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Hello, everyone. Sorry for the delay. We had some technical issues. Um Patricia um the fy one based in Scotland um in Air and I'm here with Rosa's who is an ICU clinical fellow in Southampton. It's great to welcome and welcome you here on today's webinar. And so today we'll talk about first job in N H S. And so first of all, before starting your job, what are the most important points to focus on and what hospital or your employer requires from you? So, first thing that's done is identity check and so they check your passport, they check your identity on the background of your passport. If that's the same person who is applying for the job and professional registration and the qualifications, they are also checked by GM see earlier, but again, your employer is gonna check it later on as well. Um The other thing is employment history and reference check. So uh they'll see at your look at your previous employment and they will check your references from your previous employment. Um They also check your right to work. So that's gonna be a visa in most of the cases. Um uh There is going to be also a work health assessment. So we'll talk a little bit about it on the next slide. So this will include assessment of your family doctors um allowance to work and different tests and there's gonna be also a criminal record check. So before starting the occupational health check is gonna include vaccination history. That's gonna they will require you to translate it to English. Um They're, they are going to check your family doctor. So initially I had to a ploy my family doctor from my country. Um but later when I arrived to the U K, I changed it to a family doctor locally. Uh they will also take your blood for, for some of the examinations, okay. Um And in some cases, uh there is going to be a chest X ray down for you. So it depends uh it's mostly associated with tuberculosis and the higher risk of tuberculosis in your country. Um There is also one more thing that's done. It's F F P three mask fits. So when I got my mask fit appointment, I wasn't sure what this is exactly, but I quickly found out this is fitting um F F P three mask on to your face. I'm not sure if that's going to um be the same in the future as for the COVID situation currently. Um but very likely are still going to fit masks um for you pre start of your, of your work just before starting, there are a few things that we would want to recommend. Um some jobs have shadowing period. If you're starting as an F Y one, you're going to have around the week of shadowing in some hospitals, they can give you more than a week in some hospitals can be less, however non training jobs sometimes may lack shadowing period. So we would recommend you if it's possible in your future employment um to require to ask for shadowing period. Um It's also important to check your Rotas. I'm going to show you an example of my current rata. Uh There are some rules for Rotas, Rotas, the schedule of your work and what shifts you you do if you're on normal dates, if you're on the call. Um and you can check your rata manually by yourself, but obviously, it can be a bit difficult as you're coming from abroad and you don't know what to expect. So a good place to help, checking your rata is and B M A. So it's an association. We're going to have a separate webinar to talk about associations um that are available in the U K. However, BM a row to check, check your online is a very good tool to help help you check if your rata is compliant with general rules in the country. However, you have to be a B M A member to be able to check your rata on the B M A website Um BMA also offers a contract check. So that allows you to see again if this is compliant with the general rules in the country. It's a really good tool because you don't have to manually travel with it. Um, but I check it for you. Um So some things if you decide to manually check your wrote, some things that are important, um, or listed on the slides. So, first of all, you're supposed to work, you're not supposed to work more than 48 hours in an average per week. Uh, the other thing is you're not supposed to work more than 72 hours in any seven consecutive days. So that's, um, over 168 hours. You are not supposed to have more than four long shift in a row. Okay. So long shifts are mostly around 12 hours or up to 13 hours and you're not supposed to work more than 4, 19 arose. So that's a maximum, you may have four nights, one by one, but not more than this. The other thing is you're not supposed to have more than seven shifts in any kind of any kind in a row. You're not supposed to work more than one in two weekends. Okay. You're not entitled to work at 40 sorry to have a 46 hour gap after any night shift. You're entitled to, uh, 48 hour gap after any run of five long nights. And the last thing is, you're entitled to have an 18 hour gap between shifts of any kind. So you can refer to this slide later if you want to manually check your water. This is an example of uh my rotor. So as you can see, um when it's written station, station towards station for this is award that I'm assigned to on this particular day and this is a normal day. It lasts from 8 to 4 30. in medical rotation, it was nine AM till five PM. So it's around eight hours a day whenever it's written long, the green ones, this is on call. So this is a longer day. Um It's a non call when I am normally carrying a page. Uh The other example is receiving, receiving is also a long shift. This is equivalent as to on call um end nights. As you can see in red, there are maximum four nights in a row. There were some changes. So this is not a primary schedule, but as you can see, there are weekends off and I don't have a few weekends in a row. Um Working one by one whenever I work on weekends, like let's say around um 22nd and 23rd, July, I have a day before it as a rest day. So this is when I am off and two days later, um I have again a few days off. These are some helpful um points, helpful applications for you to install on your mobile phone to install on your computer and they're really handy to use during your work. So whenever you start, you'll find yourself looking into these applications simply for um some additional support in decision making. B N F is the first one we we always refer to. So that's um, I guess most of you know, this application that's for medication. So you can see those as you can see indications for medicines in there. Very helpful tool. MD Kalg is an application where you can refer to um different calculators. Let's say you can calculate well score, you can calculate the gentamicin. Uh those you can look at different scores in medicine. Very good one. And um they give you a criteria, you just put in your numbers and it gives you a score. Uh The BMJ is this requires subscription. However, some of the hospitals can provide you with subscription. Uh you can get it through the library of the hospital. So this is just a general uh medical application where you can see um epidemiology. You can see diagnosed six treatments of of different conditions. And that's again gonna help you in um diagnosing process and treatment. Uh Micro guide is the new nation wide application for antibiotic therapy. However, some of the region's may have their own application. As you can see. Uh the last one I currently work in a Russian and are and, and they have their own application for guidelines and they have their own microbial application when, where I can refer to what antibiotic therapy uh to use in particular condition. The next one, the green one with a scalpel on it. It's a really helpful one for aspiring surgeons. Uh So it's a e log book. It's an application where you can log your surgery. So whenever you assist, whenever you perform a surgery, you can log log it in, it's a nationwide and this is accepted for future applications for uh surgical um specialties. The next one is induction, the yellow one. Um this gives you phone numbers in your hospital so you can set where you work and it's gonna give you page numbers and phone numbers um in my region. Um It's not very helpful. However, I, I have a friend who uses this application on a daily basis. Uh Talk space is really good for emergency department. That's an application. We're just going to give you um common uh common things that patient's can get intoxicated with and diagnostic and treatment guides for them to can use it in emergency department. And not, not necessarily only an emergency can be also using the word. Um I guess again, most of you knows these books, but they are golden for your future clinical work. So first of all, the foundation program, it's not only limited for people who start foundation program, I would recommend it to anyone. Um It gives you a short overview of on many um medical conditions, not only also surgical conditions, emergency conditions. Um and it also has a chapter own um starting work in N H S which is very helpful, even tells you about saving a parking space in front of the hospital or uh cycling to, to your work. So a lot of valuable tips, uh the other ones are more focused on specialties. If you start, if you're going to start working in a particular speciality, you can pick up one of these books. So they're on various various specialties nowadays. So here you can see clinical medicine, general medicine, uh surgery, um imaging, like radiology, emergency medicine. But there are many more uh such as under chronology, nephrology, and etcetera and are very helpful to mindedly. Again, I guess you, most of you know, this one, you'll find a lot of tips. A lot of advice is on um different topics. Okay. So before starting a few tips from our side, what can you do to prepare to start on the ward you're going to work in? Um it's both for those who are going to start in foundation training and those who are gonna going to start in particular specialties. Very important and very helpful thing is to read up on key topics of your specialty. Uh The previous slide that, that you saw the Oxford handbooks are very helpful for it because they have consigns information on different um topics on, on different conditions and they can be, as I showed you divided into different specialties. So if you read up on key topics as well as read on key emergencies, you will feel a bit more confident working in the field that you're going to work on. Um also helpful to read thoroughly on history and examination. So I would say this generally not focused on specialty geeky medics is really good tool to have a look at how to examine patients'. What are the common conditions? What are the laboratory tests that are commonly um requested here? And uh an additional, well, no one, not only for surgical fields also for medical, what practical procedures are most commonly performed in the world and um what how you can do them so you can find youtube videos just to get familiar rates. You will obviously we're learning practice, but it's good to have some basis, theoretical knowledge on it. How about legal things? Um So starting from the top indemnity insurance, even though a hospital covers uh medical mistakes and etcetera, it's very helpful to have your own indemnity insurance. There, there are many um companies. One of the most important ones is M D U. Um And we are going to have a separate webinar on this um indemnity insurance company or associations such as B M A. Um So as I mentioned, the other point associations BMA is one of the most popular ones. Uh they can help you as mentioned before in contract checking, rata checking, they can give you even a guide for future specialty um, selection. So if you're not sure what you want to do, there is a very helpful guide on their website. And currently, um, for a strike that's going on in, uh, in the UK strike or of junior doctors, you need to be a member to vote for it. And the other thing is uh, tax. So just to be sure, just to know what tax code you should be under. It's really important. Um The cure code that's on, on the slide refers you to a mind the bleep a link where you have all the information on tax. Um, you will find tax codes that you should be assigned under in some situations. Some people are put under emergency tax. Um So in, in, in this case, you need to reach out to your um age or department in order to fix it because if your emergency tax, you're not taxed properly. Um, there is uh an opportunity to get a tax relief on medical expenses. This is when you spend your own money on things like G M C um yearly subscription as in payment B M A um or, or even indemnity insurance. When you go to some exams that are required or some courses, you can get a 20% back on your account for as a tax relief from these things. Um Also in terms of legal. There are low comms that you can do. So this is additional work. This is picking up additional shifts or if you pick them up in your local hospital that you work in, it's out of our work and there are special forms that you need to fill in for it. Um For lock um I'll give you a QR code when you lock them, for example, as an F Y one, there's some rules to it. Um And, and this link is going to show you all the rules and um and information about la comming when you start your job finally. Um there are a few things that you should be aware of. So first thing I remember when I came and I got a page, I was clueless. I wasn't sure how to use it. Uh Those are some things that may be obvious for people who are trained locally, however, I wasn't really sure how to use it. So it's really important, however, it differs hospital to hospital. So you need to um get some guidance from your senior. You need to ask around to be able to use the pager because this is going to be your main side of um contacting from words or from other people around the hospital. You need to know how to escalate. You need to know who is your senior. Whenever you have some troubles, you're not sure how to do things you need to find out in your hospital, who is your senior and who is the person you should reach out to when you have troubles, when you're unsure. And most of the times you, you can find a page number for your senior or if you know them, you can contact them in different, in, in other ways. Um But it's important to know who are your seniors to be able to escalate to them. There are some important phone numbers like um knowing the phone number for the lab for radiology department. And in most of the words, you will find um them written down. However, the induction app may be helpful for it as well. Uh There are some people you should be aware of, let's say, for example, who has a charge nurse in the words, you're working, who is um uh a bad manager who is again your senior. So um you can ask around, you can ask colleagues that you work with to find out who are the people you should be aware of and who are the people you should address concerns too. Um and just connected to concerns. It's important to know who your supervisor is. Uh for foundation training, you will have a clinical and educational supervisor in some of the centers. This can be one person. So one person is going to be a clinical and educational supervisor. But so the provider is a point um is the person whom you refer to whenever you have some troubles that you cannot solve directly. When you need some support, when you want to develop, when you want to do some research, they can be a person to go to talk to and you need to know what to do if you face a problem and whom to talk to. If the problem is mine or you can um solve it on, on the direct line with the other person. However, when it's something that's not possible to be solved in such a way you can address this to your seniors or you can address it to your consultants or you can also address it to your supervisor. So that's why it's important to know who your supervisor is. So what do you do day to day when you're employed on award? What are your general tasks? First of all? Oh, most of the days start with handover. They again look different in different hospitals. But for example, where I work medical handovers happening in a big lecture hole and this is the time where a night shift gives handover or give the information to the day shift. What to do, what to be aware of handovers where I work happen three times a day. So there's a morning one, there is the afternoon one and there is the evening one. Um, handover is the first thing. If you uh finish your night shift, you need to let the day team know what needs to be done if you come on a day um for a day work, then you get a handover from the night team. After handover, you must get to your ward where ward rounds begin. Uh Ward rounds can be done by consultants or in this case, you join the consultant who is performing in the ward round. Um In some cases, if you're working on a more senior position, you may be a person who actually performs war drums. So wardrobes is simply reviewing patient's that are on the ward. Um You need to write the notes. Um and we'll talk about a bit about how to report in notes. Um Yeah, and this is reviewing patient's and when you perform the world round, there are some jobs generated. What I mean is, for example, somebody may require blood's to be taken in the same day or in the next stages to monitor some things. Some people may require investigations. Some people may have social travels and they may require some social care or addressing this care to, to the nursing stuff. Um, some people may, may require and some other investigations. So this is when the list of jobs is generated and either you or somebody else on the world is going to do these jobs. And it's important to remember to review the blood tests and investigations that you request. This is mostly done closer to the afternoon when the word round is finished. It may go to review the blood that we're taking in the morning, the investigations that were done and further act on it. And the big one is discharge summaries. Um, so especially junior doctors are those who do discharge summaries. So that's the ideal immediate discharge letter that is written mostly in, um, in the form of electronic discharge letter. Okay. And, um, the one that was really challenging for me at the beginning. Um, so who wear switch colors? Okay. Um This can defer hospital to hospital, but there are some examples for you. So going from the left there is a physiotherapist. So they mostly where it is light blue, um, tops. Okay. Theater staff. So that's the 2nd and 3rd person theater staff may have green or blue um clothes and they're gonna be mostly without any letters, any anything written on them. And the fourth one, the lady is an occupational therapist. So they look very similar to physiotherapist, but their shirts are a bit lighter. So they're light blue. Then the next one, senior charge nurse or charge nurses mostly wear dark blue. But again, this can defer hospital to hospital and the bordeaux or dark red color is mostly clinical nurse manager or bad manager. Then the next one is a housekeeper or a person who serves meals, okay. Um, those are mostly non medical stuff in the hospital who were uh this paint green color. And then, um, nursing students where it's kind of grayish color. Medical students uh here locally uh were black and it's written in yellow on it, medical student um stuff, nurses have the blue one. So if you see this uh suits in, in real life, you will realize that there are differences because the on the picture is not that clear. But if you see it, in reality, you will see that there are differences in colors and porters uh wear similar shirts as housekeeper or staff serving meals. So this is again, non medical stuff. A light health professionals have mostly colors on their suits or on their shirts. Uh and they're kind of bluish and clinical support staff have light blue shirts. Okay. Just, just some helpful to tool to allow you to understand what are different colors for different people in M D T. Um So what happened on calls when you're on call or when you're working? That's mostly an 12 12.5 hour shift. You most of the time are going to be in arresting, especially if you work in medical. Um words, arrest team um is made of a few people that's mostly a senior uh medical person. So that's a registrar in medicine. There is going to be a middle grade medical person. So that's a person who can be a foundation year to doctor or clinical fellow can be a middle grade who also belongs to our esteem and there will be two junior doctors and again, this can defer hospital to hospital and there are gonna be in peace in their esteem most of the time. So that's an advanced nurse practitioner. Every person in our eczema are going to have a special job to do. So this can be somebody does airways, somebody takes care of drugs administered and defibrillation. Somebody else can be a person who gains access. It puts a cannula in, gets blood from this patient and somebody is going to be a lead of arrest team. So this is mostly the most senior medical person who is leading the arrest when you're holding your, your page when you're on call. And uh the arrest happens in our hospital, there is um an arrest call. So the page goes off and it tells you where the arrest is happening and where you need to go. It's very important to find out what the coverage that you do. So what parts of the of the hospital you cover because there may be some parts of the hospital that you don't cover in some hospitals. The other thing if there's no arrest, um you are doing jobs. So you are being paged by the words and you're getting back to the words and doing jobs on the words that you normally cover. It's very important to prioritize your tasks because at some point, you may get paged a lot. So you need to know what is important to be done earlier and what can wait. So the most important thing is unwell patient. So they take priority, but it is important to check if the patient is actually unwell and if and how unwell the patient is, um it can happen that you're paged um minute after a minute uh from two different words because there are too unwell patient's. You need to be able to prioritize who needs your help and your um your assessment first. So you can do it by appropriate discussion with nurses to find out uh what, what patient you should address first. There is a new score that is used here. I guess most of you know, new score. This is a very helpful tool to define what the patient is more unwell and what patient needs to be addressed first. Um in situations when you don't really know what to do or you are unsure, um you need to escalate. So as I mentioned before, you need to know who is your senior to be able to escalate. This is a person that you contact. When whenever you need help, you need hand with anything and referrals. So when you're working out of hours, it can happen that somebody needs to be referred to different specialty. So you need to know how to refer a patient and what way are the patient's referred out of hours. It's mostly a telephone convert association with the specialty that you're going to refer to. However, some of the specialties like for example, neurosurgery here in Glasgow have online referrals even though um it's a cute you refer online and they, you get an immediate response from them. So back to world rounds, um you need to know the efficient documentation structure. So how to document and you will at some point create your own um documentation, you create your own way, way, how to document or on ward rounds. However, you can find a lot of helpful tools on minded clip and geeky medics website where there is a very good template. Um And you can follow this one at the very beginning so that you create your own way of documenting. Uh The other thing is taking bloods, which was a surprise to me when I came here because from where I am, um doctors don't take bloods. Uh It was a struggle at the beginning, but I recommend you practice how to take bloods if this is not a thing that you're familiar with, especially as an F Y one. Um I have to take a lot of bloods on daily basis. That's why it's a skill that is really worth practicing. You can do it on your shadowing period. You're you can do it during your induction. But I highly recommend practicing taking blood, putting Cannulas in. If you are more senior, especially in such a situation, you may be asked to put a cannula in for a patient who has a challenging access. So it's a very um important skill to have um different hospitals, use different bottles for blood staking. So in such a situation, you need to speak to somebody more senior or to your colleagues to guide you. Um there are local guidelines or, or what bottles to use for which tests. So you can find that uh in your local guidelines of the hospital you're going to work in and and how to send blood slab. So most of the hospitals have pudding system. So you put your blood's with the form in the pot and you send them directly to the lab. And there may be some differences out of our, for example, in the hospital that I work a lab is shot at 11 pm. So bloods are sent to another hospital nearby to uh to be red. So you need to know how to send blood's out of hours, it can be a little bit different. Um And the other thing um is ideals again mentioned by me a few minutes ago, how to write discharge letters. Again, there are very good um links on minded leap and Yuki Medics that can show you a template of how you can do the ideal. Um And you'll uh later get your own pattern that that's going to be comfortable for you prescribing is the other point. Um As an F Y one who studied abroad, I had to do a P S A test. So that's a prescription prescribing assessment test. Um This is an exam that is taken by um, uh final year medical students here. I had to do it a bit later so I had to do it at the beginning of my F Y one. Um, and it's, it's a very helpful exam actually to make sure that you know how to prescribe properly and um to, to refresh your knowledge on uh interactions between medications and, yeah, but anyway, studying, studying for exams, if you take a lab, if you take a CSA exam. So that's a clinical assessment exam. Uh most of these exams have some station on prescribing. So by this point, you will know it. However, where I work, the prescribing is done online. So it's a bit different. It's not a written form, it's not a written card. X, however, it is done on the system called Well Sky. So you need to know how to prescribe but you should get the skilled during your induction period. Uh So again, day today, so now not out of hours but day today, first thing, first priority is unwell patient's when you're on the world and the nurse addresses you that there's somebody unwell. You should um assess this person as your first priority. And this is also one of the reasons when you should interrupt your break. Okay. So if you're on your break and your page, because there's an unwell patient. So this is one of not many reasons that you should interrupt your break and the other thing day today is reviewing investigations, reviewing the bloods that you ordered doing referrals. But in our referrals can be a bit different than out of our urgent referrals. So in our referrals, some of them are done via email. So email, um particular specialty and uh they come and review patient's in due course, uh referrals and how to do them are gonna again defer hospital to hospital where I work and some referrals are done through email. Like if you want to contact microbiology department, you would write an email to them. Uh Some of them are in a template in a general forum that you just put in information in like um background, clinical history, past medical history and etcetera, etcetera and you print it and send it to uh or or drop it. Uh Let's secretaries of particular specialty, but you'll find it how to refer in your hospital where you work district letters are the one that we spoke about. There may be a lot of district letters to do when you work in hours when you work in your normal days. Um And again, don't forget to chase bloods that you ordered. It's very helpful to discuss with nursing stuff, which patient's are the priority, like which patient's need to be reviewed faster. Maybe somebody is planned to be discharged today. So it's good to review them early on so that their discharge can be adequately planned. So communication with nursing staff is very important. Um And you can prepare some discharge letters a bit later. So if you plan to discharge a patient on the next day, uh let's say there is a plan to review their bloods and discharge them. If blood's are okay, you can prepare the discharge letter a day earlier if you have time. Um So, so that you can say some time of the next day if this day happens to be very busy, but I wouldn't recommend to prepare the shirt letters much in advance like 34 days because a lot can change throughout this time. Uh So it would need to be updated. Okay. And again, day today, um some tips on how to manage your workload, how to um do well in your ward. So add the nursing staff, remember to have a good communication with N D T. So that's multidiscipline team communication with physiotherapist, with occupational therapists, with nursing stuff, with assistance of nursing stuff. Uh They will all give you valuable information on patients' on their mobility on there. Um How they're hoping if they are ready for discharge, uh what medication they need to have discharged. It's obviously based on your decision, but you need to communicate with them to be able to take these decisions appropriately. Um Try and do all the jobs in one area. So whenever you do your jobs, it's also true for on call, try to do things in one area before moving to another area. So if you're, you are on one word, try to finish everything you're doing in this word, to be able to move later to another word. Um And if you're doing something like let's say you're chasing blood's, it's very helpful to chase all the bloods that you had planned to chase for the particular day before moving to something else so that you save this time doing similar jobs in the same time. And and always think whether a job can be done by their usual team, if you are on your night shift, and there's something that's less urgent, let's say every view of patients' medication, this can be done by the by the usual team of this patient because it's very likely that you don't know this patient, you're seeing this patient for the first time and it would be more appropriate that than the that usual team of this patient is going to do this job instead of you doing it on night if you don't have um equivalent information about this patient, and always think whether a job can be done by someone else. So again, the same situation, if the patient have their usual team, usual consultant that take care of them as some jobs that are not urgent can be done by the steam because they know the patient better. And if the patient isn't in pain or the patient is nauseated or constipated, give the medications to relieve it because your assessment is going to be a bit better if you're assessing an unwell patient or if you're um introducing some treatment, it's good to relieve urgent symptoms that this patient have to be able to assess appropriately later. A bit about portfolio. So if you are in training job, if you're in Scotland, you will use tourists, for example, as a foundation training, we use tourists. That's an online platform when you create your portfolio. Um But in England there is Horace, this is a very similar to tourists online platform again where you put all your evidence for your portfolio. If you are not in training job, there is an alternative to it. So there are e portfolios. I think there are many more uh websites where you can create your portfolio. So portfolio is either a requirement on your training or this is something that you can create to prepare for the future specialty application or for the future applications wherever for, for your job. Um This is where you put your evidence where you put, you put your teaching. Whereas you're experiencing, let's say in teaching your conferences that you attended and etcetera, we'll talk about portfolio and career development a little bit later and a few helpful tools. So we spoke about referral. Uh So the most important questions or things to know when you refer a patient, there is a very good template on minded leave. There's a cure code to it. If you want to scan it. Um This is a referral cheat sheet and this is going to give you the most important and uh the most accurate questions to find out not to stress when you're referring a patient to a particular specialty. So this is going to tell you, for example, that if you refer to renal, it's important to know their, you're now food there. Um fluid balance, what is there? G F R and um what is their creatinine and etcetera? So this is going to give you some good tips to prepare just to make this referral a bit easier on you a very important bit is your well being because after all the job isn't that easy, there are a lot of phone calls. So you need to put your well being very high as a priority. Remember to book your leave. If you can some trust, allow you to book your leaves, some trust, give you your leave in advance on some training stages or non training stages, you can have a study leave. So if you're preparing for an exam or if you're going to some course or conference, you can take a study leave for, for these days. Um And it's also important to find out what are the rules of sick leave? Whom do you need to contact if you are sick? And what do you need to do if you feel unwell and you cannot show up to work? Um So, in the UK, if you call in sick, you don't have to have a sick note from, for example, from your G P. Um, there are, if you, I'm not sure how many days, uh, is that, I think up to five days you can call in sick without having the actual sick note. Um, take breaks when you're working. Very important. One, take breaks. So some rules on taking breaks again, you can find the mind deputy website. Uh but this is 30 minutes for five hours of your work. So if you work 12 hours, you have two times 30 minutes breaks. Um And the only reason, one of the most important reasons to interrupt your break, as I said is either an arrest call or an unwell patient that you're contacted about and find out if there is a well being center in your hospital. Uh What kind of support you can get if you feel down if you feel unwell in terms of your mental health and well being because you really need to take care of yourself when you're working. Um There is also an option to work less than full time. So for any reasons you can apply to work less than full time, let's say you can do 80% of full time. You can 70% of full time or even 50% of full time. You can apply for it. And many trusts allow for less than full time work. And I will now ask Raza's to just give you some additional tapes and additional comments on it. Thank you so much. Thank you, Patricia. Um Patricia spoken about most of the things that you will encounter in your first job. I'm just going to add um just a little bit about what you want to achieve in this first job and how maybe to know if this is the right job for you. Um And so I'm just going to, oh Patricia, can you sorry, can you do the next screen, please? Thank you. Um So as I MGS, I think the most important thing for us when we come to a new job is to know when we can get to training. Um And so the quest form, which is your certificate of equivalence of competency to into specialty training, something like that. And it basically just means that you are um competent enough to have made your F one F two. So this is if you're coming into the UK at an F one F two level, but not necessarily doing um an actual foundation training program. Um So when I first started, I started at as a train, just a trust trust job in a just a clinical fellow position, not a, an actual foundation uh school program. And so I needed to sign off this quest form. Um and it's basically a form that has uh lots of agendas. Some of them are procedures. So things like cannulation, taking blood catheters and G tubes. Uh some of them are personality. So you are someone who is kind and caring and prioritizes patient's patient safety. Um uh And some of them are clinical. So you are able to prescribe safely. All the things that Patricia has spoken about already. Um And some of them are even just not being clinical in the sense of having managed to see an arrest, being dealt with the clinical animal patient's. So you need a, your clinical supervisor would most likely be the best and to sign it, it needs to be a consultant who you've worked with for three months. Um who knows you, but their, their consultant. So they're not really going to be with you all the time for them to actually see you perform. Most of these, they might see you perform a couple of the required points, but definitely not all of them. Um And most of them will be happy with you basically taking this form with you wherever you go. And every time you perform something, you, the registrar that's on call with, you can sign and say that he's seen you or she's seen you perform it and usually your consultant is happy with signing it afterwards because you know, someone senior has seen you do it. Um And so I've got a, I'll show it to you in the end of got a PDF of it. It will where you'll find it will be in either in Oreo if you log into Oreo or in the health education England website. Um I think most of the time, if you just type in quest form 2021 into Google, it will come up. They normally updated every couple of years, but it's still as the 2021 version it has not changed. Um So, yeah, that's the first thing that you need to put your mind on even before you come to the UK. And I know of some people who have signed it actually before coming in um because your consultants overseas will know you and they just need to be like a G M C registered consultant. Um And you can get this signed of probably easier from your home country than signing it in the UK. Um But if you've been here for a year, then they'll ask you, why haven't you since you've been here for a while, why haven't you signed it from someone who's here? Um So yeah, either basically you sign it from abroad and come straight into training or sign it here and then move into a training program. Um Right. So then you need to achieve things in your, in your year or let's say six months to a year of first job, to be able to get into training, teaching Q I P leadership. You need to find juniors to teach. Normally in every hospital, most hospitals they'll be um there'll be some sort of teaching event going on, departmental stuff happening that you could definitely contribute to some hospital will be like actual teaching hospitals and they'll have medical students rotating through and you'd be able to um see who's responsible for the medical students who is a consultant responsible. And you can definitely do some either bedside teaching or um any other forms I know, for example, I'm in Southampton. So in Southampton they do um M I P to basically, which is the second year, every year they give you two students if you sign up. So I've signed up for two years basically. And every year I got two students and we went through bedside examinations, cardiovascular, abdominal respiratory neuro, and you just see them every like two weeks or something and help them with their examination skills and how to build it up. And that is really useful because it's not, it's not a one off teaching event that you've just come and you took a presentation and you went off. But it's actually you've got a continuation of care happening and you've been doing it for like a couple of months. So that has more points um in your application than just doing like a single teaching event. Um And what else? So Q I P. So they want to see that you've improved something or another in whichever hospital you're in. It could be something very simple as when you joined the, let's say you're an E D and you joined the trust and you want to know all the female patient's, for example, 8, 18 to 50 have they every time they presented to hospital, did they get a pregnancy test? For example. Um And you just want to see are the rules being followed. That's literally what Q I P is quality improvement project project. See if any of these things are happening. Um It doesn't have to be something complicated, literally be the simplest point. They just want to know that you are able to do it. It shouldn't really take you a lot of time. Um And it doesn't have to be like a big research project where you've got like, you know, 500 patients', it doesn't have to be that at all. Like you can do a Q I P with 50 patient's, it's not even less than that. I know definitely been doing it with less. Um But what's, what's more important is not doing many Q I P s. What's more important is doing a Q I P and then repeating it several months later to see if things have changed. Once you've said this is the problem, we're not doing it. I recommend that we, you know, make, I don't know, put more guidelines into doing pregnancy test test or put more reminders uh to the doctors to do pregnancy test for the female patient's presenting to hospital and then you check in a few months have they done it? And then if they, they haven't done it, then you check in a couple another couple of months and see if it has been done. That will be the strongest point to give you the highest, um the highest point when you're applying to training, doing it several times doesn't have to be 10 different Q I P S but doing one or two several times is the thing that's going to get you the higher points. Um Leadership be basically something like being the mess leader or um every hospital have a mess where all the junior doctors will come in. It's basically just a shared space where you meet you with your other F one and F two colleagues. Um And there's like there will be a small fee like a 10 lb a month or something like that uh that people pay to get access to the mess and you have like snacks and, and things over there basically available. Um And there'll be mess activities usually um they'll do get togethers or parties or things just to like socialize with other people. So you can be the leader of the mess. Um You can be a leader of the, so the junior doctors normally have a, a forum where they talk about junior doctor issues. Um either, you know, lack of staffing in some places. Um Any, you know, not being, not being paid enough for low comms, etcetera, any any problem that junior doctors will face in, in hospital. So these are two very easy things that you can do um to get that up in your first year. Um and then your portfolio. So as a trainee, so as a foundation doctor, you will get a portfolio. But if you're not a foundation doctor, you may or may not get one. So it depends on your hospital. It depends how I'm differently. They are, uh they may provide you with one and they may not in the website itself. So in, in England, we use Horace and you don't have to actually be a paying member you can print. So there are blank forms uh that you can actually print from horse people for you itself where you can print off the two most important things that you need cbds and minnick excess cbds. Basically just means that you have discussed a case with a senior. You know, you guys talked about a patient who would come in you, he was sick, he had something or other and you've discussed it together and you can write um it's a case based discussion. That's all it means. Um uh Mini Hkex is actually them seeing you perform everything. So you've examined the patient, you've come up with a plan, etcetera, etcetera. So these are the two things that you need. Um And what I did in my first year because I didn't, I didn't receive a horse portfolio, but I went in and I printed several blank forms and then, and that's where I could keep track of everything that I've been doing in that year and it wouldn't go to waste. Um, so when I applied to something different, I can say, actually I've got the competencies for this year because I've been collecting it all through the year. Um, write exams. So some people will say if you know what you want to do, go for your exams. So it away. So if you know, you want to do medicine, you want to do um RCP as soon as possible. Um And others will say, maybe get a bit more clinical experience if you haven't done much clinical experience, if you sort of just coming straight into sort of your F one F two equivalent. Um I think it's up to you. If you can find the time initially, your first job is going to be quite busy because you are other than trying to get to learn a whole new system of how things work that are not like how it is back home. You're also trying to achieve things like teaching and uh Q I P and leadership and on top of your portfolio and make sure your quest form signed. Um So I, I didn't think exam was the, was my priority for me, but I also wasn't sure what I wanted to do exactly when I, when I joined the NHS, I wasn't sure where I was going to go. So I thought it would just be a waste of money for me to keep doing exams when I'm not really sure where I'm going. Um, so I personally I didn't do that, but of course, if you've got the time and you, you know, where you want to go, you can definitely start studying for them. Um, and then join groups or societies, uh, there'll be different groups in. So it depends what again this is if you know, or you're familiar with what you want to do when you grow up. But when you, so I know, for example, I was quite interested in anesthetics. So joining, you know, the anaesthetic society or, and I see you joining the intensive care society for me that was really useful, the intensive care society because it had, I could do my ultrasound scanning and you couldn't do it. If you weren't a member, they wouldn't sign you off at the end. Um So just like that, if you, if there was something that you're passionate about and you know that for sure you're going to do it, then it makes sense to find the specific group of society that you're dealing with. Um And then your so taste a week low comms. Um It's very useful if you can say it will, it shows commitment to specialty. If you can take a taste a week to do any other specialty that you do enjoy if you're in medicine and you actually want to do surgery, vice versa or you into something quite niche, you know, or something that maybe it's not very common, like, it's not very common to get, let's see, an ent job or a thumb a job. Like it takes a long time to be able to get these kind of jobs. So it might be easier to get a taste a week to see what it's like, what it will be like in the future and speak to several of the seniors there. They'll know you and then you might be able maybe to pick up a couple of low, comes after that and build up your portfolio via that even though if you do that's not your main job. Um but you are working in the area that you want to be in the future or you want to get training number and it makes sense to have some hands of hands on practice. Um I'm just going to show you, I'm done with my talk. I'm just going to show you the, the horse. Uh just showing tires queen. Okay, fine. Can you see my screen? Yes. Yes, thanks Pat. Um So this is the Horace portfolio when you first log into it, literally says Horace dot he dot NHS dot UK. Um If you have an educational supervisor, you'll probably have an initial meeting. Um just to discuss basically your plans, your future plans. What do you want to achieve in this year, um etcetera. Uh and then you should have sort of a midpoint mean or uh final meeting basically before you leave. So if you're doing six months, it'll be on your first test when you came at three months and then at six months. Um what you, the things you need to focus on are basically these three, your Minnick X uh clinical evaluation exercise, your jobs, diet, observation of procedural skills and your case based discussion. So I'm just gonna go into, let's say the mini kecks and we're going to be at a new one. Um And basically you just put in the date. What exactly, you know, I don't know, abdominal pain and needy as your title. Um 69 year old female presented with abdominal pain, something very simple up here. Uh And then putting more clinical ailes. Uh and then here is basically the feedback. So what do you think? Was there anything you felt like you did really well in something you felt that you could improve in? And what did the person who saw you do it? Think of it? Uh What, what point did they give you for your future? Uh There anything particularly that they caught that they thought you were really good at or could do better, etcetera. Um And then you put your trainee and you sign it. So let's just cancel this. Um So these are the three bits that you need to focus on. Uh If you again, don't have a portfolio, if you just go all the way to the end, it will say blank forms and generic versions of each form in horrors can be downloaded here when you press that, you can get a blank form of anything and you can just print this off and have like a paper. It will be obviously will be a paper um rather than an E portfolio, but it's still something, it means you can keep all your stuff in one place. So there's my CBD 21 I'm just going to print this whole thing off and write it by hand and I have a folder folders of all of these from the first year because I didn't, I didn't have that on me. Um So just completely fine love. Um I just wanted to share that so you guys can know if you don't have an E portfolio that you can, you've got other options. Um Yeah, thank you. Do we have any questions? Yeah. Yes, fine. Um If we don't have any questions end here, um the next webinar will be on the sixth of June and it will be about indemnity uh cover with the M D U. Um And they'll basically have the floor here. We want to see, we want people to see how have an insurance will really benefit you being in the UK as, as Patricia was saying earlier, the hospital does have some basic coverage but it's not really enough. Um Right. Uh And that will be, yeah, that'll be our next one in the sixth of June. All right. So we've got a question, uh A L S and 80 less. They will be, you have a study budget. Um So you'll have about 600 a year uh of study budget and you are, you can use it for A L S A T L s whatnot. These costs are expensive though. So ptls costs um I think it cost it about 700 lbs, but it will depend on the trust. Sometimes they'll pay fully even if it's a little bit over, they wouldn't mind. Uh It depends on the trust sometimes they don't. Um But again, so sorry, I haven't actually said this, but that's probably something you want to do in your first job. A L s for sure. A T L s probably can wait but L s for sure everyone needs to have the LS bias of their first job. Um And the next question was both the M D U and the B M A so that they're the very different groups of people. Um The, your M D U is your insurance. It's basically if something goes wrong, they need to cover you. If you know a patient complained about something, you will discuss it with them. Um You will be covered from that point of view, but the B M A is the British basically medical association where things like strikes and um pay stuff like that. So they're very different associations. Um The M D U is, you don't, not the M D U specifically, you need to have insurance of any kind. Um doesn't have to be M D U but you have to have insurance BM A. It's up to you if you want to be part of it or not, it is an extra expense every month. Um They do send you a, a literally a book every month that comes to your door. So you have to think of recycling that if you're not gonna be opening every month, but it's, I think a lot of people have joined it recently to be able to strike for strike reasons. Um But before that, I, I don't know how useful is, I'm not particularly a member, so I would know how to tell you, but I'm sure I think we do have topics coming up on people who are going to speak about the usefulness of having it. I'll just add one thing. And so there was a free membership of B M A uh for some time they offered like three months of membership. Um and you could do this specialty guidance um question Ery. So you could, you could put your interest, your expectations of balance of work like work life balance and it could give you some guidance of what's the most suitable specialty for you, then they offer the contract and wrote a checking. So those are advantages. Um And then the, this strike like Rosa's just said, um, what, what's going on now is, well, you cannot vote if you're not a member, but obviously it's not mandatory to join them. You cannot vote if you're not a member, but you can strike if you're not a member. So, yeah. Um but the, I think the checking the rotor is what a lot of people are also find useful, especially when you just come into the country. Um Sometimes you're not sure if, you know, you feel like you're working too many hours and you're working too many consecutive days after each other and you're not sure if this is right. Um Or something is wrong with your contract. Um So that's something that they normally do and it's useful. So, yeah, any more questions? All right. I think we'll stop here. Um We'll see you guys on the sixth of June. Um And that one will be the MD you talk. Um So you can see then if that is something that you're interested in joining. Thank you. Thank you. Yeah.