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In me. And this is what I'm gonna talk about. Basically, I thought I talked about it in chronological order, flew through Malaysia to go to Australia. So I thought it was important to show, you know, a bit of a balance. Um So yeah, I'm gonna talk about my holiday. I'm gonna talk about my stint on breast oncology and endocrine surgery and I'll cover a bit of logistics. Then obviously, what you're all here to talk about, which is TN O and then a bit of kind of extracurricular and leisure stuff that I did. So the first thing I did was uh go on holiday, which I flew through a beautiful island called Langkawi. Um This is me heading off on my journey and this is just a little map of Malaysia. Um This is basically a chance for me to show off where I'm from, which I'm from Malaysia and this is a beautiful island called Lanka. There's lots of wildlife that is actually the beach where Crazy Rich Asians was on. Um, some monkeys, me feeding the stingray and a very lovely beach as well. And then k this is where my mum is from and so I basically just ate and ate for a day. Um And that's the, that was just before my elective and then obviously I got to Australia. So I did my elective at the Royal Melbourne Hospital and I did my full elective here. Um It's very high tech, very lovely. So the picture in the middle is um something called the Peter MacCallum Cancer Center. Um It's incredibly spanky. It basically looks like a hotel as soon as you walk in really well funded. And as you can see, there's two bridges that cross from the main hospital to the cancer center. And the third picture is me standing at the rooftop coffee shop at the cancer center. So it's very well decked out very well looked after very well funded. Um And I had a really good time. So I just wanted to talk about the healthcare system in Australia because a lot of people want to go there for f three. A lot of people are thinking about, you know, maybe migration there and um it's a bit of a different system. So there's also a public system and a private system, but the private system and public s system kind of work interchangeably and the public system is obviously run by the government. Um But a lot of people use their private health insurance. So it's underpinned by something called Medicare, which means that there are kind of state funded hospitals. So government hospitals and there are also private ones but you can also use private health care in a public hospital. So Royal Melbourne, there was a mix but I mostly saw um kind of patients under the public sector. And for example, in GPS, because of Medicare, you can pay only slightly an excess and your health insurance or Medicare will cover a slight of it. But if you can't pay at all, um you basically can get public funding, which is works out quite well. Um It also means that if you do have private health insurance, there are tax incentives which mean that people are more likely to use their private health insurance. And that means that public health insurance remains free for people who need it most. So in summary, healthcare is really affordable for those who can pay for it and free for those who really need it. Um Next up, I wanted to talk about my first placement, which is in breast oncology and endocrine surgery. But obviously, I know this isn't really the topic of the talk. So I thought I would talk about just generally arranging your elective and how you go about that and a bit of logistics. So in terms of arranging the elective RM HD are a really good system where it's not um kind of merit based. It is just you put your specialties down. So you can go on the R MH website, you can rank all the specialties you like So my first choice was TN O. My second choice is B OE. So I actually got both of the ones I wanted. Um And it's kind of based on the dates you wanna go out there in terms of accommodation. A lot of my friends stayed in airbnb S and you can get money back from the NHS for that and I stayed with my family in Melbourne, but you can also get money back if you stay in Melbourne. Um If you sorry, if you stay with family from the NHS, if you wanna get around Melbourne, I used a my card which is basically like an oyster card which you can top up and use. Um and trams are actually free in the central business district. And then I also took the train and then in terms of funding for elective, I think K A will touch on this a little bit more. Um But you can use your college funding. So Claire gave me some money and then the NHS Bursary, but the NHS Bursary is retrospective. The one thing I would say about college funding is that if you want to get college funding, not all colleges have to do it retrospectively. So because I was going to Australia, I said I really need money to pay for the flights themselves and my college gave it to me upfront. So just ask if you are interested and then in terms of insurance, you need indemnity insurance and you can get it through um the MDU but Australia is not covered by the MDU. So you need to use the mips, but it's completely free. It kind of, I could do it with a, within a day and um it was fine and then the uni of cam travel insurance so the the university can provide you with travel insurance and again, it's completely free and it's for the entire kind of period you're traveling. So that's really good. Um And then here it's my little ID bat for when I got started at the hospital. And then just if anyone's interested in breast oncology, endocrine, I did a lot of really exciting surgeries. So that was like excision of AO which is really rare, some thyroid clinics and then a lot of breast surgery, plastic reconstruction surgery. And then um good thing, there was a weekly MDT, but every week at the MDT, there was free lunch, which was sponsored by somebody in kind of breast surgery. So there was free lunch with the MDT s which I really enjoyed. Um And speaking of lunch, I just wanted to especially mention, unlike the kind of sad M and S and Costa coffee, there was a builder and salad bar. There were macarons and there was an entire kebab shop within the hospital canteen and a gelato or smoothie bar which I don't know, I just felt like it was exciting as I should mention. And then we're onto the good stuff. So I did a really amazing placement in Tim, obviously, why I'm giving this talk? I had a great time. Um So from left to right, you can see I'm holding my socks. This is not for no reason. Basically, word to the wise, if you go to an irrigation, any kind of wash out, you need to take your socks off because they will get soaked. And so I was advised this and I ended up taking my socks off and I chuck them to the side cos I was about to scrub and I left them in the, the whole day. So don't forget your socks, but also don't wear them because they will get soggy. Um Here's me and my legs and my very flattering kind of shower cap scrub hat. I don't know why I have those there. And then this is when we did some teaching um in um acetabular fractures. So when I went over the head of the department is actually British. Um he went over for a bit of a stint and then just ended up staying there and really enjoyed it. And his specialty is pelvic and acetabular fractures. And I was really lucky because there was a pelvic fellow who had come to Australia to train with him and he was actually from the UK, he went to Cambridge. So he sort of took me under his wing and because he was a fellow he had no allotted reg, which meant that any time he was having surgery, I basically got to first assist and he said, come and help me and I got to be first assistant on all of his cases, which was awesome. It was really good. Um So just a bit about the surgeries that I saw probably the most kind of exciting was we did a lot of acetabular um fixations. One case was a 27 year old girl who'd been in a road traffic accident. She was sitting in a taxi and she was in the back seat of the taxi and the taxi got rear ended and she flew forward and her knees both bashed into the seat in front of her, which meant that the trauma that was caused um backwards through the femur basically caused bilateral ati of fractures. And the way we did the surgery was we did one fixation on one side. So we scrubbed, did the surgery, we then de scrubbed, flipped her over, had a shot of espresso re scrubbed and then did the other side. So it was basically like a two in one. It was really long but very, very exciting. And then obviously, we did just kind of the normal standard. I don't know if anyone's heard the phrase like the Pelvis is like a polo where if it breaks in one place, it's like a ring. So it will often place in, it will break in two places. It won't just be one place. So there was a lot of fixation. Again. Another interesting case I saw was a 28 year old who had been in an RTA in Bali and he'd had um an acetabular or if in Bali and they had done a really horrendously botched job of it and he came back with basically total body sepsis. Um But instead of the kind of couple centimeter incision they should have used, he was basically on zipped from all the way from um his back, all the way to the back of his knee. So the moral of the story being get repat and don't get it out there, try and get flown back if you can. Um Another thing I saw, like I said, the irrigation debridement of a knee joint, which was kind of gross but cool. And then my favorite was the computer navigated TKR. So if you don't know where that is, it's basically a total knee replacement. But often the issues with knee replacements, you have to use jigs and you have to, to, to try and get proper alignment and proper sizing for the replacement. Um It's quite difficult and it's normally done by IO with jigs. So this basically eliminates the need for that and it helps with alignment and it's an infrared technology which then also has a Bluetooth sensor. And so you can use it to navigate around the joint cuts, which means that you get the correct measurement and you get the correct alignment of the knee replacement. So I saw a lot of that. They also use it in neurosurgery. I've seen it in a, um, so that's very exciting. And then just to finish off, I thought this was kind of interesting. This is um a triceratops orthopedic related in the Melbourne Museum that I saw. This is the neck joint and the neck job of a no joint of a triceratops is actually a ball and socket joint, which I thought was quite interesting cos obviously ours isn't. Um And that was me museum and just things that are really kind of, I really recommend Melbourne as a elective destination. There was some thermal springs that we went to, it was winter there. So it was kind of like AQ gardens equivalent. I went to see the abridged Harry Potter and that's the National Library. There was a can like concert and some fashion museums. A lot of absolutely incredible food. I did not eat one bit of average food when I was there the entire time. And um that's the Melbourne like sky deck. And then obviously there were quite a lot of other Cambridge students and also other medical students that I met on the elective doing their elective. And then I also had a lovely holiday in Sydney. That's Bondi Beach and some nice a balls. And that is it. Thanks so much for listening. If you have any questions, please. I don't know if we're doing time for questions. Yeah, time for questions. If anyone has them, I put them in the chart, put them in the chart if you would like to. But it can be about anything. It doesn't have to be about Ortho. Yes. We'll probably just give like one minute questions and then we'll move on to uh Rahul's presentation and then I think it's gonna be me and then we'll follow that with Jo. Um You can also put in the questions at the end, which is fine, right? Rahul? Are you ready? Ra he gets guy e hey, hey, guys, I, I'm really sorry. Um Rahul's mic isn't working right now. So he's gonna come on next, but I'm gonna quickly share my screen and do my talk about South Africa. All right, here we go. Oh, so, um I did my elective in South Africa. This is a view from Signal Hill, which is in Cape Town. So you can see the city, you can see Table Mountain over here and I lived and the hospital was over here. Um And then the beach is literally just to the left, so an incredible place. Um So this is how I got my elective last year. I went to the personal part um annual meeting. Um It's for one of the London training rotations for orthopedics. Um My, one of my mentors, Mr Kang who you might have met um helped me go and basically prof toi who's this man here was doing a talk about his hospital in South Africa. Um, and I really connected with the talk and I thought it was very nice. Um, and he seemed like a really nice guy and he ran the orthopedic department at Tygerberg in South Africa. So I went and spoke to him and asked if I could do my elective with him. Um, Miss can help me and we're gonna hopefully set up an exchange. So one of their students come, can come over here as well. So my general advice is don't be afraid to talk to speakers, try and make the mistake holder. So the reason that he invested in me and I wasn't just another person, one of the like 500 emails he receives a day. He actually had zoom calls with me after um was because of organizing the reciprocal um opportunity for his students as well. Um If anyone wants to come to personal, it's this Friday. So just send me a message um either on Facebook and Twitter or you can email me. Um My C RSI D is H VF 24. I think it's in one of the latest slides. So just get in contact or just contact one of our uh KOS pages. Um So this is where I did my elective at Tygerberg Hospital. So this is a hospital here. I've only shown you a little bit cos I wanted to show you the really nice sunset and Table Mountain in the background. Um Tygerberg is kind of crazy cos it's about 40% bigger than Adam Brooks. Um It's the largest hospital in the Western Cape. Um There's only one hospital that's bigger in South Africa, which is Barer hospital which is in um Johannesburg. Um and something that was quite baffling for me is they had one mri scanner for 8 million patients. So the waiting times are not as generous as the NHS. Um So I stayed in the Stellenbosch Medical Student Campus, which is right next to the hospital, which for these early mornings and having to be in the hospital at 730 was very helpful because we literally lived just over here. Um And with eight flights of stairs in the hospital and very dodgy lifts, you kind of needed a bit of time to get in. Um So what I did while I was there, there are a few options of what you could do in the day. Like it was actually very variable and you can kind of pick and choose how you spent your day. So because it was winter as well in South Africa, it wasn't that bad, it was between like 14 and 25 degrees every day. So it was pretty, pretty pleasant actually. But if, if we decided to go in when the weather was bad, um because we would just basically look at the forecast and if there were two days in, during the week, the weather was better, we'd take those days off if, and then go in at the weekend or whatever. You could basically go in as much as you liked. I really enjoyed it. So I went, went in quite a lot, probably about five days a week. Um, so there was a 90 minute m morning meeting. Um, they would do half an hour of a registrar presenting a case that they had dealt with and another registrar basically being examined on it. Um We sat in this big auditorium, they'll be pitched in a second. Um And there was like a massive screen where they showed all the cases on like a and had all the lights off. So it was a bit like a cinema room. Um And it was like they called it the firing squad. So the consultants would basically just interrogate the registrar who was being tested on it and then the other registrar um presenting it would essentially provide the answers. Um And then after that, they would go through every single case that was gonna be, that had been done overnight. Um cos they had a registrar on call for 24 hours straight and they would be operating alone. So they would show what they'd done overnight and the person who'd been on call in the front room, which is like the A&E department would also present what had come in um and then after that, they go through literally every single person on the list. So any patient that's listed for surgery and talk about where they were and what the next steps were. So, it was very, very thorough and for such a big hospital, it worked really well cos it meant everyone was on the same page and even though they were quite understaffed, it was, and it was an incredibly chaotic department, It meant that everyone kind of knew what was going on. Then after the meetings at about nine, you could, the, if you were in surgery, you would leave at eight and you could leave the morning meeting early and if not, you stay for the whole thing, um, you could go to theater so you could pick a list. Um, so I ended up spending a lot of time with the shoulder firm. So we were split into firms like sports arthroplasty. Um, there was um, tumor sepsis, reconstructive surgery. That was another firm. And what else was there like, uh, foot and ankle and stuff like that. So, basically, I picked a firm. I ended up spending a lot of time in shoulders and upper limb. Um And so on some days I would go and see the patient's pre op. Um I'd also see some of the POSTOP patients um in the clinics and I'd be taught how to examine them and stuff like that. So those were really helpful days. And it meant that it set you up for the third day or the day after and you could go and plan the cases with whoever was operating. Um, and then the 24 hour calls were kind of crazy. Um, you'd turn up at 730 the day before and you'd literally operate 24 hours straight. The registrar was completely on their own. They had no assistance. So it meant that you could get quite stuck in and you could help quite a lot. Um It was really good in terms of log work, you got loads of cases, you saw cool stuff and you were first assistant. So you got to do lots of things and they're really tiring cos you would literally be going until probably about six in the morning. Hopefully get a bit of sleep and you, then the registrar will present the cases and then you do a ward round. So you'd probably end up staying from 71 morning to about 1 p.m. the next day. So it was quite long, but really learned so much from doing them and you kind of build people's trust in you and they, they let you do quite a lot of stuff and then obviously there's a fun side of it as well. So we had lots of time to go hiking, surfing bouldering. We hired a car, did lots of fun stuff. So, yeah, elective was honestly incredible. Um Here's a few of the cool cases I saw. So this was a boy with cerebral palsy where he'd had a growth arrest uh in his like medial tibia. So this bit had stopped growing, the other side had kept growing and his fhe kept growing, which meant that his foot curved around. And so this was how they planned the case. So they took out a wedge and then they, they fused it together and hopefully you wouldn't need any le leg lengthening issues after. And there was a lot of this, a lot of gunshot wounds, South Africa is quite a, quite a violent place. So that was quite common. Um Here's one of the morning meetings. So some of the sort of examples of the teaching that you got in the mornings by the registrars and here's one of the um, surgeons fy telling us about how to do a latter because he'd seen a latter that week and had diagnosed it and then done the, done the surgery. So he was talking through that. Um, so this was, and the, the hospital was a public hospital. So it's very poor. Um Most of the patients that come from townships or, or sort of situations like that. So they were um getting all their healthcare for free, which meant they were actually very, very grateful to be there and incredibly polite and kind patients, but it meant the hospital was falling apart. But the orthopedic department had, had some good funding. So it meant we had more comfort there. Um This is some of the teaching I received I was learning about, I did one day a week every Tuesday. I go into sports surgery. So I saw a lot of ACL and multi ligament knee reconstructions. There was a lot of tibial nails. So that's something I thought would get a feature because there was a lot of trauma um, Clubfoot clinic. So we saw lots of Children with Clubfoot and I took all these shoes over from the UK, um, to South Africa, uh, to help the kids, um, funnily enough, one of my suitcases got lost and it was the one without the club that shoes in it. So I had very little to start with, but it tightened up quite quickly in a very rickety old car, which was quite funny. Um, and then here's what it was like in theater. So as you can see, they use cotton aprons, which is a bit different from the UK. But I think we might be potentially switching to that as a sustainable alternative. Um, I would say it was like South Africa, sterile. It was a bit less sterile than the UK. They were a bit less thorough about their scrubbing and stuff, but like, generally it was pretty much identical. The only difference in how sterile things were were mostly, um, in A&E, um, here's them using the same robot that I think Lauren was talking about. So this is the Mako robot doing, um, uh, a knee replacement. And then here's just like an example of one of the nights the calls I did so low energy fall tibia fracture fell on right here. So these are quite boring ones. And then there's like road traffic accidents, pedestrian, um, vehicle accident, um, fall from a truck just, uh, septic hands. Septic cases were really common, which is a lot less common in the UK because patients wouldn't present till a lot later. So the septic, septic hands and feet and stuff had got a lot further on which meant that they ended up having washouts and often had fingers and toes and things amputated. So, as you can see, once it hit about 2 a.m. and the surgeons had been operating phenate at 18 hours, they usually switched to septic stuff so they wouldn't make any mistakes, um or anything too crazy. And here's some other crazy stuff that I saw. So for example, gate fell on legs. Um, there's assault with an ax panga assault is like a machete. So that was quite a violent place. Um There was a lot of community assault, which is basically where the, the community just take the law into their own hands and punish people for things they've done wrong. So there were quite frightening um, things going on in South Africa, but he felt very safe in the hospital. There was a lot of security and um the patients were so grateful to be there. He didn't ii never felt unsafe. Um, so, yeah, if that's something people are worried about, I didn't have any issues with that. Um, another few assaulted with pan, slipped and fell, uh, body trauma open but pelvic fracture. So it's a bit like what Lauren was talking about. Yeah. So that's a few of the cases and then onto some more sort of happy things. So, this is where we went surfing. Um mckenna and Yak were two Italian residents who were doing some of their orthopedic training at Tygerberg, which I was quite jealous about because that's not offered in the UK. Um And male was uh from Belgium and he was also doing some of his uh emergency uh stuff there. So we went surfing quite a lot and I did a lot of theater with those two because they had more time to teach me. Um So it was really fun and then this was after a day of hiking and then we went and watched the sunset and then we went out for dinner. So Cape Town has got a lot to offer. It's got beaches, it's got mountains and it's got an incredible city. Um And the food is insane and really, really cheap because unfortunately the rand isn't doing too well that currency, but it means you can do so many cool things. Um And on a budget, uh we hired a car for less than 10 lbs a day for the whole time. We were there. We have a lot of freedom and it was just so much fun. So, yeah, cheap food and drinks. You can get a beer for like, less than 2 lbs in every nice restaurant. You ever go to the food? Most meals cost you less than 8 lbs. Um, and like hiring wetsuit and surfboard for the whole day could cost 7 to 10 lbs. Um Amazing hikes, really kind people. South Africans are amazing people. I thought like they were the most kind and generous people I've ever met. Um beautiful wildlife opportunity to see safari and much more travel. You don't have to go into the hospital more as much as I did. But if you find it interesting, you obviously can uh I'd recommend hiring a car um in terms of funding. Um I've got a document with all the stuff that I looked into and the things I applied for. So if anyone wants some help with that, um I think most of the deadlines are end of December, end of January, end of February. So it's something to start thinking about and try and get your um like your elected locked in by the end of Christmas holidays, I'd say because then you get all the official documents you can send over with the applications. Um I got funding from the Royal College of Surgeons Edinburgh, which actually have quite a few funding opportunities I got some from Bota which is a British orthopedic um, training association and then I got some from college and the NHS. So, yeah, it's really worth looking into, I, a bit of time into over the Christmas holidays and in January and February, um, because obviously it helps a lot with, uh, your, um, elective. And then this, I like, this is how I structured all my documents. There's a lot more to think about than you might imagine like insurance risks like indemnity as Lauren were saying. So just make sure you keep on top of the paperwork because hospitals don't tend to be that good at replying. So just keep, keep pestering and try and have someone on the other side who can help you out. Um And then this is one of the sunsets I saw when we went and did the garden route. If anyone has any questions, let me know. Um And if not, we can, we can come to the at the end for listening. Um Rahul Hans um sound going. If not, we'll go on to Joe next, how were the surfing conditions? Great question. The surfing conditions were so good. It was a bit cold. So we had to wear wet suits cos it was winter. Um but it depends which ocean you surf near. So if you're on the Atlantic side, so if you go to bubber and stuff, it's a bit colder. But then if you go more to the Indian Ocean side, it's much warmer. So, um, the waves were variable each day but there was stuff for a massive range of abilities and you can sort of sit in the white water if you're newer to surfing. And if you're not, um, Michael, the one in the picture I showed you before, he was a massive surfer and there were so many good, like, really local places you can go literally for a day trip. So, surfing was amazing. Amazing. Um Raul. Yeah, my mic's working now. So it should be good. We can hear you. OK. All right. OK. Can everyone see my screen? Yeah. Cool. All right. So I have and ra I did my elective in Singapore. So a little bit different to the ones that he Lauren have given, but some are in a lot of aspects as well, which I'll explore in a bit. So, first of all, why you should go to Singapore? So if you haven't seen before, the bottom of the chair is the airport. It's probably the nicest airport you'll ever go to. And it's just, you know, kind of the start of how amazing the country was. So, first of all, they had really good um orthopedics opportunities so similar to ha I went to the first World Pot meeting. Um One of the people there was from Singapore. They mentioned that the orthopedic teaching there was really good and they were in the UK for a fellowship. So I thought, why not? See, it was actually like, I really enjoyed it. The other things to talk about the weather, it was really, really warm. Every single day was 30 degrees, had a really nice wildlife which I can show you pick up later. The important thing is that the majority of people there speak English, which is very important if you don't speak any other languages and in terms of getting around, you won't need to get a taxi or hire a car. It's a very good and affordable public transport. It's also the only time that you'll probably see ac before entering the hospital. The other two have waxed lyrical about the food and I will as well. So basically go to somewhere that has nice food. So in terms of the actual placement itself, so I was at Senk General Hospital. So this was a relatively new hospital. It's only been built in the last 5 to 10 years. As a result, it looked very futuristic as was the orthopedic department itself. So they split my four weeks into different teams. So the first week was hip, the second week was trauma, third week was spine and then the final week was foot and ankle. I quite enjoyed this because I got to see a, you know, a wider variety of things that I've normally seen so far. Adam Brooks and the regional placement. So if I could do it again, I would do do it exactly the same. So, the way it work is for each week you had 2 to 3 days of theaters and 2 to 3 days of clinics. I quite like this as I got to see some of the same patients, um, who we'd operated on at the start at the end of the placement as well. Um, the other thing that I got to experience because I did it as part of the N US Exchange scheme was I got to go with the N US students for teaching and they go very in depth in teaching. So one of the sessions, they went in depth into how to actually perform a total hip replacement, which is something we don't really get. So the teaching was very good. It was consultant led every single time and then obviously the teaching in the clinic as well was quite good. Other things to talk about was that I had my weekends off, which meant I got to travel Southeast Asia and I'd get the odd day off during the week as well. So the theater days themselves. So I had to go in for half eight, which was half an hour later. Then Adam Brooks, and it was at that point where I could either consent the patient or get scrubbed in and get ready in the theater. I scrubbed in for every operation, which was actually kind of rare because um one of the previous students hadn't managed to scrub him for every operation. But I was fortunate to do so and I got to practice lower practical skills. Like my suturing drilled a few times for a high nail and then they got a senior. So unlike the previous two torques, which featured the maker robot, they had the Rosa robot here for total knee replacement. The other thing I should mention is that I was fed very well and this might be a unique experience relative for Singapore and Sang Kang. But at the end of every operation, the er industry rep would buy the theater food. So this is just an example of the food that was bought for us. Um It's quite different to my experiences in ADBR where we go the whole day without eating. So the other things that I got to see here that I wouldn't normally see were things like the planta plate repair. So we're trialing a new internal suture uh method and this was actually uh something quite good for me. Um as this is one of the few operations where I got to do quite a lot. So, um because I had small hands on the rest of them, I got to fit the sutures in a lot more easily than the rest of them managed to do. So when I got to do quite a lot of the su the internal sutures for the planar plate repair to see the sutures here. Then for the trauma week. The most interesting thing I saw outside of your, your standard hip hes and hip replacements was this uh humeral head fracture where they use bone graft from the fibula. They've got really uh big organ donation um bone grafting scheme there. So I got to see a lot of bone grafting and for my spine week, I got to see endoscopic decompression. I don't have any actual pictures of what we did, but this is an example of what it was like. So you had two consultants here, uh one operating in one port, one using the other port and they would use this to decompress the spinal stenosis uh that you get in far out syndrome. And I got to uh join in that research project as well, which was quite handy for the future in terms of research opportunities as well. And you elective, it's really hit and miss and you just have to be opportunistic in how you plan on getting them. And finally, for the week, the robot as I mentioned before now for the clinic itself. So it starts relatively the same time as it does here. And one issue is although it is an English speaking country along the elderly population, which happens to be a lot of the population that we've seen in orthopedics uh spoke only Mandarin. However, I did some Mandarin at school, I did some Mandarin at clinical school and also realistically the majority of the presenting complaints was pain and they were point where it was and you'd do an X ray and you'd see like the osteoarthritis. So it didn't end up being that bad. And we're actually very grateful for it because it gave me different ways on how to best examine patients, ways to mitigate language barriers, which will be helpful in the future. I was finally taught how to do in knee in examination because for some reason, we're never taught how to do it. So in terms of a day to day life, um unfortunately, I wasn't provided ac accommodation, so I had to sub sublet a room. Um Hawker centers are similar to food courts um except they had about 10 to 20 different stalls and all the food was really cheap and really good. So as an example, this was some si had um I think in my first week there, it was phenomenal. II can't wax more about it. And yeah, I didn't get sick once the other things was after the day finished. Um I didn't have on call. So I got to meet a lot of the other elective students like jazz nights, meet up with friends that I haven't seen since COVID and just generally explore for. So I'd really recommend this experience, Inter Singapore country, but it was a phenomenal experience. My favorite was definitely Gardens by the Bay at night. It was a really nice live show. But in terms of wildlife, you'll see some animals that I probably will never see again, like this particular kind of turtle I think was 100 and something years old. Um And then I don't know what the sort it was, but it was just cool to see. And then, as I said, I got my weekends off so I got to go traveling around Southeast Asia. So I wanted to go to uh Phuket Kuala Lumpur with the other elective students, Maya Bay Vietnam, and then a little bit of Indonesia as well. I know he's got a much more comprehensive guide on uh funding. But in terms of mine, I got a grant from my college and then a the grant is a preventative research grant. I got for doing a research project, but I did that in my ed placement, not the or ICS placement. Again, the other two have touched on the NHS Bursary in more detail than me. And because I applied as part of the exchange scheme for the year five, it was in one of the dean's digests. It's not out yet, but it will be in the next few weeks. Um But I just applied with like my CVA cover letter of why I wanted to do it. And as a result, the fees were waived and then N USI had to apply for a grant whilst I was there, but I managed to get it, which helped. So as I mentioned before, I applied to the university exchange scheme. This wasn't the smoothest process. So he has also talked about the mass amount of paperwork that you have to do. So loads of vaccinations for me to get proof of vaccinations had to get a medical examination, identity insurance that the other two have already mentioned as well. And then also there would be really, really long periods where you wouldn't hear anything from N US about the placement itself. So the other person who was on the exchange with me, uh had one of his placements canceled because they didn't hit back in time. So if I were you and you do get this, just pe on them as much as you can, cos at least you'll get seen and there was some uh niche work that you said that I needed. Um because otherwise it would have been nonclinical and just non service, but no one asked me about it. I never got an appointment. So I don't think that matters too much. But if you do need any help, I can get you in touch with the people who were successful from the other electives. So thank you for listening. Feel free to ask me any questions. Uh I also spent three weeks in an A&E placement at the National University Hospital, which is more of a teaching hospital. So if you have any questions about that, I'd be happy to talk about that as well. So I'll give it 30 seconds to a minute for questions and if not, I'll hand it over to Joe, who will tell you that this time a bit more local than the rest of us. I think in, in the meantime, I can probably start slide sharing. Yeah. Can people see my screen? So how are you from? Meet? Yeah. Uh For some reason, it won't seem to walk if you could share. That would be great. No stress. Thank you. Thanks. Um Sorry Yvonne, about the strange camera angle. I've got this weird setup of the camera in the desktop. So sorry about that. If it looks like I'm not looking at you, I apologize. Um So yeah, I did my elective in Cambridge. Um And so he if you can move to the next slide. Thank you. So I thought I first start by doing a bit of a talk about the journey to why I wanted to do orthopedics and why I ended up doing my elective in orthopedics. And so in fourth year, I did my SSC and I thought I'd be an endocrinologist and then I did surgery and I thought I'd be a cardiothoracic surgeon and I did my SSP in fifth year and I thought I'd be a dermatologist and then I thought I'd be an ophthalmologist. But to be honest, I was never really happy or satisfied with any of them and I'd supervised uh anatomy to first years and I always really enjoyed M SK anatomy and I enjoyed orthopedics, kind of from an academic perspective. But the problem was if you could just go to the next slide. Thank you. So, the problem was I was interested in it, but I didn't have any practical experience. So I've never had a placement in Ortho, I'd never even stepped into an orthopedic theater or into a clinic. Um And so I kind of had this dilemma. I was thinking, I think I'm interested in this field, but I've got no connections. I have no portfolio related to it. And so I thought I probably need an elective that will be helpful to build my portfolio. And I thought that the UK would be a better um option to do that. So that's why I decided to stay in the UK. And then I thought Cambridge is probably the best option to build my network and to try and keep, keep that network on beyond the elective, which is something I've been able to do. So that was the right decision, I think for me in the end. And so then after I decided that I was gonna stay in Cambridge, I needed to figure out who, who would I ask to do it with. And so I had a few recommendations from consultants that I knew and lots and lots of Googling and practically stalking all the different consultants at Adam works. And I ended up with Neil K who I think had to men Derm. Um I then reached out by e by email and he said, yep, I filled out the forms. I, me and that's literally how easy it was to organize. Um I didn't have to do any of the other things that any of the other people did. I didn't need to get funding and I've missed all the deadlines to get it anyway. I didn't have to get insurance or anything like that. So in terms of organization, it couldn't have been any easier. You could go next tonight, please settle. So in terms of what I did, I tried to expose myself to as much orthopedics as possible. So Neil Kang was my supervisor, I tried to spend time with the rose of a different subspecialty. So I did some hand, I did elbow, shoulder, I did some hip, knee, ankle. The only thing I didn't get to do was spine and I also didn't get to do any oncology. Um Adam Brooks doesn't do oncology. So I guess that was out of the question. Um And then if you could go next side, thank you. Um So I learned a lot and there are kind of two ways that I categorize it in my head. I learned some clinical stuff. But the thing that I really liked and I think I really got out of the elected was the nonclinical stuff and kind of what I mean by nonclinical is building the networks. So for someone who didn't have any networks in orthopedics. For me, having those seven weeks dedicated to orthopedics and having uh such a good mentor, like, you know, Kang was really be beneficial for me in terms of um learning and building up those networks. So if we could go next. Thank you. So, clinically, I spent some time in clinic, um his history examinations got to practice a lot of those, got to do a few suprascapular um steroid and local anesthetic injections, which was fun. I'd seen those in theater by the anesthetists. So it was quite straightforward to do in clinic and the patients really get a lot of benefit from it, which is incredible. Um I spent some time on call. So joining the reg joining the h uh seeing patients reducing fractures, uh which was fun. And then probably for me, the thing I did the most was being in theater. So I got about 50 cases in the E log book um which was great and actually based on the current um course surgical training portfolio that gets me the four points. Um So that means that providing nothing changes with the portfolio. I don't have to worry about trying to get my logbook signed off in foundation. So that made that a hell of a lot easier. And then if we could go next side turtle, thank you. So this slide is kind of a web of all the different people that I ended up meeting and all the different ways in which they kind of popped up at one point and then popped up at another point or through one person, I met another person. Um and I ended up meeting people from all over the UK and all over the world. And that was really incredible. And so many of these people now I'm working on with projects, so I probably have about 10 different projects on the go just from being able to meet all of these people. Um And not just people in orthopedics, but people in rheumatology. So there's Mark Ligra is down there. There's a guy uh Ben Davis who's a neurosurgeon. Um And so I guess what I'm trying to say is it's all about building the network. And if you're someone who's interested in orthopedics, but maybe doesn't have the network, I really couldn't recommend doing one in the UK enough because I think it really gives you the opportunity to go to the conferences, to go to the courses, to meet the people and build up the networks. I mean, I probably wouldn't be giving this talk today if I hadn't met the whole of the air, a medical student day. So it really is about that. And I think for me that's what made the UK elective so beneficial. I probably would have learned more if I would have gone to South Africa or Singapore or Australia in terms of the clinical aspect because you see so many things that you've done in the UK. But I don't think I would have been able to build the network to build the research opportunities in the same way if I would have been somewhere else. So could we go next slide and then just kind of a bit about the pros and cons, the pros are, is familiar, there is zero learning curve because if you've been in a before, you know where everything is, you know, how the systems work. So that's easy. It's cheap. Although I think with how much funding that's available, it probably doesn't matter that much. It's a great network in, in c we built an opportunity and you can continue the relationships after the elective. So all those relationships are built on the last slide were during the elective and I've been able to continue them after. So that was, that was really good for me in terms of the cons, you don't experience another healthcare system. So I can only really speak for like what I've experienced, which is only the UK and I suppose in some way that gives me like a less diverse knowledge of medicine and less diverse knowledge of the world you can't travel. So people were shown all these slides of like the amazing views, the Amazing Food. And I don't think there's really anything equivalent in Cambridge anyway. Um and it's a bit repetitive. So if you've done SSC or SSP and orthopedics, then perhaps been abroad will be kind of more beneficial for you than it would be for me. Um I came into this with nothing and so being able to build up from that was really helpful. But if you're coming into it with a really strong network, it might not have that much. And so I think if we go next slide happen, that's basically all I have to say. Um if you want to ask me any questions now or in the future, um My emails are JD 831. And I'm happy to answer any questions, anyone else now? So yeah, thank you for listening and thanks for sharing the slides, Heather, no stress at all. Um Right. So let's see, Rahul, it looks like you had a question from uh Kim saying, do you think you could work in Singapore so I can thank you for your question. Hopefully. Um From everyone I spoke to that, it just seemed that particularly orthopedics was just getting more and more competitive. So it was just more whether or not you got onto the registrar training program. Um in terms of work life balance, it seemed pretty bad as a registrar, but I don't think that's the same. I think that was the same in every single country. Um So overall, like the country itself was nice. I enjoyed working in a hospital and you were more looked after in a hospital or supported by everyone else than I think I've seen be before. So I'd like to, if I got the chance to any other questions, I'll keep it on for another couple of minutes just in case anyone does. Um, but in the meantime, I'm just gonna send the feedback form in the chat. So if you can, if you'd like to provide feedback, that'd be really appreciated. Um, it won't, it'll take like 30 seconds. Um, and you get a certificate of attendance if you fill it in. Um Yeah, if anyone has any further questions, we'd love to answer them because we all clearly had very different but very rewarding electives. So, and it'd be great to get more people involved in orthopedic electives. Right? I think we'll wrap it up there if anyone has any further questions. Um, if we all just put our email, like in the chat and then you can copy and paste it now. Um, I'll leave the thing open for a second. Oh, was there much of a language bar in South Africa? That's a really good question. Thanks, Zara. Um, there was a lot of Afrikaans being spoken, um, and they, most patients could speak Afrikaans and English. Um, I think in other areas of South Africa it would be more Zulu and other, other languages. Um, there was a bit of, um, Xhosa as well, but not many patients spoke it. And if they did, they usually spoke another language. Um, for me, clinics were, there was quite a lot of Afrikaans flying around. But if the, it was a nice doctor, they would make sure that they spoke in English, most patients could speak English. So even if they were applied in Afrikaans, the doctor could speak in English to them. Um and they could also speak to me about what had happened after. Um It didn't affect me in theaters because they were kind and, and the universal language of the hospital was English. So they were technically supposed to speak English, but occasionally would slip into Afrikaans, but I picked up a few words, a few phrases. Um And everyone was very kind and like the most awkward part was when patients would speak to me and the doctor in Afrikaans and they'd look me in the eye and I just didn't really know how to respond. Um But yeah, it was OK, it was fine. I didn't have a big issue. Did we travel out on our own? How did we find it? Ok. Should we start with Rahul? Do you want to speak? Um So a friend of mine who I haven't really seen since COVID cos he moved back to Singapore. Um I planned on staying with him but then he ended up moving out. So I ended up subletting the room there. So I think the first day or two, I was on my own. But then afterwards I think I spent all of it with either the friends on that or my elective friends I had beforehand or other people from Cambridge who were down in Singapore. So I think more than maybe a, I think a day at a push was basically spent on my own. Even like everywhere I went overseas I went with other people. So not really. Uh yeah, Melbourne's incredibly safe. So I was out kind of a bit by myself. But again, there are loads of Cambridge students, there were lots of uh students from other universities doing their elective. So made a lot of friends. Sometimes the doctors took me out for lunch. So I was never really by myself, even though I had some plans by myself after that I traveled by myself. But, um, other than that, yeah, there was lots of opportunity to meet people. So you did it by yourself. But then I did the elective by myself. Yeah. And I just found out that lots of people would also come to Melbourne when I got there. Um I did my elective with another medical student from Cambridge called lie. Um, it worked really well for us because, um, South Africa as you know, isn't quite as safe as some of the other countries people visited. Um, which overall II think I would have been absolutely fine on my own. But it was helpful at the beginning when you're leaving the airport and you have to pick up a car and it's all a bit overwhelming and it's a completely new place. I found it quite handy having her, how that being said we stayed in an international student elective lodge. So there were lots of other international students there, a lot of which came out on their own and were absolutely fine. And there was a group chat with all of us and people would make plans on there the whole time. And luckily we had each other and we also had people we met in orthopedics. Um, and I also had a friend out there that my cousin knew and then we met other people through her. So we had quite a lot of South African friends and people outside the international bubble. But if, if needed, that was completely would have been absolutely fine doing it by yourself. But it was quite nice having a buddy because it was one person that already you had a plan to make with and in South Africa, you can't do so much by yourself because it's not really safe. Um, and it's also better, I think in my opinion, to do things together just because traveling to places like I II drove by myself a few times. I like, took Ubers quite a lot by myself, but generally I was very rarely alone because there are parts of South Africa, you just, you just don't go to and you can't be by yourself. But if anyone does decide they want to go to South Africa, you can send me a message and I can give you all the TIPSS cos if you follow all the tips, you will never be well fair. Like, like the tiniest chance but you won't be unsafe just like if you're in London. So yeah. Um Any other questions? What sort of things are good to try organize during your elective to build up your portfolio? Or is it objected to gain more clinical experience in the specialty? Lauren, What do you have to say about that? I would say for me, I think it was like just being in theater, I think because a lot of the time with when you're a medicine, you have other things to do. You have other clinics to go, do you have things that are scheduled? Whilst this was as for me, I felt like it was a placement where I could just purely like be in theater all the time if I wanted to be. And like I said, I was with a reg who didn't really have anyone to assist. So he let me close all his cases. Like there was loads of surgery going on where you could actually really get stuck in. So I felt like in terms of building up my log book, if anyone hasn't started their logbook, I would recommend starting it. It's really easy to set up. Um You can just go on e logbook and basically log like loads of surgeries and get loads of exposure and time in theater. I think it's rare that we get, like, unadulterated theater time. So, for me that was a big thing. Um, and I actually didn't really see that. I didn't, I go to, I went to a few clinics but not that much in terms of like, a patient contact. I just had a lot of theater time. Really? Yeah. Um, Rahul. Do you wanna go next? Mhm. I think again, mainly the theater experience was the main thing for me because I don't really, I don't really enjoy clinics as much. Um, especially when, you know, I get to examine patients. I was fortunate enough that I did get to examine a lot of patients but overall I enjoyed the third time a lot more. Um, again, building up the E log book which I put the link in the chat for. Um, and I would say also what Joe brought up before about networking. I think it was a very underrated part of it because at least now if I were, was to go back to Singapore, at least I have a contact that I could talk to about it. I think that's more useful than, you know, maybe three of the weeks of theater, if not all of it. Do you wanna go next? Yeah. Um, I guess it goes back to what I was saying before. I guess it depends on what's the current state of your CV and portfolio and kind of what you want to get out of it. But I guess if I was being really pessimistic, then at this stage, it's all about the portfolio because you're not learning to operate right now. You're just experiencing being in theater and you might get to do it, you might get to do a bit of stuff. But what actually matters is being able to build up your portfolio so that you can get onto the training program where you actually learn how to do it. And so if I was being pessimistic, I would say the portfolio matters more. But then I guess it depends how much you wanna do later on in your career in terms of if you want to have to do audits and stuff or do research projects while you're in foundation rather than when you're in med school. Um So it's a toss up and I don't think it matters either way. It's just whatever works best for you and what you've done so far, if that answers the question, Laura. Yeah. Um In my, I think, I think Joe makes a very good point. I did a bit of research during my fifth year and fifth year. I, I'm not gonna pretend like Cambridge fifth year was a long year and it was so lovely having like eight weeks. Well, I had nine weeks in South Africa to purely focus on just doing whatever I fancied doing that day, like and being able to go and really buy into a special, like into like a subspecialty. So I really got to get stuck in with sports. So I saw a lot of knee reconstruction, which kind of convinced me. Actually, I'm really interested in this stuff. Um, and orthopedist is competitive. It's not an easy path. So being short, um, unfortunately he's laptop died. Um, but they're joining on Lauren's laptop. So it'll be just a second if you want. I can answer Michael Nicole's question. Next. Um A lot of my costs were covered by my travel grant from my college preventative research grants that I got from college as well that I had to apply for. Um NHS Bursary helped me pay for my room and then the grant I got from N US as well helped pay for a little bit of it. Um So for me, I think II didn't, didn't end up spending much at all. I'd say at most, I probably spent about 203 100 lbs by the end of it or even closer to breaking even. And so if you do your research on the grants and if you're successful, there's a chance that you, you know, don't have to spend much money if any at all. So what was your experience like minus three? Um Well, II guess it, it wasn't free in the sense that I still had to pay for accommodation while I was in Cambridge. Sorry, everyone died. Um Did you say carry on, I'll just, I'll summarize. But, yeah, so I think having nine weeks of, of time to just kind of go and do something fun and, like, do the fun bit orthopedics. I really enjoyed. Um, I think that in terms of research, like, it could have been a good opportunity to do some research and I'm not going to pretend it wasn't, but I did quite a lot of my fifth year, um, like started a few bits and pieces um portfolio wise and networking wise, like I've still got really great connections from being in South Africa and I also met like international people. So I'm hopefully gonna present in a, a conference in, in Milan because I'm at the Italian registrars there, like one of the um consultants, like he said to me, like when I was leaving because he was super nice and I spent all my time in upper limb. He said, like, nothing beats enthusiasm. And I think that's super important to remember, especially in orthopedics and it gets you a lot of opportunity. Um And he said that I'm welcome back if I ever ever want to come. So like having as, as Lauren said, like on adult a time where you can literally just go in as much as you. Like, I did so many 24 hour on calls, learned so much about the specialty and about the people who do it and the, and the bigger picture. Um I found that like really nice. So if you're a as Joe was saying, like if you want to build a portfolio, it's a great time to do it. But if you do just want to fall in love with a specialty, it's so nice to do that also. Um I was gonna talk about costs cos obviously mine was in Australia. So it's the furthest away, it's probably the most expensive. But just to reassure you, I basically did it at no cost to myself. So I my flights ended up being quite expensive. Um So they were about 700 lbs each way. But the money that I got from Claire because I told them I was going to Australia and I got it upfront, paid for all of my flights. And then because I stayed with my aunt and uncle, there was um I didn't pay for anything for that, but even for non commercial accommodation, if you stay with family members who aren't your parents, you get 25 lbs a day. So I still get money towards like the rent and living costs even though I didn't necessarily pay any. Um because they understand that you're still like having to live and work. Um And also if you do stay in a commercial accommodation, you also get money back from the NHS Bursary. So if you do it right, it doesn't really have to cost you that much. Like I went to the other side of the the, uh, I went to the other side of the globe and it really, I didn't, didn't, didn't make a dent in my bank account because you can get funding for it. So it is possible. I understand that not all colleges offer the same. Um, but again, there are other funding sources. There's some clinical school ones. There's, yeah, there's other, um, like surgical ones like Royal College, et cetera. So you can do it. Um, and I would, I personally would pick somewhere that you wouldn't normally, like, think that you could go to because it's such a good opportunity to get out and travel for a really long period. Um, and then, yeah, just a not on surgery, like, do what you wanna do, it doesn't really matter too much right now. You do have a lot of time and also surgery is about doing surgery. So you need to decide if you like actually doing surgery before you kind of jump in. So I think you should do what you want with your own time. I think it's a fun opportunity. And as Rahul said, as Lauren said, as I've said, like, I would want to go and work in South Africa again and by going, I know that now I'm sure Rahul was the same with Singapore. Like, it's made you realize actually that could be somewhere you'd want to work and then Lauren with Australia as well. So that's an exciting opportunity. But that doesn't mean that Joe, what Joe's done, Joe's done an incredible amount of work. Like the fact that he's got 10 projects on the go, I don't even know he's keeping up with that and that's an achievement in itself. Um And also an incredibly beneficial way to spend your elective. Um But if you're like Lauren and I, and want to try and use a two month window to travel, then then go for it. Um Any other questions? Um I think my return flights were like 750 accommodation was paid back by the NHS. But my accommodation was quite cheap because I was in South Africa and I was in like uh university accommodation and living costs were also cheap in South Africa because everything's cheap in South Africa. So if you want to do it cheaply, then South Africa is quite a good one to do. Um and the flights and then I got some funding. So my flights and stuff got reimbursed so just make sure to get receipts for everything. Yeah. Right. I think we're pretty much there. Um Any further questions, we'll, we'll stay on for a couple more minutes. So if anyone does have any, but you're free to go. Thanks so much everyone for coming. Um Does anyone want to add anything and have a lovely evening?