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Emily Mills is a member of our Asset executive committee, and she's our yearbook edit er and a plead on making a competitive application to call surgical training. Uh, my name is Emily Mills, Um, and I'm the current asset executive committee member for yearbook and the athlete. I'm a call surgical training at South End Hospital, and I remember attending my first proposed for a career in surgery when I was 1/4 year medical student. I left the day feeling really inspired and excited to get going, so I hope you feel the same. So how do we make a competitive application, Of course. Surgical training. Um, so I have to keep this brief because I only have 15 minutes, but I'll go through various components of the core surgical training application itself, where you can score points and top tips as well. So we'll talk about the MSR, a update which has been, um, causing a little bit of worry recently for candidates applicants for this year. Um, and then we'll move on to the key elements as well of a competitive application, including portfolio and interview for this year. Um, everything I say, Um, for this talk can mainly be found online and is also my own opinion. So the MSRA. So on the fifth of October 2022 this year, uh, the J. C. S T announced there would be an introduction of an exam called the MSRA for short listing called Surgical Applicants. So it's called the multi specialty Recruitment Assessment. Um, and it's an online exam that's used for various applications at the moment. So I know it's used for GP radiology. I believe neurosurgery, um, and other sort of run throughs, um, as well as an online exam which looks at essential competencies. And, um, the official line is that it assesses your competencies. That should be up to this, um, sort of level at the end of F two on the seventh of October, 2022. Um, they also put out a statement as to why they're introducing MSRA. And it looks like it will be used for this application cycle in 2023 as a short listing tool to take people through the course surgical training pathway. Um, they have sort of formally apologized for the anxiety it's caused. The short notice of this, um and they will. They've said they will learn from this in the future. So I'm not going to make this whole talk about the m. S. R A. And I would note that I'm recording this on the 26th of October. If anything's changed, then this talk will not include any updates. But please use the QR code below. Scan it on your phone and it gives you the officials of health education, England Statement, um, and advice to the MSR A in course surgical training. My tips for the MSRA having not sat it before myself would be speak to colleagues and friends who've done it before or are currently doing it. Now they might be revising and have tips for you. Practice papers should be released and have been promised by the J. C S T for this year and will should be available to candidates. And remember, it's an exam. So which resources work for you? The official line is that you shouldn't have to pay, and they advise against paying for extra resources. Um, but many resources are available, which you may find useful in preparing for this exam. So moving on for the from the MSRA, as I believe that could be a talk in itself will move on to the rest of the application. So last year you had a third of your total marks for your portfolio. Your portfolio consists of things like prizes, publications, audits, courses, things like that. Then you had a third of your marks for half the interview, a third of your marks for the other half of the interview this year, Um, the J, C S T and health Education England have recognized that portfolios will still be recognized as candidates have put a lot of work into these. So the M s already the exam we spoke about before will only contribute 10% overall, but will be used for short listing. The remaining 60% will be from the interview, so moving on to the portfolio. So they've also announced this year there's a mission of some parts of the self assessed verification portfolio domains. So this year, they have said they will admit, uh, part a success, giving you points. So for those that don't know, um, part A. To become a surgical registrar, you have to have completed your M S. M s uh, MRCs a and MRCs be, um they've taken a completion of m S e m. Can't speak MSR MRCs out of the course. Surgical training, um, application. They have said they will take out courses. They've said they will also take out Prowse is and degrees, so it will be slightly different from application cycles before. And as I said to this date, this hasn't been released yet. Do remember for portfolio and they'll everything you put in needs to be evidence. Usually this is by a consultant or with an official certificate. So remember, if you're doing an audit project or maybe some teaching, make sure you keep a record of this and keep your consultants writing you letters so you can put it in your portfolio. They said the portfolio this year will consist of four domains. Commitment to surgery quality improvement in clinical audit presentations and publications, and teaching experience or training and teaching. And we'll go through each of these, um, and explore them. So last year, under the heading of commitment to surgical training was what I have screen shotted here. So, as you can see, I've put a few lines through it, so M s MRCS part. A examination has been excluded. They've, they've said, will be excluded this year. And they've also said courses will be excluded. So I've put across through those. But you can imagine what commitment to call surgical training might look like. I imagine it will also involve the operative experience. I can't imagine that leaving, um and a topped it for this would be, you know, at medical school or if any case you assist in, you need to record on l log book. L log book is free, and that's what they use for evidence that you've been involved in cases. If you don't have that, it's going to be very difficult for them to give you the mark. So download it now or make a log in. Now, if you haven't already attendance at surgical conferences. This is up for debate. So they said they will cancel courses they didn't specifically mention conferences. Surgical experience may stay in the form of taster weeks, for example. I imagine they'll also add other sort of aspects, uh, for you to demonstrate your commitment called surgical training. Um, so I'm sure a breadth of things that you may or may not have done so far will be evidence against this. In the next section. They've said they will keep sort of quality improvement and audit, and this is what you scored points on last year. Points of note would be a surgically themed clinical audit. So last year, to get points, it had to be surgically themed. So if you are a medical student at the moment, or you may not be applying in this cycle, um, it would be wise to make sure that your project is lined with surgery so you can submit it for evidence. Um, if you've noticed as well, it says that has demonstrated, demonstrated change and is the second cycle. So it can't just be one audit. It has to be an audit with a change and then a Reaud it afterwards, and it has to be presented at a regional local meeting for maximum points. But make sure you know, if you do one audit project, make a change. You know, put up posters in your hospital, do a teaching session, reaud it it and present it in your local meeting. So most surgical departments will have audit meetings. I'm sure you could present this in as a student or a foundation doctor. So make sure that you really, really get everything out of one project that you can. That would be my main advice. Rather than doing lots of lots of low caliber little projects. Do one big one that will get you all the points again. This may change for this year presentations. Um, so last year, uh, presentations and publications. They gave you six points for doing an oral presentation. Um, and do note that a presentation has to be Each section has to be a different projects. You can't use the same projects and said I did a 22 cycle audit and I presented, and I published it that it has to be a different project each time and also publications. Um, do you know that four out of six points you know you can get for doing an editorial letter? An editorial letter could take you one evening, for example, whereas a publication that may take 8 to 12 months, you know, will score you two more points but will be a lot more time consuming. So, you know, seek those opportunities. Ask people have published before. I think barriers for publishing. I mean, there are many, but for a lot of people, it's Where do they start? You know, which journal do they apply to? Um, you know, do they have to pay? For example? So I think ask people that have done it before. Look at the generals they're publishing in Last year's specification for teaching and training gave you four points for a master's. So either, you know, for most people, you either have it or you don't, um you could also do a p g cert. But, you know, substantial training and teaching methods. Um, I know a lot of, um, a lot of regions do train the trainer courses online. I know East of England definitely had one. I did when I was a foundation doctor, which would probably give you the two points anyway. Teaching experience, you know, working with local educators, contributing regularly to teaching and evidence of formal feedback. We'll give you 10 points. If you don't have evidence of formal feedback, you notice you get zero points for teaching experience, So that's why it's so important to get a to prepare a competitive application. You have to have evidence, or you might as well have not done it. Interviews, moving on to interviews. So usually this is split into leadership and management and a clinical sort of section the leadership and management station. Usually I from the top of my head, it was 10 to 15 minutes. Um, they give you a title for a presentation again. This may change this year. Um, and it will be something like, Tell us about the time you demonstrated leadership skills and you'll speak constantly for a few minutes about that. They'll ask you a couple of questions. This will be followed by management scenario. So it could be, um please, you know, I'm the patient. Please explain to me that my surgeries councils or it might be that, you know, uh, patient may not have capacity to consent for their procedure. What you do, for example, um, clinical scenarios. Um, usually there may be one trauma, one clinical, but this can be a mix. Usually it will be something like, um, you know, there's a 68 year old female patient, five days post right hemicolectomy. She's tachycardic with abdominal pain. How do you approach the patient and the more you practice this the slicker you'll get. You know, you start with, I would follow the A B C D E principles. Using the crisp so crisp is a course that cares for the, um, sort of critically unwell surgical patient's, um you know, and you could say I would stick to Chris Protocols and I would do X y zed, for example, or with the A T l s. You would say, You know, I would make sure that the trauma team are there. I'm treating them in a recess bay And I would have, um, you know, other members of the team with me. I would say I would approach blah, blah, blah, you know, have a structure. Don't just ramble at the Examiner. My top tips for interviews will be to practice, practice, practice you in your head. You might know what to do at medical school or exams. You know how to take boxes. You usually take the right one's saying, and in a convincing way to a surgical consultant on the other side of you, I would manage this tick patient we're doing a B. C is a lot harder if you haven't practiced it. Loads of loads of times do it with your friends, but also do it with people that you don't know. So when I practice for mine last year, I set up mock interviews online on teams and we interviewed each other formally and really did our best. And I felt those sessions were extremely helpful for me. Make sure in your job you participate in actually managing, unwell surgical patient's. They'll know if you actually know how things work in your life. So you know, if someone saying, Oh, they've got abdominal papers, right hemicolectomy and you say I would as the CT one, I would march them back to theater independently. That's not the right arm answer, and it's also going to show that you don't really know how how it works. For example, if you've got a sick patient, you need to get back to theater. What you should be saying to your examiner is I would let the encore need to snow. I would let the theater team know I would make sure there's a group and save you know, all of these things that you would do in real life if you need to convey that to your Examiner. Your examiner also needs to imagine you as a course surgical trainee. So when you're talking about what you would do, you know, saying things that I would stand at the end of the bed to, you know, gain an overall understanding of how well the patient is, I would look in the notes. I would ask my nursing colleagues to help. These are all normal things that you would do. But they need to come across in the interview and you can't seem robotic either, and again involve other team members, you know, as a call surgical trainee. This might be the first time you've had juniors. You know, I would get my F one and f two to bleed the patient or do an A V g, for example. So in summary, um, I would say the MSRA looks like it's here to stay, so I would get familiar with that soon. But don't be disheartened. Um, you know, if you wait another year, there could be a different change, for example. So I think you know, someone has to get these jobs. A lot of people do. A lot of people do better than they expect. So, please, please don't be disheartened. Prepare your portfolio early. Remember to gather all your evidence right from when you're a medical student. Otherwise, you'll be frantically running around asking people for evidence, and you may not get it all. And if you don't get the evidence, you won't get the portfolio points. And remember, although applying for course, surgical training can feel like a huge hurdle. You know, there'll be many of these as you go through. You know, you got into medical school, you beat the odds. Then you maybe got into your foundation school of toys. You beat the odds. Then, um, you know, someone has to get these jobs. Um, And why Why can't it be? Um, surgical training is awesome. And I hope you'll be convinced by the end of the day that this is definitely, definitely true. Um, becoming a course surgical training, You know, I go into work every day. I love my job. I'm trained. I've I've gone from a wobbly skin closure to doing appendicectomy in about 23 months because I have been trained so well and invested in by my colleagues, my registrars, my consultants um, so, you know, I think there's a lot of negativity going around about training or medicine in general, but, you know, do hold on to the fact that it is pretty. It's a pretty awesome job, and I would recommend it to everyone. Um, remember your future self when you're on the other side of it. You will really thank yourself for pushing through. You know, taking those audit boxes, for example, may seem tedious. Do it at lunch. Break, buddy. Up with someone, um, buddy up with another F two, for example, Or F one or a medical student. Um, so you can maximize your points. Um, and Yeah. Good luck. Um, Ryan, um, and Aqua, thank you so much for inviting me today. I'm happy to share my email address. Um, or if anyone has any questions, and I'm sure Rhino Aqua can forward them to me. Thank you. And good luck.