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Ok. So just while we're sorting out sharing slides, um I'm just gonna kick off the webinar by saying good evening. Thank you very much to everyone who's um joined us this evening. Er, we hope you'll find the next, just under an hour or so very useful. Um I'll just introduce myself. My name's Garima Goins. I'm um an ST five general surgery trainee in the east of England. Um I'm hosting this on behalf of the Morning Academy who is our trainee ring of the A S GBI. Um, if you've not followed us on social media or in our big whatsapp group, I will signpost you at the end of the talk. Um, but as we are coming up to A R cpcs and at least for the registrars and some people have started their core training or higher training, er, last month. Er, we thought it would be a good idea to set up a webinar with some very experienced um, consultants who can give us some tips and tricks about how the most IP, not just as a tick box exercise, but as a genuine learning tool and how you can use it to engage with, not just your I RCP, but your learning throughout the year and throughout your career. Um, so I'm just going to click that we're ready to go broadcasting that I will introduce our speakers shortly. Can I? Great. So, if we make a start? So, um, first I'd like to introduce pro Jill Tierney who, er, is currently the head of school for surgery in East Midlands. She is also the president of the A S GBI and is a consultant, colorectal surgeon um at the United Hospitals of Derby and NHS Foundation Trust. Er, and I'll, I'll introduce our other two speakers as we go along. That's great. Thank you very much. Thanks. Delighted to have been invited. So I hope this evening that three of us presenting can show you that there should be no mysteries about your ACP. Um, and no mystery about I SCP either. So I have an extremely dull presentation which is largely cut and pasted from I SCP. But I'm aware that many people don't open their I SCP until the night before their ACP and wonder why it's all quite so exciting. So, if I share this, I show you my dreadfully disorganized desktop and do that there we are. So I wanted to talk a little bit about the requirements for each phase of training and you're aware now that training is described as three broad phases. So phase one, which is essentially core, phase two, which is the first bit of higher surgical training and phase three the last bit and the descriptors for everything that's in the curriculum are available on I SCP. There are not all those little bits that we skip over before we get to our own portfolio and it's worth having a tour around that front window. So you have no surprises later on in training. So at the end of phase two, which is at your ST six A RCP, it's what's called a critical progression point. Um And these are the bits where if you seem really ahead of trajectory, you might ask your TPD to consider bringing your CCT date forward and showing that you've evidence that you're at this critical progression point a little early equally. If you haven't got what's required, these are the phases where your TPD might suggest that you may need extra time in training. So indicative numbers of cases are exactly that it doesn't mean you have to get exactly the number described here. It means you have to get something like the number described here in combination with evidencing that you're good at the procedure that you're safe and capable just so that you're safe to practice as a consultant at the end of the day. So at phase two, everybody doing general and gi surgery has to have 50 ish give or take inguinal hernias, 40 cholecystectomies, 15 segmental colectomies and 45 emergency laparotomies. And I would say when you start registrar training. If you can try and hit the ground running with the emergency laparotomies, you'll be really glad a bit later on. And it's one of those things where we naturally hold back. But if you have a supportive consultant, you should be there doing most of the parts of an emergency laparotomy under supervision so that you can count them for these numbers. In addition to logbook numbers, you also need to have procedural based assessments showing how competent you are at what level. And for this phase is to be safe at all the aspects of performing a hernia repair, which one would expect at ST six level, you need to demonstrate level three competence, cholecystectomy and segmental colectomy. And ideally three different assessments by three different assessors. And like with everything, if you can get those done upfront and as early as possible, you won't be sweating the night before your ACP trying to find the evidence. In addition to that, ideally, at the beginning of the case in theater, you should say, can we do this as a PBA later on? You should formally be assessed during it and then you should have a debrief with your trainer afterwards and fill in the I SCP documentation live together rather than bundling up a load of them and emailing out wildly the week before your ACP. There's also a list of critical conditions that you need to demonstrate evidence of familiarity and knowledge of with either A case based discussion or a clinical examination. And these are things where a patient might die if you didn't know about them and how to manage them. The list there is obvious but the acute abdomen. So the first time you're on take on call as the surgical registrar, why not ask your consultant if they do a case based discussion about your assessment of the acute abdomen and get that first one out of the way. And each time you see somebody because some of the other things like necrotizing fasciitis are not so common and you may not see so good to use that opportunity when you're on call and ask them, say you came to this webinar and you'd like them to do a case based discussion with you so that you can log the evidence that you've seen these critical conditions. And then these are the speciality specific ones to see fecal peritonitis, um esophageal perforation, that kind of thing doesn't happen all the time. So when you see it, take the opportunity to have a case based discussion and upload the evidence that you have. Then phase three, requirements differ according to what you've chosen. And for the purposes of this talk, I've done the three commonest which are H PB surgery, colorectal surgery and trauma. Everybody in general surgery is regarded as an emergency, general surgeon with a specialist interest in their elective practice. So for phase three, the logbook requirements for somebody with A HPV interest are that 100 laparotomies and everybody in general surgery at the end of training is expected to have performed 100 emergency laparotomies. And obviously, as you get more senior, you're doing more of the other stuff in your speciality. So as I've said earlier, it's really key to try and front load your training with those emergency laparotomy numbers. Ditto for the appendix is how often would you see an ST eight? You should be logging lots of these as training another with your appendixes at this phase of training cholecystectomy 50 segmental colectomy and then your PBS. Sorry, your sorry, your logbooks and your specialty specific things are major H PB procedures. So that's left fairly nebulous. So it could be Whipples liver resections, that kind of thing and 100 and 10 cholecystectomies. And I know there's been much talk. I went to Agis last week and saw that many trainees feel there should be 200 which was interesting. Phase three procedure based assessments are as before you need to show level four competence in an emergency laparotomy. So you can do all of it. The same for a cholecystectomy. A Hartman's a segmental colectomy and an appendix. And that's cos these are the most common emergency procedures. Then the specialty specific ones for H PB would be level three at a liver or a pancreatic resection and level four, a cholecystectomy. And again at or there was a lot of talk about whether bile duct exploration should be documented. And as part of this, just as a side, the curricula are all undergoing redevelopment at the moment and there's lots of discussions ongoing about what is appropriate and what isn't. So for colorectal, very similarly as before these generic um emergency procedures that everybody will need at the end of certification and then the colorectal specific ones, anterior resections, 30 doesn't seem like many, but it's really important to try and get your numbers in early and any approach applies. So laparoscopic or open and if you're lucky enough to be somewhere where you get access to robotic training, a robotic anterior resection would count fistula surgery often more difficult to get access to if it's done in a separate place and a day case unit. So be strategic as you get to this phase, the third phase of your training, hemorrhoidectomy, again, not such a common operation. So again, may need a few scheduled trips to the day case unit and then colonoscopy at present 200. Everybody in the colorectal training community knows there's discussion about trying to make it match the jag requirement, which may well be a feature in the new curriculum phase three PBS. You need to be level four in those things of emergencies to show safety and for your specialty specific ones. Level four in an anterior section. It says high here, I think any anterior resection and segmental colectomy fistula surgery and the surgical treatment of hemorrhoids. And these are sometimes things which I've seen people in s th struggle around to get two more hemorrhoids and a fistula. It's the kind of thing that doesn't happen in main theaters. So be strategic early on the ETS and trauma curricular requirements have the same emergency surgery requirements. And then, and in this new iteration of the curriculum, there will be numbers based on evidence but trauma, laparotomy, pediatric trauma, laparotomy, thoracotomy and surgical airway management. So the numbers are required as that and the PBS for the general emergency procedure is the same as for everybody else. And then the trauma PBS um are level four and they will accept in a simulated s situation for some of these because certainly surgical airway management has proved a bit challenging to people to get in some centers. So that's all the requirements. The only course that's an absolute requirement for CT is ATL S DST S European trauma course or equivalent a course which achieves the competencies required to manage a multiply injured patient and then how to evidence what you've done the whole time. I know that lots of us don't look at the portfolio and have a big crash management thing two weeks before the ACP. But it would be great if you could almost think of it one night a week, two nights a week, almost like homework, open your portfolio and look at these bits. How have I evidenced the required capabilities in practice. So have I got an up to date MSF I haven't even started one. Let's start it early. So the responses will be in, in time for your ACP and that might draw attention to how you manage an outpatient clinic or do various aspects of the job. Have I got APB for that thing that I know is quite hard to get hold of in the critical conditions, just actively manage your own portfolio and then their generic professional capabilities. And you can evidence these in these other ways as well and they're good to upload the evidence to your portfolio. And if you're expecting challenge in an area, if you feel perhaps somebody doesn't think you're good enough at. Gosh, I don't know. And teamwork, get the evidence on there early, get somebody to say something good about it in your MSF because you've delivered a course or you've taught somebody or you've shown leadership just put lots of evidence in so that you are robust in showing yourself to your best for your ACP. Um And your clinical skills again, mostly your logbook would evidence those technical skills the same with your PBS. And that's the end, stop sharing of my presentations. So my advice would be just open up IP take a good or an hour or so, wandering around it, go to all the back corners that people don't look at and be proactive in management of your own portfolio. Thank you. That's great. Thank you very much, Pro Tierney for a whistle stop tour of overall. How, what your ICP is made of what you should think about from sort of starting your rotation. Um And at the end we can sign post where you can find all of these, but I'm sure a lot of you have already seen some of the slides that we've shared. Um So next up, I'm going to introduce Prof John Lund, who amongst many other things is the chair of the J CST er, and also a colorectal surgeon working at Derby. So I'm going to share the screen on his behalf. So bear with me. Um, the other thing to notice is the chat is open for Q and A er, after er Mr Ariel's er, talk. So if you think of anything, you don't want to forget, you can post it as you go along, but we will just address all questions at the end. Great. Ok. Oh, I'll wait for the slides to go up. Yes. Bear with me. Enteroscopy, right? If you can, can you see the slides? Yeah. Are you able to see um the powerpoint? No, no. Ok. So I'm having the same problem as everyone else. You tell us. There will be a PBA on this later getting a level one currently, I think. Ok, all you have to do it. Bear with me. Three bye. Oh, perfect. Great. From the beginning there. That should hopefully be a decent size now. Oh, that's fantastic. Thanks very much. Um So thanks very much, great advice, Jill. I think if you follow that just about getting involved early. So making the most of I SCP. And before I was chair of J CSE, I used to be surgical director of I SCP. And so I've lived with it for quite a while in all kinds of ways. Next slide. Thanks. So, what is it? Well, it started in 2007 with modernizing medical careers where the GMC required everyone to have an online portfolio. So is EP was constructed at that time because it was 2007. The internet wasn't what it is now. So it's a bespoke website. Every single line of code on is EP is typed by hand by a really quite too small web team. And I suppose that's when you're thinking could an is EP just doesn't look as good as this. And that's the reason we don't have the resources of Google and we don't have one of those sort of drag and drop websites. So everything has to be redesigned. So that's just just a thing about I SCP. But I think given resources we going to do pretty well anyway. So, but what it is, it's a comprehensive platform for all of your surgical training. So it does everything you need for surgical training, collects, collects the data, administers the assessment and also has all other parts of your portfolio on there. An ICP is part of the joint committee on surgical training and what it's there for really is is to ensure consistency across the UK and Republic of Ireland in providing a structured pathway. So all the curricula are hosted there. You go to the slide deck at the top of ICP, you can click on surgical curricula and easily find your own surgical curriculum there and wall to do that and also a record of training which you gather as you go along through all the assessments. And that is what is accessed at the ACP and reviewed by the ACP panel. And in the vast majority of cases allows you to proceed to the next training year and it's made up of three big areas, really the E portfolio, um the portfolio, the competent based assessment and the specialty curriculum, as I said before. So what are the key features of I SCP? Well, there's these three things that I said. So E portfolio is everything you need on there to record what you do. It's a central hub for documenting your progress. Importantly, your reflections, you can upload to the reflections and other evidence, parts and evidence of your competencies. And then also gives us direct access to E logbook as well. So there's a seamless between is EP and E and E log book for many years because it's hosted by World Cultures of Edinburgh. That communication didn't happen but over several years, we managed to do that. And also so you can see what you've done as well and see how you are against those things and those figures that you all showed in the last talk, the assessments. So we have both formative and summative assessments here. And it's really important to get engaged with a formative assessment because what you do is get good feedback from your trainers and that helps you get better quicker. That's an evidence based thing. If you get good feedback, you know, you know, where you are, you know what to do to get better and then you can keep doing that as a iterative cycle. Don't just save the assessment for when you know, you can do it because you'll be slower getting there. So engage early do formative assessments. We have the M cr there, which again is a formative assessment. You get, you set that up early, get your consultants to engage with that and you get a group of people to have an opinion about where you are relative to the endpoint of surgical training. Also your self assessment is really important. So because again, it's the same criteria in the same areas, but you have to be really honest about where you are and what you need to do to move to the next next year, the next phase of training, because you will identify some things that your trainers don't see and you can do that put that together in your learning agreement. And I must stress it's an agreement between you and our educational supervisor to decide what you're going to do in the next 3 to 6 months to help move you forward in training. And of course, also there, there are lots of work based assessments, something for everything. We've rode right back on the number required and you used to be at least 40 in a year. But because the M cr is there, then there is no real indicative number for work based assessments, but you should use them to sort of augment everything else and to get some feedback, to formalize that feedback, to help you move forward. And then on there all specialty and core curricula can be accessed from the ICP homepage. I really would encourage you to go and have a look at that. All those things that Jill was presenting are in section 5.4 and appendix, appendix four. And they're the criteria you need for CCT and you need to meet those to get CCT and to be assessed by the ACP panel and also from the SAC, the specialty advisor external. And then it was only then that you'd be allowed to get an outcome six. And then from there would be recommended for insurance specialist to register. So have a look at those and chart your progress again, those as you go along. So it's not all a big rush at the end, you're not running around for things. So tips of maximizing your use of ACP. Well, first thing, make sure you get the correct exposure to what you should be getting in your job. We at J CSD described agreed with the Confederation of postgraduate schools of surgery, what you should be having in an average working week, you can see those at that link there. But if you go to J cst.org, you can follow the links for quality indicators, quality shows for quality indicators. And it describes what you do on an average working week. But it's a couple of supervised lists a week, a couple of supervised think a week, an emergency list a week and access to teaching of at least two hours formal teaching a week on average. So make sure you get that if you're not getting those things and you're not going to get exposure you need. And so go to your a go to your clinical supervisors, take the quality in the cases with you and also you can see the surgical qet in your hospital and point out the deficiencies in your job plan and hopefully things should get moved around with all these things in training. If you're not getting any joy there, then you can go up the ladder a bit to the program director and from there to the head of school um be organized. This is hilarious me saying as I'm one of the least organized people in the world. But make sure you're registered with is ep as soon as you join a program through core training and then just think about what you're going to put in there. If JLL said you do a bit of homework twice a couple of times a week, what we're going to need, how you're going to get it there and then nowhere to find the resources that you need. And also as you go along, make sure you keep your logbook up to date. There's a great app. I think it's a small fee to join the app on your phone for a logbook that's going to change in the next couple of years. But it just makes sense at the end of each list rather than having loads of bits of paper around is to put it straight into the app and then you can keep up to date with that and then know what you're going to do, know where you're heading. So familiarize yourself with the curriculum early on, you can see there those are things that J and we find them. It's also important to make sure you have a look at what the genetic professional capabilities framework looks like. These are about a list of items that all doctors need to be competent in, whether you're a microbiologist or a cardiothoracic surgeon and also what the syllabus covers as well. So it's all there. Those are where to find things online and then it's great. It's, it's really important to have a good relationship with your, um, with your assigned educational supervisor and just make up, get in there as early as possible for your learning agreement. Have a look at everything, have a look at the feedback from the last placement you're in and then agree together what the best way forward is. You shouldn't be told what to do. It's a bargain. It's an agreement between your education and supervisor, their experience with training versus your self identified learning needs. And the MCR all rolled in together to make a proper plan about what you need to do. And in the MCR, the learning how you are going to deliver that in the next 3 to 6 months, take notes of the gaps identified by your trainers in the MCR, your self assessment of logbook and address those specifically to move towards your goal. And then in the mid, we have a midpoint learning agreement, make sure you do that. There's no point getting to the end of the placement and somebody telling you you've completely missed it. You haven't been very good in this placement. You know, tell me halfway through that, I'm not doing what I need to do and then I can do something about it in the remaining replacement. It's a real way to get to the end to find that you come up short. And so you do need to drive your training, but we are there to support you. All your trains, make it easy for your supervisors to assess you. So spread any assessments you have across trainers. So don't just concentrate on the one and also you get better feedback. You know, don't just ask you Mr or Miss nice person to give you assessment that really doesn't mean anything, go and speak to some people that might give you some slightly more honest feedback. Hopefully we get to give your feedback in a really supportive way. I always tell people to feed back unto others. You've had them feedback unto you. But don't just ask the people, you're just going to say, oh you're brilliant no matter what you do and give good warning so that people get their thoughts together and make some space to do your MSF. So it's not a rush to get it in before the ACP um be formed. Look at forms of assessments, do a small number of, of A S throughout the placement. Don't wait until just before the ACP and it formalizes feedback. It makes people think about what to write and help them with that as well. Understand the MCR process. So you need a lead clinical supervisor, but this is the person going to organize the MCR for you. So identify one of those people earlier and then you tell the A S and they're register of is EP we get props when it comes to halfway through and towards the end of the placement, but also then just, just let them know. So I think, you know, we come to the mid placement and I wonder if you're going to get my MC already. You don't have to do the organizing, but it's good to keep people a bit of a nudge. And if it's not happening, let your a as know early and they can look into why if there are any barriers to doing this, any problems that are faced on the team. And also be really honest with yourself about a self assessment, you're only lying to yourself if you say that you're brilliant at stuff. So be really honest and that will help you with some reflection, identifying what you need to do to move into that. So and use a text box, was there just to think out loud into those and put what you need to do, your view may be different from your trainers and that's going to be perfectly normal because you see things from a different perspective. And so it will help you identify your own learning needs so that you can push things forward through your learning agreements. And then don't, don't just score heavily in one category. You have to be the complete surgeon across all the five C IP areas and the GPC S as well. So make sure you populate all of those and you've done other things, put them in the other evidence thing as well. So you're researching any letters, presentations, publications, put those up as a record of your training there and use every opportunity you can to get feedback and to upload it from other people. Just a final thing, just to reiterate that thing about quality indicators, we know from the annual trainee survey that most trainees are a long way off receiving in their average week what they should do. So just check against what you should be receiving. And if you're not getting those things, then go and ask somebody to help you do something about it, you can find it. There you go to J cst.org, click on quality assurance. And then further down, you see quality indicators want each specialty and the core, there are pointed to general surgery, I think. And then else it sometimes can be a complicated system. So where to find help the I SCP help desk are really, really excellent, excellent people who spend a lot of time training them, they are expert in this, so interact with them and you will find the answers to just about everything there. We have a lot of online training resources via I SCP itself, but also on our J CST I SCP, youtube channel. So there's lots of how to do things and walk through how to do all sorts of things that are ISP related. But also ask your colleagues, ask your supervisors, ask somebody around who may just be able to troubleshoot for you. So that's all from me. Thank you very much. Indeed. Great. Thank you. That was my terrible slide that I couldn't quite make work. Ok. All the s are working. It's great, right? Um Lovely. Thank you very much. So, our next and final speaker is um Mr Kamal Ariel, who is the core surgical training CPD in the east of England and also a consultant at the James Paget Hospital. Um I'm also going to share your slides. So bear with me. Thank you very much. Thank you very much for the invitation. Ok. Ok, see that right there. Thank you next door. Great. Let me make sure I can do that. Yeah, sounds good. So we have listened those two wonderful presentations from Prof Tierney and Prof L. So I'm just going to concentrate mainly around the phase one of the curriculum in the ICP and uh and what the course surgical training curriculum and ISP looks like a couple of things may be repetitive, but the reputation means that they are quite important. So on this IP portfolio, there are a lot of stakeholders, most importantly as a trainee yourself and the training program directors will set up the ACP and be part of that A RCP process. And the, and the health education England office who a suitable arrangement for the two of those A R CPS assigned educational supervisors for you and pro has already said how important they are. Then the clinical supervisors there will be one lead clinical supervisor who will be looking after your MCRS and other different clinical supervisors. There may be some other assessors who may not be directly the clinical supervisors, but they'll be assessing your PBS and other WB CBD S and there may be some other people who are involved in the training. For example, in your A RCP, there may be other consultants from other hospitals and in A RCP, there is generally also thank you next one. So training placement, course surgical training program is quite short period, just two years. So for each two years, so one year placement generally in that if it is a whole one year placement on one speciality, please make it for six months. Yes, six months, first, six months, one placement, second, six months. Um next, next placement. So that there are 26 month placements and also in course surgical training, for example, in our region, we used to have four month placement, which we have converted to all six months placements. Now, if there are such placements, which are less than six months, make them six months placements each next one. So education and clinical supervision that has been tossed onto our already by pro, so please make sure you meet up your a years, set up your learning agreements early in the post and that same applies for the clinical supervisor as well. Don't leave it to the last moment. Thank you. Next one. There is a new curriculum uh after 2021 both for core surgical training and uh general surgery, higher surgical training on this new curriculum. At the top, I have noted this, the link for the core surgical curriculum and at the bottom, the general surgical curriculum when you become ST three and this core surgery involves the gap between this F I two and the general surgery, ST three. And in this gap period, although two year looks very short, but the amount of information and curricular requirements you have to achieve is quite a lot. For example, basic sciences of anatomy, physiology, pathology, then the trauma, infection, cancer. So basic knowledge about all of those. And at the same time, you are achieving a lot of competencies around different aspects. For example, managing the patients in the ward, in the emergency, in the theaters, acute and elective cases, all those things. So this is quite a lot of things to do within this short two years period. Next one place, if we look into the curriculum slightly in more detail, it has been divided into three parts. One, as you can see common content model, which is mainly basis for the Mr CS examinations. And what is required in the MRC S examinations have included a link here. Then core spatiality, there are so many core specialities. But here today, we are mainly focusing on the general surgery, core speciality. And then there is ast three preparation module which you prepare towards the ST three preparation and to get the ST three job. Next one place, this one has again been to, to by pro already as you see surgery, this is indicative number, by the way, under 20 set of something you aim for for a year. And then if you aim to do about 4 to 5 cases each week, which should be easily achievable. If we get two elective lists and one emergency list as indicated in the quality indicator by prof, then it should be quite easily achievable. We are, we are heading towards competency rather than the numbers. And it is possible that some are very fast learners and this 120 may not be necessary, but at least if you aim for this and higher, then it is very easy to achieve. I would like to emphasize again that please enter your logbook immediately after the procedure. Don't leave it for later date. So do it immediately afterwards. Next one, there are different W BS, the main four ones, as you can see CS including CS for consent cases by discussions, do S and PBS. So those ones again, keep on doing those as you go and don't leave it for the last moment. Next one, it's a part of masters in medical education. I did some work with the W BA S. It's a part of the desert and with three aims. The first one. Are you using these W ba s in a way they are supposed to be used. The second one, what is the perception of usefulness by the trainees and trainers for this W BS? And the third one, I also carried out the systematic review based on the high level literature up to that date. And it resulted in three publications and it was interesting to see that the W BA S were unfortunately not used in the way they are supposed to be used. Mostly they are used as a tick box ex exercises. The perception of usefulness from the trainer perspective was much better compared with the trainees. But there were a lot of challenges and the improvements can be made by giving finding more time, some aspects of the trainer training, more face to face validation and better training and trainer interactions. Next one please. This was a mixed method study I did initially the survey then that was followed by the semi structured qualitative interviews based on these in summary, use these as a source of learning and feedback rather than the tick box. Discuss the con if you discuss the consultant beforehand, if you are doing an operation, can you do a PVA for this, then that will give more interest on the trainer so that he'll focus on the feedback and how to use that PBA more effectively validating face to face immediately afterwards, the W BA is conducted is more useful compared with just emailing the consultants or the trainers later on. It is generally important that when you sit on the A CPS, at least about 50% of the W BS needs to be validated, needs to have been validated by the consultant. And the number used to be 40 per year. There is no set number anymore, but it is better to have more than less. Thank you. Next one, the MCR we have tossed on to this briefly, the nine General Professional Capabilities and then five CIP s on the sip si have put it here, the supervision level required for the CT for co surgical training, but for a higher surgical training, ct it will be level four required. I just want to emphasize a point. Um My consultant used to tell me when I was a registrar, although it's aimed for one level higher than you are. If you are a registrar, you should be acting in a way that you are acting like a consultant. If you are an O you should be like a registrar. And if you are an F I one, you should be like AF I two. So similarly here, what I would like to mention is although the supervision levels for phase one are stated at two B, please always aim higher than that so that you are ready for your ST three post, next one. So this one is very in, in very intimately related. A lot of stakeholders here as you can see the initial period, if you start a job placement, then meeting with the educational supervisor and then carrying on. And halfway through there is a midpoint placement review just before that there is a lead CS, so you send a message to lead to the lead CS to do the midpoint MCR and that is done and that is again related to the final learning agreement and then only the, the placement MCR can be created for M CR at least three participants, three responses should be there. And there is a window also for MCRS because once it is created, the responses have to be done within 48 hours. And if that is not obtained within that, then that closes. So to avoid that generally, we try to do those MCR at the beginning of the week rather than doing it on Friday. If we do it on Monday, then they are supposed to sit together and do it together. But sometimes if everybody cannot get together, they may ask for response via email and that can be done easily if we do it at the beginning of the week, next one. So this slide, I would just like to many of you may be preparing for ST three applications. And when you look for the ST three applications, these are the main operations, index operations, you are looked into how many of those you have done. And these are the important ones, primary abdominal wall, hernia, appendicectomy. Laparoscopic port placement, abdominal incision, closure for laparotomy, removal of the skin lesions and incision and drainage of abscesses. So, make sure there are plenty of numbers for these cases including the PBA level. You are good at PBA or DS. Either of them can be there. Yeah, next one. So last slide, I just want to take you to these wings which are quite important. The first one is around the new curriculum called surgical curriculum. And on next bit, this one will have the syllabus as well. I think that is appendix too, which contains the syllabus and the MRC S guidance notes. So it gives some guidance about what includes in the MRC S. What are the different models included? The second link, the third one gold guide. This 10th edition only came in last month and it has got all the information about the postgraduate training in the UK quite important resource. The ACP checklist I have included this for the course surgical trainees which you use in the east of England. But every will have similar thing. The one which is most important here, perhaps the course surgical course surgery, national teaching program which is conducted uh uh from this platform PCV, EA lot of resources there, please make sure you, you use those um and then or surgery teaching program. Once this PG VL E online training is started in the east of England, we are more concentrating now on the Hansen courses. And those courses are available in our website under the course of the section, but I'm sure similar websites are available for other tries as well and there is steadily policy and that is important document to have a look as well. So with that, thank you very much for listening. I'm happy to take any questions. Thank you. Great. Thank you very much um er Mr Arl and thank you to everyone that's been quite active in the Q and A section. I think I'm probably just gonna ask one summary question that summarized quite a lot of people's um question. Er, just if our speakers could give a brief summary. So it sounds like lots of people are doing lots of great useful things. Er, and I think the main question that I can summarize from that is how can we make sure that all of our experience, whether outside of a training program or as a core trainee? Um How can we use that to our advantage when trying to get signed off for phase two? What tips do you have? Yes. Um So I suppose, and, and there's been some of the chat, isn't there? Lots of people do, um, step in, step out different roles along the way at the moment. It's very unusual to do foundation called higher end product and all that experience you get will make you a better surgeon. So if you've done a teaching fellow job and you've done on call the whole time as a sort of ct three experience, you will be fabulous at those kind of cases. So you just need somebody to do a PBA and show that you're at level four already. Um, it's all about evidence. Um, and if your MCR then says, oh, this person who is just an S ti don't know, let's say four going into five seems almost like an ST six. They're really capable. They've done all these numbers, we can see that they've got a good pair of hands. And if you want your things to be brought forward, you can reasonably request nowadays because it is outcomes based. So I think if you can do the thing, the MCR is really useful logbooks strictly should be within the program. But equally if you've done 200 appendix in, you can write that in your logbook and you can mention it and you can do a reflection on I ep to say, in addition to this, you know, it's all about putting stuff for a panel to see. So as long as everything's true, upload it to your portfolio and it should be obvious in the way you operate. And a lot of people don't want to get things brought forward either these days. You know, it's a changing world at the moment of being a trainee, at least you have some certainty sometimes. So play it how you want to play it with the evidence that you upload Great, thank you very much. Um We've got quite a good question from Angela and I know some other people have asked about less than full time trainees as well. Um, so I think she is wondering if, um, anyone on the panel has any thoughts or advice for any less than full time registrar, training trainees um with how to reach their goal and what sort of time frame or how that works. I think if we could also extend the answer to core surgical trainees as well, whether less than full time, core surgical trainees can take just the two years to finish phase one. So, oh, you're on microphone in. No. So while he's fixing that, um I might say um it's well recognized that there's a bit of an epidemic of core trainees going less than full time, 80%. Um It seems to be a bit of a no brainer. So you kind of have a slightly nicer working life. You can pretty much get all the required competencies in that time and TPD S are having a bit of a headache with them knowing who will get CCT and who won't and how many posts they'll have available for the next time, how many extensions they'll require? So I would say this um system we're in involves the TPD S and trainees and honest open dialogue is really important. So it's not like a game of chess. So if you as many CO TPD many core trainees do want to go 80% less than full time, approach your TPD. They should all have time to meet with, you, meet with them and say I'd like to do it. You know, you don't have to have a reason. But if there is a particular reason to tell the TPD we all as human beings. But in this job you sent me to, I think I can probably achieve the required competence in that 80%. So it's highly likely I will want to outcome six in these AR CPS you've got, even though I'm 80% and technically, my date might be here just be really open because otherwise there's uncertainty and then it's difficult for them to run a program and difficult for them to offer you the flexibility. It's all about being professionally respectful to each other, I think. And with the LD FT, we generally have a calculator if it is a two year training program and if they are 80% so we calculate the training period accordingly a bit longer. So, but it's not time based. So you could achieve it all in that time. And how would I speak if they, they can finish that? Do it in sign language. No, no, no careful. You can always type and echo. Always be your voice. I know that's a strange set up. But if it's really not working, there's always a chat um just in answer to the other thing. No, it doesn't have to be a consultant for a PBA can be locally employed doctor. Um, yeah, not, doesn't have to be a consultant. Where else I think less than full time training should really be encouraged at the moment and there's more and more people doing it and for, you know, traditional reasons are caring, aren't they caring for a child or caring for a parent? But actually there's this new category where you can just do it because you want to maybe it works better for your life to be a lesson, full time trainee and do the other thing that you're passionate about in life. And it doesn't necessarily certainly in core, if it's 80% won't necessarily make your journey longer in higher training. If it's 80% won't necessarily make your journey longer. Um Even down to 50% you know, traditionally academic trainees do 50% clinical, 50% academic and in some regions can be CCT at the time they would have done anyway. And so the same should apply to anybody as long as you achieve the required competence. And your MCR says you're capable, the time is almost irrelevant. Great. Thank. Thank you very much. I think that those are really helpful tips and quite reassuring for, I think a lot of people, um I think based off a few questions, I would include Kelly's question and a couple of others. Um We've spoken quite a lot about operating in our log book and sort of CBD s. What about things like research, extracurricular activities such as committee roles? Um How is the best way to evidence that on your portfolio? And what sort of things are you looking, looking out for each phase? Yeah, you still can't hear you. So obviously I'm gonna say join the A S GBI in the Mohan Academy and get a committee there. But seriously, those kind of things, especially organizations, the various trainee groups, you can get a letter from the chair of that organization, from the president to put in your portfolio. You know, all Moynihan Academy. If anybody wants a letter from me, I'll give you a letter. I think you're amazing. Um Just goes in to show those things, organize local teaching, do careers evening for med students. I don't know, camera while missing the laundryman stuff in the kitchen. What would you contribute? So all those things, as you said, the leadership and the teaching and the research exam certificate, all those evidences, you may have it on the PDF file or whatever that PDF file needs to be uploaded. There is a section in the I SCP called other evidence. So you can upload it there. But there may be some evidence of self reflection, you can reflect it there itself, the audit. I think that there is a section on that so you can upload that into those different sections. Yeah, I think I'm going to be joined. Sadly in my nice bit of the house, I've got a thing about documenting evidence in developing countries about electronic health records. Yet, I agree with that. Some sort of a word document or a print, you can scan bits of paper into the other evidence bit of ICP if you get near a scanner and if you're looking at somebody's portfolio, I have to say, I don't know about you can, it's the bit I go straight to is the other evidence bit because it's always the most interesting bit and it's the bit that makes you look different, the other evidence as well. So I'll just pop around to Jill's just to solve the microphone problems. So as Kelly says, yes, link them to GCP requirements. So by the GMC made the GPC S are the GMC S, would you like to tell us what the initial GPC stands for professional capabilities? So I think it said it on the talk actually. And what does it mean? It means that all doctors need to be able to do these things to be doctors? It's the basic functions of being doctors. However, when we were so is the generic professional capability. The does a clinic runs a list there a cap. So people on this talk might not be familiar with. So the two things you need to do are the generic things, things you need to do to be a doctor to be a day one consultant. And so they're generic professional capabilities and they're things like being honest and being organized and being numerate and literate, et cetera and also include things like research skills. So and the definition of what's needed is probably pretty vague, but I think understanding research. So in the past, we used to have to, we required Chinese to publish three papers. And now we just expect people to be able to understand and interpret research, which you can probably do from a research methods course or something like that as long as you can do that. But if you're doing things like presentations or research and there's nothing to stop people doing research, it would encourage that is to put that in the other evidence. Part of your, of your is EP and just label it. So I think the thing is, I think when you go through people's other evidence, it's just not quite clear what's what. So just be really clear on the title in the document. This is a research thing and maps to GPC domain nine in that case for research and teaching and all the other GPC. So just make it really easy for your TPD to go through because you're one of 50 70 80 trainees that need to have their portfolios gone through through all the ACP. And so if you make it as easy as possible, there's a fantastic halo effect goes with that. Don't think I agree. I think um your panel at the time, your, when you have your ACP, your poor old TPD will have done all the work. So they will have been through everything and prepped it. And also hopefully they will have warned you had a conversation about things they've checked that might be missing. So you can upload that quickly before or because of a longer term issue, what your likely outcome might be and outcomes are called developmental or progressive. So, a progressive outcome from your ACP is a one which is everything seems to be on track, going in the right direction, proceed to the next stage. Developmental is either five, we didn't see any evidence for this thing. So we can't make a decision and that usually gives you two weeks to upload the evidence for something. And it's a real shame to have that when you knew your AL CP was going to be on this day. The TPD kind of told you what was required, just do what they ask. A two. We don't think you need any extra time, but we really think you maybe need to pay more attention to, I don't know, communication skills or numbers of logbook cases recorded. We don't think it's that you haven't done them. It's maybe you haven't uploaded them. So just the and then three, we think you're going to need extra time. That's usually a critical progression point and maybe you should have 50 lap code at this point. And you've got 18. So it's very likely you need more time, but these outcomes shouldn't be a surprise. It should be obvious from what the metrics are and what you've uploaded to your system. It's either going to be straightforward or it isn't. And then the reason why it isn't straightforward and the solution to that, it's not a telling off thing. I think a lot of trainees feel a cps are when they're going to be in trouble. And it's really scary. It shouldn't be that at all. It should be. What have you done since we last met? Let's have a look. What was it difficult to get access to? How did you overcome that? How can I help you next year? Get more access to that camera? What are your thoughts? I do? You want to come around here and sit in the middle? It's that easy. Just do the door open, just come straight in. Yeah, I agree. Thank you. I think that's, that's the ACP outcomes. So if there is somebody who is going to have a developmental outcome, for example, two or three, we are supposed to have the postgraduate dean, uh deans representative. So and we generally let the trainees know beforehand about that sort of outcome and outcome five, the incomplete evidence. So I generally phone the trainees and uh email them to say that these evidences are missing. So please upload them as soon as possible. Yeah. Yeah. Yeah. Sorry. Ok. So I'm, I'm aware that it's getting towards, um, eight o'clock. So if we say maybe two or three more questions, we can run a few minutes over, but I'm sure people have got to get back to their lives shortly and I think Angela did really want to hear pros, er, if he's got anything to add about less than full time training now that we can hear him. So, II think in the comments in, in the chat, it's, it's, it's outcomes based. So it doesn't really matter how long it takes you to get there. So you can, and actually, I think it's probably not a bad time to be less than full time trainee because you, it's not time based anymore. There's no kind of your indicative CCT date will be put back pro rata, but you can get them much, much quicker if you achieve those competencies. And so, but there's absolutely no penalty at all to be less than full time. Just do what you can as quickly and gather those competencies as you can get to the endpoint. It's all about getting to the point where you are a safe day, one consultant and some people will be quicker than others. And I think lots of people, less than full time are probably quicker than people that are full time equivalent. And again, you know, Jill's point about the academic trainees is also well made that lots and lots of people are less than full time, get there in about the same time or maybe just a little bit longer but not Pro Rasa than others. Thank you. And Mr Ariel, do you think you could tell us a little bit more about dos in the context of the portfolio? I realize it's probably something that's much more applicable to core trainees and how, you know, what can do PS be used for and how appropriate is, is it and what sort of things um can core trainees send off as DS. So any procedure you do can be at the DS. We generally say as co trainees using dos is ok. But as you become more senior trainee, ST three, ST four, then try to use PBS even during co trainees. If they are index procedure, for example, appendicectomy, cholecystectomies, hernias, if you have done, then use them as PBS, then we can look into the progression. And uh that is slightly more detailed than the DBS, but the DBS can be entered for any procedure we do here. And for co surgical trainees, there are some mandatory dops as well, which is easily advertised in the ICP. I'm trying, I'm trying to reply to um, Anurag Singh and it's taking me too long to type in there somewhere in the way of my keyboard now. So it might be quicker just to say, and it was a really good question. I think trainees at ST three have all got different previous experience and what's the goal if you're immediately out, of course, surgical training. And I think everybody worries about being able to operate. I still remember being terrified as a first year registrar and I had two really experienced boy Sh Os who kind of looked at me with what are you gonna do now? And it's terrifying. Absolutely terrifying. And the most important thing is just to be organized and a good doctor. So, manage your team and then be able to present to your consultant briefly what the patients come in with, what tests you've done and what you think it might be that's going on. That's all they want. They don't want somebody that can do an anterior resection with a low joint and not call them, just want a sensible doctor. And I think you probably should feel happy doing incision and drainage of an abscess and appendix, opening a laparotomy and making a bit of a start and having a vague idea of what you might do, that's all that's required. But it's communication, organization management, much more important at ST three level than anything else. And I think everyone recognizes that you're an ST three and so will support you. And I think that what people forget is that we used to be trainees. So we know what you were saying that when she started ST three, how it feels like that and, and will recognize that you can't do everything with ST three and you're not expected to and we'd much rather know early when you want us to come and help or advice, et cetera. And if you phone somebody in the night, the first thing you need to say is I need you to get up and come in or I'm only phoning to run this by. You just set the tone because it's so important and then be clear. This is me, I'm the, what's it on call for this? I'm here in recess or on the ward or on an elderly care ward. The, the problem is this, I think what I need to do is that what do you suggest? And then you'll have a really nice conversation, but there's nothing worse than somebody phoning saying I'm here and the hemoglobin is four and the Amylases and then telling you that actually the patient's peri arrest and it's just you rehearsing your head before you pick the phone, be really clear and have the computer in front of you because you'll have to be asked a question that you haven't got the answer to s Yeah, great. I think we're getting some questions about ST three applications, which I appreciate does probably link in but gonna take this segue to introduce um Sarah Jane Horn, who's our wonderful core training rep from the ma um And she is organizing an ST three application um seminar for us a little bit later in the month. So um please sign up to that. Um And I will, hello, hello. Can you hear me? Great. Um So I'm sure she will be able to pinpoint us at the end of this uh webinar towards uh when we're running that. And I think a lot of your ST three application questions will be answered that webinar. So, apologies, we may not take the time to fully answer those questions. Now. Um Have you got anything else to add Ray from the CST side? No, so you'll try and help cover. So it's mainly focusing on getting into CST. Um So it'll be myself, I'm act two and then Megan who's act one who rank very highly, the CS really well. Um So we'll talk through sort of some tips. Um It's all, all, all the information is available as with this, but it's just really useful to have some tips about how to sort of maximize um you know, making, making good use of your time when everyone's busy. Um So yeah, that is next Thursday at 7 p.m. So Thursday the 26th and it's also on medal. So have a look at the morning hand academy as Medal. Um And you should find that advert there. Also, the, the lead for, for ST three selection will be running for core selection for ST three BR and webinars on that. And also national online teaching will have a session dedicated to selection as well in co so tune in for that led by Catherine Smith, our other colleague in Derby. It's a great place to be wants a job to give me. So the ST three selection webinar is running with The Point and um Academy, I think, yeah, Nicholas Watson is running at uh sometime, I think. Excellent and Nicholas Watson will know the answer to everything. Great. So, thank you very much. Probably just gonna use subs sheet to summarize a little bit. Um, and I think, uh, everything that our speakers have said is really great advice whether your ct one or ST eight or anything in between. Um, and I think I can certainly speak from my experience is that the PCP at the beginning of the year is really important and have a look at your numbers regularly. Um, think about what you want to get from the next few months next year, next job. Um, otherwise, like prof said, you don't want to be an ST eight and looking for fistulas and hemorrhoidectomies when really you want to be getting out there doing laparoscopies without the consultant, et cetera. Um, and I think as with everything in medicine, if it's not documented, it didn't happen. So you could have done 50 appendixes. But if you, if you've not logged any of them or sent off a PBA, unfortunately, our safety panel can't, um, can't just take your word for it. So, um, it's a lot more than just operating. You do need to be pretty organized as a trainee. Um But I think it, you know, if you think about things early, all of these things hopefully are quite achievable. Um So just the organizers that's probably easier said than done. But thank you very much for all of your advice and there's lots of space online to get information. Um If you've got any questions for our speakers, feel free to send the morning Hand Academy a message or you can email me. I think my email is on the um on the post of our in the chat. Um And yeah, that I think I'll let everyone everyone know. Thank you. Thank you. Thank you very much. Thank you. Bye. Yeah.