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Okay, so I'll be going through briefly about surgical career. Um, the majority of my talk will be about court surgical training, so that that's what see ST stands for and also the application process and the interview process. Um, area of interest to you guys, I'm sure, would be how to build a surgical portfolio. So I'll be going through that in quite a lot of details and then just a bit on live as a C S t uh, at the end. Um, so the main thing I want to mention before I start is obviously you guys are different stage of your career. Um, there'll be sort of, um, the early medical students. There'll be final year medical students. There'll be some FY once, um, particularly for the, uh for the the guys in the early years. The main thing is, don't don't get stressed out by what I'm what I'm going to go through. Um, you'll be overloaded with a lot of information. Um, because the majority of the bits about the application about the interview about the portfolio probably applies more to the the final year, Guys, the FY ones. But that's not to say you guys can't Can't start building a surgical portfolio, even even from today Say, uh so yeah, just a bit about a career pathway. Obviously, most of you guys are at your beginning of your career. Um, so you gave you 5 to 6 years of medical school in the UK and then you enter your foundation year. So that's F Y one and fy to, um, there's an option of entering the academic foundation program where you get usually four months of, uh, designated time to do research or to do teaching or management role. Um, so that's something to consider if that's what you're interested in. Um, and then after fy two, you're eligible to apply for court surgical training. So that's what I'm going to focus on today. Um, so there's a few routes to enter surgical training in the UK so you can enter either via court surgical training. So that CT one and C t. Two um, there's increasingly more run through training pose, uh, which I'll mention later. Um, majority of these will be via the same application as court surgical training. Um, separate to these it you have academic clinical fellowships where you can enter as ST one or s t three. So these are run free programs as well, um, but geared towards research minded people, and usually it will be an opportunity for you to build towards a PhD. So during your, uh, CST year, you need to complete your exam. So your MRCS exam, which stands for membership of the Royal College of Surgeons and then, um, for the people who are in CST, you will need to apply for S t three selection. So that will be in your chosen surgical specialty. So whether that's e n t orthopedics or general surgery, So this is the step where you make the choice of which exact surgical specialty you want to do. Um, so So this is your registrar year. And this usually lasts, uh, either 54 or five years. And then at the end of that, you have another exam called the F. R. C s exam. Um, and those are your sort of your last set of final exams before you are eligible to apply to become a consultant. Um, there's always options of doing higher degrees, such as a master's M d o P H. D. during your surgical training. So most people will consider doing that if if you're interested in research during your registrar training. Uh, so that's probably all I will mention about the pathway. But today we're going to focus on core surgical training. So C S C is a two year program. As I said, um, so there's sort of three different types of jobs you can apply to, So there's a theme programs where it may be, um, it would be themed to a specific specialty. So, for example, if you're interested in doing orthopedics, um, you'll get orthopedic theme jobs. So in that you may have, um, four months of orthopedics, four months of plastics, four months of I t u before 12 months of orthopedics. So these are your theme programs? Um, as I mentioned earlier, there's an increasingly more run through programs. So these are this run through means that once you get in, uh, you are basically based based in the same Dean arri for your entire entirety of your training. Um, so there are advantages and disadvantages to that, but I'll go through that a bit later. Um, for people who want to stay in London or in the South. They're what we call unmatched programs as well. So these are this a match programs means you only know your job's in your first year. Of course, surgical training. And then you have to sort of compete again. Uh, and also, um, rank, um, your your preferred jobs after your CT one year. So they're around 13. Dean Aries across the country, similar to your foundation jobs. And overall there about 600 jobs each year, for course. Surgical train. Um, so something new more recently, which is called I s t improving surgical training. Um, this is introduced in 2018. Um, so most of these these jobs are run through training. Um, however, there's some uncoupled core training jobs. Um, so, yeah, since 2018, they've been run through I ST jobs in general surgery, Urology, vascular and Tien knows. Um, so the aim of the I S d. Program was to offer greater quality of training. Um, there's designated trainers with protected training time. Uh, which will look after you during your your your i s t years. Um, and it's meant to have a to provide an improved balance between training and service provision. Um, as I say, most of these are run through programs which will offer you stability and security in the single region. And instead of, um, sort of having to go through another round of application, um, you'll be sort of guarantee ST free number as as long as you, um, sort of pass your a r c e p uh, as well as getting the, uh, enough scores in your benchmarking interviews and this is this depends on the specialty. Your aim. So here is a table, um, which probably will interest a lot of the the F one's in the final years in terms of how many run through jobs there are. So as you can see, since 2018, there's been increasing the number of run through I ST jobs. So 2020. There was 100 and 75 out of around 600 jobs, which are the run throughs. Uh, most. Most of them are general surgery, but certainly, uh, there's some t a nose, uh, urology and vascular. Uh, and the word on some other run through programs. So the ent is separate from the I S t uh, the ent run through is also a pilot. Since 2018, there's around 8 to 12 jobs across the country each year. Um, it's it's so that's That's the program I am in at the moment. I'm in the ST two year. Um, this current year, there's a pilot, pediatric run through programs. I'm not sure how many numbers, but I think quite limited. Um, And then finally, you can also apply for orthopedics. Run through ST one in Scotland. Um, So, uh, so the thing to notice this ST one in Scotland for orthopedics is a separate application to court surgical training. Uh, whereas all the other run through. So ent um, the I S t I mentioned the pediatric surgery I mentioned as well as the bulk of the court. Surgical training jobs is done via one application. I hope that makes sense. Um, so, yeah, just a bit about core versus run through the pros and cons of each. So, um, so for core training. So that ct one and two, Obviously, there are more jobs available. It gives you more flexibility if you're not sure which specialty you want to do. Um, they're themed programs, which I mentioned earlier, which will help you to to build towards your your your your s D three application. Um, and then there's obviously a constant pressure to compete, which will sort of keep you on top of your portfolio. Your CVS, uh, to make sure you're you're not complacent. Obviously, the disadvantage is that you have to go for another interview process. There's a bit of a bottleneck at the end of CT, too. Um, and you can also get some non theme jobs. So if you're interested in E N. T, for example, um, and you have to do four month rotation in orthopedics. That might not be a very useful rotation for you, and obviously it's a bit more difficult to plan your life as as you might be in in London for your CT year. Um, but obviously it's you have to compete again to apply for a London ST free number. Um, so it's a there's a bit more uncertainty with with core training, um, was run through. So obviously the advantage is is that you're you get a number for ST 1 to 8. You you have a set path to become a consultant as long as you pass your requirements. Um, and you get to be in one region for the entire training is easier to plan things like you're buying a house, getting more gauge, etcetera. Um, but obviously, the disadvantage is that there are fewer jobs. Obviously, it's more competitive. Um, and as much as I mentioned earlier, some people may become a bit more complacent thinking that you've done the hard work. Um, and, uh, so that that can be one of the the disadvantage. And, um, if you're in one region and you you decided you want you, you don't even like the region or you your your your other half your partners in another region. Uh, sorting out into dina re transfer can be a bit difficult. Okay, so there's pros and cons of each. Um, so just a bit on competition. Um, so historically sort of Since the 2000, I'll say the number of people number of F two doctors entering, uh, surgery or specialty training has been coming down. As you can see from the graph and the number of people doing F threes taking gap year F three F four is going off to Australia has been increasing. Um, so in 2019, the numbers are there. About 8 1900 applications around 1400 were invited for interviews, uh, for 640 jobs, which gives a competition ratio of about 2.9. So about three applicants per job. But you have to bear in mind that a lot of these people will apply for different specialties as well. Surgery so they might might apply for anesthetic training GP training. Um, they might want to do it f three so I would wouldn't pay attention too much to the competition to the competition ratio. Um, however, the last two years since covid, especially it seems that it's the competition has been increasing a bit more. Um, so yeah, as I mentioned it, might be related to covid. It might be related to the travel restrictions. So people not being able to take gap years or take it every year and also I think since 2019, I believe, um, the application for international medical graduates are now treated equally, so there's no disadvantage. So, um, I think in the past, um, they are not able to get into the first cycle of of applications, whereas now everyone's treated equally, so that makes it a bit more competitive. Um, and from the latest figures I've heard from my colleagues, So 2021 I think around 1100 people got invited for interviews. I know 1100 people got invited to sort of to, um, invited to submit evidence based on the self assessment score. So they reached their sort of the the benchmarking short listing school. And after that, around 900 got invited interviews for about 600 jobs. So but yeah, ultimately, my advice is, um, to all of you is that you should ignore the ratio, focus on yourself and just be as prepared as you can. You can only focus on yourself, so just a little bit, uh, probably more useful for the the F ones or maybe some of the F two s around you. So usually the application window starts in November each year. So you apply, um, during your f y two year in November, and, uh, interview window is usually around January February, Um, during your f y two year. Okay. Uh, yes. So you apply via Orio, which some of you might be familiar with, um, certainly for those final year who's applying to foundation training? So it's the same application process where you enter your personal info employment history. You upload your degree certificate and then also you have to provide health assessment score, which I would touch on when I when I talk about the pope failure. So just briefly about the interviews, I think I I weren't focused too much on it because I think a lot of your med students, but I'll just give you a flavor of what what the interview is about. So historically, it's, uh, 3, 10 minutes station face to face stations, where you go off to London for a day. You dress up nicely in your suit or your your your formal wear. You bring your portfolio with you and you have free station, so your your portfolio station management station and clinical station, and each station is worth a third, Um, so important to bear in mind that you can still get a good job with sometimes the average portfolio as long as you hit the short listing score. But if you do really well in your management in clinical stations, you can still get a good job, but there's been some recent changes. So due to covid so in 2021. So the previous, um, the most recent round of application, um, the portfolio station is now scored prior to the interview based on evidence uploaded, um, in advance. And then the candidate had a 20 minute virtual interview. I think on Microsoft teams, where they still have the management and clinical scenarios. So just briefly about the management station. So usually you have to do a three minute oral presentation on leadership. So these are some of the title's, the most recent title. So, um, usually about your experience of leadership or working as a team, and you want to tell them how this will be useful as a court surgical training so that my main tips on this is just reflect on your experience and the examples you mentioned what you learned from it, what you gain from it, and make sure you tell them, and you reflect on how they will be useful in your core training and obviously make it interesting. Don't talk about just things that you think other people might mention. So, um, make yourself Stand out, make it interesting. And afterwards you get two minute questions on leadership. Usually things like what makes a good leader What makes a bad leader. Uh, and then afterwards you have a five minute, um, sort of ethical management scenario. So usually it'll be. It'll be like you are a surgical training on award. You've noticed your your f Y one colleague. Your junior colleague has been really struggling, as has been really upset. And then how will you deal with it? So you have to go through that scenario. Um, but yeah, I'll just give you a flavor. So some of the other scenarios is you might sort of notice a colleague smell of alcohol. How are you? How? How you deal with that? Um, you might notice a registrar being being unsafe, how you escalate and and sort of deal with that situation. So these are some of the examples of of previous scenarios, and then you'll get a clinical station. So this will be a 25 minutes scenarios, Usually one will be a trauma scenario. So using your a t. O s so advanced trauma, life support principles, uh, and then the next one usually will be, uh, unwell. Surgical patient, often POSTOP. So I'll be a, for example, a patient after having a appendicectomy. Um, they're complaining of abdominal pain with a temperature. How will you deal with that scenario? Uh, so generally you you aim to answer these scenarios in the A, B C D e approach and B c. Cinematic. Um, the main thing about these station is that they're not trying to catch you out. They want to know your your good, safe junior doctor that can know that knows the basics and know how to escalate. Um, so those are the main tips I would give at this stage? Um, but yeah, I think most of you guys tune in for for this part of the talk. So about the surgical portfolios and how how you can start building towards that even as a med student? Um, certainly, I think as a as a medical student I knew very little, and I have to admit, I I dip the bulk of my putting put the portfolio together during my f y one fy two years. So the fact that you guys are here today for this talk you. You guys are going to be super prepared. Uh, when you When you When? When you come to the application. Uh, so, yeah. So, Historically, you you have a big ring binder like this. Um, it doesn't have to be fancy having your name on on it, but as long as it's a good ring binder and then you can see a contents page with sort of, um, dividers of each section, but I'll go through each section in details. All right, Um, but, yeah, your portfolio is basically your collection of evidence of your achievements to date. Um, so, yeah, it's a third of your your application, as I mentioned earlier. And but it's the only aspect that you can control and that can provide you with guarantee points entering your interview. Um, as I mentioned earlier, So it's it's useful short listing, um, for interview based on your self assessment school. So, uh, more recently, this this self assessment score has been sort of going up just because people have had more time to prepare to build a portfolio. Um, so that's something to bear in mind. Uh, so in 2021 there were two stage process with this portfolio. So the first stage was based on the self assessment score. Where you where you submit a self assessment school, uh, when you apply, and then the second stage is a consultant reviewing each, Um so So, yeah. After submitting the score, you have basically have to, um, upload your evidence to upload your certificate, your letters to justify your your score. And then there's a consultant who review the score and to see whether you've over score yourself or underscore yourself. And then, based on this consultant review, you'll be invited to interviews. Um, so it's really important that so even one or two extra points can make a huge difference. Uh, so in terms of organizing a portfolio. So, yeah, As I said, it's difficult to know what will happen after in the in the future when you guys apply, Um, so they might go back to face to face interviews. They might still carry on virtual interviews, certainly in in the in the next year, I think most likely they'll probably still do virtual, Um, but I think it's probably a good good idea to get a ring binder anyway, to keep your hard copies or your things. Um, get some plastic wallets dividers to protect your certificates. Your see the, um, but yeah, I think keep definitely keep hard copies of evidence as well as scanned. Um, electronic copies. Um, and then you want to You want to order the content of your portfolio according to the self assessment categories. So what you guys can do after this talk certainly, um, is to Google CST portfolio Self Assessment 2021. And then you can open a pdf, which will basically give you all the information about the self assessment schools. And and all the information is on there. All right, So, um so, yeah, have a look. Um, but when you guys apply, so for the for the for the junior medical students, Um, bear in mind this this self assessment score get updated every year. So, um, by the time you apply, make sure you check the most at the latest self assessment because there's always some changes to the score ing each year. You want to keep a CV as well with the C V. You can use the same categories as your self assessment. Um uh, really important um is sort of make sure there's no patient identifiable data. So, um, because people can get caught out during the interviews if if you have any hospital numbers patient's initials in your in your portfolio, so make sure there's nothing that, uh, of that degree in your port. Really? Okay, so now I'm going to go through each part of the each category, basically, um, in in quite a fair bit of details. Um, so the first bit, um, So And this is based on the 2021 self assessment. All right, so the first part you can get scores for is your MRCs part A. Um So this is more relevant for the final year for the F one f two. Um, so you can sit your MRCS part one, Um, as soon as you graduate basically during your f y one year. So this is a M. C. To base exam. Um, and it's, um, not too dissimilar to your medical finals. So my advice is to sit it early on in your f y one, and certainly early in your f y to, um, if you've sat and passed the exam, you get full marks. So three points. If you have sat it or booked it, if you've sat or failed or book even booked the exam, you get one point. So there's no reason not to get some point in this categories. Um, main tip is to make sure you check the date of the exam and also the application deadline. And, uh, and you want to book early for these exams. So, um, yeah, for the fy ones amongst yourself. So make sure you you're familiar with the the date and the deadlines for booking the exam. Um, so just for the medical students, um, so your MRCs um So for people who want to do any surgery apart from ent, you need to pass MRCs A and B and for people who wanted to e N t u do MRCs part A and the dons part B. Okay, um, but the point is scored for the part A. Okay, uh, next is surgical courses. So, um, for this category, you only need to attend to or more surgical courses for, for for the maximum points. So there's no reason not to get maximum points in these categories. Um, so the main ones. Um, for the for the for the people who already got graduated, Um, is the basic surgical skills or a T. O s? Um, certainly you need These courses are mandatory anyway, when you when you enter course surgical training. So if you're able to get some funding during your f y two year to do these, um, it's good to get them done early. But for the med students, any anything related to surgery, um, I would put in this section, so definitely keep your certificates. If you've done basic surgical skills as a as a medical student, if you've done, um, if you've done some of the basic courses for preparing surgical career, uh, foundation, surgical skills, um, the RCs summer school in anatomy. So anything surgical related Count's okay, So basically in your portfolio, just keep the certificates of these courses and sort of rang them in in, um, in the order of of, um, so put the ones you've done as a f Y one doctor first, and then put the one you've done as a mess. Mess students later, but but basically put everything in there. Uh, so next is surgical experience. Um, so in this part again. It's very easy to get the full mark. So it says involvement in 15 cases of more So basically involvement means at your stage assisting. So that's getting scrubbed, um, as being assistant in a surgical case. Um, for some of the f wise doctors, um, it's even better if you if you can, um, so log it as a, um, supervisor Scrubbed as one of If you if you've done a sort of incision and drainage of an abscess, Um, that that's really, really good. Um, but for the medical students, if you're if you're not familiar with the l A book, um, after this talk go on this website, so W w doc, just Google L'aube book. Basically, uh, you can set up set up a account as free to register, and then basically, after that, you can. Each time you go to a theater case, you observe a case or you get scrubbed up for a case you basically can log each case on on this website. Uh, so it looks a bit like this. So this is my l locked. Look, um, you basically choose your specialty. Um, so this bit I get hung? Um, sort of, um, often as a med student. I didn't know what to do at this point, but, um uh, the Ellen book is a is a sort of a safe, encrypted, um, system. So you are. You are allowed to type the patient I d. In this section. Okay, um, but apart from that, yeah, nothing identifiable. So put the patient I d there, date of birth or age, date of the operation. Whether the patient, whether it was an elective case or emergency case, uh, put the name of the consultant, if you remember and then in the super efficient part. So, yeah, either put a system or observed, um, and that that's it. And then you basically Yeah, log each case. Um, and then it's super easy to do, but it basically shows your commitment to surgery early. If you if you start early as a med student and again, it's very easy to get the get the 15 cases if you start now, uh, nexus surgical tasters. So again, that's very easy to do. Um, but it's more more for for you. Um, when your f y one, um so you can organize a five day taste a week during your f. Y. One year, Uh, so just email consultant of a specialty you're interested in Or you might want to use this opportunity to do something that you haven't done. Things like plastic surgery, breast surgery, ent You might not have been exposed too much. Um, as a medical student, Uh, so it's basically just a very good way to again build your log book, uh, speak to your seniors and to get involved in projects, audit or research. Um, and also like, for example, if you're, um, in a rotation you're not not so interested in, For example, uh, medical rotation or GP rotation. It's just a good, good, um, good opportunity to take time to take a week off and go and go and see some surgery. Really? Um, so once you've done that, make sure you do a reflection because that's one of the evidence you have to upload. And I think this year specifically, they say it needs to be 200 to 2 50 words. Basically, you describe what you've done and what you've learned from it, and then at the end of that, make sure you get a letter from your consultant. Uh, just confirming the dates you attended to taste a week. Uh, so surgical electives. Um, so that's more again, Um, for the for the students amongst yourselves. Um, if you a planning or have have done a surgical elective, Um, that's you. You get three points, but make sure you you do a reflection artist. So even if you've done a elective last year, um, do a reflection now, basically, uh, and And make sure you you are able to provide your evidence for that. And, uh, make sure at the at the end of your elective get a get a letter again, um, confirming your dates and hospitals. So I'm not sure what what electives are like at the moment as a med student, Obviously, it's a bit different since covid. Um, But if you're keen to do surgery yet, right, email the email your either your local hospitals or you want to go up north or go to somewhere you haven't been, um, or one of the London centers. Uh, just email any, um, surgical. Any consultants? And I'm sure they'll be keen for you to do a elective. Um, and one. That's one. Once that's done, you get get points for it. So why not? Um and then the next category is degree. So this part is a bit more difficult. Obviously not everyone has a PhD. So to get maximum points, you can either do a PhD MD. Um, but for those guys who are thinking about Inter collating in medical school um, yeah, I would I would advise doing doing it because, um even if you're not sure, I think it's if if you want to do surgery, Um, I think it's definitely something worth considering. Uh, And if you're able to get a first class honest degree after from that, you get four points from it. Um, actually, no, no, I think they've changed categories. If it's an interrelated degree with a first class honest, you get three points. Um, but if you've done a prior bachelor degree with first class honest, you get four points. So, um, definitely consider Inter collating, because during that year, you most of you will be exposed to some sort of research, and, uh, that can provide you with more points later on. Um, but yeah, don't don't stress too much. If you're f Y one, you haven't interrelated. There's there's no point of, uh, stress stressing over this bit. Um, I think that's it about degrees prices. Um, so generally, in this section, a national prizes worth the most and it's regional, then it's local. Um, if you've done well in your medical school, so that's scoring the top 15%. Uh, you get you get some points from it. So there's there are some use in in in doing well in your medical exams. Um, but again, don't stress too much over it because you can get points in other areas. Um and, uh, something to look, um, to look for for for you guys is there's a lot of essay competitions about so from different societies. Uh, so it doesn't have to be surgical. It can be, um, can be from the BMA. Could be from the Royal College. It could be from the RCM. Have a look what what's available? Because a lot of these, um, you'll be surprised there's not. Not many people actually enter these competitions. So, um, it might be easier than you thought in getting a price, so there's no harm in trying a few essay competitions? Um, certainly, um, if you have projects, if you're SCS previously in your medical school have a look whether to see whether you can, um, submit some of these 22 conferences to to, uh, to see whether you can do a poster presentation on it or oral presentations. Basically, submit as many things as you can, um, to try to get a price. Um, and yeah, obviously, prices related to audit and Q I p. S. That's quality improvement projects. Um, you can score points in multiple categories anyway, with one project. So why not, um, and I'll speak about audit in a in a second. Okay, So here's the next section, actually, uh, audits. Uh, this slide is very wordy, but basically, um, to achieve the maximum point, um, you only have to do one quality audit. Okay, So the main main, uh, main advice for this section is quality over quantity. So you get full marks for having a leading role in the design and implementation of a of an audit. Basically, um, for the med students who might not be so familiar of audit, So audit is basically what we do in in in in, uh, clinical medicine where we've identified issues. Or, for example, uh, let's say an ent You notice a lot of patient with, uh, with otitis external. So that's an infection of the ear. For example, you've noticed a lot of these patient's are getting oral antibiotics rather than, uh, antibiotic ear drops. Um, and we know from the nice guidelines that the the gold standard treatment for otitis external is to give ear drops. Um, so you can do audit of that. So you basically look at, um, sort of a list of patient's who has had ear infections? And how many of these had oral antibiotics? How many had, uh, topical antibiotics? Um, and you collect some data on it? Um, analyze it. Uh, and then at the end. So, um, for so in this example, you might notice a majority of these patient's or antibiotics. So next thing you want to do is to implement a change. So you want to, uh So, for example, you can educate the junior doctors prescribing these antibiotics. You can, um, make posters for it. You can, uh, speak to GPS who might be prescribing these antibiotics about it um And then after implementing these changes, and then you basically re audit and to see whether you've, um, managed to improve, um, improve on on what you've done previously. So that's that's an example of a close loop audit if you are able to show you've improved after you implemented change. Um, so, yeah, to get maximum points, you just have to do one good quality audit and to have it presented at a regional or national meeting. Um, so make sure you if you do audit to register with your hospital audit department who can provide certificates, uh, and then have a look around the many conferences, uh, for medical students or for junior doctors that will accept clinical audits as a presentation. And you get points from that, Um, And again, if you can, sometimes you can win a price. Or if you've done a really high quality audit, sometimes these are publishable as well, and that can give you extra points. Okay, I hope that's clear with audit. Um, so, yeah, just some examples. Um, so this is more for the for the FY ones, or FY two is amongst yourselves who might be struggling in terms of finding examples. So some quick, easy audit are things like water and documentations. Having a look at surgical clocking performers having a look at consent forms? Um, VT documentation to see whether these are documented properly. Antibiotic I mentioned and fluids prescribing. Um, so even in a in a med student, if you have a few weeks placement, have speak to speak to your F Y. Speak to your surgical trainees to see whether you can get involved with audit, even have some sort of, um, experience of being involved at your stage will be helpful because once you reach FY one, your you can sort of kick start early and and and start your own project and and to get some points for it. Um, if you're f Y one, try to do this early on in your in your f. Y. One year. My main advice is, don't say yes to too many things. So sometimes your registrar's your consultants might ask you to do an audit, but if you think that might not sort of come into fruition to do anything, or sometimes if it's just sort of about surgical data, um, just sort of looking through how many numbers of procedures a consultant I've done. So these are these are not really clinical audits. Okay? So just be really careful, Um, and not saying yes to too many things. So that would be my advice. And just to try to identify reliable seniors and supervisors teaching, Um, So again, I'll just, um, focus on how you can get the maximum points. Um, So the main thing is, you just going through the previous slide? I think so. The main, um, to get the maximum points, you want to show that you've identified a gap in teaching and to basically work with local tutors to design and organize a teaching program. Um, and on top of that, this you must have shown you have contributed to regular teaching for three months or more and then to have collective feedback. Um, so if your f y one I would, um So start early during your induction week, have a chat with your foundation director. Have a chat with whoever is in charge with the university in the medical school program to see what What kind of teaching you can get involved in. Um, so try to sort of get a team together and to sort of plan a program in in sort of tackling the gap you've identified. So that's usually, uh, you need to sort of devise a few sessions. Um, so you want to see whether you want to aim that as medical students or or fy one doctors? Um, so nowadays, obviously, virtual teaching is very popular. So, uh, that that will count. Uh, and then afterwards, um, yeah, have a chat with your your medical education department. Get approval. Um, and, uh, yeah, and and deliver the teaching program. So obviously, yeah, leading the program is good, but you you also must have shown you've done teaching yourself as well. So, um, as I said, the main thing is, uh, you show that you've done teaching for at least three months, and you've collected feedback afterwards. So feedback is very easy. Make a Google form, or you surveymonkey um and, um, again, if you're able to sort of have a wider audience. So, for example, like a like a webinar series, Like like this one you're tuned into, um, you get more points. All right. So, um, really good idea to have a thing. What sort of virtual teaching you can deliver? So just some examples, so you can do a virtual webinar. You can do a bedside teaching programs. You can teach clinical skills. You can organize a series of Oscar revisions for final years, or you can do sort of F one or even medical student peer to peer teaching. So these are all examples of teaching programs you can do. So this is certainly you can something you can you can start now as a med student and and and and get get make sure you get evidence behind it. So you collect your feedbacks, you get your letters, uh, from your supervisors from your consultants showing that you've done this teaching program afterwards. Uh, so next is training and teaching. So, um, again, this bit not everyone gets points in, so you get maximum points. If you've done a masters in teaching or PG cert. Um, something to look into. You can get sort of two or three points is there's something called the train and train, of course, but this costs a bit of money. Uh, there's some online courses in teaching you can do, um, so on the e l f h website. There's some modules e learning you can do You can get. I think either one or two points for that. There's some open university teaching courses you can do. Um, but yeah. Have a look in your throat, your medical school, whether there's any sort of teaching modules PBL modules. Um, you might be able to sort of use them to to count towards these sort of teaching methods points. Um, but yeah, this section again don't stress too much over it, because not everyone, um, is able to do a p g, sir, or Masters presentation. So, um, this bit, um if you're able to have an oral presentation that that's gives you the most points nexus where if you have two posters, um, and then one poster. So that's sort of the points order. And again, if if it's presented nationally or internationally, that work that's worth the most points. Um, so, yeah, my advisers have a look to see. What? What S s D project? You've done what? All this Q I projects you've done, um, and obviously doing an interview later, BSC. Sometimes these can lead to projects which you can present in, um or if you met student or FY once a lot. Sometimes in a lot of the conferences you can you can present interesting cases as well so you can do a case report presentation. So again, just submit as many things as you can. And often in a lot of these conferences, certainly if if their aim for, um, junior doctors or medical students that they can be quite easy to to get get accepted. So have a look. Um, make sure you know that that lines of some for submission and at the end of it keep a copy of these presentations as well as the conference program, Um, so that you can use that as evidence publications so again, area that people can get stress over. Um, but basically, the I think this category there's changed quite a lot recently. Um, but to get the maximum points, um, you if you have to thirst offer pub met, cited research papers, then then you can get the maximum points. Um, obviously not everyone can can do that. And obviously, it takes a lot of time planning and an effort, um, doing again, like I said earlier. Doing an inter kelated degree may help. Doing academic foundation program may help. So something to consider. Um, So I think if you're Met student and you're keen to get involved or publication, Certainly, Um, I would sort of look out for well published consultants or registrars to see whether that's something you can get involved in. So at your stage probably start, um, uh, sort of starting sort of something a bit more, a bit easier. So things like letters to editors or clinical reviews or case reports, um, to see Yeah. So I think if you're early on as a med student, see some just ask around to see whether you can get involved in, um and then a bit later on if if If you're, uh get a chance to do a systematic reviews that will count towards a research paper, then that's that's great. Um, another way to get points is to write a book or book chapters, But again, that can be quite difficult. Obviously. Um, but yeah, Like I said, case reports reviews. Often, it's a bit easier, but get you less point. Um, but again, don't stress too much over it. um, but something to keep keep in mind. And and certainly, if you start early, then then that's more likely. Your you can accumulate experience in writing papers and experience in publishing, uh, nexus leadership management. So this bit again, if you have a national management role, that's worth the most points. Um, the main thing, it has to be, at least for six months, and you have to show that you've demonstrated positive impact. Um, so during your medical school, these might be things like a, you know, university society roll or a b m A rep. So, um, or a sit rep. If you're interested in E N T, there's something called SFO UK. So that's a society for, um, medical students and foundation doctors. And I know that each medical school has a has a has a place for to be a rep and that will count towards a regional rep. If you're F Y one doctor, a role in a doctor's mess or or trainee rep can get, we'll give you points. So have a think about what? Whether to apply to see some, some sort of, um, some of these positions. Uh, you can also get points. Um, if it's unrelated to medicines. So if you're in a sports team or if you have a charity role at a regional or national level, that can give you points as well. Uh, the main thing is, yeah, make sure you have you get letters and email evidence from from whoever, Um, this chair of the committee confirming you've done this role and also the dates you've been in place. All right, so that's, um all I would say about the portfolio. I'm sure you guys will have a lot of questions I would be happy to answer, Um, some at the end of the Q and A, um but yeah, The main thing is, uh, yeah, start early. Um, don't get too stressed if you're, uh, if you're in your first or second year medical school. Um, but, yeah, it's good to have have it in mind. Um uh, in what? What you can do at your stage to build your surgical portfolio? Um, yeah. So, yeah, I'll be happy to answer any questions on the portfolio in a bit, but I think I'll just finish off with a bit on live as a court surgical trainee, um, so, uh, CST. So whether you are in a run run through program like myself or corps corps trainee, a CT one or two, you're basically in your sort of your 2nd 2nd grade in hospital. So that's between FY one and a registrar, so you would have already had a one year experience of working hospitals. So you'll be good at doing your candy list. Your blood, your discharge summaries, um, take on a bit more responsibilities. So if you're able to enter surgical training, then then you have to. You can forget about medical ward rounds, which is great, as we all know, that that medical ward rounds can drag on to, um, sort of lunchtime. But the surgical ward rounds usually a bit shorter or much shorter, I would say, Um, so that that that's that's good If you're if you want to do surgery, Um, but yeah, So life is a, uh, score. Surgical training can be very varied, Um, so it's sort of spit into when you're on course or when you're not on court. So when you're on court, you're basically the your your the first surgical doctor that a doctor that a patient will see, um, after they've been referred from A and E or from a G p or from a other specialties in the hospital. Um, so usually it will be a patient with the acute surgical problem. So if it's general surgery, they might might have acute abdominal pain. Um, they might have bowel obstruction. Um, or if it's orthopedics, then usually it'll be a some sort of fractures. Um, so you'll be the first doctor going to A and e assessing these patient's, uh, so you will take your history. You examine the patient, your request, uh, the appropriate X rays or scans, and then you will start the initial treatment. So, um, so, for example, if it's a query appendix patient, then you will. Yeah, you keep the patient here by mouth. You make sure the patient have enough, um, sufficient pain relief. Um, you might consider you will do things like make sure there's a urine dip taken or pregnancy test. That's that's, um, that has been checked and in a female patient to make sure it's it's not a ectopic pregnancy. Um, and then afterwards you escalate to your senior and to get to get registrar to review the patient to see whether the patient needs to go to surgery. So that's sort of the main chunk of your your work as a surgical S h O. The rest of the time when you're not on court, you might be consenting patient's for operations. Obviously, you learn to operate as a as a surgical training. Uh, and and in more complex cases, you'll you'll be doing a lot of the assisting. Uh, you might do, um, sort of the skin incisions and also the wound closures at the end. So you'll be putting sutures at the end of a case, um, to to close up the wound for patient. Um, so, yeah, that's that's of your two years where you really, um, practice your your basic surgical skills. You you get used to it. You, um, sort of familiarize with basic techniques and and to get good at your your your suturing. Um, you might. You also sort of have a bit more, more senior role. So as a as a CT one or two, you'll you'll be giving advice to your F Y ones. Uh, when they need support on the ward or If they're struggling with a cannula, then you might get called. Um, you might do a bit of, uh, some outpatient clinics as well. So in the NT, I do a lot of emergency clinics. See, patient's with, um, nose bleed, um, infections, Uh, things like that. And in orthopedics, you might sort of start doing a bit of fracture clinics with registrars. Uh, and obviously we carry on doing sort of projects. Um, teaching, presenting in conferences, basically carry on building your CVS, um, and and to work towards registrar training. And, uh, during CST. We also come together, um, as trainees when we have dina re teaching. So, um, sort of, um there will be sort of every every few months or once a month, they'll be teaching on, um So it'll be anatomy teaching. There'll be sort of laproscopic skills teaching and depending on what specialties you want to do. Um And so just a bit of a few words on realities and of of being a surgical trainee. And also just some advice to to some of you who are thinking about entering surgery. So even even as a CT one or two year, there'll be element of a bit of service provision. Um, depending on the department or the hospital. Uh, you're in. Um, so my advisers have a chat. Um, if with with your with your seniors you who are in CST, um, to get a feel of what the hospital, it's like or what the department is like whether you'll be protected as a CT one or two to a theater time because you don't want to be entering a job where you still have to cover the ward or or where there's not where, where you don't get sort of designated theater time. Um, there'll be plenty of assisting and retracting. So, like these guys here, you'll be very familiar with the retractors. Um, but also, you also get to do cases as a junior, uh, as a junior surgeon, which is very re rewarding. Um, the CT one or two year is probably the most stressful year. I would say, um, for for a lot of my colleagues, because there's constant feeling of having to compete again to get ST free number to get a registrar number. Um, but once you get past that stage, then then you're in. You've got the foot in the door to to to become a surgeon, to become a certain, uh, surgical consultant. Um, obviously, the more you put in, the more you get out, which is great. Um, and for the for the junior doctors, amongst yourselves for the FY ones or the for the recent graduates. Um, my advice is really think about setting a good impression, especially if you want to do surgery. And you have a a surgical job. Make sure you set a good impression when you start, uh, learn about your consultants. Learn about your trainers? Um, no. About what? What procedures they do, what kind of research they do. Because the more you know about them, the more you seem keen about it. The more you're more likely that you'll get involved with projects. Um, And each time you go go into theaters, make sure you know what are the cases are? Try to revise a bit of anatomy before you go. Um, because again, the more you know, um, the more sort of impressed your your trainers are, the more likely you they will let you do, Um, some of the uterus and some of those steps of the procedures. Um, and then, yeah, just make sure you stay on top of your portfolio throughout your training. Um, and if you're yeah, if you're f y one or to think about doing your exams early because you really want to sort of hit the ground running once you once you've entered court surgical training. Um, because I know some of my colleagues who are in the CT one or two year, um, if they're sort of struggling with the MRCS exams, then that adds a lot of stress to it as well. So think about doing your exams early. Um, and just finally, uh, being a being a surgical trainee can be extremely rewarding and and office, Um, and definitely a lot of fun. Uh, especially when you're in theater. So probably one of my best day. Um uh, as a surgical trainee, uh, it was during my my ct one year. When when? Basically, I It was a day of where I I was able to operate. Um, So I think that day I had emergency case on see pot, uh, where I was the lead surgeon. So I think I had a little three year old with a foreign body in in the nose. Um, so at that, at that point, my consultant was was happy for me to lead on that case. So I think I was I was the main surgeon in In In in C pot had a f y to with me. Um, I lead the theater team brief. I I was able to remove the foreign body in in this little kids nose. Um, and afterwards, I obviously spoke to I spoke to the mom who who was incredibly anxious beforehand, but obviously, um, so even sort of little operations like that can be extremely rewarding. Um, and then after that case, I think I got to do a surgical tracheostomy, uh, with with my registrar. Um, again, Um, that's, uh, something that you get a lot out of one once you've done a, uh, a procedure like that. So whether, um, if you are interested in general surgery doing the like, being able to do a appendicectomy as a surgical training, it can be extremely rewarding. Um, so yeah, definitely. Um, it's extremely rewarding. Career being a surgical trainee. Uh, so finally, they have dragged on a bit. Um Hopefully you guys had have had dinner. A lot of you. I'm off to get some food at the end, but yeah, just some general tips around it off. So start now. It's never too late to start if you're f Y one, but certainly as a med student, um, you can definitely start at the end of this talk Go and Google CST person specification or CST Self assessment and have a look at the at those points Identify areas where you can work on it. Um, if you're set on a specific specialty so this is more for the fy one or fy two amongst yourselves. If you're set on a specialty, um, then even have a look at the S t three applications. So even if you've done a full cycle audit, there's no harm in doing a few more. Because when you're when you're in when you need to apply for S t three, then the more audits you've done, the more points you get. So make sure you start collecting evidence. Save your e mails, keep your certificates safe. Uh, have a look at your previous projects. Like I mentioned. See where you can submit for presentation and prices. Um, And then, um if you are struggling to get consultants to sort of sign over emails and things, my advice is so to type up a letter for them so physically type up and say either doctor so and so has has done this taste a week during this month. Um, he's been involved with how many cases? Uh, he was a very enthusiastic trainee. So basically draft a whole letter for and and for a consultant to sign. And most of the surgeons I know most of the consultant will be very happy to to sign it if you if you basically put a letter in front of them. Um, obviously be honest and be be be professional in terms of what? What you put in the letter. Um, and then just be smart about, um, how you can build your portfolio, how you can maximums maximize the points using the least amount of time. So if you're really struggling to get a publication, because obviously that's a very long process. And have a look in other categories whether you can score other points so easy a point, uh, and finally, make sure you don't get burned out because obviously, surgery is a very long career, or medicine in general is a very long career. So don't get burned out early. Don't get stressed out early because at the end of the day, you know you need to enjoy life as well as your career. So I hope that talk was useful. All right. I'm sure a lot of you will have a lot of information. So again, yeah, just Google course surgical training. I think one of the first link you get is the pdf for the FY once FY too. So you're thinking about interviews? These are some of the books I used there available for Amazon's, uh and just speak to your seniors. So speak to your your CTS who's been through the process who can give you the insider tips on on what the recent application is like just a few useful websites. So L'Arche book to sign up for the lock Bergheim, The Royal College acid has a few useful pages about portfolios. And then, um, Medi buddy has a has a good page on how to maximize points, which I I didn't use for some of the parts some parts of this talk, which was quite useful. So have a look at these websites. Cool, right. That's, uh that's my talk. So I hope I haven't overloaded you guys with information. But, like, like Dashi has mentioned, will really appreciate if you can scan your QR code and give us some feedback, and I'll be happy to take your questions. Thank you, Ken, for your amazing talk. Um, you've given us a very comprehensive guide in how you know what The whole surgical application process. You know what to look for. Given us very useful information about, um, about the general gist of how to apply. And I think a lot of people have kind of asked a lot of questions, so I'll just quickly run through them with you. Um, Ken, Um so with a visional asked, do you have to complete all the MRCS steps before entering run through program? Oh, yeah. Thank you. Yes. Yes. Good question. So, no. So you the, um you only need to complete your full MRCs so that that's part a and B by the end of your core surgical training. Um, So before you enter registrar training, you need to complete your MRCS. Um, so when you apply for court surgical training No, there's no there's. It's not mandatory to to to pass your exam. Um, but, uh, certainly, um, passing the part A will give you the maximum maximum point in that category. Uh, so I hope that that to answer that question any more questions? Actually, I think you're You're muted, so I can't hear you. Apologies. Can you hear me now? Sorry. Yeah, I can. All right. I think someone asked a question for you. Any advice for ent run through currently on maternity leave. But hoping to apply to ent and run through is pretty appealing. Yeah. So, um, so my advice about any run through programs apart from the orthopedic Scot Scotland one is that look at the court surgical training, uh, self assessment, because all the run through programs, uh, all the jobs are done via the court surgical training. So even if your portfolio is not heavily based on e N t, that does that doesn't matter. So, um, if you've done the project on general surgery, if you've done a project orthopedics as long as you you score well and do Well, in your court, surgical training, interview. Um, then you you'll be able to rank all these run through jobs. So basically, once you've done your interview, you will be given a score and the ranking. Um, so as long as you you're ranked high enough, um, then then you'll be able to rank. Um, you'll be able to sort of rank the jobs you want so you can rank all the run through ent jobs first. Um, and and that's the way to get in. So that would be my advice, Uh, as to don't over focus, don't Don't sort of focus overly on on on your chosen specialty. So think about doing well in the interview. Uh, think about building a portfolio to get your maximum points for CST. Um, so that that would be my advice. Obviously, things might change, um, for for the medical students. So, um so so in a few years' time that there might be separate applications or application process is for for the run throughs, but at the moment, or the run throughs are done via court. Surgical training. Um, there's a few more questions. Ken, Um, apologies. Um, so I think someone mentioned If if they do audits, teaching or publications of research after their med school, does it impact their points in portfolio? No. So, uh, so for CST, Uh, there's no, there's no advantage or disadvantage in terms of whether you've done your paper. You've written a paper during medical, medical school or during or after you graduate. Uh, so there's no dis um, no distinction between the two. Uh, so yeah, definitely. It's not Never too late to do research, audit or publications. Um, but for for for the S t three for for the s registrar, Uh, S t three application. Uh, they do distinct. Um, whether you whether the publications is before med school or after med school. Um, so that's that's something to note. Um, a few more questions. And then I think, um, well, kind of thing. But, um, the other question that someone asked towards, um with regards to teaching when they mentioned, you know, teaching for three months. Um, how regular does it need to be, or how does it need to be continuous? Yeah, Or is it Can it be spread over a larger period of time? Yeah. No, definitely. I think it can be spread towards larger a longer period of time. So I think over three months, I think, um, if you've done no other teaching, if it's just if you're only done three months teaching, then I would I would expect them, um, to sort of to look at whether you've done sort of, um, teaching every other week so that that would be my impression. Obviously, if it's spread out over a year, then I think, What? Um, if you've done some teaching for for two months and then you've had a gap and you've done some teaching in in sort of late again for for for 23 months, I think that's absolutely fine. So I think as long as you have evidence showing that you've done regular teaching, not just not just a one off thing, um, I think that would be fine. Um, just a few more questions, Ken, You guys just want to remind you if you just use the, uh, use your phone, uh, and use the QR code, it will take you to a feedback form. And once you've done the feedback form, you'll be able to get a certificate. Um just to remind people. Um And then I think, um, so I'm just running through the questions right now. Yeah, no problem. Um, and does an obscene guinea elective count for an a surgical elective? Yeah. Good question. I think if you've done that, definitely I would count it. I would try to try to include it because there's a lot of surgery element to it. Um, so, yeah, I I would I would count it when you when you go through a self assessment. Obviously, that depends on whether the person reviewing it will will count it at the end. But I would count it. Uh, yeah, just a tip on. That is, um if you've done that, then then, uh, in the reflection, Right. Just right. About what? What what kind of what? What did you learn from it? So, um, talk about the procedures, the operations you've done talk about how you were able to assist or practice your suturing, for example. So in that way, then then you can definitely count it as a as a surgical elect. Uh, and, uh, I think there's no no further questions. I think I think I I've seen a few sort of things on Ella books. Are you happy for me to to answer this, please? Yeah. Go for it to do a quick fire around because, uh, I think a lot of people typed during early on. Maybe so, um, things about l. A. But, yes. L a book is worldwide, so you can you can use it, even your international medical graduates. So, yeah, Free to sign up. Have a look on the website. Um, so when your med student, they will just give you a generic sort of a code. But when you become a f Y one when you have a g m c number, you just need to email them and and and tell them, um, you're the same person. And they can They can merge the two accounts together and sort of register with your G m C number. Yes, patient. I d is same as hospital number. So, uh, you can, uh Can you still hear me? Yeah. We can hear you. Yeah. Okay. Uh, yeah. So yeah. Patient I d. Is the same as hospital number. Can we get our Elavil signed by our home country consultant? Yes. So if, um So in the l A book, you can print a summary page. Um, so that's what you should do when? When you when you have to apply. So print the summary page and get your supervisor or your consultant to sign it on at the end of the page or on each page. Um, uh, to to basically validate it. Can you do a taste of week as a med student? I think so, Yeah, definitely in your own time. If if you are in, um, if you have summer holidays, I'm sure a lot of the, uh, consultant will be happy to take a take a med student. Especially, for example, if you're yeah, especially if if you're if that hospital is attached to your university. So definitely you can do a taste a week. We've answered that option guy. Anyone yet? Surgical taste is we've answers. Uh, other points, cumulative. Not sure what what they mean. PG, sir, does that count as another degree? So I think the PG, sir, only counts in the teaching session, I believe. Yeah. Yeah. Only the teaching category, but not the added degree section Audits. If you have been involved in multiple can you get points in each? Um, so that's a That's a no, I'm pretty sure. But like Ken had kind of explained before, if you look at the S C three applications, you get marked on the number of audits that you do. So it's probably worth trying to get as many audits as you can get done. Uh, in preparation for an S d three application, I think that's that's the case for general surgery. Anyway, I've looked into the ST three application and you get two points per cycle of audit that you would end up doing. Um, so it's it's useful to do more multiple audits, I would say. Uh and then, yeah, just a few final ones for proof of presentation. Would an email be enough? Yep. So email is good? No, no, I think email is is the least you should have for evidence. A letter is better, but I think as long as it's got as long as the email has your name, the title of the presentation, um, then I think that's fine. Uh, I think that's probably it. That's pretty much it, I think, uh, no, I think, um, I think That's pretty much if there's any other questions, Um, taste as a medical student. Uh, the last thing for the log book if you were present during the surgery a few years ago. How do you go, Philip? How do you go filling this Internet? So, yeah. I mean, if it's in the past, then then don't. Yeah, don't worry. Just leave that section bank. Um, yeah. So I wouldn't worry too much, but I think from now on you you can you can enter the patient number. Um, I think, yeah. Any other questions? I don't see if any other questions on the chat. Um, okay. Thank you. So still include it. Yeah. So I mean, so if you still if you still have the dates of the procedure, then then I think that's that you can you can log it on. Um, but otherwise, if you let's say, if you've done an elective in the past, um or even if you if you observe if you if you've done, um, if you have sisters or observe operations, um, for example, in another country, I think as long as you have some sort of log, so it could be an Excel spreadsheet. It could be, um, just even a written log of of the number of cases you've done. I think that that that would be fine as well. But in that l logbook section is it's very easy to to get get the maximum points. So don't don't stress too much if you haven't done that in the past, because I think you only need 15 assist cases to get the maximum points. So yeah, don't don't stress too much. And the last question can will evidence from Google forms suffice for teaching rooms. So the feedback part, that was suffice. But if if you want to get the maximum points for organizing a program, then then you will need some sort of letter from a consultant or or the medical school admin person. Okay, um, I think that's pretty much it. Thank you, Ken, for your amazing presentation, I think I think, uh, pretty much everyone would have found it very useful. And you've pretty much gone into depth into what the whole application process entails. Um, all right. I think I just wanted to thank you all for coming today as well. Um, and I think next week. Um, Mister Rogers Lahiri will present on liver transplant. Um so look forward to that and we hope to see you next week. Wednesday, guys. Great. Thanks. Happy Cheers, Ken for turning in. Cheers. Thank you, guys. I'm just