of April time. Um So actually the other good thing about being a locum is that you can decide a lot of the times you can decide on when you want to terminate a post as well. Um And so I went into this job in, at the start of January knowing that eventually at the end of April, I wouldn't be able to work there anymore and they were completely fine with it as well. They were very appreciative actually, the fact that I worked in that post um in acute medicine and I learned so much from that job and the the hospital was really, really friendly as well, but it allowed me to, yeah, it allowed me to um earn learn and then also move on pretty, pretty smoothly. Um come the end of April and then from April up until September, I was, I was doing this PG cert Imperial and yeah, that, that sort of took on the rest of my F three. Mm Amazing. So then why did you decide to do an F four? Cos you mentioned that you did an F four? So what, why did you decide? OK, an F four rather than training? Yeah. Um So I think to be honest, one of the main reasons I had was um disappointment, disappointment, I think with um how I had initially done in my application for specialty training for internal medicine because I felt as though the application that I launched for when I took my F four. So I was only meant to take an F three. Really, I felt that I could have done a lot better if I had the information and the understanding of the portfolio requirements. A and, and um yeah, essentially the portfolio requirements at that point in time because the year that I'd applied for training was the year when we were in the, the COVID pandemic. And actually at that point in time, there were no interviews. So it was based on your portfolio. Um And I think my portfolio to be honest was quite average. Um And I think that's simply because I didn't really understand what I needed to put in from when I was in F two, I was also focused more so on potentially moving to America. Um So that was one of the one of the reasons why I was like, I feel I can do a lot better in this process. Um And I'm not particularly fussed about going to training immediately during the MF four because it was still a bit sort of COVID in terms of restrictions and the quality of training I felt was sort of dampened by the fact that there was a lot of COVID and a lot of service provision rather than the focus on teaching and training. So I wasn't first and I felt like I could have done a lot better in myself as well. And I think that's the key for a lot of people who are out there is that just have a firm when you're applying for specialty training, have a firm understanding of the portfolio requirements. And actually, um there's so many things that you can do in a short space of time to improve your portfolio because I think that I was probably about average and then in about a space of eight months, I, I'd done so many different things which just boosted massively and to be honest, being a locum really helped with that because you have the time and the scope to dedicate towards certain projects. So I'll give you an example. Um So when I was um at Imperial and I was doing my PG cert, um I wasn't on a rota, it was actually, it was a bit of a weird PG cert where they wanted you to do a certain number of clinical hours. So, but you could choose where you wanted to work and you could pick and choose shifts. So you were basically like a locum but you have to have a certain number of hours in a certain period of time. And that was a six month period. And so I fortunately was able to have quite a consistent stint within acute medicine. And on my first day I was very keen to do AQ I project and I, they had a, they had an issue at that point in time where, um HIV testing was particularly um low, it wasn't routine, which it should be in London because the prevalence of HIV is greater than 200,000. And, and that's the cut off according to the batch guidelines. So I basically without really having much context of how the hospital worked and the systems that they have in place, I said I'm really interested in doing a quip, really interested in doing a project. I think that the, the project with regards to HIV testing sounds really, really interesting. I would love to get involved with this and some of the, some of the consultants who were there in, in, in acute medicine, they were very interested in, um having me sort of lead this and I think just grabbing opportunities and just sort of rolling with it and learning as you're going along is really, really valuable because I think if I, if I was a foundation trainee, I probably wouldn't have done that to be honest. But at that time, I felt quite reassured that I understood the healthcare system to a certain, I felt a little bit more and you learn as you go along and I learned so much from it and actually I didn't have a particular interest in HIV or infectious diseases, but it was really interesting, actually, sort of learning about how the logistics of actually understanding why people are so um stigmatized and why there's a stigma against sort of HIV testing and stuff like that. So it was such a great opportunity. There's so many different opportunities within low coming and taking time out. So I had the J CFI, had the PG cert and then doing my F four. I was doing stuff to build my portfolio but at the same time, I was sort of picking up bank shifts back home in, in Derby as well. Mm So you've mentioned a few things about what's helped boost your portfolio. So your, your PG cert, your, your Q I PS and audits and things. Were there anything else that helped to boost your portfolio during your time for applying for I MT? Yeah. So um some of the work that I did during my PG search, I was able to present at a conference. So that helped cos that was a normal presentation um When I was working in Derby Fortunate as, as William mentioned, when you have a good relationship with a, with a trust. Um as, as I did, because I did my foundation training in Derby, you come across clinicians or you come across sort of departments who are more willing to take you on for shifts and are also more willing to sort of involve you into the day to day activities. Um So I managed to sort of when I was in acute medicine, conducted a, a teaching program there as well which, which helped um, for, for medical students. Um, so that helped and it was very interesting as well to sort of gauge the, um, the thoughts and the opinions of medical students rotating in acute medicine. So, so, yeah, that, that sort of picking up bank shifts and working in that sense in a place where you're sort of familiar or a bit more well known. Um, definitely I think has an advantage but also when I did that I was in a place where I wasn't known and I had no context at all. But I think if you're keen on doing something, most clinicians will take you up on it. Yeah, I ii, 100% agree. Um, I think I, so I'm doing a junior clinical fellowship rather than doing a lo year, but I've already been given quite a few projects, um, et cetera because I've done it in a, but I've done it in a department that's completely new to me. But a trust that I knew. So I knew the systems and the way the hospital worked before going into this role. So, even though I was new to the department, I knew the trust that I was in. And so you kind of hit the ground running. So I, I'd agree with both of you in the sense that sometimes it's great to go further afield. But also if you can get your local work close to home where you kind of already known, you've already started off on a good foot and people will sometimes give you more things or if you're really keen and express that interest quite openly, um then people will go, oh, I've actually got this project that I've been meaning to get done for years and I've never got it done. Would you like this one which you just hear many of the consultants say, ask, can you shall see, you know, how it works? So, why did you go into training? Then? That is a good question. Essentially, it was to climb the ladder. I think I've worked as an sho for quite a long time. I knew that I wanted to work within internal medicine and then specialty wise, I'm not entirely sure at this point in time, but I knew that I sort of had to get on at some point. It's a lot more, although there are avenues to demonstrate how that you've met competencies to apply for registrar training and specialty training. Um But that's a lot. It's a lot more difficult in terms of having to arrange appraisals demonstrating um your clinical commitment and your clinical hours if you have to do a lot more off your own back in terms of being organized. Whereas being in a training program, you have a supervisor that's set for you, you automatically have your appraisals arranged as your A RCP. And there's always evidence of your clinical hours because you're in the post and you'll be reviewed. So, yeah, I felt that I wanted at this stage to have a bit more structure with regards to demonstrating that I'm making the requirements for higher training and registrar training. And who knows, maybe at the end of the sho stint, I may decide to actually try and do it myself and go through potentially a caesar pathway. And I think that is uh it's becoming a lot more feasible for clinicians because at the end of the day, people have things outside of work that they are interested in. They have a family, they have hobbies, they have other things that they want to want to do and want to pursue and sometimes working in medicine or a specific area that they want to live in. And sometimes working in medicine is a bit restrictive in terms of in a training program when you're in a place for say, three or four years. And, er, you're, you're traveling across massive deaneries in particular Yorkshire and hunger is a huge dery. Um it, it can be quite difficult. Um Life wise and life gets in the way sometimes, I guess. Yeah. So give me your best thing about learning the best thing. Uh The best thing is the variety of opportunity and the flexibility as well. I felt that I did so many different things in two years, experience wise. Um Even like teaching wise, Q I wise where I think that if I was in a training post, sometimes the amount of on calls that you're doing in service provision is difficult to actually focus on, on those things. Ironically, I feel like it's more difficult to focus in a training now that I'm in a training post to work on things like Q I and education and teaching than when I was a locum, which is completely wrong, you shouldn't feel like that, but actually being on nights, being on long days and things like that, which you don't necessarily have to do as a locum if you don't want to actually restricts you to a certain extent with regards to other opportunities. But it's difficult experience, I guess. I mean, of course, what was, what would you say was the worst thing about loing the kind of the worst thing, the most disappointing or annoying thing about local. Yeah. Um I think the sometimes the lack of continuity and not, sometimes depending on where you are not feeling as though you're part of a team and actually just being service provision. Um I think that's the worst thing because, um, for me personally, as a clinician, the work is, is great. Fine. That's one aspect. But I II sort of like everything. I like a bit of teaching. I like a bit of, um, I, in a weird way. I sort of do like the Q I work as well depending on what it is. Um, whereas when you're a local and some people, they just want to be service provision and enjoy their life. That's fine. That's, it's a completely individualized decision, but sometimes just being purely service provision is very monotonous and something that I, at times I was thinking, I'm not particularly enjoying this and um being, being um potentially being sort of carted to different wards as well. Um The ward is when it's on the morning as well. So you think that you're going to one ward and then actually you gonna be in respiratory today, we're gonna put you in. I don't know. And you're like what that is a completely different lifestyle or a different change change in my day. Um that I didn't sign up for or, or a shift that you, you purposely try and avoid. And I'm not big on estate. I think este, I think it's a good learning environment but like you completely, you want to avoid it and then they just start putting you there what you're doing to me not knowing where the shift is going to be essentially you're a piece in the service that is missing. Whereas I think as a junior fellow, you almost have more rights to your placement and to kick up a fuss and say no, I'm employed as this. So don't move me here. And with regards to what you were saying about teaching. So I'm a junior fellow for three days a week because I teach for two days. Um and I have a clinical um for the middle day. So I've kept that as my, I then get to do some projects in that as well with my trust and then I lo come in different specialties as well. Um because I do AJ CF, as I said in orthopedics. Um so I get some theater experience and I teach in orthopedics, I'm the orthopedic teaching fellow. Um But then I'd like to dabble in medicine and dabble in neonatal intensive care as well. I did a, a weekend shift in neonatal intensive care. Very neat. But, but because they can't hire many people, cos not many people have had a Nico experience. It's quite a nice locum that I can jump into because I'm not on a full J CF rotor, I can jump into those shifts and still get that experience and keep that experience up in that hand in. Whereas if I was on, as you say, a full J CF rotor, I would not have time to work a weekend shift or a night shift in ni so as a low, it's keeping your hands and specialties that maybe you don't want to pursue, but you have an interest and you like to kind of keep on the side a little bit to say, oh, do you know what I really like this? I'm going to have a day here as a refresher compared to my normal medical or orthopedic life. So, thank you so much. Both of you guys, we're gonna open the floor up to questions. I know we've got one already, but if you guys could, um viewers could pop your questions in the chat box. Um and we'll answer them as best as we can. So we've got one already that said, could we hear a bit more about the clinical placement you had in the States? And is there a series covering this? So there will be, we've had an Australia referee. Um But if you guys have any suggestions for series um episodes, then please drop us an email at the portfolio clinic and we definitely look into providing more for what you guys want because we're completely guided by you as a um company, so to speak, whatever you would call it as we're completely guided by what you guys need. So, um yeah, tell us a little bit more. Um sergeant just quickly about your United States experience. Yeah. No, that's fine. I think that um I guess if you're happy to invite me back at some point, II wouldn't mind talking about this in a bit more detail because I think it's something that is um not, is, is very foreign, I think for UK er graduates. Um and I actually got to the, so I II got to the point of actually applying for residency as well. Um So I sort of have a good understanding of the, the, the full process um clinical placement wise. So this was in my, in my F two. And I knew by F one, when I was at med school, when I was in fifth year, I knew that this was something that I would potentially want to do. Um I took the USM exams and then in foundation year one, I knew that if I wanted to launch an application in the end of F two, I would need to do some sort of um clinical placement in the US. And I want to gain experience showed that I'd had us clinical experience and also er obtained that as a recommendation which is a critical part of their application process there as well. Um So in terms of um the experience that I had the clinical place and in terms of arranging that, um I emailed 100s of hospitals, um 100s and 100s of different sort of um program program directors and also um administrators. There's a website, um um which is the, I think it's the A AMC website which basically has a list of program directors and, um, the administrators and it has their emails. So I emailed and I would say probably about 99% of those, um, said that they don't have any placements for foreign, er, students, um, or foreign doctors because they barely have any for, um, their own sort of us graduates. Um, so it was a very difficult process and II think in the end I sort of went with an organization actually in order to arrange the placements, um, because they sort of get, they got my foot, um, in the door and then once I was there I was able to sort of make contacts and, um, network a bit better. Um, and all you need really is the foot in the door. Um, when you're there it's a very, um, it's an odd system. It's a system in which who, depending on who, you know, you'll be able to, er, gainer a place, um, at a, at a certain residency program in terms of getting time out of the foundation program, very brief, very briefly because II feel probably that I could talk about this for hours. But, um, I, I had to fill out a, a, out of applica, out of a foundation program, er, form and I had to justify the reasons why I wanted to take a certain period, what the amount of time I wanted to take out when I was gonna come back. If I was gonna come back, um, which I was and um, following on from that, I had a meeting with the, um, foundation director of the trust. Um, and we went through it together. She was very amenable to it. She said it seems as though you, it's thoroughly planned, you've not just sort of done this off a whim or want to take that time out. It seems like you really thought about this. Um So she was happy she supported it and then went to the clinical director of the Deanery, um who put the final sort of seal of approval and I got my time to, to leave and then I had to arrange the placement, otherwise I would have got into a lot of trouble. So I think maybe we should have a United States talk. I think that would be really interesting. Whilst you guys think if you guys have any questions, as I said, please pop it in the chat box because then we can ask live. But will I just had a couple of like a question for you? So you said that you wanted to go into either se aviation medicine or coronary care? How are you in your local year? Developing your portfolio to those really quite niche specialties? So like, like I said, with that J CF position, let, let's say first I managed to get a position on CCU so you get a, you get a taste for it and I feel as if I wanted a tad bit more experience. Uh when I was AJC F sometimes you can feel a bit hospital owned as you were. So you, you can, they expect a little bit more of you. So sometimes you, you couldn't go off and do the things you wanted to do. You wanted to go off and do some angiograms, you wanted to go off and do AQ IP for a bit and it, like, like he said as well, it sometimes when you're in training, it is very difficult to arrange Q I PS publications. Well, whatever it is, when you're alone, you have, I, I'd agree as a junior fellow. I, I'd agree. Yeah. So, um, I wanted a bit more experience to be like, actually, is this, is this what I really want? Um And yeah, I think that that helped towards it, particularly with stem and aviation where it, as you said, it's very, very niche. Um It allows you to gain a bit more sort of understanding of the specialty, look at different courses. Perhaps I know, I know you've mentioned a APG C and, and so forth, but you can look at masters, for instance, I've been looking at a masters in sports cardiology. Um and you can look at different ways and it's obviously talking about money and these things obviously do cost a reasonable amount. So when you have that low income, you're able to afford that a bit better than as you were on a training position, you could, you could say, actually in my four year I want to go all out earning as much look, income as I can. So I can afford this to put towards my sports and exercise career or, or, or so forth. I think, I think with aviation medicine it tends to be a bit more sort of forces based, let's say rath based. Um, yeah. Yeah. Yeah. So you can look about perhaps doing experience in that. I know it can be, be quite limited um with that. But II think the biggest thing is the free, the free time, the flexibility to look at these courses and let's say particularly to those tho those ni specialties you need, you need your projects, you need your courses, you need your additional experience. What can you bring to this job because they are very challenging to get into, they're very limited posts. Um So it, I think it allows you that time to, to do that as well cos as soon as soon as you're on the the training treadmill, um You, you, you can get off. There is no denying that, but less than full time as well. Yeah, there is that and I think it's when you're in training as well, it's very difficult to arrange those kinds of projects and those things. But I do like the idea of like a hybrid, like you mentioned. So you're at J CF for a couple of days and then actually I'm open for the remaining three or I know that a couple of people in my J CF position, they did, you can do uh less than full time or you could do, actually, I want to do 88 months on this contract and then the other four months I want to do. So I think, I think, I think that's a very clever way of doing it. Um So, yeah, once again, I, I'm hate hate going back to it, but it's for me, it was, it's the flexibility and it's the, the income to afford that. Those, those, those projects, the courses to go towards eventual careers, let's say, and I think with flexibility as well, um it's being able to dictate your shift. So I know that when um NRC S was coming up for me, the locus there could say, well, I'm not working for two weeks beforehand. Um And I could tell I, they were, my, my interests were really good with me and they allowed me to take some study leave. But I can't say I'm not working for two weeks because that's like all my study leave and annual leave used up in, in, in one session. Whereas the locus can just say that's it. I'm not, I'm not, I'm not coming and things like that are of benefit as well because passing your mrcs is four points. I think on CD applications so that four points are the same amount almost as some of your other big things. Um II did the same thing as well. II when I, when I was um revising for um Mr CPI actually told when II was locum at the time. Um And I actually said these are specific shifts which I just will not be able to do. And as a locum, you have the right to do that. So, yeah, and it's almost owning yourself as you say, you feel hospital owned. Whereas if you are a locum, you own yourself and your own ability to work and what you feel comfortable with and what you're happy and not happy to do. Whereas as a, a junior fellow in any specialty, you are kind of dictated by the trust, what you will and won't do and, and, and things. So it's quite an interesting dynamic. So that's why for me working a few days a week as AJC F and then having the other days that I can locum in my department if I want to um picking up on calls and things in other specialties, et cetera means that I can then do other things. And I've got a national leadership course that I'm doing. And I've got one of my study days tomorrow because I only work three days a week. I don't have to take annual legal study for that. I can just do it. Um So it's that flexibility. So if anybody has any more questions than speak now. But thank you so much for listening. We just also wanted to highlight reasons to register as a mentee. So in the portfolio clinic, we have a, a mentee scheme. Um And in this, you can have virtual clinics with your mentor. Um It will help support you with your um clinical development and your professional development as well. So your portfolio, you get personalized feedback on that, which is you, it sounds small but it's so significant because people have gone through it and seen it and it's only when you've really had that experience that you know exactly what's needed in a portfolio. Our sergeant said, you know, his portfolio wasn't as strong as he wanted it to be the first time around. So if you sign up with that, your mentor mentee scheme, then you can have almost like a heads up of actually build on these areas and you'll have a glowing portfolio so that if you decide to go straight into training, you've got that glowing portfolio behind you. And even if you take a year out, you'll still have that glowing portfolio. You also have advice on specialty applications. So we try and tailor you towards someone that's in um the similar kind of course surgical training, I MT et cetera for you. And we get smart goal setting. So it's something that's really valuable and we have a lot, a range of mentors available for you. So please sign up for it. It's free and it can only really be of benefit. So why not? We have feedback forms which will mean certificates for attendance. So please fill in your feedback forms. I will send that feedback form on the chat now. Um And it goes via email as well. Um And please come to our clinical f three next week. So we'll be discussing more in detail about your junior clinical fellowships. We've touched a little bit on it today, but for more detail on those and the different types of clinical fellowship, then please come along. We've got someone that's done a palliative care clinical fellowship. So that will be really, really interesting um and their experience on that. So, thank you so, so much for um coming and we wish you all the best take care. This was provided by the Port.