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Evening. Within the next hour on getting involved in clinical research. We've heard about basic science laboratory research, but I know some of us here are more interested in in the clinical aspect because of your training as doctors is emphasized on the clinicals. So we are listening to getting involved in clinical research from medical student and early career doctors. We are Professor Adar. Professor Adal is, is a professor and consultant laparoscopic surgeon at your Mi Awa University and Obafemi Awa University teaching hospitals complex elite. His research focuses on general surgery including expansion of minimal access surgery in Africa. His current projects projects are laparoscopic surgery and global surgery. He is a fellow of the West African College of Surgeons, the National Postgraduate Medical College of Ni Nigeria and the American College of Surgeons. His special interests are in the field of minimal access surgery and he has pioneered laparoscopic services in the in general surgery at the oaut ce. The floor is over to you, sir. Thank you. Good evening everyone. Thank you for having me. Thank you for inviting me. So this can I share screen? Am I permitted? Yes, I am. Yes, sir, please. You can share your screen, sir. Ok. So I will just get started. It's quite exciting hearing sha go speak. And I think um you guys make want to feel quite jealous because the kind of things that you guys are discussing and being exposed to right now is um they're, they're far fetched in our own time. It, you needed to have gone to somebody and gone to another person to be able to, you know, have this understanding and then you, then you keep them in some business, not the kind of well structured, organized um discussions and feedbacks that you get. And it's um it's quite um helpful in those days. It used to be the privilege ones that get to understand some of these things. But now that this is in the public domain for um as many as are willing, it's, it's quite encouraging. So I, I know you guys will have um spoken a lot about the basics, but I just also think I should ask um starts by asking this question and the, the real question is what is research? And there are a lot of misconceptions. There are a lot of um things that people say about research. I tell the residents. Um Are you interested in this research? And the, the guy will say right to my face, uh Let me finish my residency first. You know, whereas your residency itself in itself should be what should be leading you to research generate and ideas for you. OK. So research is about asking questions, generating ideas, challenging the status quo. Looking at what exist I asking, can it be better? Is there a different way of doing this same thing? And all around us today, almost everything is changing. Almost every handphone you have every device you have, somebody is changing from one version of a software to another. Every drug that I was taught in medical school for treating hypertension in this same medical school, two thirds of them, you'll be crucified if you prescribe them for a patient today. So research is all about asking questions. It's all about you can do research in your home. But even though there's no what we're talking about today, I'd like to encourage you to keep asking yourselves that question. Why? And don't try research so much to career alone, tha research to the public domain Thai research to thinking th research and to what is going on around you ask questions. Why? Why should these things be? Why are we here? Why are we still using this method? And if we develop that attitude, if you develop that inquisitive mind, you would do a word rand and every other person would leave that word rand and go through their rooms, their play area. But you leave that word and you will have written down 45 things to generate ideas to do um the whole humanity a a favor. When you ask a question. It leads to different ideas running through your mind. How do I solve this problem? Uh Mostly today, there are millions and millions of risk that going on in the world. And there are quite a number of things that are been asked that really do not impact um the society of people. And that is why, you know, countries like ours, people don't fund research. People don't see value in research. But if you generate an idea on how to solve the problem, I remember presenting this to um newly employed lecturers in health sciences and I was asked to speak to them about research and generating research ideas. And one of them was asking the question, what if somebody beside me, if I, you know, I was talking to them about collaboration? And it was like, what if uh people you invite then steal your idea? I said it means that your idea are too few that somebody can steal. You need to keep generating ideas on a day to day basis. You need to um design ways to find solution to problems and in conducting invalidate research, there's no answer questions. You need to be aware that there are things that can invalidate your answer. If you say that, oh, this is the best way to do this. And everybody is going to say, did you consider this? Are there are things that makes uh a Nigerian perspective or something different from an American perspective. So when you are saying this, are you saying it globally or are you saying it for a look group? What you have discovered and decided how is he applicable to different patient population? So in that, if you're taking care of all that, then you analyze your results and make a valid conclusion, the process of disseminating your finding started with what we used to do in publishing in the journal. But now I'm part of collaborations all over the world where the Genna publication is just probably one very small step of dissemination. And today, I mean, there are so many avenues of disseminating your findings across the Globin Kevin Cly that I took this um quotation for he's a medical student and he published um on a page and he wrote this just last year. He's saying that it is becoming increasingly important for medical students to participate in research but also to publish. Nowadays, I heard struggle talking brilliantly about you know, the different opportunities out there. Um Ladies and gentlemen, I must say to you that OK, you know, the bar is being raised every day, the bar is been people became professors when I was student with a 10 15 publications. And nowadays, I have some of my colleagues that with 100 publications, they are not yet made a professor. So even stat residency nowadays like Sha was mentioning in the United States, I've had quite a number of guys leaving if I going to the U SI want to be a neurosurgeon and then get there and discover that you're coming from Africa with your M BC B. The guys that have MB BS from the US cannot even get into some of those positions because the colleagues who have P ad have lined up for the same limited number of positions. So it's becoming increasingly important for you to enhance yourself. But having said that this is not just about getting placements and appointments. This is about demonstrating an aspect of knowledge and skill. This is about showing people who are assessing you that yes, I can. And if you, you, you know, everybody looks at a blank page CV and says this one has done this. So it means that this one has the capacity to do more. So it means that if you, if you haven't done it, the impression that your assessors have is that you can't do it whereas it may just be that you have not availed yourself the opportunity of research. Um I think it was just last year that this was all about the news. A 17 year old student was thinking and came up with an idea and I I mean many times I talk to students, I like showing some things like this. She just talks about it that if bacteria can give colors of acid and alkaline, you mean if we could switch that we use for closing surgical wounds then if there is an infection and this bacteria produce this materials, then the color can change of the suture. So if you have a nurse in a low middle-income country who is a non managing the patient, because the surgeon is not always available, then the color of the suture that has changed from black to red. We a lot, the n and then she can go after the surgeon. That was a medical student that was a 17 year old student and of course, eventually was celebrated all over the United States. Um This was in 2016 that I had, I had a travel grant to visit um some institutions in the United States and one of the places I visited was the University of Utah where there is actually a center for and there is actually a department that only looks at student led innovations. We're not even talking about publishing papers there. We're talking about innovations, designing a new post oximeter that connects with blue suit to the no sensation. You will see what a simple thing to do. But the addition of a Bluetooth device to a pulse oximeter and putting it on the finger with patients such that when it goes wrong, then the noise sensation is a lot. And the kind of things I saw on display in this center. And I'm mostly to you guys, those are the people guys who in their second year are already thick up research thinking generating ideas and doing what's um you know, in this part of the world, we don't consider to be ideas for students. So I, I just feel like pushing some of these things to just stimulate your thoughts, even if you don't want to jump up and you are here in Nigeria, like I used to say to residents, I sat down in my room thinking of what's projects to do for dissertation. And I saw that the whole world was a ma surgery but that was some in 2003 and in my own hospital, it's never happened before. So you need to be abreast. You're using the same iphone, the rest of the world is using you, you, you're playing the same game they play, but you must also do the career at the level they are otherwise you'll be publishing and thinking and be your own academic in a local level. So medical students in research, there are international groups uh in Africa, across Nigeria, there are regional groups, there are different things and I want to publicly acknowledge the FF AD journal um probe and what it has um done over the years. Why we were students. It was so limited. Of course, I I published twice in E MA as a medical student. And today seeing people like Chia Steven talking about if a mad and all the other young ladies I see with you guys, it gives me joy that the medical student asci he has sustained that, you know, climate of research within the medical school. Unfortunately, he appears as if he's only usually a very small group of students that participate in this over the years. But the the opportunities there and can only get better and better the international opportunities for medical students. I've seen different groups advertising for joining, for partnering for mentorship. So there are opportunities locally, the opportunities here in I it the opportunities internationally, there are regional opportunities. And I'd like to say to you that you must avail yourself of this opportunity. I've spoken about if I made journal, there are so many journals abroad, up to up to regional international standards that are only for medical students. And I want you to know that if a made journal to pass this um aspiration, you must, you must begin to, you know, upgrade the standard of the journal. There are some of these journals have shown out here that professors competes to get their papers published in even though it is Domi with medical students departments or associations in different medical schools abroad. So the sky is the limit and the fact that you're starting here and you're starting small. Please don't um don't please don't, don't be the effort, effort. There are different types of publications and research today, you asked me to speak a lot about clinical research. But let me remind you that in the clinical scenario, there are case reports in which you just report about a patient or a case series where you've seen a few patients that have breast cancer and goiters together. And you're wondering, is there any connection between this? And you say let's publish this series of five patients that have been seen in the last two years. A review article looks at its subjects and try to see what is the current knowledge about it. The retrospective studies where you won't look at the pattern of how patients manage with this and that I've done over the past few years in prospective studies. Then you want to prospectively either observe or intervene and randomized control trials are the best ways to that. The whole world wants you to do research, systematic reviews, meta-analysis. This is in the clinical scenario. He asked me to speak to you about clinical research and clinical research. Um There's so many things we do in medical practice like she was saying before me, now, there are a lot of things don't as public health as global health. The clinical research focus essentially on patient care. Um And the aim of this is to increase our knowledge about patients, how to treat them better, how to improve their care. This may just mean that you want to increase our knowledge, how do patient's kidneys react when you add these two drugs together in them, you also want to improve safety, you want to improve efficacy. And there are two main ways we do clinical research to observe and just look, either look at patient as they are coming or look at their records. Observe what has been going on over time. Give them some things and observe, operate patients in different ways and observe how they do um do different treatment methods and observe how they do it. Um Interventional study means that you are changing something, you are adding something, you are intervening in the normal way in which things are done. So those are the two broad, there are different things in between, but those are the two broad ways in which clinical research is done. Um Clinical trials, yes, like the word says, you want to try out something, a new drug that just been um introduced for treatment of one medical condition and you want to try that drug and compare it to the one you've been using for that same condition over years. If you just do it habitually, we will not be convinced that it is the drug that has produced the effect. So the best way to do it is to use a method that has to allocate patients randomly without they or you being able to select randomly assign them to take that old drug or that new drug or to take that new treatment or surgery. All the old, that's what is called randomization. You need a control the ones that are not even exposed to this thing that you're talking about. So that when you say you have not done a randomized control trial, we know that randomly assigned patients, the outcome is not due to chance. So that is what is called randomized control trial. And that is the hallmark of interventions, particularly in clinical practice. It is, it is so held in high esteem that we don't want to listen so much to case report because we think that oh that may be due to chance. Maybe your patient took um a we do before taking that Lisinopril. That's why your patient was color popo. It can be due to chance. But when you are randomly assigned patients into different groups that is respected as not due to chance, especially if you have used the specified number of patients that are required to answer that question. So randomized control trial and this can happen in different phases of that tra is one, is 234. We won't go further into that so that we can discuss the main subject of treating, which is how are you being involved? How can you as a medical student or a junior doctor be involved in clinical research? And I must say to you in medical students in particularly in the clinical posts. Ideally are the ones reading freshly. That's why I always fight when I see students reading all the old s of this world being a medical student should be AAA very good appetite to read the latest books. You know, not a book written 15 years ago. Some of you were not even, you were not even in secondary school yet. When somebody wrote a book, how can that be correct? When the app on your phone has been asking for updates every six months? Ok. So clinical research is very, very open for clinical students to start thinking for residents, junior doctors to get involved. And how do you get involved? I wrote here that if you have a desire to being involved, then you take a step, then you get started, then you consolidate this and then you achieve success. Um I will, I will start by showing you um a few steps and I hope that this will be helpful. I'm not, I'm not going to come up here today and say I'm a very good student, uh best researcher know I wasn't the best student in my class, but I, I woke up one day and I went to doctor about there and that was Professor Rabo was very prolific in writing and I went to meet him and I said, sir, I want to be involved in research and he looked at me and he was impressed, you know, he used to teach us final year communication skills. He would go outside of his own topics and teach us, you know, look at yourself in the mirror, get confident. So I went to meet him. I said you're doing a lot of research I want to be involved. And then I finished medical school just around that side and I started out job two days or three days after induction and I was posted to his unit. So you can imagine how lucky I was. And that was when did directly observe therapy of um anti tobacco drug was started and I was running clinic because all his own residents were going on outside posting to legals. So I I just packed all the case notes of the patients. I spoke to police doctor Rabo then and I told him sir, I'm interested in seeing how has this thing worked. And he said I should go and write it. Then I wrote my findings from the case note and I give it to be in love. He say, wow, you tried. But this is certainly not how to write an article, that article was published in the journal of the American Medical Association. Of course, today I miss so John today I cannot be cooking. I I don't even cite it on my CV. It's not even on my CV. Because what do, what am I doing with anti tobacco drug? As in as, as a surgeon, you understand? But that desire led me to that first step. I expressed my interest and I started doing that. I must say to you that till tomorrow he keeps asking me, how are you doing and how is your research work still going? I say to you here today. Ladies and gentlemen, that, that is the best way to start showing interest, expressing a desire. There are research groups across the world. Don't limit yourself. If you hear me speaking a lot about surgery, you understand that that's my own personal bias, but whichever aspects of medical practice you are interested in. I'm happy you guys were talking about basic research earlier. If you're interested in basic research, then go for it. Don't wait until you finished our job and finish the no start expression interest. Start joining groups. I met a medical student recently who has undergone online training and certification in six or so online training courses in Mason, I Mason. And I keep telling myself you have sufficient time to do this. So if you're also interested in research, there are online training certification models that you can begin to access. If you want to wait until you are then on a phd program. And that's when you want to start learning some of these groups, then you have challenges. So start taking those steps. Now, I'm not saying you should abandon or very cool. Um Your, your studentship so far. But I must say to you that then devote some of those times to building capacity for a research future. Like I have said, um I had a classmate also who told me I'm not going to go into academics, he's going to travel abroad, then he went abroad, then he joined a group, then he started working for an NGU. Then the NGU got the NGO got a United Nations project. Then United Nations wanted them to start giving field reports. Then he got into the same research that he told me he would never get to his life. So you can imagine if somebody like that at early on in life decided to acquire the skills to be able to um do this same research. So he had to then start scrabbling up and down to acquire the knowledge and the skills that he needs, you know, and even the public health, the field research, it's probably more challenging than the clinical research that someone like me to, you need to identify him. And so I just give you an idea how I identified a doctor Arabo in do this even though eventually I didn't go to his own field, even though I didn't, I didn't like tuberculosis or anything. But that's aspect of him being able to show me the way to get into research, particularly clinical research. You can't get involved in clinical research without identifying mentors. It, it it may not have to be one, you can have different mentors, someone who mentor you in one particular aspect or the other. Almost all of you are required to write projects either in community health or in something. Please, can you also take those things seriously? I've had instances in the past where of course in, in our own days. Each individual does their own research present in community health. You defend that dissertation. I was the first in this hospital to write about HIV A I DS patients. He was no, when I was going to finish in 1999 a medical student was writing about HIV. He was on head off around here then. But now I learned that you guys do group projects and there are groups that they just leave it to one person. Please get involved, start getting involved u utilize that opportunity. But I also want to say to you that you can initiate research. I am in firm B general surgery. There were some students in firm a general surgery. They came to the theater with their own consultant and a few of them came to my own theater. And so I was operating on a patient that has a very rare congenital anomaly that has been carried to adulthood. And a week or so later, these two boys came to me with a case report that they have already written. They didn't see one, they didn't even ask me to mentor them and whether they just sent it to my email. And as I speak with you, I've submitted that for publication and I told some of your um guys in glory land the last time I was there to speak that the two of them are the 1st and 2nd. Also of that people, every other consultant I put them behind, you can initiate research as small as it is at your own level, you can present research in meetings, apply to present, apply to speak at meetings. These are some not all of the step, but these are some of the steps that can help you to get involved. I must say to you that time management is key. If you want to pass in your medical school and graduate with flying colors, which is also very important, you must be able to marry this with your desire to do something extra and maybe of you are already doing extra things. So you must be able to manage your time. Don't um don't fail and repeat the class because you are doing too many things outside of the class. Are there opportunities? Yes. And the first one I would like to say to you is that um there's a welcome league grants and I will be selecting a few medical students. I just need like four or five who will be trained to perform laparoscopic surgeries. Now, I'm coordinating this across Africa because there is a grant from Welcome Lip. And the aim is that the old world now is saying it takes like 15 years to produce just one gene. So you what rubbish, we want to start training people to be able to do appendectomy alone and certify the. So I won't be surprised if in, in the next few years, we begin to have training for surgical procedures where individuals are trained. So the one I'm saying is that there are opportunities where we can also engage students, not only as participants, but also to um perform tasks to also get involved in procedures, but also to participate in research. If you get involved in clinical risk, generally, whether in mental health, whether in medicine or surgery, it gives you an exposure that ordinary posts does not give you your CV. Like we said, at the beginning would be better than every other person that is applying for the same job that you're applying for. There are scholarships that are meant for students. There are research grants are meant for students. There are, there are conferences being held abroad where students are given travel grants, but you must be coming there to present the people and some of these things will come out 34 weeks to the conference. So if you don't have the research, you are working on, you would not, I mean that three weeks is not sufficient for you to then quickly go and get something packed and then submit and used to apply. So there's so many opportunities out there that you will miss and the day you graduate, the opportunity is no longer open to you because it's only for students, their careers in research. And you know, some of us in this part of the world, our brains are so wired that you think everybody must be professor of general surgery, laparoscopic. This, they are professors today of clinical research. I have friends and friends. I can name same people for you. I have friends abroad, particularly in the UK, who are associate professor of clinical research. The only thing they're doing is clinical research. Not, not to say I'm a surgeon or something like that. So this, this is also a career in itself and this guy sits on millions of dollars and pounds of grants to now recruit people here and there to ask this question and answer this question. There are a lot more out there like you know, so this is um the brief introduction, I would like to say tonight. And um I'd like to thank you for inviting me. But also to say that if, if you have questions, this is perhaps the time uh to ask you can me over to you? Wow. Wow. Thank you so much prof we've personally, I've really, really learned so much tonight and I'm sure a lot of us have questions for pro. So we would go directly into the question answer session. So as usual, um if you have a question, please raise you um use the raise hand icon so we can mute you from um Steven will on mute you so he can ask your questions. And if you prefer to use the chat box, please also send your questions to the chat Boxx and I'll read them out. So we have um somebody raising your hand. Now, Steven, can you mute? Um the person who is raising his hand? That's a Mustafa Mubarak. You like me? Yeah, hello. Um Good evening, sir. Thank you very much for, for the light session, which was inspiring and thank you very much for me for um session. So I have a question. Um So I, I am a medical student from the University of Ri and I, I've tried as much as possible to involved in research um after writing papers doing courses, gotten lots of rejection, I've been able to publish a book them, but I'm trying to step up my research um like with um stepping it up from no narrative reviews, commentary, articles to systematic reviews. And I have got in lots of face a lot of challenges which I would love you to, to advise me on. So I've checked on youtube, checked courses and systematic review, but I haven't found um any that gives me what I wanted and I'm generating lots of research ideas calling. So um surgeons to collaborate with me. But I noticed when we get to the writing phase, after we generate the protocol, we submit it to prospero, we do lots of steps in fact, see the writing phase, then everyone just stops, they tend to be busy. It has happened to two of my um research ideas like that. So um I don't know, it's difficult in the skills. What can you see about getting mentors that would, I would love to train you on how to um carry out this specific kind of research so that your research ideas will be able to give birth to something meaningful. Excellent. Um Mika, do you want me to take um each of these questions? I think I can start with the Zoom and then probably we take all the others together. Yes, sir. You can start with his own questions, sir. Others will be sending in. Yeah, most of all I must encourage you if you had rejections, you are in very good company. Uh I don't know how many things I've written that have been rejected. Um But I will give you two examples. I wrote a research idea. Uh immediately I passed part one for my dissertation and my supervisor, Professor LA looked at it and said, no, this is not doable and he told me no, this cannot happen. So you, you know what? I, I just left it on my shelf. Um It was supposed to be a, a research where you measure the um acute face proteins in patients undergoing surgery and you look at it over time and, and it told me 45 reasons why we can't do it. The reagents are not available in Nigeria and then I went online so I could buy it from South Africa and then there was no money. So I left it on the table and I was very sad because I've read so much about it, written the proposal. So I started applying for grants and rejection upon rejection. But most of one day I got a grant and it was to do something. And then I keyed this one that I speak to you today. That paper was published in the journal of the Society of Laparoscopic Surgeons in the United States of acute face SAS in sickle cell patients undergoing laparoscopic cholecystectomy. So if, if you have an idea and he rejected, I had another one, I wanted to talk about expe of laparoscopic surgeries. And um, I applied to Global Surgery and they said no, that was in Rwanda in 2020 16. Do you know that by 2019, 3 years later, they were looking for meat by themselves because the university got a grant to do a health economic research regarding laparoscopic surgery in low middle income country. And nobody has ever spoken to them about laparoscopic surgery here except my own that they rejected. So they went to fish it out and one of them gave me a call and say, well, are you interested in applying for this? Of course, who am I that I won't be interested in it? So let, let me encourage you that rejection. I've given you the positive ones I really encourage you with the ones that I ended up with. I have loads and loads of other things that were rejected. But today, the one that were positive has led to so many of that do that. Now, I'm even saying I'm tired. I can't continue doing so. So don't be discouraged if you are rejected. Number two, if you have mentors that um let me say kill your ideas or um do not support you the way through. You probably either have chosen the wrong mentor or probably uh you're expecting too much from them. You should to me now about meta-analysis, I'll probably uh OK, sou is one of the medical students and probably is on this call. He has a group of friends, they did one research and he came to me, wanted me to mentor and I looked that everything is done and I called him. I said, look, I know somebody else that would do this better for you because he's in that field. And you know, he speaks the language of this research that you've done better than me and in surgery. So I linked him up with somebody else. And as I speak with you, he's applied for ethical clearance there. I think he's going to start analyzing the work very. So you do not necessarily have to have one single mental, you do not necessarily have to have a mentor in your own institution. You do not necessarily have to have a mentor for everything. Like I said. Now, if Tolu comes back to me with another research that is in my area of strength, I'm going to tell him, oh, fine. Let's do this. But if I'm able to identify that there's somebody else who can deliver this better to him, then I'm going to help him to identify that mental. So I'll link him up with the person and I've been linked him up with the person. You can be it. There's no time I see him and I don't continue to evaluate whether he's doing well with the person. I linked him up with them and I'm very happy with them so far. Systematic review, um, is not something that so many people probably in your long have done. So you probably need, uh, somebody else apart from what they have done, you probably need somebody else to take it further with you. And this, I was saying to a group of medical students, uh, a while ago that there was a time I wanted to acquire some skills in laparoscopic surgery. I wrote more than 40 people abroad and they kept giving me wrong answers until one of them in Israel said, I think you can come, you know, so you, you don't get discouraged because, uh, one person didn't know, keep trying, keep looking for different persons. Try another person who will have more time for you or who perhaps has the expertise that you are looking for. Ok, I hope that's uh, uh, answers you more. Yes. Thank you very much. I really appreciate and thank you so much. Um, I think it's Steven or Chikwe Maker that is showing this symposium. Um The guys in the in Birmingham are so, so excited and they're really looking forward so much to this um symposium. And I'd like to personally advertise it to you guys that um you should come there and ask questions. We've decided that each one of them will just be speaking for 5, 10 minutes each and then we're having lots more time for discussion in lots. If what I am last you are done. Meeting is for here. I mean, these are guys, most of them are young, young people in their own career out there. So they're eager to answer your questions and I'll be very happy to see all of you there. Um For this program. Thanks you. Thank you, sir. Um The program is actually holding at a university um teaching hospitals, link group. So it's a physical event. Um So we actually have people from other medical schools here. I think what we can try to do is to live stream the program to a youtube channel also. So that other people from UNA we have people from Ilori and Poco here can also benefit from the program on um September 14th Thursday. So, um do you have any other questions? I think there was one in the chat about someone asking if they want to be excellent at both clinical um clinical research practice and cardiothoracic surgery with hands-on experience. Whether there were any trainings or courses they can take cardiothoracic surgery. If you go to the United States, everybody abuse cardiothoracic surgeons because they are so busy with clinical houses and everybody abuses them that they are the least academic. They do all, all their things by, you know, by this is how it should be done. So, but that's by the side, that's, that's just a joke. There's no aspect of medicine that you don't have people um making a lot of advances. So essentially what we said today uh for you to don't jump into cardiothoracic surgery before you start acquiring skills for research. Uh I belong to the Global Search Collaborative and um we're creating online modules. I don't want to advertise that because I'm in the educational committee and it's not yet uh concrete, but I'm going to send the link so that some of those models that are already up and running you can in your free time. Some of these things are just few hours, some a week or two and you get to finish it. So I would um I will send that to you f journal when this is ready, you can take advantage of some of these opportunities and begin to um acquire the skills for yourself. So that when you start your cardiothoracic surgery, I don't know where you want to um do your training. If you are doing it in some centers abroad, you have the option. You won't take a few a year or two off to, to do a PD, which aspect of sory you want to do in the United States? That option is there for you to take a year of and go into research, acquire a phd or acquire a fellowship in another field entirely different from the mainstream that you are doing residency on. So that's very possible. But I will advise that you start now, I will advise that you from now begin to up the game and, and um improve, improve yourself. Like I also said, and like Shaun said before me, um it probably will enhance you in getting a place for some of these um trainings, particularly if you're thinking of doing it abroad. Thank you so much, sir. I think um those are all the questions we have and we are able to take for now. Um Our time is fast spent. So if you have any other questions, our email is in the chart. If you send it to the email, we would be able to have your questions and, and email back to you. Thank you everyone for joining us for this enlightening session. I'm I trust we've all learned so much. I can see some positive feedback in the comments box and also on whatsapp. Thank you so much, everyone and we look forward to seeing you again next week and we, we'll be ending our et seminar series um with our last two sessions Thank you so much. Have a great evening. Thank you, sir. Bye bye. Thank you. If you haven't already signed up on fill the Google form, please do so. So you can have the certificate for the course. Um Steven, please paste the link for signing up with the Google form in the chat box. So those who haven't done that can also fill the Google form and get the certificate after the entire series is over, we would also be sharing the links to the um recordings of this session after the whole series is over at the end of next weekend. Thank you so much for joining us. We look forward to seeing you again next weekend.