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Hi, everyone. Um Welcome to the last week of this Fy Survival Guys series. Um Thank you for joining us again, if you've been to the previous ones and if not, um that's great that you've been able to join us tonight. Um So this series, we're focusing on um sort of the intro to your first foundation surgical job. So a those that are sort of um senior medical students or fy one doctors about to enter their surgical job. And this lecture this evening is focusing on um the things you can do to make the most of your surgical job. So some top tips and things to prepare for things you can prepare for during job. Um and a bit of um just top tips really how to make the most of it. So a little bit of background about me. So hopefully some of you might have seen me before. So I'm one of the organizers of the series. Um and I have taught one of the other sessions. Um but I work as a clinical teaching fellow up in Cumbria. Um So I completed my medical degree at Newcastle finished in 2020. So we were the year that started from work in mid court as the interim ones. So of finished university early um two years foundation training in Cumbria. And then I've spent the past two years. This is my second year teaching again, working in Cumbria and teaching Newcastle University Medical students and then hopefully going forward. Um Hopefully I will start CST next year, but we will see. So enough about me, let's go on to this evening's talk. So what I plan to talk about and this can be as interactive as you guys want it to be. So ask questions whenever um I'll try and pick them up, I can see the chat at all times. Um But it's really just letting you know what opportunities are available to you, um how to make the most of some SDL time that you get. So if anyone's not familiar with that self directed learning time and our foundation doctor, get that. Um And then we've got some sort of practical tips from myself and other members of the NSTS committee regarding things you can do to, to make the most of the job and on a little bit of portfolio tips. We have got series coming up um at the end of Novem, end of October, November time and that he's gonna focus on portfolio. Um So I'll touch on it this evening, but more will be in our next series um regarding the, so let's get on with it So my 1st, 1st big thing I want to say is the job is not making the most, does not mean just working towards a CST. Um It does give you opportunity to do that, but ultimately, you need to enjoy your job. Hopefully, most of us go into this job because we enjoy it. And II, I certainly do and it's not all about just building that portfolio. There's a lot of opportunities out there that can help you learn. Um, familiar with, um, things that happen on a, in a surgical department. Um I had no idea going into a surgical job as left one that I wanted to use as a career, had a surgical placement at a university. Um The one I did have planned was cut, cut out because of COVID. So I had no idea. I had never even considered a surgical career because I'd never been exposed to it. So I did not go into my job thinking I'm going to build a portfolio ready for CS T because it, it out of my mind. Um, and I think that's important in thinking, you know, like to start thinking about it. At this point, you can go into the job, enjoy certain aspects of it and then think, oh, this might be for me and that's fine. Um People I think you always hear of people that want to do surgery, you know, since the moment they were born, born, they knew they wanted to do surgery and that's just not the case all. Um, but hopefully if you make the most of it, you might decide that that's the job for you. So, what sort of things can you do? So, particularly in time that you've got off the ward, spending time off the ward. Um, most ward based jobs and f one are pretty similar wherever you are. Um, but the important thing is to think about what, what else is going on. What else can you get involved with other than just seeing, seeing the same patients on the ward round every day? Um And I, I've grouped this together with SDL because some of these things you can do within your SDL time. So you are allocated SDL time as part of your job. So you don't have to use it for any of these things. There are other things you can do. Um But you can also do a lot of these things in, you know, in that time that's not designed for STL so some people get um assigned specific days for, for example, clinics or theaters as an F one. I did not. So it was something that between us on the ward, we used to decide, you know, ok, this afternoon, I can go to theater and then the next day somebody else can go. So you, you work it between yourself and you've got the walk getting exposed to all these other opportunities. Within that time. Um And this, these are a list of some of the things that you may like to get involved with. Ok. So I think the obvious one that everyone thinks of is going to theater, um, if you want to go to theater, that's great. Lots of exposure to things really interesting. Um And there's a couple of different ways you can do that. So, um, there are, there's only elective lists, Um, you can go to elective list and the best way I would say to do that is the secretaries for the whoever's list is the day before finding out what's on the list. And then you can have a little read through the operations, have a little bit of an idea going into it, sort of things, you need to watch him for what the key steps and it will not just help your learning if you have a little bit of a grounding, a bit of an understanding to start with, but also helps show that you're really interested in what's going on and people really like that, the more interest you are, the more pe, the more opportunities they offer you. Um So it, it not only helps your learning, but of the opportunities for the future is, um, otherwise the other things you can do is on the ward that, you know, is going to theater and you've been looking after them all week asking everyone has the ward if it's All right with them, if you went to, when that patient gets taken to theater and then you can sort of see the progressive journey through the admission to the, the theater and then continue to follow them pop, er, which I think is a really interesting way of doing it. I can't mention go to theater without mentioning starting a log book. Um If you haven't heard of it before, this is, it's an online log, which is called E log book. If you Google it, it's the first thing that will come up any time you go to theater. So for any students that are watching as a student log these, um and it's quite a self explanatory system where you just input patient details and what you were involved with doing in the theater. It's really, really helped when it comes to CST applications and it's not a lot of work if you start it and then realize, you know what I don't actually want to do surgery, I'll scrap that. That's absolutely fine. But if you're going to theater, then please please log it. Um If you scrubbed, you can ca class that ac um So and that, that's what's important for getting points for CST. So top tip number one, get any log book o next other things you can do are go to clinic. So again, this is something that you don't often get the chance to do as a foundation doctor. So if you've got that time where the wards well covered, you can get yourself down to clinic, whether that's with your supervisor or any. Um, if you just ask the team, them people are more than happy to take you with them. I think 11 of my other key top tips is if you don't ask, you don't get so no one's going to say, oh, would you like to come to clinic with me today? Because they'll assume that you're busy on the ward. But actually if you can, I come to clinic with you, then of course they'll be like, yeah, of course, you can um again showing that you're really interested and people like that. So clinic, you see aside to medicine patients that you often don't see as foundation doctor, you see the outpatient side and some of the um teams that are involved in outpatient clinics, you don't really see anywhere else. You, you've got a lot of things like specialist nurses um that will never come up onto the ward because they only deal with outpatient things. Um So that, that's something really interesting in part for your learning in terms of learning opportunities. I think we often forget about the follow up, you know, post discharge or even pre pre admission. So where you can see these things that you often don't think about when you've got that, you know, acute admission in front of you. But it's a really good learning opportunity to build, um you know, if you're preparing for exams and things, you know, learn why. So why did this patient get offered surgery? And this one didn't, what, what helped your decision making there? Um You know, why, why do we follow this person up but not another person and that sort of learning opportunity that you, you don't really get in any other setting interest. And it also helps for, you know, patients that perhaps when you're then an F two in GP um referrals. So, ok, I remember I saw this patient when I was in clinic that had, they were referred him for this reason, but actually, it didn't really need to be referred in. Um and you can sort of think about that when you're seeing patients in other settings as well. So all for a knowledge basis, um you've got that of one on one time, either de either registrar or consultant, which is quite, quite rare to come by. So use it and you know, abuse their knowledge. So, um particularly in the trust I work in the way that admissions work is that either GP or will refer the patient to surgery, they'll often be seen by the same day emergency care team um prior to coming up to the ward and they will clerk the patients um prior to coming up to the ward. So it's something you don't really get to do much as an F one. But actually, it's such an excellent learning opportunity. Um You feel like sometimes you lose those clinical skills that at the end of med school, you think, you know, tip clinical skills. I just finished my break. But you then sort of an f one when you're, you're not doing it, you know, day in, day out. So clacking can be really useful of keeping up these skills but learning slightly different techniques for things, all the patients that you collect, you will discuss with the senior. And again, that's that sort of one on one time to pick their brain about with specific management plan. Um You know, for example, um that person that comes in with sin and you just, you're not quite sure if it's an appendicitis or not. Um using certain examination techniques. Um you know, blowing the tummy in, sucking it in, blowing it out, coughing, standing on one leg there, sort of things that you don't get taught as part of your med school or ski checklist, but actually really useful in deciding, am I gonna take this patient for a diagnostic lap or I sit on them and wait because I'm I'm not really and that one on one time with a senior to, to build that knowledge and those clinical skills can be really, really useful. It's also a great opportunity to get um sle es. So these are um learning events that use for your foundation portfolio. So you need to evidence throughout your foundation training um that you are getting feedback on your clinical skills. So in the form of actually having someone watch you review the patient or case based discussions and discussing the management plan for these patients. You've seen some ways to, to just, you know, further your learning, other things quite specific to surgery are um is endoscopy. So the likelihood is there's gonna be a number of lists on each day. Um So for example, um ODS, you might have a bleeding list, you might have uh you know, standard referrals. Um You might have surveillance list, you might have colonoscopies, you have screening colonoscopies, you might have flexible sigmoidoscopies and they really, I think it's something you very rarely see unless you put yourself in that situation. As I said, no one, no one's going to invite you down, no one's gonna say, ring up the ward and say cla do you want to come down to endoscopy today? That's not going to happen. You need to put yourself out there and say, is it all right? If I come down to endoscopy with you today, I've not seen that before and people will invite you with open arms that everyone loves to depart their knowledge on junior colleagues. So if you give them the opportunity, they will do that and they will really help you. So MDT so meetings MD, meetings, M and MS and so many other clinical meetings that you can get involved with and again, these are really good for building on knowledge and your clinical reasoning. So why we made that management plan for one person but not the other where, where when you went in, you thought these were very similar presentations. Mets usually happen weekly for um more specialties. And for example, in upper G I that I quite regularly, you have a benign me malignant meeting. Um and you discussed with multiple different specialties. So, pathologist, radiologist, um depending on where you are, you might discuss with tertiary centers that do you know larger procedures than you do in your trust. And I think that's a really good learning opportunity to, ok, why are we sending that person to that hospital? But not that one. Why are they appropriate? And they're not, I'm trying to pre op assessment. Um So this is something that again, it's not surgical because it's led by um the nursing team and the um anesthetist, but a hugely important part of any surgical, um you know, patient journey. So is this patient even gonna be suitable for anesthetic? Which we think, you know what they might, they might need this operation? You might need the out, for example. But you know, is that actually a benefit to them or do the risks of the procedure outweigh the benefits? And a lot of that is dependent on Anestis and you know, whether they're actually gonna be suitable for a general anesthetic. A lot of the knowledge you can get from this is around what, what makes them more suitable or not suitable, but also if they're not suitable for general anesthetic, what other options are out there? Could they have for whatever procedure could they have spine or could they have local? What are the implications of that? How is that gonna affect the surgery? Um Remember the Anestis is such an important part of this patient journey and you know, probably most important part of the procedure as a whole. Even once you get to theater, you don't start any procedure without checking with the anat that they're happy for you to start. Um So it's gonna be a really interesting learning opportunity for, for you. These are just some of the things that you can get involved with. Um, there's a lot more out there, um, depending on, you know, what specialty you're, you're with in your foundation job. Um, even if you're not with that specialty, if you're interested in it, um, they'll be happy for you to join in, you know, if you're on a colorectal job and you actually really like vascular, going to find the vascular consultant on call and saying, you know, I'm really interested in vascular, would I be able to come to your or your clinic one day? And that without a doubt, they also say, absolutely, you know, more than happy for that to happen. Um, or if not, you know, oh, I've already got somebody coming in today, you can come next week. They're never going to say no, I don't want you to come that just, that just won't happen. Um, these are some of the things you can do, as I say either in ward time. So decide between the team on the wards. Um, who's going to do what, on what day? And that keeps it fair. It doesn't, it means that not one person is doing everything and someone else is getting no opportunities and you don't have to be interested in surgery to do these things. You know, this is all about getting exposure and making the most of the job. So when you've got a colleague that says, I absolutely want to do surgery, I need to do all of these things and you're not quite sure that's fine. You can still take these opportunities, you know, create a fair environment, um where you can, you can get exposure to all of these. Has anyone got any, um, does want to message in the chart if there's anything they feel they'd be interested in that I've not mentioned, um, or anything that, um, they've heard of, they're not sure about, um, and how they might be involved with that and I can try and try and clarify anything. Give that a minute for you to want to have a little think. No. Right. I'll move on then. So MDT, so slightly different to MDT, I just mentioned in that previous MDT was focus on the MDT meeting. So where everyone sits around the table and discusses each case. Um This time we focus in the MDT a bit on what are the teams available on the ward that you might like to see you might like to speak to. Um And I'm gonna use a couple of cases to just make you have a little think about that. So answer in the chat, But we've got an 84 year old lady um, on a vascular ward, she had a FEM pop bypass and she lives alone. She got twice daily carers. She got past medical history of diabetes, high BP, COPD, skin, heart disease, CKD stage three. She reduced appetite. She's just a bit, you know, doesn't tell, she doesn't maybe look after herself as well as she used to. So in this admission, following her, her operation, who do you think is likely to be involved in this lady's cancer care and pop in the chat, we should have quite a few different things and a few different teams that might be involved. So send, send some messages in the chart of what, what teams might be involved in this lady's care. So I haven't got any messages through yet. Come on paper. This is interact in that case, I'll just go on and list some of the, some of the teams that I, I think may be involved in this patient's care and this is absolutely not an exhaustive. Oh, here we go. We've got some coming through. So we've got diabetes specialist nurses. Absolutely. Um, it's possible that she's in this situation because of poorly controlled diabetes. Rest, cardiorenal dietician. Yeah. Absolutely. Frailty. Definitely vascular surgeon, endocrinologist had not thought of that one. Not quite sure about. Yeah. Potentially diabetes one. Yeah. So, these are some of the things that I thought of. So, we've obviously got the vascular surgeons, they've dealt with the they in the procedure, they will certainly be involved in the care. We've got vascular specialist nurses, um or tissue viability nurses with your vascular patients. You usually have your vascular specialist nurses on the ward, um dealing with all sort of wound care, um pressure areas, things like that. Diabetes specialist nurses. Absolutely. Um I said she may well be in this situation because of her poorly controlled diabetes renal team. Um because, you know, she, she had an operation. Um she, she already got CKD. It's likely that she, you know, she could end up with A I um deterioration of renal function. She may need multiple scans. Definitely gonna want to make the renal team aware. Um potentially the delirium team. Um you know, POSTOP delirium is really, really common. You'll hear quite a bit more about that on's session. Um But the delirium may be involved. Absolutely. Gonna want to involve the family in a lot of this provided the patients happy for us. Too. Um, and then some, the allied health professionals that very likely to be involved. Misla, we got physiotherapists. Um, so how was she at before level? Now, does she need any further, you know, sticks AIDS, frames, anything to help her at home? Does she have stairs? Can she manage that? And they're very closely linked to the occupational therapists, um, who we're gonna do home to this lady to go back to living as she was before. Does anything need to change? Is there any, um, anything she needs help with any social workers, um, social workers? So she's already got twice daily care. Um, social workers are often involved in either restarting this care or if redacted occupational therapist, um, feel that this care is no longer appropriate in sourcing further care, um, dietitians for this lady. You know, she, if she's not managing at home, she's not mobilizing. Well, is she making meals for herself? Um, is she malnourished? Do we need to be assessing that all patients will get a must score when they go into hospital? Is she at risk of malnutrition? Um, and very likely as well pharmacists. So if we look at her list of core of past medical history conditions, there's probably a lot of polypharmacy going on here. Um, is she managing with all them medications? Does she need a blister pack? Can we rationalize some of them medications? Um, multiple teams involved and these are all people, you can get involved with on the wall. So vascular specialist nurses do a round with them, you know, review wounds with them. Um, why are they using those dressings? What you know, why, why is that healing? And that's not um extremely knowledgeable about their conditions and you know, really interesting stuff that is again, just going to further your knowledge on these conditions. Um, also use for MRS, look at wound healing, very common. Um and it's just, you know, that that side of care that you often don't see on the medical side, some of the diabetes specialist nurses, they're often the ones that alter medications. And so it's rare that they would see a consultant for their ongoing, you know, adjustments in medications. Often the diabetes specialist nurses will deal with that and they're both teams are really actively involved on what. So go round with them and see what they do, um, learn about, you know, what, what they deal with day to day. Just look at a slight difference now. So we look at a 56 year old le and she's on the colorectal ward. She had a laparotomy, Harman's and she had an obstructing sigmoid tumor. So she's left with a colostomy, um, background. She lives with her husband, two Children. She works full time past medical history, diverticular disease and hypertension. So it is slightly different patient than the previous one. So who is likely to be involved in this lady's care again, put some, put some suggestions in the chart. Um, the chance I'll probably be because there are so many teams that are involved in patient's care. So, don't be afraid to write something. I'll give you another 20 seconds and then I will click on to the teams that I think might be involved in this lady's care. So, ST myiasis. Absolutely. So, these are some of the people that I think are likely to be involved in this lady's care. So obviously, colorectal team, they've performed the operation. Um Yes. So someone said colorectal MDT, radiology, oncology. Absolutely. Um, this thing is likely to be discussed in, in the MDT. Now, uh certainly if she was not known about before, um, ST MCA nurses, so Stone can play such an important role in both POSTOP care. So those that, you know, like this lady came in with for emergency surgery, she did not know going into hospital that she was going to pot the stoma. Um, so they deal a lot with that, but also in a slightly different case, they often deal a lot with the pre op care and preparing people for what it's going to be like to have a stormer site in the stoma, sort of mentally preparing people for that as well. So they will got the stoma she's on the ward. Um They will be involved in looking after, you know, essentially teaching the patient how to care for that stoma when they need to be worried what sort of things to look out for, you know, down to the absolute logistics of changing the bag and you know, what, how do you empty the bag? How do you actually get the bag on and off that sort of thing? Um, potentially tissue viability nurses had a laparotomy if that wound doesn't heal for whatever reason, if it breaks down and you're gonna get tissue viability involved. Um If you can, I would really, really recommend spending, you know, your SDL or that, you know that off ward time that you work out with your team going on around the STIs or tissue. So you're not just seeing one patient round of patients, every patient is so different. And I know we say that with everything, but you know how, what, how does this wound differ from the person across the bear's wound? What different dressings are you putting on? Why is this one healing? And this one not so interesting. And as you progress through training, you're gonna get less and less time, time to be able to do this a knee or a surgical wrench, you don't have time to do. So, I'm going to spend this afternoon going round to the ST nurses because by that point, it's sort of, there's a slight expectation that you may have done that as a foundation doctor and have this background knowledge. Um And if you don't make the most of it as a foundation doctor, then you've sort of missed that opportunity. So do, do take these chances when you get them um colorectal cancer, um sort of within that colorectal MDT um umbrella again, the family. So we, I think particularly since COVID families weren't in all the time, we forget that we need to communicate this with the family. So our patients happy often they, they like one of the medical team to speak with the family. Um And then they can make sure that they're relaying all the appropriate information. Um And you know, if they haven't quite understood it, how can the family, so always ask the patient if they want the family to be involved, um Allied health professional. So she had a colorectal with enhanced recovery, um which we touched on a little bit weeks ago in the nutrition talk. So making sure that the patient's mobilized, the um getting them back to their birth as possible. So, um particularly in patients that perhaps have an, it makes a huge, huge difference to the diet and the things that they might need to change their diet, they might need to eat food, not eat certain types of food. Um that's going to have on the stoma output. Um So dietitians who really help with these patients, um, enhanced recovery, you know, do they need any nutritional supplementation? Have they been by mouth for a prolonged period? Do we need to, you know, TPN something along to sort of tide you over until they're back eating, but level the meet the requirements, like different patient. But as you can appreciate, there's a lot involved and I can't emphasize enough how interesting and just see what they did there to get involved. And same principle again, if you don't ask, you don't get, ask one of the stone. I, I haven't seen a lot of stones. I don't really know what I do with them. I don't really know what I'm looking for. You know, I want to look up there. Absolutely because that also them that they don't get in enough role for things. So they're more than happy to have you along. Said we'll touch a little on portfolio, good dive into um you know, the need to and things that, that absolute evidence you need, but I will touch on. It is a really good time to build the portfolio if, if today. Um mm it's good here. So the ready portfolio I tip and then I've got a little bit more but they that the request for portfolio is for things like CST they change all the time. You can start working towards one as medical student, as an F one you get to applying it may well. So it is not the be all and end all. It's not the I most worked towards this as but it is a risk. So if you start this, um it will make your life so much easier when you do come to A as I mentioned that I had absolutely no idea that I wanted to and start F one and I felt like I was so on portfolio because I had no idea what I needed to do. You know, ju just having, having a look, getting an idea of the things you need to do can be really helpful and you got some really easy things early on um with minimal effort. So have a look through, get those easy mark, extra check everything you do. Yeah. So similar to the theory should not um it's not documented. It didn't have, if you haven't got evidence, you didn't do it. Um So I do every teaching session, you do every audit, you do meeting you present that get some evidence for it because it didn't happen. If it's not worth it, then don't do it. This really specifically applies to audit and Q I. So a lot of seniors will try to get you involved in audit um Q I projects, which is great. They are, you know, for you're learning off the number of things, it's useful for them if you do the day, but have a look at what you need to do. So look. But for example, if you looked at the 20 TST guidance because they haven't, they haven't even released this year yet. What from it um of what is gonna get you point if what they suggesting you do is not going to you at all then. So. Well, thank you very much for that actually, you know, I'm a bit busy. I that that's fine. Um You know, at the end of the day, this is your time and if, particularly if it's gonna be a lot of work and you're not gonna see the benefits for it, don't do it. Data collection can use quick and easy. Um And that's good enough evidence for your foundation portfolio, but it purely for CST. So just have a little think about what your aim is with the project and work towards that. And really when you look at the guidance, it can look a bit scary, some of the things they not expect you to do, but they have points for you. How on earth am I going to get any of these points? I have no idea where to even start. But remember then not expecting these points, what this is designed for is different. You know, the top candidates from the the standard candidates, you know, you people will be out there with publication and they've, and they've, you know, been to 20 conferences of that, you know, that person will probably do well but not everybody has that and, and they know that and that they have to put those in to de differentiate them panic as the requirements change every year and 25 at least. Yeah, but there's a similar team self assessment criteria. So this is what you want to be. Look, Google the 2023 CST self assessment criteria, you'll get a doc and this gives you what gave you points and what evidence you needed, it will change. And what you need to think about is the general themes because the type of evidence you will need will change the number of cycles you need will change. But the broad things are very much the same last year it was split in two surgery. So basically in theater, going to conferences, going to courses, um doing an elective surgical job. Um these sort of things, if you, if you're still a medical student, you can because a lot of um committees, a lot of societies, student memberships and student conferences sort of thing. So have a look there, like as a royal culture, a lot of them offer um discounted prices, things get really expensive, the higher you do training foundation again, there's usually a um but want to go to level et cetera, really, really expensive to make the most of it while you're a student. Um and, and you can evidence that your portfolio give you points quite easy things you can do. You can intend. Now since a lot of conferences are online, you don't actually have to travel anywhere. You can, you can sit on your laptop and do it at home. She broadly audit or Qi I touched on in the the previous slide, if it's not worth it, don't do it meet the criteria for, for CST for lead on two cycles of a, doing a bit of collection for that has taken you three months is not gonna fit. You don't waste your time. If, if you find it in great, do it. Um If you're doing it purely for the point, it's not gonna help. So just have a look at what you need to do. Teaching, um This has quite a big bearing on. So it's both teaching experience um and teaching qualifications. So teaching experience in that of who you teach to, whether it's local, regional, national. Um If you organize the and um whatever you do every session, you do, make sure you get feedback. This is I'm gonna hammer hammer on the message that feedback is evidence and, and that's what's gonna get you the points if you love teaching, great getting. Um I'm biased because it's my job, Jenny is great and, you know, you can really enjoy it. If it's a subject you like, you can really get into it and, and enjoy it. But just make sure you get that qualifications relates to things like if you to. So if you've in or something, got a med ed master's postgraduate certificate. Absolutely. Do not interco a certificate for the so purpose of points. It's a lot, a lot of effort and a lot of money if you're doing it as a post grad. So it, if you don't enjoy it, do not, you don't, you don't need to fa and lastly, um publications are present thing that I looked at is how on earth am I gonna get any points for this? How will that uh presenting and winning National prize? I just don't understand how, how is, but have a read of the t really need and particularly our foundation doctors, some conferences um specific for students or foundation doctors. And is it much easier to get in? Even if you project surgical, you get top points for having surgery, surgical. But if it's medical, you're still gonna get some points se send you up for things that projects that you've done, even if you think this is never accepted, um might accept it. Great and the complications and people that I know um got publications from inter research research ins um do inter purely function. You've got to enjoy. It is a full year. It's hard work, do it for the points, do it because you enjoy it. So find something you enjoy. They, they're so broad what exactly you need in there. But overall they, they are, they overall over up and all of the things will be made easier if you so and then tell someone usually, usually very uh sort of thing on the world good seeing you to, you do the things that you want to do and they can help you, they can advise how to start building this portfolio and who, what seniors are really helpful, you know, everything that you think, I don't even know where to start. Someone who's been through, it will be able to help you with that. So for example, for me, there was a, I had a surgical who I met when I was on my f one job really got on with. She was so helpful. She was always offering for me to, you know, do you want to come to the, with me? And as I said, I hadn't even thought about surgery. And I said, yeah, go on. Then she told me about the log book. She got me involved in an audit that three years later, I'm still doing the third cycle of, um, you know, could be really, really helpful that's going to get me points for my application and she knew that she'd been through it. She knew what I needed. Um, so finding a mentor is so important, pe it can be difficult. You know, if you don't just hate somebody in the department that you, you seem to click with, you seem to have things in common with be difficult but speak to your educational supervisor. You know, it might be that they, they end up being your mentor that and they could be really use, but if not, they might find someone, um, or, or somebody that could potential be a could be really bad. So they will have had trainees in the same position. They trainees before, you know, if they were a medical, medical, yes, then they, they will have had people for who have wanted to do surgery. They will know who in the hospital will, will be able to help you. They'll point you in the right direction and it just makes your life so much easier if you've got someone to help you with this, um, can't emphasize that enough. So top tips with portfolio, don't get bogged down with it. It'll probably change while you get there. But have an idea of what you need to do, start these things early and it'll make your life so much easier. Whatever you do, evidence, everything you do, you have great get certificate, save it in a file that's called portfolio and you've got it for when you need it. Um, and really don't, don't be scared by the self assessment. You are not expected to get all these points, do not panic. Um, and as I mentioned, the next series focuses a lot on CST portfolios. Um And what, what do you do if you don't like surgery? So you've got this F one surgical job, you think? Absolutely dreading it. What am I gonna do? I don't like surgery. Um, what, how am I gonna make the most of it? Well, actually, there's so many things that can be useful. Even if you don't want to do surgery, you don't have to like surgery. I do. I it, it's the best choice but not everyone thinks that. But you can, you can still make it really useful if that's, if that's not for you, any projects you do in surgery. So this is audits qis et cetera will also be useful towards a medicine application. So if it's your first f one job and you find an audit project that you can continue for that whole year, so you can get multiple cycles in that will also account for points in your medicine application. Um as in post foundation, that's an option. You, you have to have it specific to, you know, I want to do cardiology. You don't have to do a cardiology, specific audit. It will, it might give you more points, but you're still going to get some for doing any, any multiple cycle audit. It's to show that you engage with the process. It's not specific to the topic you have um also surgical patients, also medical patients, they can be really complex as with the two examples we had, they had multiple comorbidities, really complex and really interesting and your medical, clinical skills and knowledge from seeing the surgical patients thinking, you know, why did this happen? What, why did the surgery affect this condition and sort of looking at it that way in the I I love respiratory. So why did this patient's anesthetic affect their COPD and and learning about it that way? So whether want want to do GP you're gonna learn, you know what these patients that have surgical problems in, in the psychiatry setting on the medical ward. Um, they've got a surgical condition and they've got a SOMA for example. Ok. How do I manage that in the community? How do I manage that without referring to surgery? Is it necessary to refer to surgery? I saw that as F one, I'm, I'm quite happy with that. Do I need to ask some advice? Oh yeah. Do because I recognize, you know, like the one I saw when I was left one in need refer and it's going to help you build your, you know, diagnostics massively for other settings. So this isn't all about applying to surgery. This is about, you know, the bigger picture on patient care and Thursday's session will focus on um complex patients. So with the so be sure to come along to that and even if, but also if you do so a summary of how to make most of your f one job, enjoy it. Um And but there are so many opportunities out there that you don't get a chance to take when you're when any other job. So most of it start building your portfolio only if you want to, you don't have to time, it's almost never too late. Um But it's absolute portfolio. There's so many learning opportunities out there just making most of it, please. Um put any questions in the comment chat box and um, I can try and answer anything. Can I've got other also, do you know anything discussion wise we can help with wise, um, complete survey. You'll get to, uh, you'll get your certificate as men session is um, how to deal with these complex patients. So how to deal with the medical patients as well as and also complex surgical conditions and a little plug again for regional leads. Um So originally the application closed tomorrow. So there's a number of universities and foundational places still available. So I've got a little um some of the um medical school and foundation medical schools still need a lead. And these foundation deaneries here is a QR code to apply. Uh So ple please do reply if you're interested in joining the team. Um Otherwise last session of the series on Thursday, um Please come along to that and as mentioned, the final series of the uh sorry five calendar will be the um CST um which will start um November time. So keep a look out on Instagram, Instagram, Facebook, wherever you you whatever social media you use will be advertising that very much and we did manage to finish a little bit early. Thank you, Claire. Um Just wanted to say that was brilliant and very useful and I don't know if you just want to flip back or we'll post the feedback link as well as well, which um could also share that but any questions from anyone just pop in the chat and we'll stay on here for a few more minutes. Oh, the clinic as in um so this relates to outpatient clinics. So when um patients get an appointment through the post to see, you know, for example, the colorectal surgeon, they'll come to a clinic. Um It's an outpatient department and this is where they see them for that, you know, appointment, whatever it is. And they're discussing um where they get a, a sort of specialist review quite often for um surgical patients clinic where they have been referred in for their G so that spot symptomatic gallstones, the GP um and this is where they'll see a OG I surgeon or HP being where you are. Um and discuss when a cholecystectomy is an option, whether it's something they want to consider, manage care, anything else they can do before they consider surgery. Um oh, knowledge to help them make that decision. What is an audit of Q I? So, um A and I sort of similar processes and an audit is where you look at the practice within a certain department or within a certain ward and compare it to some usually of national set standard. So for example, all patients that are admitted to should have a V risk assessment performed. What we can do is go around the ward and look at, at have all the patient who had their A T risk assessment um assess that actual standard. Is that all the patients that? But if we're, if all of our patients have that great, we're meeting the standard. If they don't all have that um improve that, how are we gonna meet that? So often things are things like um you know, teaching sessions on the importance of VT risk assessment, things that are gonna help us to meet that, that standard and that's an audit. So you assess against standard project is slightly different in that. It doesn't really have pre set standard, it's improvement project. Um And you can relate that to most things really. So for example, a Q I project I did was um I felt that when I was on acute me, um almost impossible to find the equipment needed to do. Ok. Equipment. So complete little survey was everyone else just me that wasn't looking. Um Everyone said no, you know what it is urgent care. So we made trolley that has all the equipment in. So whenever you need to do catheter, you walk into the cupboard, you grab this trolley and everything's there us over and again, how do you feel this gone? Do you think it's better now? Everyone said yes, one cycle Q I project. So it, it's full improvement in the standards that of whatever it is, but it doesn't have a pre set standard. No problem. Then for another couple of minutes, if anyone has any ones, um and again, thank you everyone for attending. Thank you Claire.