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Ok. So can you see my screen? Yes. All perfect. Oh, perfect. Yeah. Good, perfect. Fantastic. Well, uh good. Well, good evening everyone. Uh My name is Vinci Aruca and I'm a cardiothoracic uh surgical trainee. I'm an ST five, as I said, and I'm in based in London. I'm also the training representative uh for all the trainees in cardio surgery in London. So hopefully, it gives me a bit of a perspective um on application processes. And um and I've been doing this for now, 56 years actually. So I've gathered quite a lot of experience um through these talks and uh Q and A s for many, many students. So I would like to thank the British Surgical and Medical Association uh to give me this platform and share some tips on how you can make your application successful for both uh ST one but also CT one core surgery. And I'll be covering some key areas for a successful application um for both. Now, I'll try to compare the two applications sometimes uh the core surgical one and the ST one application for Cardiothoracic. And I'll do that on purpose to show you that um they are slightly different and also to uh kind of give you an idea that how um application process could change in the near future. Some of you guys are potentially early in your medical school. Uh years and applications do change um every year or two sometimes with the wording of it. So I think it's quite useful to have that comparison. Now, before we start some points that I want you to share, um I hope to give you some guidance. And in fact, I really wish that I was told this when I was a student, I had to learn all of this the harder way. Uh Some of you, some of you when you're hearing, this might feel a little overwhelmed, but please remember that you are actually fortunate uh to hear about this very early on in your uh medical school uh careers. And um and what that means is that you actually got time. It's not like your application is in, in a month, time or two months time, your application is in hopefully years', time to come. So hopefully that should relax you because you know exactly what you need to achieve and what sort of tick boxing you need to do. There's a lot of people out there that actually want to do surgery. Um But they are either put off from their first uh bad surgical experience as a student or from the general stigma um that surrounds it and I hope I can change that. I just want to clarify, um, what you will hear are my personal experiences uh, that worked uh well for me and for many, many students and junior doctors that I've shared with in the past who ended up actually achieving um, co surgical, if not even ST one cardio classic numbers. And um, they're not set in stone, that's very important, but I hope I can give you some sort of ideas for yourself and how you can improve your own application. Um So let's, let's, let's, we can start off with that. Now. Um I like to uh I find it useful to just share a bit of my journey. Um And hopefully it can show you that. Uh actually, it is achievable, it requires a lot of dedication, a lot of stamina. Uh And in fact, often opportunities had to be created. They weren't just handed over to me and, and you will realize as you progress in your career that that is true pretty much throughout your career until you retire. And for example, as you can see, uh well, in the first year of med school, I had no idea what I was doing. You were just sitting exams. Um You don't really think about careers uh in your second, in my second year again, I didn't really think about much. I mean, um my medical school was pretty hardcore in terms of a textbook based, very lecture based and we barely had any patients contacted the, you know, occasional every few weeks, it is very different from many other medical school. And, um, for that reason, I ended up organizing an observer, um, pretty clinical orientated and an observation was, uh in India, um, and it was in cardiac surgery and that was for four weeks. So that's how I basically used my summer holidays already at the early stage and it was all self funded by the time, the reason I chose a specialty cardiac surgery. And, uh, and it was mostly why did I choose that? It's mostly because, well, at that time I was thinking, who doesn't want to become a heart surgeon, right. And, but that was, it, it wasn't really thought through properly. And, you know, I liked the heart, I liked the art and I thought, let's, let's, let's do a bit of an observer in it. Um, and actually make a holiday out of it as well. Uh, from the long summer holidays in the third year, we had to do an intercalation uh at Cambridge and, um, ended up doing uh a dissertation, uh which was, um, in uh cardiac physiology. Again, I just followed some sort of interest in the physiology, anatomy. Uh But again, I wasn't thinking about career, I didn't even know how to go ahead about it at that time. Um And then, yes, again, I used my summer holiday uh for some sort of internship that uh luckily, uh I won the Well Trust uh somewhere grant and, and I did some sort of uh laboratory work at the Manchester um uh Royal Infirmary. And uh because my parents live in Manchester, it's quite close to be there. Again. You can see I was using my summer holidays already year by year uh to gain skills. Uh Every time it's only in clinical years when I really started to finally realize exploring the actual specialties itself. Uh from fourth year onwards is when I really fell in love with surgery, I explored a lot. And if you ask any of my year group, I'll be the guy who always is clubs. I mean, I'm still am and trying to get in some theater or another. I self organize a lot of it, internships and electives, uh which I'll share in the next few slides again on how I did all of this and through this whole process of exploring and soul searching. II really started to build uh characteristics of a surgeon such as building resilience, hard work and determination, which you really need in any medical career. To be honest, but definitely in surgery, you need to know if you have the stamina uh to stand up and focus for many, many hours during an operation. And the only way to do this is to actually get scrubbed in. And in fact, I meet a lot of enthusiastic students and young doctors who have great C vs on paper. Plenty of publications, lots of, um, you know, CD building stuff but have barely been in the operating rooms and I will share some tips of course on how to do that later on. But please, please do get involved. Uh We love having students around and another day you are applying for surgery. You're not applying for an academic uh job right now, uh, by just being keen uh, at the end of the sixth year, uh as a medical school, uh, a me as a medical student, I already scrubbed it in over 100 and 40 operations. Now, even now. Thinking about that sounds like a lot. But actually, it is not because it was spread out over a period of three years. And, uh, and of course, you get to do a lot in each of the internships and especially the electives. I remember doing 4050 in that couple of weeks time already. So if you spread it over a long period of time, these numbers are very, very achievable if you, uh, do it over a period of six months, of course, it's pretty much impossible now, um, going on forward. So after graduating in the UK, uh I did, uh, you have to do the foundation here since you guys know, um, to, uh, give you an idea. I did a stroke uh, job, then I did, uh, uh psychiatry, uh, during which I sat my mrc S exam, uh general surgery. And after that I did, um, and the foundation year too, I did vascular surgery, uh, during which I made applications and then uh renal medicine during which time I was interviewing. Uh So in your fifth rotation, you'll be interviewed uh for any job that you apply, to be honest, not just surgical. And then finally I had my GP, which was actually very nice because by that point, um, well, it was summer, I had my job lined up in a couple of months time and, and it was quite a nice job to have at the end, actually a very good perspective again, from the GP point of view as a surgeon. Now, uh I then applied in 2019. Uh And I was pretty fortunate to get the job in six ST 11 through first time around. Um The application process is one of the most competitive. Um uh a lot of people apply. Um 2nd, 3rd, 4th time round. So despite competing with all of those guys, um lucky I still managed to get a job in London, which is one of the hardest ones to get in again. Now, I'm not trying to say this to show off in any way. I'm trying to say this. Uh The reason I'm saying this is, it took a lot of years as you could see already from my previous journey to gather all that CV building. So if I could do it with very little guidance. In fact, uh these matrix that I will go over later on of checklist uh and point gathering well, didn't exist, it did not exist, it was much harder at that point. Uh going a little bit blind making this application. Uh So if I could achieve it, I am sure you can as well. You just need some guidance and determination and, and after that, I've been training in London um in Clastic. We're quite lucky. We train uh in tertiary hospitals and we rotate throughout London. Uh So I've been involved in Harfield that have met the bar and now I'm in Harfield Hospital and uh in five. So again, uh to share here to give you an idea, as I said, uh S one application is one of the most competitive. This is directly from 2023. There were nearly 300 applicants for 11 jobs. So a competition ratio of 27 applicants for each job, neurosurgery, fairly similar. Um A lot of applicants again, 20 jobs uh a little bit less competitive and you can see core surgery is very doable. Um There's four applicants for each job. Now, by being here this evening, you already have an edge compared to the other three people basically um that are applying for your job in few years time. Um The key is starting early and having guidance. If you, you know, if you have those two things, you will be absolutely fine and you will be getting that job compared to your other three colleagues who are applying for the same job for co surgery. Now, the key areas on this talk will be the ones listed here. Uh This is all taken from uh the online uh matrix which you can easily Google and I will go over it uh step by step. Um I will go through some of the ideas on how you can maximize each of the points for each of these things. Uh based on my personal experience, um The key areas have been pretty much the same uh since calling system started, as I said, um these scoring matrix has really started to kick off 2016, 17, you know, when I was finishing medical school. Um and uh and now it has become pretty much a norm every year. It's all uh on Google, you can easily find it and it's very nice because you just have to print it, score yourself against it, make a self assessment and then know whether you, where you're standing basically. Um Now, the important thing is that remember all of these, each of these um components or in key areas, all of them will improve your CV by a lot. And uh when the time comes to get an interview, uh which is all selected based on these points, you'll have plenty to talk about. And now I'm not gonna focus on the interview today, of course. So that's the whole talk about it. But um I just want to reassure you that the years and years and months you're gonna spend gathering points in each of these domains. Um When the time comes to the interview, I remember going through it and just thinking, well, I spend last, the last four or five years gathering points. I should just relax myself and just think I've done everything that I can do to maximize my opportunities. There's nothing more that could have done. Let's give it the best. And when you are relaxed in that moment in an interview, um the interviewers can see it and you, you yourself finally come across as a normal person rather than stressed out and, and uh and anxious and, and then you get the job again as a medical student, you might not be aware of the various uh training pathways. So, uh you do medical school, um then you do foundation year uh one and foundation year two. It's important to remember that uh the job application, this is something that I mentioned because very, not many people will tell you this. And um and by the time you're realizing this, it could be a little bit late. The people think that I've got two years of foundation here to kind of go through each of the specialties and kind of realize what I want to do in life. And also that, OK, I'm gonna be applying two years after graduating. In reality, you graduate in June, July, you're starting your foundation year one job in a, your application is in October the year after literally 1415 months after graduating. So not two years because as I said earlier, doing your fourth rotation, so out of six, so three in foundation year one and three in foundation year two. And so the fourth one, you're making the application and during your fifth one, you're gonna have interviews. So interviews are always in January slash first week of February. Um And uh so it's important to kind of remember not to have a very demanding uh uh job as their fifth rotation. So I have uh I had previous uh colleagues and a lot of uh men who basically come and tell me I've got A&E as a job and that's pretty hard because remember to get um you want to take time off for your interviews and ideally a week would be ideal and every single other doctor will be taking time off at the same time where there's academic jobs, ST three applications, consultant jobs. And so and so on. So um swapping nights, you know, doing all of that is much harder when everybody else in your department is doing the same as well. So you want to try to have some sort of um when you're ranking the jobs have something which is not as demanding as, as A&E probably, um because you don't wanna be going to your interview after your night shifts because you couldn't swap it around. So, again, things to remember again here. Um And, uh, and another thing that I just wanna say again, um, you probably heard of Foundation Year Three and Foundation Year Four. Now, from experience again, when people come back to me, um, it's, it is a potential year where you can take it easy and um potentially do something completely different than medicine, but you'll have to justify it. What often ends up happening. People end up taking the extra year or two after foundation year training is because they didn't get the job that they wanted to do. So instead of being nice relaxing job, a relaxing year, it actually becomes quite stressful. Um where you uh where you basically um need to uh gather more points because you uh didn't get the job first time around. And again, to give you an idea, um your foundation, your, you will know by March of foundation year two, whether you got the job or not, if you didn't, uh you do not have a whole year again to, to um gather the points. You have 78 months because the application is in October again. So again, these are things that I'm not trying to scare you, but it's things that you kind of have to be aware because um as a medical student, you will never think about in that way, unless you're going through it already. Like I have over the years and, and, um, and it's important to what I'm trying to point out here is that start early so that you don't end up in those situations. And of course you can take an fy three or fy four year to do other things. I know people, um, went into medical journalism, uh, or, and so, and so on, which is great. Uh And that's, that's different, that's very different compared to um where you didn't get the job. Um The other thing is so after that, you get, uh there's two pathways either core surgical, which is CT one C two. So I'll further as that or the run through, which is ST 12, ST seven or eight. As you can see from the slide here, you make an application for the CT one C two or ST one if you get the ST one number, uh which is, for example, in cardiothoracic neurosurgery and more recently, also ent urology and general surgery, a couple of other specialties. Um You don't do any more interviews or application all the way till you become a consultant where you're applying for that job. Whereas in core surgery, you have to reapply for ST three again, which is much harder. So that's a big, you know, big difference there now. So when to start, um it's simple as early as possible as I as you probably gathered by now, especially if you know, uh that this sur surgery is a career for you. It is true that the earlier you start, the more time you have to accumulate all of these points. Another tip which might be obvious but not always followed is to speak to trainees who recently got in or actually have an interest in helping you. We will encourage you and help you to, uh to make you realize that actually it is achievable. Uh We would check secrets in and out of the application and interviews. So I've got a couple of um guys who recently got in uh came top of the years for ST one cards uh interviews, which is a couple of weeks ago. And um and I've known these guys for four or five years now, I've met them when they were medical students and they were very and over the years, I've been mentoring them to uh help them achieve what they achieved just a couple of weeks ago. So um all you need is a bit of mentorship to make it achievable. It's pretty difficult to do it without some sort of mentor now who are mentors, mentors are basically helpful people. They can be a few from junior doctors, uh senior medical students, of course to consultants all the way and who basically see potential in you and want to help you out. Um They will help you a lot um and start trusting you. If you deliver, then they will start giving you projects, whether they lead to publications conferences and eventually they will provide you with excellent letter of reference to support your actual application in few years down the line. So keep in touch with them and, and share uh your aspirations and goals with them. Now, um this is basically a list of all the surgical specialties. Um As I said earlier, cardiothoracic and neurosurgery RST will run through for nearly 10 years now. Actually, um more recently, a nt urology general surgery have started uh uh I couldn't find the most up to date which ones are gonna be for the year after. It's been d I think they are trialing a lot of things right now. Um But what is the difference between ST one and CT one? Um as you saw from the previous chart, obviously, the advantage of being an ST one is an early entry and there's no interviews for ST three and by direct training pathways all the way to consultant, which means that you have to work very, very hard to get the ST one number pretty much during your me medical school and foundation year doctor. And this is the whole point of me giving this talk to medical students. Uh not to guys who are applying uh two weeks before the actual application. Whereas co training act one, it is more generic. It's not yet specialty specific. So I think uh it's important to realize there is a trend in the last few years that by the time you might apply more specialty out of these ones will become ST one entries. And uh but I'm sure the core surgical one will remain for those who of course, haven't made a decision at that time. Now, one of the reasons the application for cardiothoracic or neurosurgery ST one is more uh competitive and more difficult, It be it's the difference I is that all these points are specialty specific. So for example, if you did an elective and you apply for thoracic, it has to be a cardiothoracic elective. If you got a publication, it has to be cardiothoracic publication, a general surgical publication for a chic application will not count. That's the difference for the ST one. Whereas for this is only for cardiothoracic neurosurgery. Currently, the other ST ones are using the CT one application. OK. So the aim of an ST one run through application is that the candidate has really thought through the career and demonstrated commitment by each of the covering each of those areas that I mentioned earlier in that specialty in core surgery is generic. Um And I'm part of the European Committee, uh basically for cardio classic surgery as as for trainees and I get to speak to a lot of trainees around Europe and, and the world. And II can definitely say the UK system is one of the most vigorous and selective one where commitment needs to be shown in each of those domains I showed you earlier, very early on. So you need to spend time, uh you need to spend time in your medical school, uh in your summer holidays if you can not all of them, but a couple of weeks here and there to what I've written here. Soul searching what I mean by that, you need to explore um each of these. So where do you start from? Well, you have a list of up, you have a list of all the pro surgical uh specialties. Um, you probably don't like a couple of them because based on anatomy preferences, whatever you eliminate those. Ok. And then you narrow them down and then you probably have a list of four or five, out of those. And you get to how, what do you do next? You, then it's important to then start spending some time in them because there's no way you're gonna know that card classic is not for you unless you come and shadow me, for example, or, uh if you shadowed a consultant cardio classics or spent some time there, uh, same for any other specialty. Um, and that's exactly what I did. I, for example, I was never attached to ent surgery during medical school. Um, you probably might never be attached to any, uh, some of these in your medical school. So what I did, I just went, uh, and shadowed a couple of ent uh registrars in the local hospital by just turning up and basically, you know, asking them, can I come and shadow you? Basically? And, and within a couple of days I realized actually, it's not for me not to be complex, too many nerves, whatever, you know, and I took that one out and then basically, by doing all of that pretty much I came down to trauma and cardio thoracic. And um and after spending some time in trauma, I realized actually cardio thoracic is what I want to do. So only when you've done it and that takes months, it takes, it could take a year or two, sometimes even, you know, it, it doesn't happen within a couple of days. And that's, I think the time when you're in medical school it's should be used valuably by doing that soul searching. Because once you realize that what specialty you want to do, my God, it becomes so much easier because then you can find, finally dive deep into that specialty. So for example, my fourth year end of fourth year after doing the soul searching stuff I knew is for me, I mean, I didn't know that I'll be good at it, but I knew that's why I was really interested in and I then started working on audits research projects. Everything else was. So by the time four or five years passed an application happened, I mean, looking back, I was thinking everything was relevant to it. Um Whereas if, for example, I did do a couple of audits on orthopedics and so on because I was still interested in that and, and um and none of those were useful for the application, for example, for ST one. So what I'm trying to say here, a lot of students, what they do is straight going to research projects, straight going to publications because that's what they've been offered. What they should try to do is find a specialty they're interested in by doing what I've said earlier. And then even if you narrow down to two or three, then dive deeper, then accept publication, then projects, audits, surgical exposure. And so and so on. So just something that you, I think it's quite important to make you realize and again, no one will really tell you that. Now there's a surgical experience. So this is uh as I said, I will be doing a perfect comparison. So left side is core surgery. The boxes with highlights is the ST one cardiothoracic run through and um in, in the surgical experience for uh uh core surgery. Um what he says is that I have attended um uh basically a surgical test a week. Uh And that's how you get pretty much maximum points, you get two points if you're undertaken and elective in surgical specialty. Uh Whereas in the cards, um it's a little bit more um specific as you can see, um this is very similar to potentially to neurosurgery or to any other future applications that could uh change. And it says actually you need to do two or more electives and clinical attachment in cardic surgery in a non home institution for four weeks, making it very specific here, right. That's to get five out of five points. Um Now evidencing it, it's basically this is again the top one, it's called surgery. Uh It's pretty much a signed letter document um by your education supervisor saying, uh the surgical placement, the hospital, the dates and, and the name of your supervisor. And basically what I'm saying here is you need to, you should additionally try to make some sort of reflection, um write a couple of paragraphs of what you learned because they can also be used as evidence, email confirmations, of course pictures and what written me letter recommendation, which I'll tell you what that means in, in few slides. Now, again, coming back to me, this is what I did. Um I told you earlier this sort of matrix, I just showed you for this surgical experience. I just loved exploring. Um And uh and you can see slowly, slowly, pretty much everything was became cardiothoracic. Um And um once I knew that I wanted to do that specialty, I targeted all my opportunities to maximize that learning. I learned a lot. I really cemented my passion for the specialty and that's basically picturing my electives in the States uh were basically uh it was a Sunday. Um And uh I was uh lucky enough to be one of the 56 people that was allowed to go on a private plane to go and retrieve um some transplant as a donor. And because of distance over there, they, they, they basically use private planes. So for three hours, we flew all the way uh collect the organ and then come back and transplant. And of course, I had to take a selfie at that time. Um But these are experiences that you, you will probably even get better experiences for sure. It is just about exploring and by doing all of that, you will get plenty of operative exposure, plenty of research exposure. So that's the way I believe to start it off. And as I said, yeah, um as I didn't know that I had to do all of these were actual requirements. Um No one told me, but I can say that having done all of those, it really cemented my passion in my Children who I am today. It exposed me to a lot of variety of surgery and even healthcare systems. I got to assist a lot in many operations and, and definitely got me involved in research audits which then led to publications and conferences. So can you see, I started off by finding the surgical specialty and then everything else just worked out. Um And, and you as I said again, by doing all of these internships, you will come across mentors um that I mentioned earlier by, by doing them. Uh So that's again, very, very important. This is a letter of recommendation. So basically all they are, it's pretty similar to what the application says. It's some lines written by your supervisor about what you did when anything special that you got involved in um such as research projects that presented in MDT, uh assisted in X amount of cases and so on. Get signed because this will be evidence for any future application and you never know who these referees are. And until years later, I mean, again, my, I just put one of mine over here. This is from 2016 when I spent my electives in the States. Um Dr Griffith is the surgeon who some of you probably will know is the guy who did the first transplantation, the big heart transplant, which was all over the news and this is very recent. But this letter is from 2016 and I've got him basically saying stuff like a Vinci did very well. He had excellent uh hand eye coordination was very eager, blah, blah, blah, and you never know who your referee could be and how they can be used many years later. So definitely keep them um in terms of operating experience. So um I'm glad that the core surgical application actually kind of tells you exactly how many numbers OK, the cardiothoracic one has kind of removed that um because they couldn't really potentially, it's quite difficult to put a number to operative experience, to be honest at this early stages. Uh This is from a few years ago on the right, it's exceptional procedure of this was when I by exceptional procedural and operative experience. I mean, no one knows what exceptional means right from the co surgical application, 40 or more cases is exceptional. Um As I told you earlier, I had 220. Uh I went way overboard obviously because I had no idea that there was actually some sort of guidance. I would have probably saved a lot of time by um focusing on more other things. However, it's important to scrub in because you are applying for surgery. It's important that you scrub in and get your instruments, handling, not tying closing wounds, all of these skills they need to be really developed and that's what they're probably looking here. Um It's very easy to follow just the matrix and look very good on paper. You know, I've got audits the teaching and so and so on. But when you actually become a trainee, when you're finally become the ST one ct one surgeon, uh or even later, you will be expected, certain basic skills such as closing the wound, you'll be left alone to do it. So, um remember you are trying to become a surgeon and you will become very evident and I can tell you that it is very evident uh when um ST one, ct one has ac has done a lot of operating beforehand. Um And, and that's important to realize. So as a student, you can already develop these, these skills don't just come because you suddenly become an ST one, they take many years to develop and um basic handling, tissue handling, these can easily be developed when you are as a student. I'll explain to you how you go ahead about that. Of course. Um So um this is again from the uh course surgical application. All of this evidence needs to be provided by an E log book format which I'll explain to you later what that means. I just want to go a couple of um slides about how to maximize your chances to get in and get scrubbed in. Um If you want the surgeon to allow you to scrub in uh as a student in that operation, you need to know the patient well, you need to know them well. OK. I, I've had students in the past who um basically turn up in the morning. Um and they are uh late from the briefings and, and what happens unfortunately because no one knows them. They were introduced at the beginning of the whole, you know, when everyone introduces themselves. Uh um no one knows them and they don't have the same experience as somebody who's actually um and they don't know what the operations are and it's not the same, it's not the same as an experience of someone who's actually, uh who is going through the patients, who knows the patient actually turns up, you know, on time to be introduced with all the surgeons, nurses and anesthetist. Um, so it's, how do you go ahead about it? Well, uh you know, you can find the operating list, for example, uh from the theater coordinators at the beginning of the week once you're attached to a placement. Um, and, and you know that, ok, X surgeon is operating on Thursday on these operations. Uh, once you know that and you get to, because you got the logins locally from your, uh, local, you can, or you can ask the team to kind of figure out where the patients are that are going to be operated then the day before you and basically, uh, ask the registrars, um, and tell them, can I, um, I'm quite keen. Um, I'm a medical student very interested in surgery. Um, and I've seen a note before but I would like to, uh, come tomorrow to us, you know, to scrub in. If it's possible, I would like to see the patient as well if that's ok. And that's great because you're doing all of that already. Um, the registrants will basically take you on board and say, oh, great. Yeah, why not? Let's go and see the patient together. Why don't you go and see the patient. Tell me what, you know, what issues they have. Not only you're doing your OSC examination history, but also you are pressing registrars and consultants that it's much easier having done all of the hard work beforehand. Knowing what the patient is gonna have in the morning of the surgery, you're just a little bit more likely, uh, over time to get scrubbed in compared to somebody who just turns up and doesn't know the patient. So it, it's just about earning the trust. Uh, it is very normal at the beginning. Maybe surgeons are a little bit hesitant because they don't know you, you know, you just turned up and so on. Um, compared to other surgeons who obviously very willingly say, yeah. Yeah, of course, get scrubbed in. But once you build a relationship, um, of course, they start trusting you and under supervision, you'll be scrubbing in and if you try to help the team on anything that you can and you earn their trust, you, you will, you will really succeed. And that's how that was. That's the little secret in a way and unfortunately no one will really tell you that. Um I learned it again the harder way, you know, turning up at the very beginning of the medical school years, turning up without knowing the patient and the surgeon saying, do you know what we're doing today? And you just look like an idiot. Um, and, and you then want to go and learn the patient that remember, um, the patients are someone's father, mother, grandparent child and so on, you know, um, they know they, they need to be respected. Uh, so you need to, you need to know them well, before you go into an operating theater and further to that you, you should then attend surgical courses. Um I'm sure you, you know, there's plenty of them these days from surgical societies. Um A lot of them are free. A lot of them are very cheap as well as for medical students to go in watch youtube video. Um uh how to close the skin by watching subcuticular suturing over youtube videos, then going to courses free ones. I ended up um getting a lot of expired sutures and leftover instruments from courses to take them home and practice. The key thing is practice if you do a bit of under the supervision and you immediately can tell if somebody's practiced a lot and next time they will let you do more and more and more. And that's the, that's the secret basically courses. Um they've been removed from course surgery. They used to be there beforehand. This is directly taken from the cardiothoracic application again. And currently for cry thoracic to get maximum two out of two points, you need six or more clinical courses. As I said, I just want to emphasize the core surgical one doesn't have that this year, but it was there in the past, it was definitely there in the past. So by the time you are applying, I would not be surprised if it turns up again. Ok. So it's just the reason I'm putting this is because of that and courses are expensive. I mean, there will be the ones which are free locally organized by uh other team medical students or, or doctors. Um, but then there will be the ones which are, as you see in the next slide, a couple of them, which you have to do as a junior doctor, as a foundational doctor, um, like the basic surgical skills and uh advanced trauma at basically courses. Um And these need to be done basically for you to become a court surgical and eventually surgical registrar. This is a picture of the course where we were learning to under a onto a coronary artery on a big heart as a medical student. And it was great. I mean, it gets you really interested. And this is the list that I ended up putting in my application. Now you're probably thinking my God, it's, it's really long, but it's, you can see the dates it's over a long period of time. Um Some of them are compulsory. A lot of them are free. Uh And the, the way I got the free ones is by knowing local. So registrars were keen to set up wet labs because they have to also prove to their bosses, they have to do teaching, II still have to prove myself to do teaching and organizing teaching locally. And then by knowing the right medical issue, you know, the right people, you basically be invited for free. And it's great, a lot of these worry factory and some of them, of course, as I said, are much more expensive, such as the top two ones, which you because they are a Royal college of Surgeons accredited. We need to pay for that. Unfortunately. And then there will be the ones which are very specific. You can see again, uh, a lot of them were specific for cardiothoracic surgery. Um, some of them warrant. So it's important once you realize what specialty you want to do, it will become much easier to go to course as relevant to your specialty. One thing I just want to point out some of the ones which are the top two, the basic surgical skills in the advanced trauma. One, the waiting list is, I mean, the last time when I checked was 6 to 8 months, you can only do these when you are a foundation year doctor if you want them to count for your application in fy two. and your, and the waiting list is that long. Um, you kind of need to get on to it pretty soon after you become a doctor. Something that I have no clue about. I have no idea. I mean, you can see the basic surgical skill. I did it in May that one. I was very lucky that it was advertised in my local hospital um uh a month earlier, but the ATLS one I had cancellation. Ok. I was literally looking for it since March of 2018. In fact, um and it was all booked out all the way to November. And um there was one or two that turned up in a couple of them that turned up in summer and I was willing to drive all the way to Cornwall to do it. Um And that also got canceled. And luckily there was a last minute one that turned up in November, literally the week before my application went through. So you can imagine the stress going through all of that. Um So again, another reason I'm giving this talk is to don't, don't do that, you know, if you know, in advance that these things are very, very booked up in advance, um, try to book them in advance if you can basically, um, the log book, I think this is quite useful. I found in the past, um, keep track of the operations that you do that use club. And, um, uh, as this, this is pretty much, this is what I use as well as a trainee. All of us use the E log book. It's online, that's the website. Um As a medical student, you can now actually, uh sign up for free when I was a medical student, it was not allowed, you had to have a GMC approved number. Um Now you can so definitely keep track, keep them in. Um If you observed if your assisted put them all in. Um as and again, I just wanna say as a student, I had a long time to, to uh to prove myself and go and scrub in as a foundation year doctor. It was much harder to scrub in because you are a doctor. You need to look after the patients on the ward first. Um Getting theater opportunities, it's much harder. So for people that think, oh yes, I will have enough time during foundation doctor to, to go and scrub in. Um It's much harder and the numbers, the 87 surgeons that did during the foundation you one and two, there were a lot of them were during weekends, a lot of them were uh uh you know, uh on my off days in fact, which you do get as a doctor um or just after finishing shifts. Uh because some there's an emergency laparos, you got more time, more summer holidays and so on. So definitely, definitely use that w wisely, these are just a couple of uh uh Snapchats on Instagram uh just showing how Kena used to be um and still am to, to basically just always be in scrubs and try to get to the to another. This is what the E book looks like again, I thought it would be useful to go over it. I found people in the past uh found it useful. Um uh Basically, you need to know the operation uh operation specialty. The patient ID is important, the patient age or date of birth and the CBO, right of operation, of course, a seat board which means it was elective, scheduled urgent or an emergency as a grade which you get from the anesthetist. Um You pretty much never find the responsible consultant name within the list. Uh but you can write it further down which I'll show you next supervision, which basically means um did you observe or did you actually scrub in and assist? And at my level, did I do the operation that is not expected of you? Ok. At, at your level, it should be pretty much just assisted. And then you put the, you go to the list of the operation titles, you click the one which is uh relevant for you and the hospital. And then below that, there will be basically um a box, a white box and the white box is where I write a consultant, name, the actual title of the operation. And exactly what I did, I cut the sutures. I it grows a bit of the skin, um I helped with whatever, you know, so it's, it's there and it's quite nice. Now, I actually my first operation that I put on there, it is from 2014. And it's quite nice going back to it as a four year medical, you know, looking when I was a four year student, uh looking at what I was doing it. So, you know, it's nice to keep track um conferences. So um quickly whizzing through this one. the core surgical one says you need to attend three surgical conferences to get uh maximum points. Um These need to be official surgical conferences. Um I believe not the ones which are organized by surgical medical schools, uh surgical societies, uh which of course are very good because they provide a lot of learning opportunities, but official ones should be the ones attending and Well Society of Medicine and the asset ones are the most popular ones for students. Once you know what specialty to do, you then just target those and it's pretty easy to do uh to, to achieve these over the years. Um going through audits now, uh again, um the core surgical one basically worries us to achieve maximum points. Um You need to be involved as a lead in all the aspects of the surgical. The so, and can you see surgical theme, no medical um audit or qi project which demonstrated a change. Um And, and I'll go over that what that means in a second. And also on top of it, you get additional five points if you presented that project nationally or internationally in a conference or regionally three points or locally one point, the cardio classic one, actually fairly similar wording, but the number is more instead of having just one has become three, it used to be one audit full cycle to get maximum points. But because everyone does it these days, apparently, um they now want three or more completed cycles. Um The reason I'm mentioning that is um if I were you as a student uh and as a senior student even try to, to try to have two or three completed audits because in that way, you are being safe. Uh So that even if the application changes in four or five years time, um you've done pretty much plenty, it's not gonna be 10 audits. OK? Uh It's always gonna be 12 or three. So, you know, that's, that's the reason to put that there. And what's an audit? Well, basically an audit is a quality improvement process that seeks to improve patient care and outcome from an existing knowledge, you implement a change and then you compare it against uh current guidelines of practice. Research is seeking new knowledge. Now, this is not a cycle where basically you identify an issue, collect the data, you compare it to the current standards, you then implement a change and then you re audit it to close the loop. That's what that means. That's one full cycle for cardiothoracic, you need to do three of these. Um And again, of course, surgery currently. It's one. Um, so how to find one? Well, ask your supervisors, ask your team, your mentors. Remember the ones I mentioned earlier, this, this, this once, you know, the specialty that you want to do, it's very easy to get these ones. Um, and they will always have something for you. Let them know what you want to achieve. Give yourself 3 to 6 months from start to finish as a closed loop. Hold it because it can take a bit of time. Um There's a lot of admin involved from registering all the way to after that and think about what intervention and changes you can bring in already before embarking into one. The most important one is keep it simple. There's no point collecting 100s and thousands of patients because an audit, it's about proving that there has been a change and that you've closed it, closing a loop of audit where you collected 500 patients. You have to recollect another 500 patients compared to 50 patients where it's much easier. And um and she doesn't have to be super fancy to fulfill. This research is different as I said earlier. Um And you need to try to bring a new change. So if you manage to do that, the department would up. We love you, you know, they will adore you because you are, you know, there no department is perfect and these are simple stuff like checklist posters, you know, anything uh clerking is not great. Why don't we drug uh errors, that kind of stuff. Um And if you're able to prove that there has been an improvement by introducing an implementation, they will, they will be really grateful for that and your fulfilling points and to be able to lead design, collect data implemented change and present it, um, you're not gonna get the first one straight away. You probably have to have done one or two sim audits where you're probably only the data collector and somebody else had the idea of it or leading it. Um, and, and then the next time because you picked up on how the process is, you'll be able to do the same as well. So it takes always one or two before embarking and achieving all of these points presentations again on the left side here, it's called, it's called surgery, um, uh, to get the maximum points and said you need to have won a prize for the best oral presentation at the National International Conference. Um, whereas if you don't win the prize, but you still deliver it, you get two points less, uh, to win a prize is very hard. I mean, I can tell you, uh, I still haven't won a prize for that. Ok. It's really, really hard. Um, and here this is what they're testing. You basically, a lot of it is luck as well, uh, and kind of, uh, you know, having the right project for it comparing to the Cardiothoracic one, you uh personally delivered three or more or presentation. So not just 13 or more. Um again, um for Cardiothoracic a couple of years ago, it used to be only one. OK, just like the cold one. But over the years because um students are becoming better and better, um they changed it to three or more to make, to maximize the points. So again, I would advise you um if you have one amazing work towards the one obviously. Um But if you get two more than one even better because you don't know how the application might change in a couple of years. Time. Again, it's not gonna be five or six oral presentations. OK? It's always gonna be 1 to 2 or three. And again, as a medical student, um there are certain conferences again that uh are very uh student prone where you can actually win and get accepted for these things such as Royal Society Medicine and the a one, they've got actual student select student sections dedicated for you where it's much easier for you to get an oral presentation within the student section compared to the generic whole um from professors all the way to junior doctors, um uh where everyone's competing against each other. So it's, you know, just knowing that you are being a little bit clever and it's, and you still get the point. So it's important to know that again, publications. Um, so, uh, again, core surgery on the left cardiothoracic ST one on the right. Um, it takes a lot of more time to get a publication. A lot of hard work. A lot of chasing around a lot of rejections. Ok. I think you probably don't know this but only 10% of, uh, submission. Ok. Uh, get actually accepted for publication, not at student level. I'm talking about at every level. Ok. So they're very, very hard to get even at my stage, even at a later stage. Um And for cold surgery, it says one first order which uh should not be a case report or editorial letter to get maximum points. Uh if it was a case report is four points. Ok? Whereas for cardiothoracic is actually five false daughter publication within cardiothoracic surgery. Um Again, you know, this, uh this is to show you the variation of it cardio thoracic application a couple of years ago, it used to be three as far as total. Now there may be five. the core surgical one could change as well. So I would probably aim uh not just one if you, you know, try to aim for one at least, but aim for two or three if you can. And if you got the time, um again, you need to have the right mentors for all of this, you know, people that actually published a lot and they're successful. Um One thing that I just wanna say again, students all just keep focusing on this for some reason, every time I get students coming to us, they like, do you have publication opportunities and uh even before deciding what the specialty they want to do for the rest of their lives? So as you can see for the ST one application has to be specialty specific publication. So um you know, this could change in the future example, I don't know uh ent or general surgery or whatever. If you have a publication in medicine, it will not count for example. So, so it's important to know the specialty first and then you will get plenty of opportunity to get the publication presentations and so on and so on. Um again, you know, if you have oral as original projects uh for both presentation and publication, just more likely to achieve those things. It's, it's pure hard work. Um You know, there's not much money involved here. You don't need 100 publications either, you know, just the 1 to 2 or three. I remember when I mentioned mentor, some supervisor that can actually help you. Yeah, and um reapproach them. If you lost in touch, mentors will tell you what conferences to target, what journals to target and set your goals, for example. Um if you already go an oral presentation, but you don't, you got a couple of, let's say you have a complication already as a second order, you know, approach your supervisor and ask them, I haven't got a first authorship yet. Would it be possible to have a project where I can get a first authorship? If you don't tell them, they will give you a case report, you know, or they'll say they will give you something simple. But if you tell them what you want to achieve and you built a relationship with them already, um, it's better, you know, there's no point in doing unnecessary work here and just like surgery, like I explained to you guys earlier, it takes time for them to trust you. They will start with very simple things. Uh that might not lead too much, it might not even lead to a publication but, but it could be just a case report or a presentation. But if you're delivering it and you can do it and you're showing those skills, they will give you more, they will trust you more and then they will blindly trust you. And then one point uh some of you might notice or uh are in that situation actually, um you get too much, you get too many uh things asked to do and you then then to start saying no, so that will happen. Um But you need to start, you know, in the right direction and that's exactly what it is. II just want to share a quick story where as a foundation year doctor, I was in Kent and I reconnected with my supervisors in Cambridge and under an honorary contract, basically, I was able to um get logins uh in the in the other hospital and outgoing involved in projects. I remember driving for two hours on weekends just to go and collect data. And eventually this led to a multicentral evaluation of renal impairment in thoracic surgery which we call merits. It all started off with a local project where I collected the data and then I had some idea, I knew a lot of other students and basically, I got involved two students across the whole of the UK and with across 17 units, uh thoracic units in the UK. And within six months, we all collected 15,000 patients which no way I could have done any of that by myself. No way I could have done that if I did not reapproach my supervisors, my mentors who trusted me to deliver all of this. So that's just a bit of an example to show you how it all well was all inception uh of, of this, you know, uh achievement and so on. So definitely reconnect with your mentors in terms of teaching. Uh for core, it says here, I've worked with local educators to design and organize a face to face teaching program, not online. OK. Um And uh for ics, actually, they go into a little bit more details where you need to have had a formal teaching role for six months or 12 months to get five maximum points. Um The one that quite difficult to get, that's only been in the last year or two when they changed that. Um the core surgical one is a lot more doable to be honest. And I can again, ii explain to you how you can achieve that. Um Again, how your evidence it is to get the letter from your consultant to show that uh what you did basically um uh exactly a letter recommendation. Like I told you guys earlier, this is what I did. So basically, um initially, during medical school, I had no idea again. And these were the different points at different levels of teaching. I just love teaching and helping people um by doing different things, lots of bedside teaching, wet lab sessions. Like here, I was um fifth year medical student and basically, I was teaching 2nd, 3rd, 4th year medical students and, and this is how we all started. And um by doing these things, you start to really gain organizational skills, teaching skills, leadership skills. Uh all of the, all of which are important as a, as a surgeon, as medic definitely, but as a surgeon for sure. And then slowly, slowly you start to make connections, you then start to organize courses which are national level and it takes time, it all starts from something small and then it just blows up eventually. And um and then you start to then design teaching programs. So you need to find the gap. So I remember a foundation doctor um in a, in a district hospital and we were getting medical students from um uh the local university hospital and they were really getting surgical teaching. And so I just asked them by doing a quick survey, I was a foundation ear doctor. One at that time, I asked them. So what sort of teaching are you lacking in your curriculum in your university? And they said to me vascular teaching, um they didn't know how to uh orthopedic teaching or fractures and uh stoma and stuff like that. So that's what exactly what I did. I designed basically um four presentations on into each of these four topics that were not covered and uh for each cohort of students that were coming in, I gave the same presentation, got the feedback each time and I did that over the period of one year and, and that's exactly what they tried to say here. OK. That's exactly what, and, and then I got a nice certificate saying basically, um that's exactly what I did. So you need to find the gap. You know, if you ask by finding the gap, you ask the people who are being taught and they will tell you what they're lacking. Um It's easier done when you're budding up together, you know, um when you have similar minded uh senior students or um adventure foundation doctors who want to also help you out and then it's much easier when you have a couple of pair of hands to deliver this kind of stuff. I always get feedback, Google forms, certificates, slides feed, you know, um, this is how you need to evidence all of these. These are a couple of, uh, the ones that I did, as you can see, um, the, the secondary medical school. Uh, you can see, I was teaching as a medical senior, medical student, junior medical students about how to do subparticular suturing. And, and I used all of these, all of these were used in my application and this is from King's uh later on from the director of Medical Education saying what I did for the other. Um and in terms of training, um again, core surgical on the left uh cards ST one on the right, this is hard, I must say um you know, to get APG certificate, it's expensive. Um And then, you know, I don't know if you are aware of this, but PG certificates are basically um a training course where you, they teach you how to teach basically. Um and uh the PG certificates are roughly 2 3000 lbs. Very, you can't do them as a medical student, like you can only do them when you become a foundation doctor, but the points can only be achieved when you're fully been awarded one. So um you need to kind of get on with it very early on. I didn't do it. I II was, you know, I could have done it but it was too expensive. You know, you don't have to get every single point um to maximize your chances. Um I focused more on publications and presentations which were kind of free, pure hard work rather than spending a lot of money. So again, II don't say do it, don't do it. It's up to you. Um, obviously, for example, people that end up doing it most often are people that take the F three year because they didn't get the job as a selling foundation year too. So they go an extra year to pretty much get these points and get the extra, you know, p certificate education nearly done. So others that didn't come up, they don't come up and they've come up in the past, this is cardio. So MRC S exam, uh the MRC S exam is basically um the surgical uh entrance exam for, for you to become a registrar. Um MRC S part, it's insecure, part B is uh oy, um the, the part A you can do as a foundation, your doctor, one. And that's why I did uh at that time it counted. Uh it, it doesn't count uh currently for core surgery, it could count in the future. Uh It does currently count for cardiothoracic. It didn't for the last two years. So, but you need to do it anyway. You have to do it to become a eventually a co trainee so might as well do it because, and it's better to do it when you just freshen from your finals again. And lastly, again, organizational skills, these are for cardiothoracic again, um um has been taken away from core surgery. Used to be there before um for cardio to get the top points is to uh basically be a chair, Secretary of National International uh Societies and so on. Um a lot that you can learn here uh again, is not for this year's applications, but it could change, it could well change. So if you are being involved, all of these uh things, then it's, you might, it's important to be involved because having leadership skills, organizational skills are I think the essential as a surgeon and you will definitely help you out. This is what I did. Basically, these are some of the examples and you can see it from number nine here. These were um I started off as a medic in medical school. Um you know, as co organizing um engagement days and eventually uh becoming vice president for surgical societies and you know, small walls locally, which then I learned a lot of skills over the years, which then led to uh becoming uh now on the training representative, as I said for the whole of London, for Cardiothoracic. And I'm also part of the whole of the European residence committee uh for training committee in the whole of Europe And uh and recently we designed a new um web series for uh for medical students as well. But all of this has been achieved because I started many, many years ago by doing things locally. So I would encourage you to do that. So in summary, um I focus on many aspects of the application that what is required. Unfortunately, it's not very clear uh when you are a medical Assurant again, uh it can feel overwhelming. I can completely understand that, but, you know, understand the thing that it, it can take many years to accumulate all of this and hearing all of this as a medical Assurant is better than hearing it a week before the application. So, uh that's an important thing and, and I hope I given you some sort of a sense of a direction um so that you're not going blindly like I did during medical school uh by just doing random things, but luckily worked out. Um but have some sort of guidance. Um If you do all of these sections that we talked about, uh you'll be fine on interviews, as I said to you for any application, including even national selections. And most importantly, you have to uh you need to tell yourself at that time that you've got enough soul searching and realize that actually this specialty is for you and, and to tell yourself that why you actually deserve the job. You know, if you've been through all of that. You will, you need to tell yourself that you'll be fine. Sometimes. It's just luck. But you know, you've at least you've done ever that you could do. And some of the key points I believe uh from the whole message is start early. Find mentors, plan ahead, be organized, seek opportunities and please please persevere don't give up. There will be times where no matter how hard you work, you just don't get much out of it, but this will build you into a better person. Eventually, soon. Surgeon remember surgery is competitive because you're dedicating your life for your patients. You got stamina dedication to be able to do that. And I can definitely tell you even now that II love every bit of my job. I feel it's one of the most rewarding careers you can do and you really do change patients lives. So, and I hope I'm sure you will too when it's your time. So thank you very much for listening and um here's my email again and my Instagram if you uh want to follow me and again, I'm sorry, it took me a little bit longer. Um But hopefully we've got time for questions. Thank you again. Just her or anybody else is there or I'm just seeing a couple of questions here. I'll probably just go through that if that's ok. Um Yeah. Could you please guide me on how to find a mentor? Well, it's a very good question. Hopefully, I answered that question during the presentation. Um It's not easy and you will meet a lot of people who um have no interest in helping medical students. Uh Fair enough, you move on, you stay away from them and then you will meet people who actually have an interest and you should, um, and that's a good thing and you should stick with them basically. So, um and the way you do that is basically by um you know, presenting yourself by being there. So, for example, uh it's important to realize as a medical student. I remember just turning up in the surgical department, you know, if you are part of a university teaching hospital and you got the bad, you know, the badge to say that yes, I'm a medical student here. No one is gonna say why you're here, you know, uh you know, it's, it's, you have the right to be there. You're part of the university hospital and you're a medical student. So I remember doing that and just walking up to sending a lot of emails at the beginning which don't work out because uh surgeons are very busy. Uh But then just turning up and say, look, I'm a very me medical student. Um uh I've had, I haven't had the chance to explore X specialty. Would it be OK if I shadow you in the next couple of days or next week or three months later or whatever? And the likelihood of them saying no, it's, it's pretty low, you know. Um, if they say no, well, you move on to another guy, old lady, you know. So it's, it's, that's exactly how it started. And once you do that, uh, you know, it's much easier by what, which year you would recommend, find the specialty you want to pursue. There's no set stone for that. Ok. Um, as, as you, the reason I show my journey is because you could see it took me, it was fourth year for me. Uh for some people, it might take longer. Some people it's earlier. Uh some people are, are doctors and they still don't know which specialty they want to do. And that's absolutely fine. The key thing I wanna say is um go around and search, you know, go and explore because in medical school you might be attached to certain specialties. Um but you might never be attached to others. I mean, for example, I can say I was never attached to oncology. Um And uh who knows, maybe I could have been a great oncologist. II will never know. Right. Um But it's, it's important to go and explore it because then you can actually make an informed decision saying well, that specialty really is for me. No, that one is not really for me. So, um it doesn't matter which year, I mean, 1st and 2nd year is always a bit harder because you, you're not used to the jargon. So, you know, uh I've had first year medical students come to shadow in cardiothoracic and um explained to them heart attacks and stuff like that. It's a bit harder because they haven't relearned it compared to a 3rd, 4th year medical student who's, who knows the basics and actually is focusing more on, um, learning the career itself. Hopefully to answer your questions. How do you self organize electives in non home institutions? Um Again, it's, it's a very good question. So, um this is cardio thoracic. OK. Specific, it's not mentioning core surgery could change again. Um But um to give you an idea, once you, um once you built some sort of CV, so you start off from your home institution, which means your local teaching hospital. Um And once you've had some sort of, you know, over the period of months, um you delivered, let's say, you know, you approached the general surgical department and um you got stuck in, you know, in the operating theater, you scrubbed in, in 20 operations. Um You've come, you know, you're part of an audit. Now you've done going to a couple of courses um to then apply for um other uh non home institutions. It's a little bit easier because you got something to show and you can send basically emails to surgeons or uh people that, you know, that you met in courses that you met at conferences, say, oh yeah, I've had a chat with that consultant in unit who lives three hours away, let's say. And, um, he seemed very nice and he was very keen to teach. Why don't I send him an email saying that can I come and shadow him in the summer? Let me, or, you know, let me send my CV to them, let me send them what I've done so far. That's much easier. You know, that's, that's the way to go out about. This is why you need to go to conferences. That's why you need to go to courses. That's why you need to basically go a network because that's why you will meet consultants, registrars and like one speaking, don't be shy, speak to them, you know, tell them how interested you are uh that you have experience and so on. I can tell you an example. I II had a student. So I was in the European meeting in Milan uh for six and I had a student um a UK student from uh I'm not gonna say from, from Plymouth, basically 17, his home institution and, and he wanted to come and shadow us in London and within a couple of months he took a bit of paperwork, he came over and um he had an absolute great time and, and basically we have a lot, you know, gave a lot of projects to him and, and so and so on. So, but that all started because he approached me during a conference and we were in Milan and I was like, this is, you know, very brave, very good. He was presenting. Amazing. Yes. Why don't we link up so and so on. So that's the way to go ahead about it. I mean, this is one of the ways I'm sure there's many other ways and uh to do that, I just want to carry on with the questions. So do keep writing them, I think. Um hopefully I'm answering your question. Would operative experience done in a broad institution active for the operative case evidence for the ECs application now? Good question. So I did. Ok. So when I, my electives were in trauma surgery in Cape Town and they were in uh cardio classics in Maryland in, in the States. Um II can't remember the exact date, but I think I was probably in 40 cases in Maryland and something like 3040 as well in, in um in Cape Town. Um and II used them. Yes, I mean, you know, as long as you have IUDS and one way to really um make sure of it is by the time you're leaving that institution, um it's uh it's important to get the letter of recommendation to prove it and get your log book signed off in a way from that consultant uh to make sure that because at the other day, as you know, from the evidence you need to a consultant needs to sign you off that. Yes, he's clogged in, in X amount of surgeries. But a UK supervisor, your local home institution might not sign off what you did and example, Mary, you know, us uh or Cape Town or whatever because they weren't there to get it signed by the right consultant bus to prove it. Uh But uh unless things change, um uh you know, I don't see why not get it proved obviously. um good. Any other questions that no, I haven't missed anything. Now, does this all the questions so far? Don't be shy. You can even, I don't know if you're allowed to speak on here. You can even just uh speak up, I guess. And uh let me just stop shining here. Sure. Just gonna wait for the organizers. I think they're just been having some issues. Mhm. Well, if there's no further um questions, I mean, uh I provided my email as well in the presentation. Um You know, and um thank you very much for inviting me and I hope, I hope uh I've given you hope that it is all achievable. Um But please keep, keep pushing for it, keep working hard and I can guarantee you'll be great surgeons when it's your turn to apply. So, thank you very much for everything. Take care. Thank you. It was very incredible to. Thank you.