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the hi everyone. So I'd like to introduce uh, ms till she's an s t eight level registrar in Ent. Working at the Royal Sorry County Hospital. She's completed her training in centers in the West Midlands kss in London. Um, and she's also the trainee representative for the specialty advisory committee for E n T registrars in K s s. She has an interest in head and neck oncology, paediatric head and neck surgery and laryngology. I think I've pronounced that long, so apologies. Um, but I'd like to give her a big, warm walk. Um, this evening, um, so I'll hand it over to the steel. Hi. Yes. So I am Miss Deal. That was very nice. Welcome. Thank you. Um, yes. So I've done a fair few things during my career, and I asked to give a talk about E N T s. Try and inspire people, Um, and also talk about it. So let's talk about a bit of what I've done, uh, in my career path. And then hopefully what? What wisdom? I can share what I've done, what I think I would do again and what I wouldn't do again. Uh, but first of all. No one understands my specialty. Um, so for ent, I don't just deal with tonsils and grommets. And I know all everyone ever talks about when they do Ent talks mostly to foundation doctors and at med school is hepatitis mastered itis Crestor at home in many years, they're all really rare. I don't see them. Uh, Master Litis will get about five referrals a day for them, and only one a year will be mastered. Itis epiglottitis maybe a couple of times a month and cholesteatoma they're fairly unusual to find, Um, same with many years to actually get through many air ones you don't see. So what is it? Um I try to create e n t and what we actually do on the computer, and it just became too complex with computers. I'm afraid you've got a screenshot of what I did on paper. We have a lot of mix of medicine and surgery. We're actually one of the surgical specialties that have, uh, one of the lowest conversion to theater than some of the other specialties. Um, and we work with a lot of other M d T s. So we do do the obvious mg t s, which is working with cancer. But also we deal with endocrinologists, uh, particularly thyroid parathyroid. We spend a lot of time working with speech and language therapists. We spend our time whether we're pediatrics, audiology, plastic surgery, rheumatology, um, and lots of other specialties where there's this odd crossover. I was once told, uh, that ent exist simply because of the nerves that we have in the head neck. So most of what we can do was used to be done by other types of surgeons. But we became specialties that we could just focus on being careful around those nerves. And the key thing about E n. T is what I see every day is something I see something different day to day and even patient, patient in clinic. So trying to say we now split ent into various subspecialties, of which one is allowed to be general ent. But what we do in all those specialties is very varied. So otology that work with, yes, the glue it and grommets everyone knows about, and the cholesteatoma is when they come in. But they're also deal with dizziness, and it isn't just many years we've got BPPV. Most of the time it's multifactorial. We've got lots of other things, Uh, hearing implants. Middle ear implants is a big thing at the moment in otology and how we can reconstruct hearing when you're not at the level that needs a cochlear implant. But you don't have normal hearing. We know that you're more likely to experience dementia or your dementia will get worse. If your hearing's reducing, you can't engage in the world around you. So we're really keen on, uh, improving that with rhinology. We have a lot of overlap with asthma with masculinity, so G p a e g p a. And there's other things that happen in the nose. So we have to work a lot with respiratory doctors, try and, um, and immunologist sometimes to look after allergies. And there's a lot of research going on about how we best manage that head neck, which is what I spend most of my time doing. It isn't just cancer. Sometimes it's two benign tumor. It's lumps in the wrong place to deal with swallow. I deal with airway as well as infections. Thyroid's sort of comes under head neck, but it can often be a specialty on its own. And they deal with modules but also patient's with high calcium patient's with medically resistant hyperthyroidism, which is the Iniesta's always loved us. Bringing those, um, on top of that, we've also got subspecialty of laryngology and airway. And as the population increases, the need for this increases and they'll work with voice not just with professional voice users, but also just helping people with communication day to day, um, Parkinson's voice, people who've got essential tremors or other things in their voice and also as part of that we deal with breathing, which includes tracheostomy knees. Pediatric ent is a fascinating specialty because you do everything and you're dealing either doing really simple stuff and really complex Children or really simple normal Children with really complex pathologies, which is quite interesting. And some people choose generally auntie, where you do a mix of everything to a greater or lesser degree as you like, So why don't choose it and why do I think people do choose the ent? As I said, there's lots of specialties to work with. Um, everything we deal with affect your ability to function in the world. Can you communicate can you hear? Can you engage? I think we've all had that heavy head cold where, um, you just can't focus or do anything. And that really bothers people when it becomes chronic. We weren't. These are pictures of the super surgeons, Professor Pullaria, but the Royal master And we maybe weren't quite quick of as quick off the drawers urology. But we do use robotics. We have a lot of equipment that we use. We went endoscopic years ago. We use a lot of lasers. We use all kinds of fancy things, and we're always trying to improve and try and do the simple things better. So although we've been doing tonsillectomy for years and years, we're still publishing research on it. We're still looking at new ways of making it better, making it less painful, making it easier to go through checking that we're doing the right thing. We like simple things. I occasionally joke that I have my orthopedic moments. If everyone knows that YouTube video and reference just like there's a simple problem, there's an abscess. I need to pop it, and I will go and do that under local anesthetic, um, in quality of life in the interview. Far more important, they I saw this. This was sent to me by a friend, uh, that if you want the happiest marriages, you should go into E N T rather than other specialties. As per self reported happiest marriages, the rate of divorce amongst ENT is much lower than others. The rate of, um, there was another study that looked at how often surgeons swear in theater and e n t have the lowest rate of that, which is seen as the level of stress that we deal with in our theaters. And I'm sure you know, e n t is ear, nose and throat, but we sometimes think of it as early nights and tennis. We like to have a good work life balance, and it's strongly encouraged, particularly as you get older. I'm sure you realize that early nights are really quite enjoyable. So what do I do in my normal day? Well, um, as a trainee, I currently all of our training jobs in the Southeast. We've made them four day weeks to make it easier for life and childcare and everything else. So I have for this sessions a week and three clinic sessions a week. Um, and on top of that, I have an M d. T. In my, um, subspecialty that others will do something slightly different on my s p A days and supporting professional activities. I will do education, which my interest. I sometimes do a bit of research, and I read and try and improve what I do for on calls. Um, most of our races are pretty easy. We end up in, um, rotors with sort of one in seven, which means I do one night, week, and one weekend is seven. And as a Reg, it's non resident, so I'm on call, but I can go walking as long as I'm within half an hour. I can still have a bit of a life. Although I do get called in at four. In the morning sometimes. And of course, we all know the courses that we do. But these pictures that I'm showing you around, I could see all of this in one clinic. Um, in one clinic of 10 to 12, patient can see swallowing issues, voice issues, thyroid issues, cancer lumps, breathing things, and it's completely varied, which is something that appeals very much to me. I don't like things to be to see me and how it's going. Ent we at the moment are rates of cancer in the head and neck are increasing. They used to be the sixth most common. It's now gone up to fifth, and it's looking like it's going to overtake into fourth. It's currently the fourth most common in men, Um, and the sixth most common in women, and that's because of HPV. Now we know that with vaccination, they've shown it. In Australia, the rates of HPV related disease is reducing. But because it takes about 20 years between your exposure and when the cancer appears, it's going to take another decade or two, probably a couple of decades before we see that effect on what we do. We're doing a lot of robotic surgery, and we're looking at it traditionally because of where we operate. It's always been chemo. Radiotherapy is how we treat these cancers, which does leave people with a lot of side effects, particularly with voice and swallow and how they enjoy food. Their taste is, which affects them a lot, so it looks like what we're going towards is can we actually use the robot to treat people surgically and reduce the toxicity of the additional treatment. And so far, they outcomes of those trials are looking really promising. Although it's going to be another few years before they can publish, we keep talking about interventional radiology. Uh, there's something. So for multi nodular goiter, some people are doing radio frequency ablation to try and shrink down some of these cysts instead of having to go for surgery. But also, instead of me going and plunging around in a blood filled nose, try and, um, stops that really heavy bleed in the occasions where they happen. We can embolize it. We can ask our interventional radiologists to go and do that and cauterize it. And as I've already alluded to, we use a more medullary implants. So these are sort of the hybrid between the traditional hearing aids. If people can't use them to cut clear implants, trying to find better ways of giving you better hearing. But as I say ent, we love our work life balance, and there's ongoing support for less than full time training, and we're already talking about Could we do job sharing like GPS have for a long time how much research we do in training Is the expectations reducing? We now just have to show commitment to research rather than prove that we're publishing, although there is a little bit of a push because we know that what goes out is not always of the highest quality. And with the curriculum that changed two years ago, they want to reduce the reliance on fellowships for training. Try and make sure that your training is sufficient. Um, so there's less requirement for people to go abroad, to go out of region to do extra training. And one thing I have to say. I use Twitter a lot. It has become over the last few years, a huge resource for my training. I learned a lot from looking at it, but also there's a lot on there about careers, and I follow all the main organizations for us. So follow RCs, which everyone will know but also follow our head neck oncology group, Barno Bates, which is endocrine and thyroid surgeons and lots of other people. So I stay up to date with all the changing guidelines, etcetera. So how do you become an ent surgeon. Um, well, everyone, I'm sure if you're coming, if you're looking at these, uh, talks will know the basic process of how you get through medical training. So you go through foundation years, and then you've got the option of either a run through post or split training course specialty full of a higher specialty. The run through there was recently another pilot. Every 10 years or so, they do another pilot of run through training and then it's taken away because they don't like it. Um, for a variety of reasons, Um, I'm not sure how, because they've only just finished it. I don't think it will be back for another 5, 10 years minimum before they try another pilot of it. So we do training. It's meant to be up to eight, but because this is competency based training, not time based training, you can finish earlier. So to get into ent at the moment. If you do it through competitive entry, you got two years of poor surgical training and then six years of higher training. So what I did, I started undergraduate training in, um, southwest. This is Saint Michael's melt, which is where one of my T. P. Uh, practices were I then went up to Burton, which is a brewery town in the West Midlands. I didn't know where it was, either, um, to do my F one Birmingham for F two before coming down south again, Going to Hastings. This is a picture of Santos because I ended up in friendly and working a lot with the military. There took a couple of years long training, so I did an education year, and I also did a year as a trust level fellow in Shogun fellow in great Ormond Street, where I learned a lot and we found my love for ent. And then I'm back in in, uh, the Southeast for high training. And I'm sure those of you who are here already know how big KSS is. It's huge, and the ent units are fairly spread out. I've met in nearly all of them now, apart from temperatures and retail and in terms of my career plan, I put that down at the bottom because I started convinced I wanted to be a GP. And my second job in F one was an ent. Uh, and my boss was like Well, why don't you do ent? You should do ent. And so I compromised by saying, okay, all the special interest in ent. And that was what I wanted to do. I applied for GP and call surgery, Got a better call surgery, jobs. I went with that start ical surgical training and then saw what some call specialty some surgical specialties have to put up with and had my first career wobble as I say it. But I started finding more and more of a love and want to do ent full time and again, I went through my non training years. The first year was entirely intentional. The second year, I didn't get a number the first time around. Um, so I took another year, but I absolutely loved what I got to do. But it did give me a small career bubble, and then I've gone through training. And like everyone else, um, most people have a wobble in ST three because you go from being a really good S h O to be in a really bad Reg just because of the transitions. And it's it's quite a tricky transition. Um, So I had another wobble But I am now convinced on E N. T. And I'm pretty sure I'm not going to duck out and do G P now that I'm in my final year of training, sometimes a careers advice. I kept looking at it, Um, and these are the three main source is where you need to have a look at what you're doing. So the Royal College of Surgeons will give you an overview of what you should do, what the entry requirements are for everything, and they'll point you to the medical specialty recruitment website. Um, but for ent specific and ST three recruitment, we've been running it through Yorkshire and Humber. Dina Re for at least the last 15 years. I think they have been the ones that run it at the moment. I'm sure you know, most of these are virtual, but I'm speaking to one of the people that runs national selection, which is the S D three recruitment, and they really want to go back to face to face. They think they're missing a lot of things, and they're not sure they're getting the right trainees through, so they want to go back to that. Um, I thought I I had to mention the MSRA. So the Multi-specialty recruitment assessment, which has been brought in for call surgical trainees, Um, I'm sure everyone is just as confused and upset by it because of the change. Yes, it's tricky, but there is a reason for it. They need to make sure you don't forget everything else, particularly with our growing population. We can't be ignorant of medical problems anymore. So as much as I hate how they brought it in having followed it and paid attention to what's going on, listen to their reviews and reports and some of the evidence behind it. I don't think it's a bad thing, essentially what you need to do. There's no point in going through the specifics because it will change. But you need to show you've got commitment surgery. You need to engage in the audit process to show that your interest is in quality improvement and that you understand how all aspects of management in the hospital works essentially free and t. You do get points when you go to ST three recruitment for Allied specialties as well as the amount of time you spend an ent so they like people to spend time in plastics. Max facts, pediatric surgery, ICU, cardiothoracic, etcetera. There's lows that I couldn't listen more audio for similar medicine, etcetera. And yes, we're meant to get some publications. But like I say, the the emphasis that's given to that is reducing. And there are two approaches to how you go towards training. You can either take as many boxes possible on the portfolio. So when the self assessment criteria come out, you look at them. That's the call surgery and for S C three and just work your ass off to try and get as much ticked off as possible. Um, that is what most of most people do. But there is a point where you have to accept what you have and work on the interview. The Do you the self assessment process in the portfolio points is designed that it's meant to even out So, for example, if you spent more time in ent, then you should theoretically have had an opportunity to get more audits, more papers, more publications, etcetera. So you get fewer points for your time in ENT if it's over 18 months, but then you get more points for all the extra things. However, the way things work with doctors, they give us hoops to jump through and we will jump through them. So they give us a tick list and we will take as many boxes on that list as possible. But I went through. Most people had portfolio scores of 80 or 90. I had 60 and I got a job in K S s, which is really competitive, so it is possible to do it through interview. But I need to say, Don't forget about the Caesar route. Sometimes training is not valid for people. Um, and I've only got one for general surgery, but you need to do. You can do it by other routes. And there are some fantastic people I've worked with who do it via the Caesar route. What you need for it. You need a good unit who will support you. I think most people are realizing that you have to look after your non trainees as well as you look after your trainees, because people will vote with their feet and go elsewhere. So with season, you just have you have to make the same requirements for curriculum. But you don't have to travel between units, there's less pressure and you don't have that start and start with every new job where you spend the first couple of months getting to know them. And they get to know you before you know how to trust each other and work with each other. But the downside is there's no a are CP panel to push you. You sort of have to be your own driver, maybe with your, um, supervisor, which can be a downside. But it is there as an option. So what advice can I give you? The best advice I was given. I was given it as a C. T. Two was daughter. Take your time. Get more experience. We're going to be working till we're 70. Um, so don't rush to be a consultant by the time you're in your early thirties. Take your time, get more training. Um, make sure that you've you've had fun as you go. I have traveled all over the place and part of the reason I showed you my geography was I've lived places I never would. As I said, all of us in Burton we had to Google where it was, um but I've got to live there, and I got to spend time there. I've made friends with people, lifelong friends, uh, people I probably wouldn't have met, uh, any other way And when I'm on call because I can go out. But I just have to stay within half an hour. I do go out, I go on walks around the place. Um, try and see areas when I'm staying somewhere or somewhere where I work rather than where I live. I will go and spend time with at the local area what I've alluded to, everything changes. So do you have to be prepared for the changes in the process And the M s already this year really screwed up with people. Um, covid is completely change everything that's gone. Everything's gone online, but things will change again. Uh, and again, um, and they constantly change. So if you can build in a bit of resilience, a bit of flexibility, you're going to find that helps both your career, but also getting through this process, which feels like a complete farce, but also make friends as you go. We spend so much time with our work friends. Um, so So you just make friends for life? That's what I'd say. But essentially e n t. I hope I've explained a bit of how much there is to do. I wish I could have gone into more detail, but I think we'd be here all night. Um, hopefully, I've given you a good overview of the specialty, and I'm happy to take any questions either if anyone on the call or by email. My email is my first name. Surname. Catherine. Steal NHS dot net. Um, and we'll make sure it's attached to the talk so you can email me if you got any questions. Thank you. I was still thinking thanks so much. Um, I actually did have a quick question. I was just wondering, in terms of emergencies, you get to see the ENT. Are they quite that you get called to come in for or are they quite rare, like the conditions you had at the beginning of the year, So it is actually very rare, so often talk to people and say we're pretty chilled as specialty ent. But when we jump up and down, that means something's important something's happening, and that usually means airway. I get called in for all kinds of things, but it is rare that I have to come in. Um, but what I do tend to come in. I was in last Thursday night. A child has swallowed a 20 p coin. And even though it was in the esophagus, the child was comfortable. I don't like leaving them. So I went in an operation on that at midnight. Occasionally get called in for epistaxis. But having a life threatening one that needs theater, it really happens out of hours. Occasionally we needed for airways, but it is very rare that we need to do any emergencies. And it is rare that we do it overnight. It does happen, but not very often. And yet most of the time, most of what we get in through the front door is tonsillitis and epis Taxus, and you will occasionally get an airway compromise patient or occasionally I t you will call us and say they did this a few weeks ago in Guilford that they had they had to do an emergency cricothyroid ectomy datta me so And they want us to come and formalize tracheostomy, which is easy to do, but it's very rare that we do big things in terms of Pedes E N t. Is that kind of a sub Specially within e n t Once you become worse at an S T level, Yeah, so you can train in pediatric ent. So I did it as an s h o um, and then I've gone again. So as ST six, um, we all those of us in K s s, we'll do six months up in London, either at the Evelyn or Great Ormond Street, where we do pediatric ent and we learn to do the complex stuff. So we do. We try for everything you do with training. You train to a higher level than what you're going to do day to day so that you can deal with all the emergency. So I have done the rare things like juvenile Nasal and Joe Fibromas have done the reconstructions of Pinar. So when you have microtia no ear, put them back together and been involved in a lot of those cases, Um, and most of the emergencies you get there would be the rare things like coronal atresia. So Children ball with no nostrils. Essentially, the prostate is based completely blocked. But you will do it and you can branch off at ST six, which is how the new curriculum works that we all train in the ent. And then at ST six you branch off into your subspecialty and spend your last two years of fellowship like training. Amazing. Thank you so much. No problem. Um, I think if there's no more questions I just wanted to say thank you for coming on this evening and giving us a comprehensive talk about the career path into E N. T. I feel quite inspired myself to pick up the ent now. So excellent. My job to start. No problem. If you ever need us. If you're in Guilford, we're usually in theater. Nine. Just come say hello. If anyone shows a bit of interest, people happily talk to you. And otherwise just give me an email. Great. Thank you.