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Summary

This on-demand teaching session is relevant to medical professionals looking to apply for specialty surgical training in the UK and Nigeria. It will provide a comprehensive overview of the application process, from the person specification document to supplementary handbooks and self-assessment score forms. There will be a discussion of the main criteria for core and specialty training, as well as a breakdown of the time line for applications and interviews. Finally, attendees will gain insights on how to best prepare for the application process and maximise their chances of success.

Description

Topic:

Mentorship Series: A Guide for Young and Aspiring Surgeons (Session 2)

Speakers:

Mr Ademola Adeyeye

MBBS, FRCS (Eng), FACS, FEBS, FMAS, FWACS, MMCS, PGDE

Surgical Oncologist & General Surgeon, University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Mr Segun Komolafe

BSc (Hons), MBChB, FRCS (Glasg)

Colorectal & General Surgeon, University Hospital Wishaw. Clinical Lead for Colorectal Cancer, NHS Lanarkshire.

Learning objectives

Learning Objectives: 1. Understand the timeline for the medical school, core training and specialty training applications in the UK and Nigeria. 2. Identify and describe the eligibility criteria for core and specialty training. 3. Explain the domains of the self-assessment score used in medical training applications. 4. Explain when the Crest form is necessary to demonstrate a medical applicant's competency. 5. Summarise the disadvantages and advantages of applying for a run-through vs. a traditional post in surgical training.

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

And the journey is so successfully. Um So I thought that it would, you'd be better placed to share some of your experiences and insights because you applied and you were actually your application was so good because you're a good candidate that you got to run through and scored very, very highly. So you'll be very well placed to advise people on general dues and don't and you'll do that. And then once you're finished, I will give a quick talk for hopefully no more than 5, 10 minutes max on general. What makes a good trainee if that, if that's okay? Is that all right? Happy with that. Sounds like a good plan. It's an occasional. Yeah. Yeah. Yeah. Profits. Okay. Let's go. Sam, the floor is yours? Did you want slides for this or will I just normally just, yeah, if you have slides, that's good if you don't, but it slides are good. It's not want any harm. Okay. I can try and share them. Uh huh. Yeah, I'll try it and see. Can people see that at all or? Uh yeah, I can see. That's perfect. That's very good. Ok. Um Yeah, so like I said, thank you so much for having me today. My name is Sam and I'm one of the ST one general surgical trainees here in the west of Scotland. Um So like Mr Mom said, I'll just be giving you a brief overview into what surgical training is like in the UK. Um So for a bit of introduction and for those who are not familiar to the medical system in the UK, so medical school roughly takes about 5 to 6 years. And once you graduate with the degree, your then asked to do um foundation training for about two years. And that's a sort of two year long rotation whereby you have four months of different jobs. And um towards the end of that, you're invited or you're eligible to apply for higher specialty training. And in this case, we'll be focusing only on surgical training. And so after fy one and two, which is what we call the foundation training, um you then apply to surgery and surgeon, general surgical training takes a total of eight years and that's further broken down into the first two years or a lower surgical training, which we refer to as court surgical training or a CT for short. And then you've got a six year program which is S T three S S T eight and ST stands for specialty training. And so in general and to become a consultant and the UK takes eight years of general surgical training. Um The general surgical training application um is a national recruitment process that just means that there is one single online application that you do and that enables you to apply for surgical jobs across England, Scotland and Wales. Um And again, the division between in the lower surgical and higher surgical training program reflects the two separate recruitment times. So typically people will go into court surgical training, they'll apply for court, they'll get an offer for a two year long post. And then towards the end of core training, you would then apply for the six year long post, which is the specialty training. Um There is some exception to that as Mr Coffey has alluded to um that you can get a run through number and that just means that you only have to apply once at the CT one or we call it ST one level. Um And then you don't have to reapply again. Um When it comes to Essie three, if you do manage to secure this run through number, um the application is exactly the same as a course surgical training application. Um You just take an extra box saying that you do want to be considered for the run through program. Um And then that's you set for the next eight years. And the only slight, you know, caveat to that is that there's much fewer posts because England have stopped this program altogether. So it's only Scotland and Wales are still running the run through program and my side's moving ahead. So I call it, sorry. Are the slides moving ahead as I'm talking or not really? Uh that moved ahead. But what I would do some is make you can you, you've got it on the editing more. Can you make your presentation mode maybe bigger and clear? Yeah, click that. See what happens. Okay. Did that work? Uh in a second? Um No, you know that it's not working, it's not shown is it? But that's okay. It's okay. That's fine. Okay. So um yeah, so like I said, it's the the application to the UK surgical training is quite transparent. Everything is available online and if you're looking to apply, you only need to get these three documents and they're easily avail, you can just search for them on Google. And that's number one, the person specification document, number two, supplementary African handbook and finally the self assessment score NG. Um and I'll briefly talk to you what each of these three documents um sort of include. So the rough time line basically is very similar for both court and specialty training and sort of briefly the applications open in November and close in December. And this application is basically for you to submit your self assessment score, which I will explain briefly later on. Um for core training, you have to do an additional online exam which is called the MSRA. It's basically like an online sort of like multiple choice question answer that is similar to at the level of your final medical school test. Um and then based on that, so say that there's a maximum score of say 70 that year, there'll be a benchmark and say, for example, everyone who has self scored themselves above 50 gets to be long listed and they can move to the next round. And the next round is basically you submitting evidence to say why you think you deserve the 50 points out of 70 that you've scored yourself in. Um Again, you have some time between January and February to um upload evidence for that. And then based on that, the highest kind of candidates say that year, they're deciding to interview 1000 candidates, then the top 1000 scoring candidates will be invited for an interview and after the interview, then again, the number of places um the offers will go out and then you can decide to accept or decline the offer. Um So yeah, that that's basically the summary of, of what training is like um in terms of what might be relevant for for yourself in terms of if you're thinking to apply. So you might be asking who is um suitable to apply for court and who is suitable to apply for specialty training. So um that's, you know, easily found in the person's specification document that I mentioned earlier on. And in summary, for court surgical training, you have to have a medical degree which I'm sure everyone will have. Um, but you have to have completed your foundation equivalent, um, within the last 3.5 years to applying. Um, and for, you know, yourselves, you might have, you know, be doing the pledge exam to, to come across, but you must not have done your foundation for more than 3.5 years ago. Um, and you wouldn't have done your foundation here in the UK. So in order to prove that you have met the competencies equivalent to that of a foundation doctor here, there's a form that you need to download and get your consultant to sign and that's called the crest form or it says the readiness to enter specialty training form. And on top of that to apply for court, you must not have done more than 18 months of surgical experience and that includes any sort of surgery is not just general surgery, even E N T or plastics that all counts. Um So that's basically who qualifies for court and then just a bit about the self assessment score ing, there's four broad domains in which they assess you on. Um the slight variation from year to year, but broadly, the main four categories are the ones that I've listed below. Um And you have to sort of the more evidence that you have in each category, the higher that you'll score. Um So this is just some information about um the different areas which if anyone's got questions we can answer. And then finally, for specialty training, um who might qualify to apply for specialty training. So, um again, you have to um have your medical degree, but on top of that, you need to pass the mrcs exam and that's the MRCS part B exams. You would have had to do part A and part B and then that qualifies you to apply for this. Um You also must have, um, again, the same Crest form which shows that you are competent in a foundation level, but also the Crest form that says that you're competent court surgical level as well. And the more important thing is that, um, the problem with higher surgical training is that it actually disadvantages people who have done um a long period of time in surgery. So you can see the desirable criteria is having less than 72 months experience in general surgery. So that's less than six years. Yeah, quick check. You're projecting slide three. Is that what you're still on? Uh No, I'm sort of like quite far ahead. Um I thought that was just the double check. Um That's okay. I mean, we can, we can go back and if anyone's got questions, we can. Yeah, but anyhow, um yeah, so basically for higher surgical training, yeah, like I said, I said, yeah, protecting that. Was that intentional? Uh Let me see, I'll try again present now, share your screen. If you're clicking, I had to stop clicking or something. I don't know if you stop clicking or what happened? Ok. Let me see. Entire screen share. Am I sharing now? You're sure in your entire screen? Yeah, that's good. That's probably a slight. Uh Yeah, that's self assessment form. 10 questions. Okay. Yeah, so sorry just to go back very little bit. So like I was saying the court surgical training, so the application criteria. So this is what the person specification document will look like. And these are the things that I told you earlier on about who qualifies to apply for this. It's quite clear here. Um So you can have a look through that and then the self assessment score ng as I said, there were four different domains and this is what the PDF looks like and that's quite, it's quite detailed in telling you what you can score for what you know, what evidence is, is applicable. So, um if anyone's got questions, we can go through that later. Um but continuing where we left off, so who can apply to specialty training. Um So like I said, um it disadvantages people who have had lots of surgical variants and it's designed to for those who have done between one and three years of surgical training. Um but on top of that, you should have done at least two rotations which is out with of general surgery. So other surgical specialties um E N T plastic. So things like that will actually put you uh in a more advantageous position for your application. And also appendicectomy is is the single most important operation to apply for higher surgical training because you get um scored based on how many you've done. And again, you kind of done too many. So the sweet spot is between 50 and 100 appendicectomy is whether that's laproscopic or open. Um So again, we don't need to go through every single bit. But what I was trying to explain is that in question one? So like I said, there were 10 questions that they'll ask you to fill in and create your score. But in question one, it actually tells you to, um, let them know how many, how much time you've actually done in general surgery and that gives you an end score. So as you can see if you've done less, your end is like one. And then uh as you go down the ranks, if you've done more surgery or end score is higher and that becomes relevant because the other few, the other questions, there's a lot of questions about how many presentations have you done? How many publications have you done at the end of the day? They're going to make you divide all that you've done by your end score. So say you've worked in surgery for 10 years and you've got 100 publications in the end, you've got 100 you have to divide it by 10. So versus someone who's only done two years in surgery but done say, you know, much less. It doesn't mean that if you're trying to get on saying that it doesn't mean that at the end of the day, it's not an absolute number of publications or presentations that you've done because they averaged over the amount of time you spend in the specialty. Um, so that's basically it really. Um And then based on what your application or your self assessment score is, you then submit your evidence. If they think it's justified, say you're, you're, you're trying to claim 50 points and they say, yep, all your evidence is fine. And in that year, 50 marks, you're unable to go through to the next round, then you get shortlisted and you'll have to do an interview. So the interview for um you know, core surgical training is shorter than what this, this slide that I've got on is for the highest surgical training, but it's quite similar. There's two broad sections of the interview, you'll do a clinical and a management part and then you've got a bit about portfolio. Um And then based on that, they'll again give you interview scores and finally all your scores are added up and the best however many candidates can offer for that year. Um So yeah, I'll stop sharing. Now, that's a brief overview onto application um here in the UK and I don't know if you wanted to take over Mr Khorafi. Okay. So that's very, very, very, very, very good. So I'm very informative and very rich and very put together at short notice about an hour and a half ago. So thank you. I am in your debt for doing that. And what I will try and do if I'm able to is share present now, share slides, uh Nope, share screen. Nope, give me a minute guys. I've never used this platform before. It's my first time using this platform. So, apologies. Allow. Whoa, okay, I want to share this. Can you see this night? Yes. No. Yes, we can see a slide. Okay. Good. Okay. Hopefully this will work is that. Can you see that? Yes. OK. I can't see anything anymore. I've got some I screen. So basically, thank you for the invitation. Um There isn't a lot to say. I thought that would supplement what Sam said about just the nitty gritty and the details of how to get a training, how to get in the training system uh with just general things that I think make a good trainee. Um And I've divided into two groups. If you like one group, I would say it's just kind of more character traits um which I hope our self explanatory but maybe not. Then the second group is going to work in a practical things or tips. So initiative which is to take initiative, try and problem solve, try and be active, not reactive, trying to anticipate rather than waiting for things to happen. So, you know, a good, I tell Sam when Sam work for me, I was always kind of telling them consistently to move the camera. And over time, they began to, you know, she would do it instinctively as with other trainees. So a good training takes initiative to try and problem solve for you work hard hope that's self explanatory. There is no substitute for hard work. And then as a consultant, I know when my trainee is hard working or not because there are things that I will find out from other people or from my secretary. Actually, she will tell me, you know, this train is very good at clearing all the admin and paperwork gets done whereas the other trainees and so we've been the paperwork or admin for example, so be hard working because if you are, it's always evident and transparent. The enthusiastic enthusiasm should be free and easy. Um to be positive, be energetic, be enthusiastic. The emotional intelligence is one that's a bit trickier to quantify. But I think it's actually one of the most important features that you need to have. And sad to see the kind of personality types that going to surgery tend not to have emotional intelligence. Surgeons tend to be surgery, self select people who are confident, arrogant, some might say psychopathic who want to operate and fix problems and like to have a problem to fix. And that often means you don't appreciate yourself, you don't appreciate how you come across. You don't appreciate how you're perceived. So it's really important to have emotional intelligence of how you are, how you function as a person. And then the last kind of character or trait, I guess is knowledge, be knowledgeable. And by that, I mean, know what's current in the evidence, not what you read in Belize in love textbook or this textbook. What is the latest scientific evidence? What are the guidelines if you're a colorectal? What are the current colorectal guidelines? And what are the current upper gi guidelines? What are the current guidelines for appendicitis, appendicectomy, colonic polyps, etcetera, etcetera, be knowledgeable and the current in your knowledge. And then the other thing that can help you as a surgical trainee is um these are four, I guess broad groups you think about one is try and get to go on courses. These courses cost a lot of money. I know that, but you pick up so many, so many skills, you get headspace to think in particular. People who have transitioned from the Nigerian system to the UK Hill system often find that um because of the Nigerian healthcare system in our hospitals, Nigeria, we don't tend to have a lot of intensive care facilities. So we don't get trained in intensive care for a surgical patient. So one of the most important courses the crisp course, which is the care of the critically ill surgical patient care of the critically ill surgical patient. That's a vital course to go on. And I would recommend that anybody who comes to the UK from Nigeria must get yourself on a crisp course. Within the 1st 12 months, it is mandatory because it will make you a much better surgeon for managing patients'. And the Nigerian Health surgical mindset is very much operate, operate, operate in the UK. There's a greater emphasis on looking after the critically unwell patient because we have people who are older frailer with brittle physiology who need more help and support A TLS course is worth doing for managing trauma and emergencies and any get yourself and skills courses, laproscopic courses, endoscopic courses, uh general surgical courses, G and S two most courses as many as you can if you are in a formalized training post and some of these are sponsored. If they are not, you have to be self pain, but it was a worthy investment wherever you are in the U K training, there will be a local college of surgeons. So in Glasgow and the west of Scotland, Edinburgh, in the east of Scotland, in Southeast London, in England, and in Ireland across the pond. Um And I would say that even if you're not a member, all the colleges have affiliate membership rolls or have trainee rolls that you can get involved in and run programs too because what they want you to do what the college my college in Glasgow wants is literally when you're a medical student, they want you to come an affiliate of the college. So that if you're an affiliate of the college in time, you will do your membership at the college and become a fellow of the college because then that's how they make money off you is your annual fellowship that you have to pay. So all the colleges are very open to having affiliations. So explore those and get involved in those. Third thing to think about is scientific meetings. A SGB I, that's the position of surgeons of group written in Ireland A L S G B I. That's laproscopic surgeons, A C P G B I. That's cool. A proctology, august upper gi surgeons, basil breast uh breast surgeons, all the different surgical, especially as have the surgical bodies at a national and international. And I would say try and get to when I was a trainee, I had a target of getting to one meeting a year and I would alternate between A C A S G B I L S G B I K C P G B I. And that's national meetings. And there are also regional meetings. There will also be local meetings to try and get to those because not only do you learn, not only can you get to present but you also network, which is very important. I mean, the last thing I would say is that all the surgical specialties have trainee groups. So in colorectal, it was a Dukes Club for General Surgery. It's as it for the breast surgeons, it's Mammary Fold. So if you inquire all the UK especially have their trainee groups and you can join those for a nominal fee. And if you're a trainee from abroad, it tends to be free or very cheap. And that's another good way and that, that allows you access to resources, to meetings, to educational content. So I don't want to take up too much time cause I know that we started a little bit late, so I want to just stop there. And I would say these are just general things that I think help you to be a good trainee and we can either do questions now or at the end and I will try to stop shearing. Is that okay? Am I still sharing? Uh uh Can you hear me? Okay? Yeah. Yeah. Uh Thanks. Thanks a lot for that. Thanks Sam for share ing that as well with, with us. Um That was really fantastic. Um We, you've got, I talked to a D A back now. I think he had a bit of connection issues. Um Yeah. So uh just gathering the questions and we can, we can I suggest we just take all the questions at the end of the session or what do you think? Do you want us to talk with the question. Okay. Brilliant. Yeah, happy to do questions later. Okay, cool. Uh Dr Addy am not sure with uh Yeah, Sheena, both of you have channels are opening to meet one probably or one of both your volumes are open. That's why you're echoing for the rest of us. Oh yeah, that's true. Right. Hello. Can you hear me? That's good. Brilliant. Yeah, we can hear you. Yeah, apologies have been struggling with internet connectivity where I am so I would have to uh speak without my video, improve the bandwidth out. That's okay by everybody. Excellent. Thank you. So I will try to share but I don't really have much to talk about. Give me, give me a sec. This thanks mate. Yeah, very clear. So I would just skip this just to thank for the indication and grateful for the position from Sam. And then Mr uh so I was meant to talk about uh the practice of becoming a surgery 19 Nigeria. I would just say a few things and about the popularity that we have in here and using this slide and a few more slides too. So unlike what are represented before now, the sequence of events from becoming surgery. Nigeria has a straight pathway, but there are a lot of activity in between. So definite secret events that you should have completed medical school training and have a medical schools and certificate M B B S or M six units depending on where you got it from. And then complete mandatory one year of a house manship as an intern. And from there you get your uh suspicion from NBC N to fully license to practice as a doctor. And there's the rule that we have to spend one more year in the National Service Corps or you can get exemption for that if you're beyond the criteria for that service came. And so having completed six plus x years of medical school training, one year house job and one year of good service, you will be entitled to enter the residency program to become uh agriculture. Uh Now the one like in the UK where there's a structured format to enter the program. It's very happens that here in Nigeria. So we have to make college is the Psychology of Surgeons and the National Local American College of Surgeons. We'll see the medical training, it becomes surgeons in Nigeria. Uh The criteria is mainly institutional based but explaining that you would have had your medical school graduation, done your internship at your EN Y C circuit, the exemption and then written an exam called the Primaries exam, which is the entry exam into the training program for both your several college of soldiers and all the national provide medical college. You may decide to write boats or right one or the other and then pursue uh pathway through those colleges in the past days to allow exemptions that see if you pass the primary exam for the National College, you could apply to join the Bottle college of surgeons and vice versa. I'm not sure if they're still holds. Now, the exam is came mainly a computer based test and emcee cues and then there's a favor applicants and are now giving the results and then encouraged to apply for residents into institutions now that there is, it's very difficult to get people to even come into the program. So many incisions are now accepting candidates without even the premise exams. Um I am aware of the number of centers now who actually encourage you to come into the program and they write their premise exams while we started training, but we came here that they would have passed exams within the time frame, probably six months or one year into the training. Um So once one has started a training program becoming general district and by the request of allergies, we spend at least three years in that post where you rotate through in the specialty, general surgery and then some other cord a cord specialties and urology, orthopedics and accents, emergency three months of neural postings and some other elective postings to make up three years. And then by that time, you'll be eligible to sit for the membership exam and it's now called a member, for example, the best quality of surgeons because people can actually decide to stop the training after that program. And Rick, recognized as a surgeon put on on coat uh called a member of yourself college of surgeons uh but still not a lucrative party. So people still going to continue training after that after that stop gap. So um the energy for that is to complain you all the required rotations attending reverent ob bit courses, including your basic, basic vocal skills course. And then having your log book signed for the aqua number, quite a number of the cases to have participated in and having your your form signed in an accredited institution. And thereafter, um once one has passed the exam, which is mainly an MCQ exam, essay exam, and whiskey. And then clinicals, you go into the senior training program at a senior instruct and then walk towards the fellowship exams again, that's a three year uh program. And they knew that period of time we have tried to write a dissertation which is already the new for the same quality of surgeons. And then at the end of that program, at the end of that program. Excuse me, please. I'm so sorry. In, in in. Thank you, Mr Chris. No problem. He he mhm. So keep your questions coming and we will take all of them after after doctor R D A U Stock. Mhm Please forgive me. Um Somebody was tampering my cat. Can I, can I continue? Yes, please. All right. I apologize for that. That was a bit dramatic. So I was trying to say that the, the second stage of training is, you know, registered training is a three year program and where you complete as a general surgeon training, you complete most of your training in general surgeon, but you're actually supposed to spend six months outside general surgery were taking through some electrics venue, your choice, uh pediatrics, geology, characterised allergy and just get a feel of other specialties while you're still a general surgeon in training. And then thereafter, you also write a executive as part of your training and then going for the exams. So it's going to be more of a clinical exam for the ERCP they pronounce, they will have to pass the risk. I part of the exam executes and essays and then those who have successful that going to write the clinical exams and also defend a dissertation of the choice. So people can actually pass both, that's part of the exam dissertation and the the rectal part of the exam or pass the ocean alone or pass the correct part of the exam alone. And that will be reflected in the score. But you're meant to pass both sides of the exam before you be allergic to become a fellow of the colleges. And then once you become a failure, you get both of your graduation and then get and you start to apply for post to become a consultant. So that's basically it is the pathway that we see uh for Nigeria. So in the challenges we have in here that there's a lot of ambiguity in the process of selection chauffeurs of training. And we don't sometimes at times have the volumes that are necessary to get trained. And a lot of interruptions based on strike actions by the doctors and the general health sector is deteriorating. And so it's really to adequate standards are very poor. The many of trainings don't even have a good experience to endoscopy, laproscopy, and other uh advances in cycle training. Uh Many of the standards are still below what we expect globally. And it's actually a source of concern and the exams can actually very, very object subjective. Some people may get bad cause just based on their parents based on what they examiners, the field and I've been a victim of people have been victim of that. So it's been very, very difficult um setting. So, uh and then that takes into the second part of this government discussion that um having identified these lapses. The question is we want to go through that same training program and then come out as a surgeon probably have the and try to augment your training or will you be able to shut to and, and find a greener pastures? So we're seeing many of our residents actually leaving the program, me training to go to other centers, other places outside Nigeria to get trained. Uh and it's actually a source of concern uh in one institution in Nigeria, as many as 100 doctors, medical practitioners live in a monthly on a monthly basis. And then people are very, get, getting very worried about this. For what I decided to do when I was in training, was that when identified these lapses, I decided that I'll complete my training as fast as I could. And then go on to get further training outside the country and acquire other fellowships too. So that took me the quest of getting and you provide of surgery and fellowship fellowship, minimal access surgery in India. And then also the FRC has recently uh in general surgery and two tegument. My training, my own advice for people who are in training in Nigeria who want to get argumentation in, in their, in their training portfolio is to actually try to meet, compare what you have to what is expected globally and they record your surgeons have a good template for comparison and where we identify those gaps, find a way in which you can cover up those gaps and lapses, joining societies and, and professional bodies could actually give us access to 22 scholarships uh fellowships. So I joined the University of Surgical Oncology and applied for training fellowships. And that took me to less than in UK in, in 2018, sponsored by, by the College and American College of Surgeons. Also give some sponsorship for me to go to the, to the US. And I got uh other training grants to from different societies and bodies. And there are some, there are some training girls actually available for people from low medical countries to encourage training in this sector. So people can actually go to apply for those. So in a nutshell, I have just given an overview. A sorry, I'm sorry for the interactions between that uh story training Nigeria, although has some level of structure is still a bit ambiguous and a lot of deficit gaps in there. And my own advice for many people in Nigeria is to find a way in which we could get training outside the country to fill those gaps. Thank you. Yeah. Thank you, Momma doctor for that presentation. I was really awesome. Um Well, start taking questions. Now, if you've got any questions, you can pop it in the chat box. I think the first question here is about whether um one can apply for a training program before starting work in the UK. Um Can you uh my committee? Okay. Yes, because my screen is frozen at my end. Okay, because short answer is yes, you can apply for a training post. But assam has laid out because the, the, the criteria for entry are so strict that not strict, that's not fair, but they're so precise that if you don't meet all the criteria won't have a chance and the reality is by design or default. Um, trainees who trained in West Scotland, er, the UK who are coming through the system tend to meet the criteria more naturally the point that doctor, hey, wait a minute ago about actually having a clear plan and looking at what you have versus um, what, what the requirements such as a very, very good one. Because if, if you, if by some, how you meet all the criteria for a training job, you'll get it really no matter where you apply from. And if you get a training and if you apply from abroad and again, you get accepted for a trading post, you get your visa because you've got training post to come to. But the hurdle will not be paperwork. The hurdle will be, do you meet the criteria which are quite precise? Sam you can say more about that possibly. Yeah, I agree with what you said. I think the limiting factor because they want you to prove, for example, whether you're applying to court that you have met the foundation competencies or whether you're applying to hire training that you have met the core competencies and that can only be proven by getting your certificate or readiness to enter specialty training. Or in other words, the crest form signed off and that usually has to be, or I think I'm quite certain that it can only be a consultant that signs you off on that. And so if you haven't made connections or if you don't know no a UK based consultant who can vouch for your competencies, then that becomes very difficult because that is the requirement for you to apply. So, um oftentimes what happens as this clam face said, people will come across and then they'll maybe do a year um as a clinical fellow to get to know the consultant gets to know them as well. Once they get that signed off, then it makes it easier because um yeah, I think most of the other things you can work on it from afar, from your, from your country. Um But that is probably one of the main ones that would sort of limit your application from afar. Yeah, I totally agree. Um So applying from any part of the world is not the problem. I think the major thing is for you too, sort of score points or tick the boxes that you need to switch that you, you can um be able to compete quite um well, because of course, there will be lots of applications. Um So if you're, if you're applying from say Nigeria or from Ghana, from Malaysia, from any part of the world, um you need, you need to see the criteria. Um There's a, there's a self assessment form which you would see and um sort of score yourself based on that and depending on whatever you call, that's what's going to decide whether you're going to be um long listed for interview. And um like Sam said as well, you need someone to sign you off, you need a consultant most of the time they prefer um a UK consultant um with the G M C number to sign that form. Um but sometimes they, they also accept um the form signed by consultants abroad. So far, the it's clearly stamped or the um medical body um number just like GM see Nigeria to be um M D C N if the number is clearly stated there and it stands, I think um you stand the chance of it being accepted, but preferably um to be a UK consultant and of course you wouldn't be able to get that except you are here already or pro adventure. You, you've worked with the UK consultant in your country who can also sign that off for you. So the, I think that's okay. The other question we've got here, um I think I've answered on in the chat box. It's not uh it's related to Max Fax. I don't know whether some knows anything about Macs. Far as I don't know much about Max Fax myself. Yeah, neither do I, I try to have a Google but yeah, I think probably just like you said, that link will take you into it and you can probably have a good read. I haven't had a chance to read the handbook yet. Yeah. So um that link should help um Opare me. I think it was a way for me to ask the question that link should possibly help um to get the answer. But most of the time, um whatever you do in medical school counts, um conferences, courses attended and all of that, even if you do an audit, um sometimes they do specify that I should be post medical school. So you just need to read clearly in between the lines and read the small print's as well. So my, my wife, I was buggy there so I dropped out very quickly. The last thing I had was the max fax question. Um I don't know what answer you gave. I can certainly try and making some inquiries for a max fax trainee. Um But I don't know there would be any different. I don't think the sequence that you do. Your max facts or medical degree matters as much. Um I have a sense that if you're a max fax, sometimes the medical degree could be shortened, the first year can be taken off for example. But beyond that, I really wouldn't know, I can certainly ask people around if that would help, but I don't know about your asking. Very, very good question, quite insightful. I don't see why it wouldn't count, but sometimes they're, these bodies can be funny. But I also know, I also have a sense that has been a move to try and synthesize and integrate the dual qualification. You have to have to get into max facts. So I wouldn't be surprised if it counts and something or other. And I will also wouldn't be surprised if you're not punished as much for having more experiences with the max facts, but I would need to ask properly. Okay. Thank you Mr Kola for, for that. Um Yeah, I can, I can drop an email for you too, sort of reach out so that um, once we get a proper answer for your question, you can send it across or basically that's that, um, that's, that's the logical answer to give. And if you check that link that I dropped, you possibly would get an answer to it as well. But I would drop, I'll drop my email in the chat box. And if you drop me a meal, then, um, after this meeting, I'll try and confirm from a max bags training to get you the correct answer if that makes sense. So, um, I think that's all the questions in the child box. I believe every other person on sort of understood everything that I've been said very well. That's why there are no mode of questions. Be that as it may, if you've got some questions after the session, you can always drop me an email as well on. Um, I'll try my best to get an answer to your questions across to you. So I've dropped my email in the chat box. Um Thank you, everyone in the absence of no further questions, I think, um, it's safe to call this a wrap. Thanks very much Samantha for turning up. I was um really fantastic given with the very short notice. Uh Thanks Mr Carmel Affair. Thanks. Um Doctor, the a really much appreciate um your presence and the talks. Um I've literally gained one or two things myself and I'm sure the audience have gained quite a lot as well. Um I will send the feedback for now is um should be in the chat box now. So if you feel the feedback form, then, um, um, that would be very helpful for us to know what we've done rightly and what to improve on. And also that's gonna get to a certificate for attending this um, session. So this is the part two of the mentorship series being organized by Cigar General Surgery. Uh, cigar stands for Surgery Interest Group of Africa. If you want to join the organization and just drop the link as well in the chart box. So you can, you can join via the link. You literally can join any specialty you want. We've got over 10 specialties and sick of and I'm gonna say that's it for now. Thanks everyone once again and, um, have a lovely weekend by everyone. By, by one. Thank you. Thank you.