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Lovely. So, last but not least we have Omar and Akbar who are here to talk to us about how to smash the clinical station. It's very high demand. There's lots of clinical situations that could come up. Um But what's really important is just knowing how to prepare for it, how to structure your answers and just how to approach it. Um The examiners have been hearing people all day, pretty much give the same answers or roughly the same answers. So, uh hopefully today will hear how best to answer. Hey, Omar, how's it going? Iron? Thank you so much for joining us today is, is Jack. Well with us as well. Do you want me to invite him to this stage? Yeah, he should be um he should be joining uh stuff. Hey, how's it going? Hey, hey, I'm you. Not too bad. Not too bad. Thank you both for joining us today. I've helped you guys up a little bit. We've got a lot of people in the uh in the room going to hear all of your expert pro tips. OK. OK. All right. I'm gonna just try uh share the my deck. Perfect. Can uh, everyone see that I can see that. Yeah. The floors. All yours? Ok. Ok, perfect. So, um, hi, everyone. Uh, my name is Omar. Um, I'm a plastic Sea Ct one. and I've got up here with me. He's a, was my best friend, but anesthetic one. so, um, I also could be, be here today just, just because, um, he helped me a lot in preparing for my interview, so he knows a lot of good tips and a couple of things we can talk about together. So I thought that might be useful. Um So I just, if I go to the next slide, so, yeah, no conflicts of interest or affiliations with paid courses. Um, we both, I got in the top kind of 1% of applications, not just, you know. Um, so I think, you know, WW I went last year to a similar talk to this. It was by a, er, I can't remember if it was exactly this one but it had an instrumental kind of effect on, on uh my preparation and, and interviews. So I just wanted to give back um, and uh hopefully pay forward. So, um I'll start off by saying I personally, I think that the interview is the most important um, aspect of your application. Um, last year, I think it's the same this year. It was, it's worth about 60% of your overall, er, score and it can really, so if you've done well in your portfolio, it can really kind of supercharge your application and if you've got less points in your kind of portfolio and M sra it can really boost your marks. So it's, it's um it's really important and probably people have told you already that you need to prepare for it and, and treat it like any other exam is basically an oral exam more than kind of a generic kind of interview. OK. And the main thing that you wanna do is practice, practice early. Some, I know some people they would uh practice, you know, while they were preparing for the M SRA before they find out about their, their marks, everyone does it differently. Uh I started preparing like properly after I'd completed my M sra I know people who started before but it's whatever works for you. But remember if you don't pass the M sra aspect of it, you won't get an interview. So you have to, you know, uh you have to kind of play the game and then I made a note here. So II like this, this quote that practice makes permanent, only perfect practice makes perfect. So you have to be really intentional with um your preparation and to make sure that kind of you're reflecting on your answers when you practice them and looking at what went well, what can you improve on? So um so that you're kind of you're working smart, smart and hard, but you more working smart than anything. Ok. Yeah, I think just to jump out here two, the two key points on the side that I would echo, I'll definitely focus on the exam. Smash the exam, the M sra because especially when I apply for anesthetics. I know it's a bit different but they, they jacked up the cut off because of the issues with the interview. So loads of people who didn't concentrate so much on the exam didn't even get an interview in the first place. And it does count for points, right? It, it does have a percentage associated with it. But then as soon as that is done, take a couple of days to chill, I think we'd like, I don't know what we did, but we definitely didn't do any work. Um and then start your interview practice straight away. And as says, rightly try to practice with people straight away and it feels horrible like I know, I remember when you were practicing with people from the beginning and you were like pushing, like, come on, come on practice with me and I didn't want to because it's so awkward and embarrassing. But if you think about it, if you've done it with your friends and your registrars and your colleagues and whoever 100 200 times before you've got in front of your camera at the interview, those initial nerves are gone and they definitely were for me because I've been in that situation so many times already. Yeah. Um Exactly. Let's um if I carry on. So yeah, um this is an important thing to say as well is like, ii wish that we could give you like a kind of a perfect blueprint to say this and you know, say this exact spiel and we'll get you the marks. There is a lot of subjectivity and there's differences between interviews. So if you ask me how my interview structure was, you know, how uh my clinical scenarios, how much I was able to speak for the interrupted blah, blah, blah, it's very different between every candidate. So you have to be aware of that. So you can't go into the interview and expect that. For example, you're gonna be able to give a a full answer for 4 to 5 minutes. You have to be aware that some consultants might mark differently. They might, you might, as we mentioned later, you might be asked to skip your A two E you might be interrupted in the middle of, you know, giving your answer. So you have to be kind of um aware that it can, can be very different for each candidate. And that's why it's quite useful to speak to numerous people who have gone through the process. Obviously coming to, for example, talks like this, speaking to CST S who have recently got in um just to have an idea of kind of what could happen. Um because it's not always the same. Um, so these are some recommended resources. So these are the kind of things that I use. So this is the core surgery interview book. It's, it's quite popular. Um, it's quite good. It's got, er, loads of different scenarios. Um, that I think actually, yeah, they, they, they do come up, um, it's got quite a lot of detail. It probably you wouldn't be able to fit in all the detail of the kind of the model answers into the, the five minute scenarios. But it was nonetheless, it was still very useful and I would recommend it the ATL S um manual, very useful as well because as we'll men in a moment, there is a kind of usually an ATL S kind of style station. Um me and H I think we did our at LSI think um in December time. Um Just because yeah, November, December. Yeah, which was really useful. Um I know not everyone can do it. We, I think we managed to get on to some last minute um courses. So that was good revision and good preparation for the interview. You don't necessarily have to do it, but especially reading through the or skimming through the the manual to have an idea of how to structure your answers is really useful. Medi Bdy as well, so that they've got a lot of kind of um scenarios that you can run through with friends. So between Medi buddy and the core surgery interview book. There's, there's so much practice that you can do the, the w I didn't finish many, but there's a bank that you can use on anybody. And even the book, I don't even know if I've got right to the end of the book. There's, there's lots of scenarios to practice. Um the most important thing is, is your colleagues. So number one, as I mentioned, to get kind of their experiences of the interview. So you have an idea of kind of the spectrum of what things may or may not come up and how it might run, but also to practice, to practice with them. And I II know I'm, I'm probably gonna say this quite a lot like practicing is the most important thing for me. Personally, I I'm not like the the most amazing kind of naturally at interviews. So I knew I had to put in practice from early and it will feel odd, like at the beginning, it feels rough and you're like, how am I ever gonna do this? But if you, you'll start to pick up things and you want to, hopefully by the time the interview comes round, you feel confident, nothing really can, can phase you, you've gone through lots of different scenarios and you'll feel nice and comfortable in the interview. That's the kind of stage you want to want to get to. Yeah, and just on, just on the point of kind of talking to your colleagues and um and getting advice while you're prepping for the M Sary exam. So when I was prepping for the exam, I still spoke to anyone in the department who had just been through the interview process, uh Registrar as consultants, just do a bit of fact finding, you know, what kind of questions they asked. What, how did you study? Some people recommended to me, you know, make flashcards at your questions and go through them. So you'll get, if you just speak to people on a day to day basis, get an idea generally of what people are doing and then when it comes to the time to practice those interviews, you can, you have a head start and put that all into, into practice basically. Hm. Um Someone's asking about if there are P DFS. Um I personally have the course surgery book. I'm pretty sure you'll be able to find the ATL S book somewhere online. Um I have the book cos I went to the course, but I'm sure you can find it online if you look hard enough. Um ok, so the clinical station is what we're gonna talk about. Ok. So usually it presents, they usually both present as kind of emergency scenarios. All right. Um So they'll usually be an ATL S Star star station. So like a trauma patient and ASR which is kind of like an unwell award patient. But as I said earlier, the interviews vary a lot. Ok. So you could potentially have two ATL S star stationss, you could have two ward er unwell ward patients. So you have to be kind of um on your toes and you're ready for whatever basically could come up. But for example, for me, I had one ATL S one kind of traumacal style station and one C crisp. So an Unwell POSTOP patient, I've also heard of people so previous CST S having medical problems. So I think one of my uh uh one of my friends who was act one when I was applying, he had, I think um yeah, I think it was a pe he had after an operation. So you have to just be open minded with what kind of scenarios can come up. Ok. Um So yeah, as I mentioned, practice, practice, practice, you also, which was good for me and Ukr be um obviously is applying for anesthetics, but there is a lot of overlap as we'll, we'll show our um scores sheets and stuff to show kind of what was important and the feedback that we got. But assessing others is really important as well because it puts you into the examiner mindset of thinking about, oh, what it shows you what you kind of the examiners might be looking for and it really does have an impact on, on when you start to give answers and you can implement those changes to your, your attempts and your, your answering. So, and we'll mention it, we can mention it a bit more later on as well. But even simple stuff like eye contact, body language, lighting, you know, those things really play an important role as well regardless of what station you're actually answering. But I think that was also something really important that um showed me for sure. Yeah, definitely. And you can only get that from, from practicing. So we used to practice, we practice online like it was the real thing. I'd usually personally, for me, I would usually wear like, like my shirt and everything just to get myself into the kind of the zone. Um And also like, I was like, we were mentioning speaking to other CST S and speaking to other people who have been in other things. So for example, um having a microphone makes a massive difference. I've not got my, my camera, I had an external camera connected. So when you start to speak to people, you start to notice like important things. So two people who scored highly told me both, you need to, you know, but with your presentation ideally have a, a microphone, uh you know, your background to be clear, probably a bit clearer than this now. Um And have like an, an external uh camera. So these things you only pick up or you actually speak to people um they make a big difference. Um OK, so what I'm kind of getting to with this slide is that your clinical skills and knowledge are one thing you could have kind of MRC S knowledge of different surgical conditions, your anatomy, et cetera. But that's only one facet of your kind of your, your answer and your, your, your scoring. OK. There are so many other other aspects of how you're gonna be marked and your overall performance. So this includes your communication, as I mentioned, other subjective things or having, you know, having a microphone, they can hear you clearly is your uh camera clear, having the right amount of confidence you, you know, it's a spectrum. You don't want to be overly confident and you know, starting the surgery on the patient and start taking the people and starting the operation. They want you to be safe, they want somebody, you know, if they were, if you were working for them and the team would they be happy that you'd be safe, you'd be able to escalate early um to provide the best care for, for the patient. So all all of these things. So this is just to highlight that your skills and knowledge is not necessarily, you know, it's only one aspect of, of your answer and, and your score. Yeah, it's gonna, it might, it might sound silly if I say don't overthink it. But in general, all they want to see is the same for anesthetic surgery, whatever that you are going to be a safe competent trainee and actually the scenarios they're going to ask you about by the time you're in end of F in F two or maybe if you're in F three or whatever, you've probably been in those scenarios before. And just that if you were to be placed in that scenario, you would do the right thing for the patient. That doesn't mean you get the diagnosis spot on and like, says, rush into theater and start the operation before anyone comes in. It just means you did everything in the right order in a safe and logical way. And it really is that simple. Yeah, exactly. And you remember you're being assessed at the, the the level of knowledge of an F two. So you don't have to have like, like I said, MRC S knowledge, I didn't have my MRC S but um uh when I, when I had my interview. So um so yeah, multiple facets you need to kind of hit all the the right boxes er fine. So I don't know if you can see this clearly, but this was uh my feedback from my clinical station. And the reason I'm putting this up is to show you the comments to th to show you kind of and to highlight the important aspects of the feedback in which what they gave me and what they liked. So as you can see here, a logical approach, so we're gonna talk a little bit about how to structure your answers. But that was a key thing that would come up time next time again about how well you structure your approach, you organize. Can you come up with a logical way of kind of going through the scenario? Um reflection. So I'm gonna talk about that as well. Always mention reflection at the end of your answer as well, which is useful as we mentioned earlier. So early escalation, full assessment unprompted. So ideally, you want to um from what I heard as well from previous est s, if they're prompting you about things, particularly if they're trying to get to your point, sometimes you can lose marks. So ideally, you want to try and think through things and have um uh an array of different for, for example, differentials. So they have to kind of prompt you less uh what other things, awareness, see, good awareness of the wider team. So this is kind of like this lays into the kind of the human factors which we'll mention. And to be honest, the the the the next comments are very, very similar. So just having that general awareness, the human factors which you mentioned about earlier un again unprompted. So um you're, you're kind of getting to bits of the scenario without having to be prompted or to them to ask you what you know, what would you do next? What would you, you know, how would you go on from this? This only comes with practice, to be honest, it's not something, you know, uh, that you'll get straight away. You have to keep practicing and you'll start to, like I said, with that examiner mindset, once you practice with others you'll start to think about, oh, this is probably important in the scenario. They probably want me to talk about this. Um, and this is yours if you want to talk through it, maybe. Yeah. So again, like we said, obviously, we apply for two different specialties. Obviously, they spend most of their time in the same area which is theaters. Um But with the clinical scenario, it really isn't the scenarios they give between the both specialties aren't much different and how you answer it isn't really different. So again, like similar things to s excellent situational awareness. So just knowing that understanding the gravity of the situation you're in and acting appropriately structure, so they want to see that you have a structure, you're not just jumping between bits of the assessment and getting sidetracked by clinical details. Um It also talks about again, early escalation. So recognizing that this patient is unwell and as they're assessing you at the level of an F two going into CT one that you're not gonna just waltz down there into the room and fix the situation, you're gonna get people on board to help you from early, right? Um What else does it say? Yeah, staying calm. So I think again, when you, when you get faced with the scenario, they might give you some horrendous vitals or whatever, but it's just remembering that you're just talking to someone else about clinical scenario and not letting the pressure get to you. Because again, if, if you start to panic and sweat, when you're at the end of a laptop, then it's gonna, it's not gonna reflect too well if you're like that in a real scenario, obviously, we're all gonna be nervous. That's a given. I know mine, my voice was like wobbling away and I was probably sweating, to be honest with like my suit and tie, but that's different from like they can see that you've, you've panicked when you've given the service. So try and stay nice and calm. And I think the most important thing as well, I would say here is that if you read the, if you read both me and Omar's feedback, it doesn't say, oh yeah, they picked up the diagnosis straight away and they gave the exact correct dose of antibiotics and then they titrate it. They don't care about the clinical details. Obviously, it's good if you know what's going on. But all of the teamwork, situational awareness, escalation, communication, staying calm. That's where I'm mopping up most of your points. And actually the chary on the case is just saying, yeah, this was a septic appendix or for me. Yeah. Ok. This is a guy who's got chest sepsis and needs to go to ICU, for example, that's just the tick, the last tick, but the rest of the points are coming from all those other non technical things. Yeah, I definitely agree and hopefully we'll give you some pointers which will be able to help, help structure your answers to help you kind of get to that stage. Um Right. So as I mentioned, there's usually one A LS style um station. Um and you typically would use this for trauma patients, but also wanted to mention that if the presentation is unclear. So for example, someone's come in and collapsed or they might have had a head head injury, for example, they're in A&E better to go with an A TLS style approach because it, it's safer. Um And they might have an underlying trauma which might need to be dealt with. Also just to mention that again, trauma patients, they might have underlying medical problems, they might have uh an M I which might have led to them to have a trauma or whatever. So just be open minded. OK. So how did I structure my A TL S answer? So I usually started with a bit of an instruction and with human factors that we kind of mentioned. So these kind of things that I've put, you wouldn't necessarily say them for every, every scenario. So for example, if there's a massive polytrauma patient who's, you know, super unwell and stuff, I wouldn't say that necessarily, I'm gonna, I'm going to make sure there's no patient of, you know, of greater clinical priority. It, it really depends these kind of things on, on the sit on the situation, but these are some things that you might wanna say. So you see a patient immediately, uh a good thing to say is that you let your registrar know that you're going to see an unwell patient, they may or not be with you. Uh So just keeping them kind of in the loop. And then one tip that I got, which was very useful from a previous est is that while you're going down to the, you say you're going down to the patient, you could start to mention some of your differentials. So let's say, for example, you're on your way to uh you know, any of this patient who's had a, a lower limb trauma and they're in excruciating pain from their leg and there's pain on passive extension of, of, of their foot. For example, you could be saying that, OK, for example, I'm gonna go see this patient and let my reg know I'm gonna go see this other patient on my way to the, on my way down to A&E I'd be thinking about kind of things I'm most concerned about in this, in this situation. I'd be most concerned about compartment syndrome. Uh and something that I'd want to, to rule out or, you know, and give me list some other differentials. I'll probably only say this if you're kind of, you've got a good inkling into what is kind of going on. So for example, if it's clear, clear cut, you might wanna mention a couple of your differentials in the beginning, I think it just looks good. And then um as you mentioned earlier, some more human factors things. So you could say that um you could um I use my non technical skills to make sure you're aware of the wider team around you. Remember, in A&E you're gonna have a array of people around of different kind of uh healthcare professionals. And if not done already, you could put out a double two, double two to put out a trauma call. So and then II usually like to say that I would introduce myself and then conduct a primary survey um of the patient use the principles of advanced trauma life support protocol. So say it, say it fully. So don't say ATL S advanced trauma life support protocol. So it's usually a bit of an instruction, try to keep it quite brief. Um uh II was I was gonna say that. Yeah, so I, so for my, for my clinical stations, I obviously because we did so much together, we basically had similar things that modified it to suit our purposes, but I did the exact same thing. So again, treat it as real life. You don't get, you don't pick up a bleep and then immediately you start sprinting to a patient and do an at E, that would be really weird if you came running into the room saying the airways pay, you never do that. Right. What you would do? Well, what, what I can do you think? Ok, I've got 25 patients or patients. How many patients is a bit, I don't know sure if you're touching something but the best it's a bit crackly. I would consider maybe taking the headphones off and just using the, um, uh, laptop mic. Yeah, that sounds better. Oh, now I can't hear you. I can't hear you. How about now? Yeah. Yeah. Yeah. Is that good? Mhm. Yeah. So for example, you would look at your list of 25 30 40 patients, whatever it is and decide. Is there anyone else who is this sick or how many jobs do I have to actually do? Are they critical? Who else is in my team that can help me? And I don't know if I can, I'm talking about but whenever I receive a be, but I always just like, call my registrar who's more senior and say, look, I'm going, I'm going to Ed this patient's really sick. I might need a hand. Just keep your phone on you in case you know, and then from early again saying that if the situation sounds dias so if they say there's a, there's a, a trauma in research or there's a septic patient on a ward who's got BP of 80/40 they're not responsive then actually saying to that person on the phone, ok. It sounds like you need a bit more help than just me. You wanna out of double two, double two and with those three things that you've said, which takes you what, like 30 or 40 seconds to say, maybe less, you've already mopped up tons of those non technical points that we just discussed in the previous feedback sheets. Mhm Yeah. Um OK. And then, so once you get to the patient, you've said you're kind of a bit of your introduction spiel, then you can get to your kind of your A to E. So I, like I said, I would recommend going through some of the ATL S stuff. But um kind of the main difference is in, in ATL S versus kind of a regular kind of A two E is that you have to remember about stabilizing the um cervical spine and ruling out any catastrophic hemorrhage. Um Other things that you should mention is that you'd always put them on to 15 L of, of um an oxygen by a non rebreath mask. Um And then basically you want to just come up with a, with an A two E kind of spiel that you can give. So this I've just given kind of an example as what I kind of what I would usually say you don't wanna go into too much detail. Yeah, ideally you want your A two E to be nice and slick. It needs to be a minute to a minute, minute and a half maximum. Ok. Remember the whole scenario was only five minutes and sometimes, you know, by the time that you log in to the, the common things and it connects and then they give the scenario, it could be just kind of around four minutes, 4.5 minutes. So these are so, you know, kind of, I won't read it out. But these are kind of uh what I say for um my A, my A two E. So I'd move on from, yeah, mobilizing c spine, hemorrhage, uh looking out for catastrophic hemorrhage, looking at the airway, um moving on to breathing. So saying these kind of bits um and then circulation. So something that's quite useful that um actually, uh previous CST told me about is that you could start from the hands. So just try to make it logical. You want something that, you know, when you're stressed. For example, in the interview, you can just go from the hands. So you look at peripheral and central cap refill, then move up to the radial pulse, then up to um you know, the elbow. So you, you can take your bloods, do your BP. Uh You ask for, you know, um for blood count using these clotting group and saves crossmatch BBg. Um So all of these bits here. I'm not necessarily gonna read them out, but this is kind of uh something that you can use and I'll mention this a bit later. But the way that you're really gonna stand out, OK is having kind of a, a baseline structure answer, but then adapting it and making it specific to the situation. OK. So if, for example, they're saying that, you know, the patient is, is hypoxic or blah, blah, blah in your A two E, you might wanna focus a bit more on the respiratory kind of or the or the B aspect. So you want to make sure, you know, you take ox oxygen saturations, you're gonna, you can mention about the hypoxia, you're gonna put them on oxygen, you're gonna titrate it to above, you know, 9 94% blah blah. Um So you want to be kind of tailoring your A two E to, to the situation and that will really make you stand out rather than, than giving kind of a bog standard, straightforward an um answer, even if it sounds good, if it's not, if it's not kind of adapted to the, to the um to the scenario, it won't look as good. Um So yeah, so these added bits. So for example, if there are concerns of a pelvic fracture fracture, you might wanna put a pelvic binder. But you know, if it's a, a stabbing or something in, in, I don't know in the chest or whatever. And there's no inkling towards a pelvic fracture. You don't need to say that. Otherwise, it will just look like it's memorized. Um an answer if you see what I mean. And then d so disability G CS, temperature, glucose, et cetera, look for any lateralizing signs and then fully expose the patient for e and then once you've got to that bit, then you can start thinking about um what you would do is then focus your examination on the area that is for exa that is um the area of importance. So let's say, for example, in my A when I had a stabbing, so I did my kind of a two E approach and then after that, and then I pay, pay attention to, you know, to the area of injury, you know, I place pressure on the wound, for example. So then you can focus a bit more on that, on that region or the area of interest. Um After you've done that you can, if, if you said it earlier or if you haven't, you can start, you can give you differentials. Um you can talk about kind of what investigations or imaging you might like. Um and any referrals you'd like to make this, this patient needs to transfer. Sometimes, you know, you might not be in a trauma center, you think about whether they need to transfer. And there's something I like to say, always like to say is that you document clearly in the notes you'd follow up on any investigations or referrals that you make. And also you can mention on reflections, you can say that I would reflect on, um, the situation using something like the Gibbs Reflective Cycle and discuss this with, uh, my clinical supervisor at the most at the next appropriate time. Something along along those lines. Ok. Uh, sorry, I'm ca cautious that we're running over a little bit as well. So I'll take as much time as you need to you guys at the last session. And so don't worry. Ok, great. Um, fine. So like I was saying, you want to, ideally what I used to do is when I had a, you know, a, a scenario when you were practicing, I'd picture myself in Ed, um, you know, in, in a recess and try to think about what kind of things would you do? Like it, it might be difficult if you haven't done, you know, an sho surgery job, but you just have to try think and be logical, you know, you want to keep them nil by mouth if they're probably going to theater. If it's, for example, I don't know, like a stabbing, I think I said I spoke to speak to general surgery. I speak to the clinical, um, you know, the theater coordinators, the on call anesthesin, this is really, this will really make you kind of stand out. So thinking kind of in broader terms about the, the overall treatment of the patient, not just doing your A two E and prescribing something or, you know, then telling your read about it, you want to show that you're proactive and you're kind of thinking about the next steps before they've arrived. Ok. Um So for example, in my, in my scenario, I had a stabbing, um, they were um hemodynamically stable but um because I was um concerned about what kind of where the stabbing was. I was worried that this patient might suddenly become, you know, he hemodynamically unstable, they might start to bleed if they've plotted off somewhere. And for that reason, I need to get them ready for theater regardless. And I was doing all these things which II think probably, you know, helped me. Um So yeah, you need to be structured and logical but you need to make sure that you adapt it. Um adapt your, your answer to the scenario that will really make you stand out. Yeah. And I think it, it's all those, it's all those again when I practice with my registrars and anomer as well. It was always those, those little bits on the sides that stand out. So again, the, the clinical scenario, I don't know if it's the same for surgery, but anesthetics, it was never gonna be anything wild or some crazy thing that no one's ever heard of. It was gonna be simple stuff that you would see on a day to day basis. Um so getting the clinical stuff down is good. But for example, in mine, it was an unwell chest sepsis. So from, from early I said, you know, this patient mines go to ICU. So I'll contact my registrar and discuss with ICU about bringing this patient up. And at the end of mine, I had, I don't know if they do this in the surgical ones, they might add it on, but they said, ok, so you know, your patients are going to ICU his wife has come. What are you gonna tell her? So I would say also if you have time, II appreciate the surgical one I think is a bit more pushed for time. If you do have time, it would look really good. If you said at the end of the day, this is gonna be a patient in the recess or on the ward, they're probably gonna be terrified. Make sure that you're including them in the in the decisions. Mhm. They have capacity if they don't have capacity, make sure their family are aware of what's going on because at some point, either the anesthetist or surgeon or the junior is gonna call the family and, and say, look, this is what's going on. We need to take them to surgery or whatever, you know, what would their wishes be? So, just being aware that these processes are happening in the background and if you have time, I think it would be really good to mention as well. I think that's an important point if like if you have time. So as I'll mention a bit later, I'm not sure if it's the, the next slide, but sometimes when you've done gone through your full, you know, your full answer for the first station for the second scenario, they might, you might get to your A two E and say they'll, they'll stop you after, for example AAA or stop your B or ask you to skip your A two E fully. So that will give you a lot of extra time where you could, you know, potentially explore all these other bits, you know, to, to, to show off and make you make you sh you know, make you look like you have a, a kind of an awareness of the whole situation as a whole rather than just kind of doing your A two E and coming up with a diagnosis and management again, it was mentioned in a previous presentation, right? Like they're sitting there all day back to back candidate after candidate. Like if you can be confident and say something that not something wild but something that maybe previous people haven't thought of to mention, you might just get perk up and sit up and be like, OK, this candidate is, is a serious candidate then what they're talking. Yeah, definitely. Um Right. So I think we've spoken about a couple of these things already. So you might be. So for example, for me, I was allowed to speak for the whole scenario for both scenarios. They didn't stop me, they didn't interrupt me. Um I ha I went through my A two E fully for each one. So I was as prepared. So I had enough to say for each of them and they were quite like I said straight. So one was like I said, like I said an atl S scenario, one was um animal. So a POSTOP temperature a day, one temperature. So I had an idea of what I wanted to say, my differential things. So I was, I managed to speak for the whole time for both of them. I know some people it was, it wasn't like that. OK? So they, like I said, they had to skip their A two E they got interrupted, asked questions. So you have to be, as I said, this multiple times already adaptable in the sense that you have to be prepared for whatever could come up, you might be expect, you might be able to speak the whole time. You might be stopped. Yeah. Um And yeah, so for example, there's a scenario, I remember I did a scenario with me when we were practicing about um doing it A to E and then there's an issue with the airway and then you know what this next step is gonna be at that point, you know, then you'd maybe go for um you know, Cadel start bag um bag masking them or, and you know, then talking about surgical airway. So that's why it's useful to have a look into the ATL S bit. That would be quite tough. Um uh Like I said, they're only assessing you at the level of me two, but it could potentially happen. But it's good to know that cos for example, in mine, I was flowing through my airway breathing was going well. And then he just stopped me and said, when I asked for an E CG, he's like, OK, the E CG shows heart rate of 150 with ST depressions. And now he's saying he's got chest pain. What are you gonna do? So they might just like right in the middle, just stop you and your flow and you have to be prepared to be able to answer a question and not and not be so robotic. And that again, back to the point of being adaptable and practicing different scenarios where they let you talk for the whole time or they stop you in the middle because yeah, any of it, I know one of my friends did his interview in Scotland or whatever and they stopped him at every single thing that he said, they stopped him and questioned him and he wasn't at the, and the thing is if you haven't practiced with colleagues and you know, your friends and things that can really throw you off, especially if you then answer a little bit that they've interrupted and then try to get back into your flow to get to the rest of your answer. The only way that you're gonna be able to get back into your flow, get back into answer is, is, is practice basically um fine. So C Crisp is um if you haven't heard of it, it's um it's care of the critically ill surgical patient. It's a course like at LSI have, haven't done Crisp. Um II didn't look through the manual of this. It's this is more toward this is more kind of uh your general kind of a two that you would do on, on, on the ward. So it's typically gonna be typically going to be an unwell ward patient. So for example, I think mine was a, a POSTOP um day one patient who developed a temperature and a slightly um hypoxic. So like a um like the scenario just given with the ATL S, you, you can start with the human factors first. OK. So you can start with saying, you know, this patient is uh uh is clearly unwell and I'd want to kind of assess them immediately given there's no other patients of greater clinical concern. I'd let my reg know that I'm going to see an unwell patient. So there's other bits that you can add for this as well. I'm not sure. I think I might have put in it on the, uh put it on the next slide. But you can say that, you know, on my way to the patient, I'd call the wall, I'd ask the nurse to take a full set of observations, uh to prepare some blood taking equipment, ideally have a free computer and to have the patient's notes. So, just a little thing like that, that took me, what, 5 to 10 seconds to say, it just kind of shows that you're proactive and you're thinking ahead and you've been in this situation before because that's, that's what you would, that's what you would do in, in the hospital. Like I was saying, you're not necessarily going to hear someone's unwell and start sprinting towards them. You, you have to be logical, you have to, it just shows that you've been in that situation before. Um, so then you'd write them whatever, introduce yourself and start doing your A two E and as I, as I mentioned, keep it tailored to the scenario. Ok. So if you're there, uh, uh, POSTOP, they're probably go, they might have drains in, er, they might have a catheter in other things going on around. They might, you know, have an ECG. So you want to be thinking kind of picture, picture yourself, put yourself at all of you have probably been in this situation. So just put yourself in the shoes of being off, for example, on ward cover and things and think about kind of what you would do. Really? Yeah, there are some differences in the A two E um for kind of the crisp versus the ATL S patients in ATL S. You always give 15 L of, of oxygen via non rebreath in, in a, in a war patient. You wouldn't necessarily need to do that unless for example, they're hypoxic. You don't need to look out for catastrophic hemorrhage or immobilized c spine. And I think in one of my previous slides I mentioned about, you know, looking for signs of bleeding from the pelvis, long, long bones, blah, blah, blah. You wouldn't necessarily need to do that if you can have bleeding in a POSTOP patient. So be aware of that particularly, you know, if they have abdominal pain, blah, blah, they have abdominal surgery, but there are some slight differences but they're pretty much similar. The main difference with wall patients and C crisp is that after you've done your assessment. And then, so you've done your A two E, then you focus on the area. So for example, if they've got abdominal pain, then you fol pay more attention to the abdomen. You're looking for drains, you're looking at the wound. Uh what is the, the wound? Uh What, what are the drains draining? Is it your fluid? Is it pus blah, blah, blah. Then one, if you're happy that the patient is stable at that time, then you can read the notes. So you can have a look at the operation note, uh you know, recent clinical injuries, all things that I've said here, but like I said as well, these are quite a lot of things just try to, to aim it towards the scenario. So if you think that the patient is, is septic, um you think about, for example, looking and checking if they're on antibiotics already, ideally, you'd probably mentioned that you want to start the sepsis six early. So if it's a sepsis patient, I'll probably mention sepsis six early. So say it, for example, I said it, I think in my c section of, of my, my, my A two E. So while I'm taking bloods and things at this time, then I'd want to start sepsis six, you know, um give antibiotics, blah, blah, blah, et cetera. So I mention it from early, but all these other bits are gonna help you kind of stand out. So looking at kind of their obs chart, their drug charts. Are they on, on, on, on medications? Are they, are they already on antibiotics? For example, if you were the septic, are they into eating or drinking? Do they have an NG tube treatment escalation plan? These are sort of things that you can talk about, especially if they, you've been asked to skip your A two E, you have more things, you have more time, you can speak about these things. OK. Um So as I mentioned earlier, so these are kind of things that you could say to start off your answer. So the patient's clearly unwell and you need to see them immediately. You'd be aware of the wider team ava um available and their level of experience. I think Oprah mentioned earlier saying as well that if you, if the patient is clearly very unwell, you can mention from early about putting out a double two, double two emergency call, ok? They want to know that you're safe and that you escalate. Like I said, that you're approp you have appropriate confidence that you're not um kind of not confident to do anything and you're, you know, second guessing yourself. But at the same time, you're not taking the the patient to the theater and starting everything yourself and not escalating to your reg and, and consultant. OK? Um So we've spoken about all these things. Yeah, asked for a full set of observations, blah, blah, blah. Again, you can mention on my way down to the patient, this is a day one POSTOP patient with a um with a pyrexia and a, you know, and uh and some hypoxia, the main, I'd be thinking about this, this and that as my differentials et cetera. And then yeah, conduct the A two E using principles of the care of the critically ill surgical patient. Would you like me to go through my A two E? They might say yes, that's what they said. Yes. For both of mine, they might say no, that's OK. This is these are your findings, blah, blah, blah. Um So yeah, as I've mentioned already, so once you finish your at, then you can focus on where the problem is. So for example, they've got abdominal pain, they've got pyrexia. You're gonna examine the the abdomen, looking for any signs of peritonitis, look at um look at the wound, ideally, look at the drains what they're draining, et cetera. So these are kind of a couple of things that you could mention after you've done your focused examination. Yeah. So, and I probably the most important thing is if they're POSTOP looking at their operation note. So just think about what things you would do in work you'd look about, you'd look at when they had their operation, who did the operation? Was it a consultant? Was it, you know, uh a junior registrar? Was it, uh, was it complicated? Was it a complicated um, um, operation uh pay attention to any kind of POSTOP kind of, er, plan or kind of management? Bit so that it make you kind of aware of? And I think for mine, I escalated earlier that I would try, I would get a hold of my reg and if I couldn't get through to my reg, I'd contact the on call consultant or the operating consultant. And I think that was mentioned also in the feedback. Um, and then these things, they're kind of already similar to what we've discussed already in the ATL S bit. And then, yeah, once you've got to the end, then you can talk about reflection as well. So talking about reflecting on the situation and bring up at the right um the next appropriate opportunity. Um Yeah, that's it. I think. So, what do you do from now? So you've got some time now until interviews obviously make me and would say they probably put your M sra as your main focus at the moment. Um But I think it's good that for example, you guys are attending something like this because it gives you kind of an idea of kind of what to expect now. OK. And personally what I did, so I went to a very similar session like the like like this from A I last year and I made some notes on kind of the slides that were given. So I'm sure they can um give these slides out and I'm happy for you guys to have them. And uh ideally, I'd want you guys to make some notes on a little introduction. So for your a if it's an ATL S or CRS scenario and then a com kind of a model baseline answer for an ATL S and A and A CRI, but you can remember that that is kind of your baseline kind of model answer that you're gonna be adjusting specific to the scenario. So once you're happy with your baseline, you practice that a couple of times with your colleagues or friends, then you'll have more kind of brain space to start adjusting things and making it specific to the scenario, which will honestly will will, that's what makes you will make you stand out. Ok. Um And your A two E Yes, your A two E definitely needs to be nice and slick. Um and again, tailored to the scenario and like I said, it might be that um you know, I kind of made my notes and things say to what worked for me. So I went through multiple adjustments and kind of reflecting after each time practicing and things. I'm not necessarily gonna say this is like the blueprint that will get you top marks and things, but you just have to practice and just see what works for you. And um I think that's it. So all the, all the best, I hope that was useful. Um Like I said, uh I found the, the, the session last year very helpful and ii honestly think it was instrumental in helping me with my revision for er interviews. So, uh I hope this has been useful for you guys. I know it's a stressful time but um just keep your head down and step by step and, and hopefully you guys will be ok. Uh I know we've overrun, overrun quite a bit, but if there's any kind of um pertinent questions, then feel free we can hang around. Thank you so much to both of you for taking the time out here. And II think it's really useful. I think you've laid out the slides perfectly. You've explained things so clearly. Um I definitely think people who have attended are gonna take this on and remember it when they're, when they're invited to the interview. If it's ok if we could just linger for a couple of minutes in case there's any final questions. Yeah, of course, of course. Um What about booking ATL S? Right? I know. Yeah, I just basically cos we me and I were kind of discussed it like cos we basically do everything together, right? As you can probably tell even though we did two different special. But um we sat down like how are we gonna count this ATL S? Like people are saying they were on a waiting list for years, all this stuff. I basically just looked at the places that offered it. So I think Jonathan sent a link. So I looked at all the places that offer ATL S and instead of trying to book, I just emailed like the the medical education, whatever person that looks after it. And I said, look, I'm keen to ATL S are there any spaces if not, there's a cancellation email me and then one day I just got an email saying, do you wanna come, someone dropped out like two weeks before or something? And I said. Yeah, of course, I booked it. So that's probably the, that's probably the way I'd go about it. Cos, yeah, the, it's quite a big, um, waiting list. Yeah, I think similar with me, there are cancellations and stuff. So I would just check like, every other day and then one, I think there was a cancellation. So I just booked it in quite last minute. Uh, and I managed to get onto it. I wouldn't say it's um it's like the end of the world. If you can't do it, most people won't be able to, having to read through the course is probably um the, the manual is probably the main thing, but it was definitely useful to get in that situation to be practicing kind of the moulage of kind of um simulation of seeing patients and things. I think the main, the main thing that we kept saying to each other was like, but I know it's really competitive and if you look at the competition ratios and you think, oh man, there's no way I'm gonna get this. So that's what I was thinking and that's what I don't know what I was thinking that. But like if you put in the work, you, you put in the work for the exam and you come to the courses like this and you, you study for your interview, there's no reason why you can't be one of those people that gets offered the job. It's not, it's not rocket science, you just follow the advice and put your head down and you might get unlucky on the day. That's fine. But most times you will get in. Yeah. And I think it was also like we mentioned about just being intentional about your practice, your um uh you know, when you, when you're doing your practice interviews and, and everything really, you just want to try to be intentional to try to work smart cos you could be practicing interviews, you know, for 12 hours a day. But if you're not um making it specific to, you know, what the examiners are looking for and practicing the right way, then it might not help you as much. 100% 100%. Thank you both for taking the time to be here today. I really do appreciate it. Uh I can see a couple of questions asking for your dms and uh whether there's any courses that you guys would recommend. I know typically a asset was always um I'm just speaking on behalf of asset, you guys can say whatever you like. So um it's all good. Um Yeah, go for it. Oh, no, sorry, I was gonna say about um the courses. Um Yeah, I think practicing with your colleagues and friends is probably still the best thing to do. Um I went to, I think a course um I can't remember exactly what, what course it was. It was kind of like a mock interview course it wasn't, it wasn't great. It was, and it was quite, it was like 203 100 lbs. The only thing it was good for was to make me nervous and to put me on, on the spot. Yeah, you can also do that with, you know, with your friends and colleagues and try to also practice with some people that you might not know necessarily as well. So for example, a registrar, you might not know as well. I think I did that once or twice with someone who was outside of my, my team just puts you, you want to just, you want to, like I said, you want to, when you get to the interview, like just be for it to be quite hard to phase you um that you've been put in so many kind of uncomfortable situations that the interview just feels like another one of those I didn't want to, I did a load of consultants who are so harsh, but it was good because when it came to the actual thing and they were super nice. It, it felt good. Yeah. And one last thing to say as well is when you're practicing or when I practice as well, try and it's gonna sound so pedantic, but I always wore like the same suit and tie that I was gonna wear for the actual thing you wanna take as many, as many factors or factors that are different as possible to make this, make it. So every time you practice, the only thing that changes is the people who are asking you the question. So your camera, your, like your position, your tie shirt, jacket, the lighting. But the only thing you have to focus on is getting and smashing your answers. Exactly. Yeah. It, it looks so funny when we practice and I have like my blazer and my shirt on and stuff, But like it's true. Don't let you do the interview like that one less thing you have to worry about because you don't want to get an interview and you're like uncomfortable in this, this new shirt and, and Blazer and you're in a new room and stuff. Do you wanna practice? I used to practice in the same place in my same, you know, in the same study. Um, same clothes and things. I always have to wash them and stuff in between but, or shirt, not the exact same shirt anyway. I think we're digressing. But yeah. No, not at all. Thank you both for your time. And, yeah, practice, practice practice. Don't be surprised if somehow they create a new clinical scenario. I think I had one that I wasn't prepared for and that took me a little bit, but I stuck to their frameworks, just applied it and it works all the same. Anyway. So, um and Akbar, thank you so much for being here today. Are you guys happy to just linger for a couple of minutes just whilst I wrap up. Lovely. Thank you. Um I've just posted in the chat, a little advertisement for Assets 49th Conference. Uh It's gonna be hosted in Belfast, I believe in March next year. Abstract submissions are open, go to the link, log in and you'll be able to submit whatever you need. We get about 1500 submissions every single year. So do apply. Um This obviously does help with your points, but it's also a way for you to be able to um meet other people, particularly if you're not in F two and F three applying for, to see if you're early on. It's a great way to get a bit more experience. 10, some more talks and speak to people who have gone through this whole process. So yeah, that's it from us for today. Um For those of you who are on the breakout sessions starting at half 12, um Do have a little break and make your way there. Uh Please be on time. We're gonna try our best to, to stick to the allocated slots. We've got the portfolio clinics. Uh Unfortunately, all fully booked the mock interview slots which are fully booked. Uh We've hosted more this year than we have in any other previous year. We've also got the fy three planning your Fy three for those of you who are unsure what to do next year you want a bit more guidance as to how to go about applying for F three and what you could do tips and tricks. So that's all from us. Thank you so much for your time. Um I can see a final question on how to become an asset rep. Uh I'll dm you uh shortly afterwards. Ok, lovely. Thank you all for attending and enjoy the rest of your day. Nice supply. Take care of everyone. Good luck.