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way. Yeah. Hi, everyone. And I hope you managed to have a bit of time to, You know, you have a comfort break, gravity or coffee as needed. So we're good and just kick right back into the start of things on. Continue with the specialist. He talks. So the next talk will be about general surgery. Um, from Miss Katy Strong. Who's a general surgery training, Um, and I'll hand over the floor to her now for her to deliver her talk. Thank you. Thank you, Emily. I'll just share my screen, but with me. So hopefully you can all see my screen. I've just turned my video off for Internets sake. Assembly said my name is Katie Strong. I'm an ST five general surgery trainee in the Northeast. I've done all of my training in the Northeast, including medical school, so I know the area very well, and I don't know, and you are also at all, so I just wanted to have a quick word with you all about general surgery. Wind to choose it. Why not to choose it on a few thoughts I had about the interview process. Obviously, when I've done the interview, it's been several years ago, and over the course of Cove it and last year on the interview has changed dramatically. I know you either have had a We'll have another talk on the interview itself, but there are a few thoughts my housemates last year on something interview and so have a bit of firsthand experience off the vibes of that interview. Eso just to start why you should choose general surgery. For me, general surgery is a fantastic specialty. It's one I came to quite late in the day. I started off life wanting to do orthopedics, and then I changed my mind to plastics on via breast surgery, sort of meandered into general surgery on DNA on a diet in the world upper GI I training, and I wouldn't want to do anything else. So for me, general surgery just has so many opportunities. There's a huge variety of different types of work to get involved with, and for me, something that really gets me involved and gets me excited about what a specialty I'm doing is the ability to get stuck in and the ability to, you know, from Day one I was suture ing from day one. I was getting into the abdomen and I was doing their self doing nights. It's a specialty with so many different individual parts that you can feel like you're progressing every day. There's also such a variety of things to get involved with. Laparoscopy, for me was something that I hated initially, having gone a little bit better at that, having, you know, had a bit of practice after I now really see it for the for the amazing thing that it is, you're basically changing light bulb or standing in the corridor. You know you're holding these huge on instruments on affecting change within the abdomen. And for me, that's really exciting. Robotics. It's emerging. It's coming. It's just not in the hospital network that I've worked, but I work in. Although the trainees are getting a very good go up things at the moment. There are training modules for the robot on on the on the training brubach on. But it's really exciting, Teo, you know, be it the front forefront of this new emergent technology, Open surgery is never going to go away. It's brilliant to watch its greatest hands dirty. If you come away from a surgery with blood on the gloves, you're automatically a bit more satisfied about life. Natural orifice surgery is amazing as well. With Thomas you know you can use without a single incision. You can take away a cancer from a patient if I'm not brilliant on endoscopy, which, although there is a cross over with gastroenterology on, there is more and more training being put into general surgery doctors doing endoscopy. And for me, it's really something that's really knighted. My passion for a GI guy. There's also the more exciting stuff. The trauma, the emergency surgery, the blood and guts were going down to a any in the middle of the night and, you know, putting your hand on something, something that's posing blood. It's a little just, you know, such a variety can go from generally stroking somebody's hand and telling them that everything's gonna be okay to the next minute. You know, putting your hand on someone's carotid while they're a day edge of life. And for me, that's that's the reason general surgery is brilliant. Um, US Saving General does not mean that you're a generalist. You are a specialist surgeon, and there's subspecialties with in general surgery. So breast up, Gee, I colorectal are the kind of standard ones. But then there's also a possibility. Transplant, endocrine and within apologize. Bariatrics. You know you can specialize in subspecialized and subset of specialized. There's so many different routes in toe, finding your niche and making your career perfect for you and for me as well. Because you are one of the forefront surgical specialties, you are making a real difference every day. You can have a surgical uncle take where you get to the end of it, and you feel like the whole day has been a complete waste of time. You've just been doing paperwork will slow growing or whatever, and you look back and you realize that just from volume of work, there is always, always at least one patient who you've made a life changing difference to you that day, even if it's just solving there pain that they've been in for three weeks or giving them an explanation about the disease they didn't know was going on or some some really small things could make such a huge difference, and actually every single shift is worthwhile. I wouldn't be fair if I didn't also talk about why you shouldn't choose general surgery. And for me, one of the heart think things when I'm on call is the patients who come in with abdominal pain who you just cannot given explanation as to why they have abdominal pain. You know that blood to normal, that tested normal scan is normal and they're still sore. And there's nothing you can do except say to them. I'm really sorry. I have no answer for you. I find that incredibly unfulfilling and really frustrating on Don't sure the patients feel the same way. I'm sure it's worse for them, but that's for me a big reason. My general surgery, every shift. There will be at least one or two patients like this, and it can get a little bit frustrating. But as I said before, you know there are so many opportunities to do good that these patients do. You sort of get filtered out. I suppose, in in your mind, although with every general with every surgical specialty there is the next thing that I'm going to talk about, it feels particularly apparent in general surgery. There's a huge variety of finished time. You are never, ever going to be able to rely on the fact that your day finishes five. You're not even when you're on call, you're never gonna be able to rely on the fact that when the person comes in for the next shift, you can leave that maybe some unfinished work that you need to continue with, Um, and for that it does make making a planning. Social life could be a bit difficult. Workload can be huge one day, and then the next day you're wandering around the hospital without any real direction or abilities to do anything helpful. But these are the times when you can focus on on audits and presentations on paper something. There's also quite a large variety of opportunities and experiences. I've always found that certain training is seem to go on call and get. You know, six laparotomy is in the day, and then I took to work, and this one abscess and nothing else and equally certain consultants will take somebody under their wing and they'll, you know they'll somehow progress much more rapidly than everybody else. There's gonna be that to a degree in every specialty, including medical specialties and outside hospital specialties. But general surgery because there's so many different types of consultant so many different levels off for whatever that word gonna, um, you do you Do you have this variety between you and your peers Having said that, these are negative things, but I still wouldn't choose it. Another specialty. Um, for me, general surgery is something that has kind of really let a fire under me. In terms of wanting to be a good doctor. I found something that has I'm giving me a passion, and it's given the direction. So for me, John surgery is absolutely the specialty that everybody should choose. But don't everyone to use otherwise no job. So those are my kind of lyrical force on white on a surgery is the best specialty. And but I'm gonna have a little bit of a check with you about how I think preparing for the application should go, So none of this should be new to anybody. The only thing I really want to stress is you must be careful with your appendix members because if you're getting towards the 100 mark, your scores will go down after 100. I think it goes from 5 to 2 or 5 to 1 something like that. So just be careful with your appendix is gets many as you can, but as your protein 100 just take your foot off the brake little bit for me. The biggest thing when I did my interview and I think it's no different to the interview that happened last year, is use your crisp algorithm. I hated the Chris course. I thought it was completely useless and stupid, and it's basically you assess the patient and then you turn your back on the patient and read through all their notes. And I never felt that you were actually doing anything. But it's a great structure, and the examiner's seem to love it to be logical. I think out loud, show you're working, work through the problem in your head out loud because anything you're thinking in your head, they need to know in order to be scoring you. The other tick that I picked up was Don't be, don't be re explaining yourself when you don't need to. So if you've used a technically accurate phrase, so I've used the theater sample of a set of observations. Don't then explain what those observations would be. So you don't need to say, Oh, I'll do a set of observations That would be BP. Heart rates at oxygen saturations Don't do that. You've already said observations. Move on. Don't be wasting your time. It looks like you're stalling. So if you've used a technically accurate term, trust it and move on, the better. The next biggest thing that you absolutely must do is practice. There's no way of getting around that you have to body up with the other people who are applying. You have to annoy consultants the best ones to find out the ones who are involved in the interview process or have been, at some point or in some way affiliated with colleges on annoying the current S t three. Is there gonna be your best resource because they've just been through it? So the current ST three's will know what the interview was like. Well, no, what it was like to sit on Zoom, and that is such a difficult thing to do an interview. When you're in your own house, it's just the vibe is so different. So definitely pick any brains that you can. And for me, when I was getting ready for my, um, for my interview in my application, I was very aware that there was a lot of things on the scoring system. I was like, I haven't gotten an extra degree. I haven't got any publications. I haven't got this. I got that. If you're running at time, you're never going to get an additional degree in three weeks. So maximizing audit numbers close any loops that you can get a presentation done. Get a certificate from your order department. Get consultant to give you feedback. Anything you do, you must have something from external source of validating that you've done it. So if you presented a meeting absolutely, absolutely must get somebody to either give you a certificate. We'll give you some sort of piece of paper where they said I witnessed this happening and it happened. I promise. If you cross cover another hospital in your hospital network, theoretically, is it regional like if it's ah hospital trust, that's not regional. That is very much local, but I know that from the Northeast we have Carlisle Hospital that does cross cover, don't freeze in Scotland, and I would consider that a regional presentation if you're presenting in. In that scenario, anyone who's publishing is likely to be quite precious about their paper. But do they need help? Do they need somebody to collect data? Do they need somebody to spell check to the need somebody to? If you're particularly the statistics, maybe you could offer your services there. Are you well, are they willing to do your favor in order to get your name on the paper? Now, non accepted papers are not going to get you any points. So somebody who's had a paper accepted for publication. That's what you need, because if you've got an accepted for publication, you can still get points. If you can set up teaching for your left one's or medical students Doctor Menti and get them to give you feedback, make it a regular teaching session and collect just any feedback at all. Because I was absolutely what you need on just a bit of advice about her appendix. A hernia numbers. If they're scoring you on appendix numbers, try and body up with somebody who's more senior than you. You can supervise you doing it so that you're gonna be more likely to do the operation. I've always found it. A consultant is involved in the appendix operation. They generally say something to you like Oh, just the quickness is sake. I'll just do this one, and you can do the next one. That's no good to you. You need somebody who's gonna be. I was driven to get you trained as you are on at the moment. That's gonna be another registrar. So see, if you have a spare afternoon, just shadow the on call for a bit. If you have a spare day when you're not doing anything and you want to just see if you get one more appendix, that's what I would suggest. So just my final thoughts. I'm gonna again mention how wonderful general surgery is a particularly general surgery in the Northeast. I think it's a for gotten region, and often it's kind of other, and out there and in the wilds, it's not quite Scotland, but it's barely into England anymore. I would just say the trading in the Northeast is fantastic. Think uncertain, Sarge N u in the lovely people, for the most part, for the most part, and they genuinely taken interest in progressing You on Certainly my experience training. I'm one of these people who is quite know this. I don't necessarily back myself. Always. And I've really found that. Despite that, you know, when I'm desperately trying to hand over the instruments because I've kind of lost confidence in myself. I've got a consultant behind me. He's saying, No, no, keep going, that worry you could do it. I'm here. Don't worry on day. For me, that's absolutely help me blossom. Having said that, no, every region is going to see everybody. So if you are putting your preference is down, I would just encourage you really think you're going to accept the job if you offered it in that region? My my husband last year, you stopped the application and stop the interview. And, thankfully, job. Her initial region that she offered was someone had never even heard of before. She didn't know the hospital network. She didn't know which hospitals were in that region, and she had to 48 hours before. Thankfully, she was upgraded to northern where she wanted to be. She had 48 hours where she genuinely sat. There was like I don't know if I can accept his job. I don't know if I can move my whole life to somewhere where I've never even been before. It's a bit of a step into the unknown on for some people. They're not willing to do that. So just be sensible about which regions you're putting. And don't put yourself in a position where you've got a job with so many downsides. Don't discount Starting in February, I'm not sure if they're still doing this, but they certainly were last year where they have on jobs that start in February. If it gets you the region you want, absolutely go for it. Having said the thing about the region's be prepared to move regions, particularly if you're a sudden train the Oreo training around London, there's a good chance that it's massively oversubscribed and you may have to move regions, and that's just what what life is. But like I said, don't pick a region absolutely wouldn't go to. And if you do by accident, make a decision, pick up either except your job. Don't accept your job, but don't leave. All the other training is hanging because it is a bit mean, So those are my thoughts on by Think now is the time for questions. So I'll just stop screwing my screen and come back home. Fantastic. That thanks so much, Katie. So we actually have a round round about 34 minutes. If anyone has any questions on the chat, I can read them out to you. I can't see any of the moment, but, you know, if anyone is thinking about I, I have one for you eso for in terms of general surgery. Know some people from the start, like I really want the optic eye on the detail of actual What point? That, you know, do people make those decisions? Do you have to know from the beginning? No, not also. Like I said at the beginning, I didn't even want to do general surgery. Fell into it by accident. And for May. And once I decided I wanted to do general surgery, I was kind of aware I didn't like colorectal. And that was about much decision, as I've made. Strictly speaking, by ST five, you should have an idea of what you want to do. Just because it helps some with direct in your teaching on, but I don't know what it's like. Another regions. But in the Northeast, we have cattle, very training sessions. And so, in order to put you in the right groups, they need to know by ST five. Certainly you can start S t 3 to 6 months up for six months lower. Get a bit of experience about what's going on and then kind of make your decision slowly. Some people I know are ST Sevens and still haven't made a formal decision about what they're doing in terms of upper GI I or specialty. Other than that, um, but I think it's it's you do certainly get a chance to to ease away in Nice, nice, Thank you. And, um, couple more questions. Those, um, Mohammed asked where just transplant come into the picture? Or is that not three genocide? Or is it through John search pathway? So my understanding, particularly in the Northeast, use not general surgery. You specialize in hepatobiliary and transplant, and then that's a training program that you go on through there, but it starts his general surgery, certainly in the Northeast. Nice. I'm one more from Hannah. I'm saying I've heard from other trainees that they have to come in on humor, stays off and not use all of their leave in order to get case numbers. Is this always the case? So this is a real big Bob Baer of mine as a female training. I personally don't want Children. I'm not gonna go less than full time. But I have a lot of colleagues who do do that, and I think it's really disadvantageous to them. If I'm coming in on my days off and I'm coming in on my zero days, Teo, come and get extra training less than things. My viewpoint is, if they can't train you during the days that are meant to be paid to be working the training program, is it fault? It's not you. I absolutely refused to not take all my annual leave. There is a cut certain zero days where I will come into work because my endoscopy training always falls on a Tuesday afternoon, which is quite a difficult days. I'm always getting zero days, so that was the only exception to that wall is I'll use my cheese afternoons, but I kind of do three or four and then move it zero day here and there. And I'm very much of the opinion that if you can't get your numbers during the time you're paid to be at work, that is a fault with the training program. It may be a bit stubborn, but that's for the attack I'm taking, and I'm certainly I don't think I'm the only one, and particularly at the female training is there is. There are a few people who will go in on their extra days off cetera, and that will be very smoke about it. There will be people who go faster than you go slower than you. But as far as I'm concerned, absolutely don't do that exactly. And I think you know, the point of annual IV is for rest, for wellbeing and everything as well that you know, you have to take into account the long game. It's not just about like getting those numbers. Now. You know this careers for decades know maybe not the code it starts. Anything is. We need to make sure that we don't run out exactly, And, um, one more question just before we move on. Teo Tash is fourths of a surgeon has asked for breast surgery. At what point do you specialize? So with the new curriculum that's come in this year, you start terrible surgery. You announce that you want to be breast surgery. You continue doing general modules up until about ST five on then for your ST 67 and eight years. You just do breast surgery. And if you achieve your your general competencies, you can come off the on whole rotor for ST Seven and ST Eight. So used to do a full year of breast general calls as ST six. And then, if you've achieved all your competencies ST seven and eight, your breast.