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Okay. Hello again. Um, thank you very much for waiting. Our speaker is in. My name is Kara Petajakarta. I'm one of the psychiatry trainees up in North Yorkshire. And let me introduce you to Doctor Dave Crosser, who will be doing our talk today. Hi. Am I the only one here? Hello? Um uh, Yeah, we're ready. You start your sorry. Is that you? Uh right. So, uh, so we're hands up. Who? Who's who's here in the room? Do you wanna say hello in the in the feet? Have we got We're up to numbers. Are we about 13 people in the chat with people staying high? Sorry. It's been a bit chaotic. It's been a bit of a chaotic time. This is Barney. He's not a doctor yet. They do start them young these days. You got to go and find money? Uh huh. Okay. It's like I've been asked to teach by promise who's working with me in a an e in Chesterfield. And he asked me to teach on the acutely unwell patient and how to recognize them. And really, the answer to that question is, how do you recognize unwell person? You've got to do a course, and that course is an advanced life support course. I could teach you how to do that. I could spend some time doing it, but it's a it's a couple of days long. I'm an instructor. In fact, it's the clinical lead of our one recently, Um, and it's a good course, but it's more than an hour can take. Really what you want to know, guys is, um, more than how to recognize sick person. It's How do you do the whole package? How do you do the full full thing of getting through to being a doctor, a consultant in whatever specialty that you choose to to to work in? Uh, I've got a chat screen just on the right of my screen, which is what I'm looking at now. And my eyes flick across. Can you pop on their people who are listening and watching what what stage you're at and what specialty you're interested in. And they'll just give you a feel for where I should be directing my energy's. But I will crack on with the slide show. Uh, can I have the next slide, please? Car? Uh, what do I have do I have the ability to control that? Okay, so there are various questions that that you ask yourself when you're going into a career in medicine. What do you want to do? Why do you want to do it? How do you get to the end product? What happens when it all goes wrong? And what do you do when you get there? I'm going to answer those questions. I'm going to hopefully take some of the anxiety of decision making into your career. I'm going to do some things which may break you. It may break a couple of you. Um, but the next hour or next, three quarters of an hour or so are going to be a crucible in which you will hopefully come out of it, understanding more of what you want to be. And we'll also ford you like a a hard steel or flexible steel. Um, that doesn't crack or break in stress and duress. Get the next slide, please. Uh, so who am I? Do I have any credibility? So I'm the son of a doctor and a midwife. I graduated from Southampton University in 2004. The I should say the top picture top left picture is me. I'm the one at the the in the high chair. That's my day, Dad. And that's my mom. Uh, I graduated from Southampton in 2004. That's the picture of the guy holding the badge, which says, Final Year Medical Student. I was so excited to be in my final year almost there. I could taste it almost, Um, I did junior doctor posts until 2007. That's the shaven headed chap in greens that's in, uh, bright and A and E, which is a major trauma center. Um, and I did my emergency medicine Pediatric emergency medicine up until 2014. The photo of the guy in Blue Scrubs That was my 55 minutes of fame on the TV program Panorama, which is a British British investigate investigative program. Uh, I thought I'd stuffed my career in by being honest on on the BBC, but it didn't turn out too bad. I've been a consultant in post in an emergency medicine since 2015. Next next line, please cover it. So how do you go from being a a student to being an emergency medicine consultant in Britain. This is similar in Britain, in parts of India, in Australia and New Zealand. They will follow a similar, uh, similar pattern. We have, uh, six years of training with some bolt on. So, first year of training, you do some acute medicine. You do emergency medicine year to you do your anesthetics and intensive care medicine. So six months of each, By which point, you can pretty much quite happily do a simple anaesthetics list or look after an intensive care unit. This is after your house, officer years or your foundation years, your first two years of training. Then you do six months of pediatrics, six months of muscular, skeletal stuff. Then you go into a higher specialty training where they really hone you for becoming a consultant. And then you can do as I did and bolt on other bits sided pediatric emergency medicine training where I do accredited. So I'd be just as happy in the pediatric, purely a pediatric unit as I would be in a mixed unit. And in that I did P. I see you in general pediatrics and a bit of PM, but you could do pre hospital care you could do intensive care medicine. There's all sorts of things that you can bolt on to emergency medicine in the UK Parallel to that, we were doing exams. So there was, uh, full of your membership exam. There was a three part three stages of the exam. There's a party which had a 30% pass rate, and everything after that had about a 60% pass rate. So there was short answer questions. There's an endoscopy, and that would get you through two parts of the cascade would be 16 stations, uh, which was seven minutes each. And there were things anything from, uh, manage this patient with acute psychosis to, uh, to do an ankle block on this patient whilst teaching a medical student how to do it so complicated stuff as well as the simple things like do a cardiovascular examination. Moving on from that. There were more parts in the fellowship exam. There was a linked short answer questions and husky, uh, where if you failed one part, you have to reset both, which was a particular hurdle. Then there was answering a clinical topic so almost like a a extended piece of work, a bit of research there, some critical appraisal and the management of fiber. So there were nine hoops nine big ledges to leap over, uh, nine bars to get over to finally become a consultant in emergency medicine. Was it tough? Can we get the next slide, please? Well, it was a tough job. Yes, there was varied support. There was a lot. There's a broad case mix, some major trauma. There's very little penetrating trauma in the UK. Unlike other parts of the world, lots of elderly patients some amounts of intoxication shifts are hard. So as a registrar I'd be running a major trauma unit overnight. 13 hour shifts, seven shifts in a row. Um, I've been managing a major trauma center like a city center. Um, so Newcastle City Center, looking after a quarter of a million people with five juniors and and me. So that's quite a lot. Quite a lot to do. If you wanna knock on to the next slide, please care. Uh, how hard was it? Well, 16 people went in at the start of emergency medicine training when I was doing it, and one person came out. So there's a nutrition rate of 15 out of 16. Um, at that point, when I was doing my training, we the attrition rate was so high that junior doctors would go from the UK to Australia and New Zealand to the point where we had 250 million lbs worth of trainee working in Australia and New Zealand. That's what it costs to educate them to the point that they when they when they jumped ship. So was it a hard job? Was it hard training? Yes, I would say it probably was. Next slide, please. Now you get to the nitty gritty. So here's here. Here there are a couple of studies looking at mortality in clinicians in their various specialties. So your life expectancy as a physician or an internal medicine doctor, you get to 76.6 years of age. Um, anesthetics. Not so good. 71.5 to 71.9 years of age. Then you get to emergency medicine 57.5 years. It's your life expectancy, and that's not great. Now there's lots of confounder is that there's not big numbers. They're 17. Compared to the anesthetics, there was a big number bigger numbers, primary care, bigger numbers. So you could. You could argue that there's lots of problems with that as a as a number, It's probably hopefully not accurate that that we're going to pop a clock before you hit 60. But it goes to serve a purpose that emergency medicine isn't easy. Do you want to take on to the next slide? This guy, On the other hand, any medical job that you will do will will be hard understanding that journey will help you get through when things are tough. The best piece of advice that I was given by a supervisor when I found things tough was that training is a small part of your career. Once you go through training, things will get easier. When you said that to me, I was like, Oh my goodness, that's That's what I needed to hear Right now, this is a short period of time. I can knuckle down and I can do it for the long haul. So focusing on the endpoint on the endpoint of trading on your on your career that's going to be from the age of 30 yards to the age of whenever you jacket in, UH is important, and understanding why you go through you jump through hoops of training is also important. Why do we do exams? Why do we do the portfolio stuff? Why do we try and get that reference and move on? The process that you go through is important so that when when it's important for defense, it's important for professional image. The reason why it's important for defense. If I make a mistake in my in my job, if someone dies whilst I'm doing my job, I'm pretty comfortable in saying if another consultant was in the same position, there's a good chance he would make us. He or she would make a similar error and therefore it's not. It's not my issue here. This is a systematic. This is a training issue, or this is just bad luck. Bad timings. And there's nothing that we could have done to foresee this because I'm trained to the same level, uh, the same standard as other people. That's the simple answer for that. For accreditation. The other point is understanding who we are. I need to understand what an orthopedic surgeon is. I need to understand what a what a pediatrician is and we need to understand each other's rolls, and having accreditation helps set that homogeneity. And that's both within a within a country and internationally. Which is why we have other exams to help. Help homogenized when you go from one country to another, like the lab for the next, like, please come in. So what do you want to do? Have you chosen your specialty? How did you choose that specialty? Now there's a difference between experience of a real specialty and er So I used my these photos of an example. I'm the guy in Scrubs all suited and booted on the left hand side with my registrar doing orthopedics, trying to figure out what's going on with the patient had been mauled by a dog, and that was pretty groovy. But actually, the top right slide, uh, is a colleague of mine took this photo on my phone while so I've fallen asleep whilst working, um, doing the same job, orthopedics and just just collapsing and just collapsing from the resource. Um, have you chosen a specialty because you understand the reality of it, or have you brought into, uh, this? The slide in the middle with George Clooney. Get out in the in the TV program, which was, which is the big TV program? When I was a student, Be like, Oh, my goodness. I want to be that guy. I want to do what they're doing. Next slide, please. Okay, so here's an exercise that I'd like everyone to do. I'd like you to grab a piece of paper and the pen, and I'd like you to write down 1 to 10, like I've done on the screen here. This is the exercise that I used to do on night shifts when there was a little gap in in, uh, in the business and it would make or break junior doctors. But I say that it would help you to understand where your priorities are in life. So once you've got that 1 to 10th, I want you to do another 1 to 10 next to or give a bit of space. So you've got 22 columns, 1 to 10 and then in the left hand column. What I want you to write down are your priorities as you see them in order in life, right? Right. At this point in time. Um, if you click on to the next slide, please. Car. Uh, now, these are two examples that are slightly different. Uh, please do keep going and filling in your 1 to 10. But this this is what, uh, junior doctors, Some junior doctors, in my experience, have put down this kind of thing. But this isn't the be all and end all this is just what they put in the past. Try and put them down as much as you can in in order of priority. So just talking through the examples that we've got here. And in fact, the one on the left was me at the time that I first did this. I'm a Christian, so I have to put God first. Otherwise he'll strike me down with a bundle. And at the point at that point, I think it was girlfriend rather than wife. But now be definitely wife, family, friends, church work, music, good food. Good food is so important. I was playing a lot of a lot of hockey when my kids when I was a registrar. First little little test and holidays. Who doesn't need a holiday? Uh, other colleagues have put financial security. You could argue a different kind of God. Friends dating. Oh, my goodness. Please. If you feel like you need to put dating on hold for when you become a consultant, it's, I know lots of people who have done their specialty training and then got out at the end of it. And now I need to find that significant other. And it's really difficult to later on in life. So don't don't put these things on hold. Life will partially bye family work, football nights out. It's important to get out and enjoy yourself. Sleep often. Sleep was a really high high priority, especially when talking to people on nights. This is something they hadn't done for ages. They hadn't had a good night's sleep. You know, that's what I drink. Getting on the housing bladder is a big thing in the UK How these are incredibly expensive. Okay, next slide, please. Okay, So your column on the right. Now what I want you to do is write down. What do you spend your time doing in in order of how much time you spend doing it? So this is, uh this is, uh, an honest and honest assessment. Are you spending most of your time at work, or are you spending most of your time sleeping? If if number one is working, number two is sleeping. Put that down. Try and work down that list. I'll give you 20 seconds. Okay, You pop on the next slide, please, Caroline. So there's an example again. Another another colleague. They had holidays as the number one thing. They lived for holidays. I can remember this being me. At one point in my life, I lived to snowboard, loved snowboarding, but save up my money to go snowboarding. Now, can you start to see a problem here? Um, although I loved holidays, that was my priority. That's what I really lived for. Actually spent time. The time that I spent holidays was number 10, and that was a real problem because the thing that I really wanted to do, I wasn't spending any time doing, uh I was around three tick talks, so number five would exist for me. But it could be for you. Waste a lot of time on the Internet if if dating is really important for you and it's it's not even in your top 10 Because you just don't have time for you for it. You're going to have a conflict here. Whatever is taking the most amount of your time. If number one is work and actually priorities wise, it doesn't even feature on you. It's number six on your list. Work is going to be increasing burden. You're going to see I'm doing all this work. But actually, I don't want to be do this now. Another way of looking at this is actually, if work is number six on your priority list at the moment, I have to have it as number one because I'm in training. You know, I've got no choice. I I've got a I've got to suck it up. How long do you need to suck it up for? What is your What is your strategy for the future? How are you going to plan your career and plan your choice of work so that when you come out the end of your training, you can have more of a work? Life balance? Work can come down the time order and it can can fit in where your priorities are. Other things can come up like having a family like, um, being a being a fantastic musician or whatever that thing is, so that work work doesn't become a problem. We'll talk about that in a bit. Work doesn't become more problem. And this this isn't necessarily something that you share with other people. This is something for you. This is an exercise for you. But feel free to do it with other people to try and get their reactions. And it helps in balancing out how you feel about something. I talked about breaking this something that breaks people. It's something that challenges you, and it should challenge you if everything lines up. If, if your priorities and you're spending your time doing actually matches up all the way through them, then great doesn't mean to say that you're not without conflict. But this should help spot those priorities. I did have a colleague. One colleague who puts out the number one priority was work. I said to him, No, surely surely work is not your priority, he said. Yes, it is. I've moved from another country so that I can work. I have left my friends and my family behind so that I could come work all about emergency method. This this is my bill and and all this is all I wanted to do. He dropped out of emergency medicine training about a year later. It became too much for him that that putting pressure on emergency medicine for him but for work for him, it came back to stinging it couldn't live up to that level of pressure next, like please, come on. So why do you want to do the thing that you've chosen to do? I've got a couple of myths. And what? I've been a bit cruel, and I've punctured those myths. Now I'm doing it with a with my tongue firmly and cheek. Um, which means to say that I'm doing a low blow. I'm I'm doing the easy puncturing of this aspiration. But it's the purpose is to compare and contrast. So why do you do What are you wanting to do this career? What I've always wanted to do, I can remember I wanted to be a doctor when I was five years old. It's like when a kid fell over on the playground. I was there rubbing dirt into it, going Oh, this will make it better, you know, because I wanted to be a doctor. And, you know, that's what I took all through my youth. I want to be a doctor. I had no idea what the doctor was. I had no idea what a doctor's career would be, but I had this image in my head. Thankfully, it's turned out to be as much as I wanted and potentially more. But it could have been something completely different. Oh, myth Number two. I did a job. I really enjoyed it. So that's what I want to do with the rest of my career. Well, it may be that you didn't actually enjoy the job, but the people that you worked with fantastic. You had that you had that, uh, those colleagues that you really clicked with. You had that bus who was just the best. You just wanted to teach all the time and thought you would be his knees. And then you go from that, that job, you want to be a nephrologist, then you go somewhere else to do nephrology. And suddenly it's really hard because the people you don't get along with and your boss is just just on your back all the time. And, well, did I love nephrology in the first place? Well, maybe it was just the people that I worked with. Maybe it's that you love the skill. You're a surgeon. You're all about that precision cut and putting it all back together. But well, does it stand up to doing it once, Maybe twice, Maybe 1000 times for me doing something 1000 times, I just get so bored. And, um, I can remember working for an orthopedic boss who can do skin to skin hemiarthroplasty so they could They could take a broken hip, they could put in a prosthetic hip and they could close up all within 10 minutes. And I can remember thinking that's really impressive and watching him do it Wow, that's amazing. But thinking, Wow, how board are you that you are timing yourself? I need to get this. I'm going to get this under 10 minutes. That was the thrill of it. It wasn't actually the procedure you might think. Oh, this job looks really exciting. Emergency medicine, blood and guts and gore and excitement. Well, is it exciting or is it really exhausting? It can be you might look at that registrar and the specialty and go, Oh, my goodness, they are the bee's knees. The medical registrars in the UK are amazing. When they're on call, they're here. They're they're they're everywhere. The thrombolysis strokes, their their pacing people they're running here and there. But actually being the medical consultant doesn't and exciting to me being in outpatient clinics all day long. Sing being a gastroenterologist, seeing one person after another person after another person with irritable bowel syndrome. You know, Not for me. Another myth being a GP or a family doctor. That's easy. They're just on the golf course all day. Oh, my goodness, I could not be a general practitioner. Could not be a family doctor for me. When people say, Wow, emergency medicine must be tough, I say I could never be a GP. That is the hardest job of the lot. A lot of people go into things like that, and they think it's going to be easy and they get shocked and upset when it's really hard. There are no easy jobs. Finally, on my list is I want to be this because the prestige when you are the professor of orthopedics. Everyone thinks you're business. Actually, something that I found being in leadership is a little bit like Wilfred. Uh, next, Like please, uh, So who is Wilfried Owen? I was challenged by a boss when I was registrar. He said, Tell me, who's your Who's your leader? Which leader do you aspire to? And, uh, he confessed afterwards that he was expecting, um, like a football captain. Or, you know, Harry cane or, uh, some some martial, some some warriors, some really impressive person. And I chose a poet. I said Wilfrido. So this is Wilfried. Oh, and he died seven days from armistice, from piece being signed in the first World War. And he was a famous poet. And he wrote the most harrowing accounts of the first World War in poetry Anthem for a doomed youth Don't see a headache or a mist, which means how sweet and glorious it is, uh, to die for one's country and futility and others. He really understood how horrifying war was, how futile it was, how desperate was he was. He was injured during fighting and he could have come out and he could have gone home and taken that injury and gone, you know, I've had enough. I'm injured. I'm out of here. But he went back to the front knowing how horrible it was. Two lead his men, and he ultimately led them into, um into death. He died along with a whole bunch of his men. For me, that was the leader. That is what leadership is about. Um, and the reason why I said that is because you understand the size of the challenge. You understand how hard it is and you go towards that challenge. You go towards the sound of broken glass. You go towards the difficulty you lead into the difficult situation. You take a bite of the two sandwiches. One person, um, colorfully sent to me. Um, being a leader is tough, and it's not about prestige. It's about looking after the people around you, and and, um, yeah, sacrifice is what it is. Anyone who's doing it for procedure is going to be so really upset when it lets them down. Next line, please. So why do you want to do it? Well, yes, there is a cost to There's a cost to any career in any line of, however, it's balanced out. Buy reward. I can put my hand on my heart and say, I love my job. I love the people that I work with, people that I work with, some of the most amazing human beings I've ever come across. The nurses, the doctors, the care practitioners, the health care assistance the volunteers like every single day. I'm inspired by the people that I work with. I get to do fun stuff. No, no days different. The rewards are there that balance out all the difficult stuff. If you concentrate on the difficult stuff, you're never going to take the next step, for it's important to bear them in mind. It's important to look at the career that you want to do and go. You know what? What are the costs here? But the costs are balanced out by the awards. Some of that is financial, you know, orthopedic surgeons doing working six days a week, getting paid an awful lot of money so they can pay for their Porsche's. And they're Ferraris and their mistresses. And they're happy in that. Um, that's not for me, but it is for some people. Um, I know cardiologists who are doing research. I know you know there's people who find that thing in their career. What you need to do is find that balance is what you're going to go into. Will it be rewarding enough for the costs? Next side, please. Surgically surgery is really practical. I love I love being an orthopod. Briefly. I really enjoyed doing those procedures. You know, that was great fun. I love theater. Um, that's a reward. Pediatrics. It's great if you're a tiny person now these are somewhat tongue in cheek. I do have a friend who's 6 ft four, who's a consultant. Pediatric emergency, uh, down in Portsmouth. He ran an audit looking at the height of pediatricians, and he found out that, uh, pediatricians in his unit with the smallest out of all the stuff I think that's been replicated up and down the country. So if you are, if you are challenged in height and pediatrics is good, pediatrics is come on. Working with kids is great. Anesthetics is great if you're into sudoku. Um, I've got a friend who's the training program director for anesthetics in the Northeast, and he's a he's really keen on his chest and he does brilliant anesthetics. He's a regional and anesthetist, but he's also really good at chess, and he gets a bit of practice in theaters. Well, medicine, you know, medicine, I'm sure. Medicine. There's fun things in medicine and internal medicine. Um, it's not for me. But, you know, I know lots of people who love all that kind of studies. Wow, uh, or grounds patients. And obviously emergency medicine is the best specialty. Yes, it's tough, but my goodness, it's glorious. It is the means, uh, it's one of those things where I was talking to one of my colleagues. I said, There's nothing that you can do in medicine that you can make as deeper an impact, uh, in an individual's life as an emergency medicine. In my opinion, I'm totally biased. Next slide. So how do you get? How do you get to that end point of, um, fully trained specialist? You do your research, don't do as I do and stumble into a career. I stumbled into emergency medicine because of the way things changed in training in this in this country. What I should have done was I should have got a road map Mr Rickets, when I was doing orthopedics was the He was the the president of the Royal College of Orthopedics, and he sat us down all of budding orthopods and said, This is what your next six years are going to look look like And he mapped out beautifully how every weekend you're going to be doing this paper and that paper and this audit until your stack of papers and audits gets bigger and bigger and bigger. So when you go to interview, your stack is bigger than the next person, and therefore you'll get the job. And I just thought, Wow, that road map does not look attractive to me. I couldn't give up every single weekend. I want to, You know, I want to go and play hockey, get a roadmap. It's very important. Talk to someone who's a new consultant who has just been through the training is just fresh out of it. Who knows just what it's like and say, Ask them the important questions. Have you got a family? Did you start it during your training? What was that like? Oh, my goodness. The most inspiring. Any emergency medicine consultants that I know. Uh, women who have had, like, four kids during training, which is extended their training. And how do you balance having kids and do all that hard work? All those shifts and all that? All those. All those exams I can do. Shit. What? What happened? Did you ever want to quit? How did you do your exams? Did you have lots of support in this country? Anaesthetics. There's loads of support. There's focus groups and books and websites. When I started my emergency medicine, there wasn't even a book. You just touched up to exams and cross your fingers and failed generally, which is why the past it was so bad to start off next slide. Please come. What happens when it all goes wrong? You can't do it alone. At least almost no one can do it alone. You need to keep your family. Uh, you need to keep those communication lines open. You need to work on your friends. You forget when you leave University. That actually, when you're at the university, when you're at school, those are the times that you make your friends. It's really hard to make friends outside of those times when you've got intense times with people. When you go from to your career, you're you're here, there and everywhere, and everyone else is here, there and everyone. Everyone else is really busy. It's hard to spend that shoulder to shoulder quality time with people doing stuff together because friendship is all about. I like this stuff and you like that stuff. Let's have a conversation. It's It's very difficult to do that when you're when you're in the work, so keep those ties work on them. My best friends are still my university friends. Work on your colleagues. Try and make them your friends. Invest in your colleagues. Um, I was the social secretary for about three or four jobs, like I would be the one organizing. We're going out for some food. Guys, this is the time. This is the place. Let's all go. And that was so important, so important. I can talk about that. Talk about that a lot. Invest in the people that you're on the journey with. Even if it's a short post, you've got to look after each other and your significant other celebrate them. Picture on the right is me getting my membership certificate shaking princess ans hand, uh, which was amazing. She's an amazing lady. She's very funny. Um, but why did I turn up and where the silly ropes and spend 100 and 50 lbs to pick up a piece of paper that already and I didn't know princess and was going to be there, obviously. Otherwise, I've been there with bells on. I thought it would just be some kind of president of the Royal College, but she picked up because she's our governor of some variety. Anyway, why did I do it? Because my wife had had to suffer me going through exams, and she'd been an exam widow, and she got to go to a big fancy celebration. We had a buffet, and she got to see kind of the fruits of things and that pride that she had in me, um, she got to really enjoy that. So I felt like a bit of an idiot in the suit and all that kind of thing normally wearing scrubs and looking a bit of a scrub. But you've got to you've got to use these celebrations to look at, look at the support network and say, here I am with my silly hat on Granny. Here's the picture. And Granny will put that picture up on the mantelpiece, and that would be something that really connects. Okay, so celebrate those. Understand Port. Next time, please. When it all goes wrong, you need to You need your colleagues. You need your colleagues to come and help you. They will spot when you're struggling. Before you do, they'll they'll spot when you're starting to break and they will come and put one arm around and make you a cup of tea and say, Why don't you have a little break? Take 10 minutes out. You can go to your trainers and say, Look, you know what? I'm really struggling. If you don't do that, I guarantee, as a trainer, we spotted and go. Why are they coming to us? We could help. Yeah, use them. Use the people who are training. You say, Look, how did you get through this? What advice will you get? And you'll be if you're in training, you'll be in a training institution and you can ask for help from that. I'm dyslexic and man, I waited too long before I got help for that. I failed a bunch of exams. And when you know what, guys? I think I'm dyslexic. I mean, really? Okay. Have some extra time. And I passed my exams after that. I wish I had done that sooner rather than run into a brick wall times. Dyslexia, incidentally, is very helpful. If you're an emergency medicine person, it's all about the chaos. Okay, next one. So what do you do when you get there? You finally got through training. You've got that job of your dreams. Where do you go? Do you go for a small friendly center? A large, glamorous ivory tower center? Well, that depends on what you want to do. What I will say is that there there are very few jobs that our lifetime jobs and the job that you start on as a fully trained specialist. It's probably not what you're going to do for your whole time and going somewhere where you'll get a bit more experience will stand you in good stead for for the long term. Now I've I've been a consultant for seven years, and my CV is stacked. I've got so many things that I've done because I went to a smaller center, and I got given the responsibility. But, you know, I've missed out on the big, sexy things. Have a large center. I could still do that. I could move to another center and do those rules. But that's for me to choose. That's worth asking about and thinking about. Look at the roles that you want to do with in your job. You can work on your CV. You can diversify. You can do things that you think I've been given jobs. I thought, I don't want to do this. I don't want to be in the sepsis lead. What? Why do I want to do? That sounds really boring. And actually, as soon as I started out so actually this is quite interesting. I could I could do a job here. I can make an improvement here, and suddenly you find a roll that you can actually achieve something in and make a big difference. And you know, you can be surprised if it's not just the things that you want to do that will, you'll you'll enjoy the most. It's often the things that you don't want to do, and you think you'll be rubbish and actually turn out fantastic. Find your work life balance. And that's critical for longevity. Okay, um, you know whether it's going to the gym, making sure you go to the gym. My goodness, that's important. I'm in my middle age. I am in the gym. I tell you what, and trying to keep alive past 55 it's important, you know, family, friends, you've got to make time for them. Otherwise, well, you might have to change and do something else. Sometimes you get down, uh, brick wall. You've got all the way in training and you know what? It's not for me. You can take your training elsewhere. I know emergency medicine consultants who who are doing acute mints Just a slight change. But it's enough for them. Next line his car. So this is my work life balance. I need to balance all these for a little people. And outside of my working time, um, my my wife is my boss. She tells me what I can and can't do with my time, which is a It's an important check and balance on work. So if workout asks me to do something else, I said, I'm sorry. Not my time to give you. It's my wife. It's her time and I need to ask her permission. I think that's a really useful way of looking like we're partners in this next slide. Angels and demons. Anything that you idolize will let you down. When it does, it will become a demon. So, like my colleague who put worker's his number, one thing had sacrificed friends and family and proximity to things he knew when it when it let him down. When he when the slightest thing was like was was thrown in his face, he went, You know what? This isn't all it's cracked up to be. I'm just going to have to suck it in. And he really didn't like emergency medicine, and that was really sad. And I've seen that time and time again. You can take the pressure off that career by building in other things, saying, You know, as much time and energy, I've spent going into medicine in order to sustain it. I need to take it off the top pedestal and move it down. Sometimes in your training and in your career, time wise, it needs to be right up there. But you know it's going to come down, you know you're going to change it when you have the option to do that. And even when it's number one in time, it doesn't need to be your number one priority. Quality time doesn't necessarily mean quantity. Quantity of time. When I was dating my now wife, I would. As soon as I finished my shift, I'd call her whether it's 10 o'clock at night, I'll call her up and she'll be sleeping and say, What is it? And drive to wear flat is. I'd knock on the door and just say Hi. I just have a face to face hug And then I drive up to my dicks just just that little two minutes. Interaction face to face. That five minute telephone pole was brief, but it was enough to make sure that our relationship was one that went onto marriage and kids rather than to just didn't have the time. Yeah, and that was enough to sustain my career. She was the one who helped all those exams. I wouldn't have been able to pass them if it hadn't been for her help. So my final thought I've got from Professor Rocko Djukanovic, who? When I was 1/4 year medical student, I can remember now who is Rocko? Jackovich. If you Google him, you'll find he is just the man when it comes to research. When it comes to respiratory stuff, critical care, he heads up. He doesn't just head up a paper. He heads up conferences. He's just the most amazing, incredible research clinician from Southampton. And he was my supervisor and boss when I was a student and undergraduate for a year and we're on a car ride together and he said to me, Dave, if I could do have done anything in medicine, it is I could do I could do anything. It's so varied. I could have found something to keep me interested in anything that I did and that blew my mind because here was the guy who at that point was laser focused on respiratory allergy stuff. It was already complicated to me, but he could have done anything, he said, And I absolutely agree with that. Now that I'm 20 years down the line from that moment, I would say anything that you do can be it. That is how you do it. How you do it is finding that wrapped code you can pitch finding that interest, finding that reward that balances out the costs go in. They're aware of the costs. But find out that thing. That's the reward. And there will be something. You can be a physician. You can be an orthopod. You can be a pediatrician. Um, you can you can be Not sure. Go in there and try to have a little look. Have a look at the end result and go. You know what? I want to be able to choose when I work in which case may be an aesthetic?