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One and welcome. My name is John Da and I'm an A&E FH O currently working in Queen Alexandra Hospital for Smith. And welcome to our first webinar presented by AF PS for BAF. That is the British Association of Filipino Physicians and Surgeons. And today, our first topic or our first webinar is called preparing for M SRA. And so we're going to, you know, tackle the M SRA and specifically on how to prepare for it within the next four weeks or eight weeks if you're applying for GP or psychiatry, um we'll also have a little bit of coverage when it comes to interview preparation and it will be CST themed, but I think this is also something that has similarities to other specialities. So it will also be beneficial if you're not um you know, planning on going for CST. Anyways, without further ado, I'm, I'm happy to introduce our first. He is Robert Hwang or Bobby. He is a CSC one in Ashford and Saint Peter's Hospital Surrey and he recently took the M SRA last year and scored pretty well pretty good, I would say, and that's why we have him for today to give you some tips and advice on how to crush the M SRA uh in January 2025 or February. Um Welcome Bobby. Do I need to share the slides or? Yeah, I have your slides with you. So perfect. Ok, thanks for the introduction, John. So hey guys, I'm Bobby. I'm act one in trauma and orthopedics at ST Peter's. And last year I was in your shoes this time last year and I was preparing for the M SRA which I sat in January of last year. Um, next slide, please or do I change them? Ok. So I kind of made this very CST orientated and I apologize for that in advance because that's sort of where my experience or expertise is in, in the application process. So, firstly, why is the M SRA important? So, ah for different specialties using MSR in very different ways. So for psychiatry and GP training, I know that there is no interview and you're right based off your M SRA score only. And essentially, it's important to do well in the M SRA because it will impact your overall rankings and make you more likely to get your top choice job in your desired location. Ah, for core surgical training, they only interview the top 1200 candidates at the M SRA and it's only the M SRA that's taken into account for that. So it doesn't matter how good your portfolio or well, you interview if you don't come in the top 1200 applicants. You sadly won't be invited onto the next stage. Um And when you progress past the M SRA and hopefully you've all smashed it. You'll be invited to interview for CST. And the M SRA is a roughly a 10% proportion of your final score that's using a ranking. So that's sort of why it's important to do well in the M SRA uh next slide, please. Ok. So, uh I thought I'd start with the real basics. Um You, it's up to you to book your own MSA exam. So I think roughly by now, you should have received a booking link via email and it's important. Part of the reason why I think I did one in the M SA is that I picked my date that I sat it very carefully. So II was actually on emergency medicine at the time and um it is a very hectic rota. Um So the way that I approached it was I looked at my rota and what I couldn't take annual leave or study leave on, ah, looked at the, on calls and sort of the night shifts and tried to book the exam the furthest possible away from a night shift as possible to make sure that I was, I was well rested. Um You if, if necessary and I know this is sort of unpopular, it's possible to use annual leave to try and make yourself first leave refreshed and also to aid in revision. Um, and if possible, your department, depending on what stage you're at and which department you're in may offer, you study leave, you're at least guaranteed study leave to sit the exam because it is a professional commitment. But different departments have different policies. So, um, II know that some G CFS allow you to have five day study leave for, er, M SRA. And if you use that with your annual leave as well, you can get quite a nice chunk of time off just before the exam that will really help you stay refreshed before the exam and also help you with your revision. Um, and also it, it's free. So if you're having to pay for this exam, I think you might have quit the wrong link next line, please. Ah, this is also very important. I had a bit of a nightmare with this. You need to make sure that you have a government issued ID with a recognizable photo. So I'd actually booked all of my study leave and annual leave and got a week off beforehand and went to my parents' house to study and I realized that I'd actually forgotten my passport and my driving license. So I had to waste some valuable time to go back to, ah, my flat to get my ID. So just bear in mind they won't let you in unless you have the appropriate ID. Next slide please? Ok, let's without further ado, let's get down to the format of the exam. Uh You can break it down into the two categories. Um There's a professional dilemmas paper which is very similar to the old situational judgment test that we used to set for the foundation program. And the other half is the clinical problem solving. I've got up here the length of time that you're given for each part of the exam. So you get 95 minutes on the professional dilemmas and then you have, you're entitled to a five minute break and then you have 75 minutes to get your clinical problem solving. Um, it's important to note that the break, the clock keeps running during the break. So if you took six minutes instead of five to get a glass of water and pop to the loo your any excess time after the five gets taken off the second paper, the CPS. So it's important that you stick to that, that five minute, five minute break quite, er, quite strictly. Um, the going into the professional dilemmas aspect of the exam. Um, it's a sort of situational judgment type exam where they give you various ethical scenarios that you should have come across in the course of your foundation training and it assumes the level of knowledge and sort of outlook as, as a, as a foundation year two doctor. So, um, I know that some of you may be a bit more senior sitting this exam, but you have to try to get back into the mindset of an F two. Um And if you've sat the situation of Judgment Foundation, the difference between this exam and the, the um S JT here is that instead of being the most junior an F one, you are F two who may have an F one beneath you um in working in the team that you might need to give advice for. And that's something important to bear in mind. Uh There's 50 questions on the professional dilemma side and you have roughly 100 ish minutes. So 95 minutes to sit at what I found quite useful during the exam itself was to pace yourself. Um So I would do around 10 questions at what I thought was a reasonable pace. And then I would have a look at the clock. And as long as I was doing those 10 questions in just under 20 minutes, I was, I was, I was at about the right pace and if I found myself going a bit faster, I would force myself to slow down. Um And if I was going too slow, I would try to try to speed up to compensate. Um And within the exam, there are two styles of questions. So the first is ranking where they'll give you five options, they'll give you a scenario and give you five options and you get asked to rank them from 1 to 5 in terms of most appropriate to least appropriate. And we'll go through some example questions in a bit more detail. There's also the multiple choice aspect of the paper where they give you a scenario and they give you around 10 options and you need to pick the best three out of the 10 options. Um Then moving on to the clinical problem solving, you have 86 questions which you're going to have to do in 75 minutes if you're on normal time, um which is just quicker than it's about 45 seconds of questions. So then again, I'd like to after 1015 questions, do a little bit of a time check to make sure that I'm making the correct pace. And I think I would advise doing the same because some of my friends found it very difficult to manage their time in the exam and ended up uh not, not completing some questions because of the time management style side of things. So it's important to bear in mind before setting the exam and come up with a plan that works for you. Um There are 86 questions and 75 minutes. There are two types of questions. There is an extended matching question where they'll give you around 8 to 10 options and then they will ask um there are so many questions and themes. So I'll show it to you in the example questions, but they may have three or four questions on, let's say headaches and all of the em Q's answer options repeat. It's just the scenario that changes, you're meant to pick the correct E MQ to the correct question. And then, uh lastly, there are the single best answer questions, which is probably the format that you guys will be most familiar with, which is, there is a, a question on the scenario and you need to pick the best option of four or five of them. Ok. Um So for reference for the sort of clinical side of things, there are 12 different topics that you need to cover. Um from my memory, it's sort of med school finals level questions. So you should have covered all known the material at some point or another. It, you might just have to dust off the cobwebs on some of the topics. Um And so think about which jobs you've done as either as a foundation doctor or as a trust grade and those topics are more likely to be stronger for you. So it's appropriate to tailor your vision to try and tackle some of the other topics. So for example, I didn't do any pediatrics across my foundation training. So I found that I had to revise pediatrics a bit more than um let's say my, my medicine because I, I've done quite a few gen MD and GP jobs next slide, please. Ok. So um I've put up just a example question of each type of question that we went through earlier to try and show you how I would approach the questions and give you a bit of advice. So this is the scenario, you're a foundation doctor working on a medical ward, you're preparing your consultant's ward round which takes place this afternoon. Andrew, another F two is working with you and is also expected on the ward round. Andrew tells you that you must leave the hospital in the afternoon to attend a court hearing about a parking fine, which you failed to pay but does not want the consultant to know this. He asks you to tell the consultant doctor Stevens that the reason he cannot attend the ward driver is because he is unwell. Um And then they give you in this instance, four options. So option A advise Andrew to request leave for the afternoon. Option B suggest Andrew informs Dr Stevens that he's unwell and so cannot attend the ward round. Option C explain to Andrew that you cannot cover for him on this occasion. And option D inform doctor Stevens of Andrew's absence explaining that you do not know the reason why. Um So the way that these are marked is you write them from 1 to 4 on the, on the module on the computer and it's out of 16. So you get four marks if you write the appropriate option in the correct in the correct place. So for example, um if you put uh option A as one and that happened to be correct, you get four, but you also get, er, marks for near misses. So, for example, if you put option a second and it happened to be first, you would receive three marks out of the four and you would lose one mark as you lost a place. Um If you order all the possible combinations, ah there's actually a tactic in which you can limit the number of marks that you lose if you follow the strategy. So what I like to do is ah read the scenario and then if you get the first option, the most appropriate and the least appropriate, correct. It means that you are guaranteed at least. Um So you get 44 and then you got these two wrong, you would get 14 out of the 16 marks, for example. Um So it's very important that you make sure that you get the most appropriate and least appropriate option, correct because then that minimizes your chances of losing marks. But sometimes the 2nd and 3rd options can be a little vague at best. Um So the first thing that I do when I approach a scenario is I read the scenario and then I try and in my mind break down what is important about the scenario. So I'm gonna have to on a medical ward and we're preparing for the ward round and there's another doctor and basically this doctor wants to leave the hospital and go to his court hearing, which is fine, but he doesn't want the consultant to know and he's actually asking us to lie to the consultant about um, what about his whereabouts are and why that he's left? So it's very, uh so in this instance, in my mind, this would highlighter probity and, and honesty um is probably the theme of this er, professional dilemma question. So then using my technique of uh finding the most appropriate and least appropriate, I read through the other options. So advising Andrew to request leave the afternoon, that seems fairly appropriate. So I'll part that and I'll leave that as a potential answer suggest. Andrew informs Doctor Stevens that he's unwell and can't attend the ward round. So I'm basically now telling my colleague to lie directly to the consultant, which is again a probity issue and then Steve, I'm telling him that. So it's definitely not b is the best option ST explained to Andrew, you cannot cover for him on this occasion. Ah So that's reasonable because I, I'm not lying for him. However, it doesn't really solve the problem. So it's probably not the most appropriate. And d informed dot Stevens of Andrew's absence explaining that I do not know the reason why. So instead, now I'm actively lying to the consultant. So that is not a good option. So I would then rank option A as the most appropriate and then I'd read the question again and I would try and find what the least appropriate option is. Um And with this patient, not with this patient, with this scenario, um I can either tell my colleague to lie or I can lie myself. And I think probably lying myself for the consultant is um sorry. Uh You basically got the option of lying to the consultant or um telling him to lie to the consultant. Although the, um, option D is not, it's dishonest but it's not, it's not a, it's not actively, it still sort of helps the situation cos you're saying that he's not here. So I'd actually say that telling your colleague to lie is the worst is, is the least appropriate. So I put that as option four and then between C and DC is better than D. So I would go, um, a CDB like that and if you have identified the most appropriate and least appropriate, it limits the marks that you've got, er, that you're gonna get wrong. Er, next slide, please. Ok. So I think I've got that correct. I'll leave this on when you send the slides out. You can go through it on your own time. But, um, it, it basically talks again about prob and dishonesty in a bit more detail. Uh, next slide, please. Ok. So this is now a EQ question, you need to pick the most three appropriate actions to assess the situation. And it's important that you do the three options. And this is something I struggled with when I was practicing. The three options are independent of one other each other. So don't pick an option, relying on an option that you've already picked. They need to stand up individually by themselves. And it's very important to bear that in mind. Um So with these questions, what I do is I read the scenario and then I go through all of the questions and all of the options and I cross them off depending on whether I think they're a likely answer or an unlikely answer. And then I see what I have left at the end to go through. So this says here, you've been busy at work recently as some of your colleagues have been on leave, there's a number of personal issues which are troubling you, you're not sleeping well and you're not performing as well as usual and often do not complete your duties by the end of the shift. And I've been irritable with colleagues. So sort of two issues here in this scenario. Firstly, work's busy. And secondly, there's a number of personal issues which are troubling me. And from reading the style of the question, it, it appears to me that the personal issues are troubling me more than issues at work and these personal issues are affecting my rest and they're also affecting my performance. So it's important to bear that in mind um because it would be very different the way that you answer the question, whether you've been struggling at work more or if you've been struggling in your personal life more because it will affect the options here. So now let's read the options option a arrive at work an hour early so I can complete the unfinished task. This already seems like an unlikely answer because this is just gonna contribute to my burn out and it's gonna make me more tired and it's not sustainable in the long term. So I'm going to just cross out a B arrange to see your GP or occupational health physician. That seems like a very reasonable thing to do in this scenario because you, um like I'm not sleeping well and I'm not performing well and maybe I have a bit of burn out. And I've also got some personal issues that maybe they might be able to either reduce my hours or, or come up with a management plan, um, with. So I'm gonna keep this in the back of my hand. So I'm not going to cross this one out, see, book a course on time management. Um I wouldn't pick this option because from reading the scenario again, it's more the personal issues which are troubling me and it's not mentioned that it's not mentioned that I'm struggling, I'm struggling at work more than the personal issues. It seems to be that I'm not completing my duties because I'm not sleeping well because of the personal issues maybe. But let's, let's keep that there d consider taking time off work. That's a very reasonable option. I'd leave that there option. E discuss the issues with a senior colleague on the team again. Very reasonable. I'd leave that there. F focus on work and put my personal issues to the back of my mind. Well, I'm already failing to do that. So that's just gonna make things worse. So I'm immediately gonna cross F off G make a complaint about your workload to the hospital management. Uh Potentially not that strong. I'd leave it just at the moment. H visit your local pharmacy to obtain a sleep remedy. I would do this because the sleep remedy is a potentially addictive. It's not a long term solution. So then I would then go back. So we only can pick three options and I would then see what's best out of B CDE and G and I would say that the D and E are probably the best because I talked a bit about why option ci think is, is, is less strong than BD and E and G. Um It's, it's inappropriate to make a complaint straight out of the gates. You probably first want to discuss it with your, with your senior colleague on the team next screen, please. Ok. Again, I've just copied and pasted the answer. All of these questions are from the practice paper. So I thought I'd just go through some, some of the mo the closest questions that you get to real life and you can look through these in your own time again. Next, the next slide, please. OK. So now we're gonna move on to the uh sort of the E MQ. So you can see here, it says one of two. So this means that there are two questions on blood and urine as they follow themes and these are all of the options and these answers are gonna stay throughout when this splits to two. It will be the same answers but a different question. So I then the way that I approach the EMQ S and the the clinical problem solving is read the question firstly and take and took out the salient points from the M CQ. So a 59 year old male complaining of sudden onset severe pain in left loin associated with visible hematuria. He returned from a holiday in Africa yesterday. So 59 year old sudden onset severe pain in the loin visible hematuria holiday in Africa. That's what I bear in mind as I was reading through the answers. Um and then let's just go through the answers one by one. So a bladder cancer. Yes, it would cause the hematuria, visible hematuria. But no, it wouldn't cause the severe pain because it's normally painless hematuria associated with bladder cancer and same with the glomeru nephritis. So A B it's not C it could be because sudden onset, severe pain, which would be a kidney stone and visible hematuria fits and well with this, with this and also with bladder cancer, it's less likely to be a sort of a sudden onset. It's going to be more insidious. So not a, not B it could be CD March hematuria that's associated with people, athletes and soldiers who do a lot of exercise and end up having pain hematuria. It mentions nothing about this in these scenarios. It's not that uh prostatitis again, it's going to be more insidious. Um And it's, it just doesn't fit as well as the kidney stone, renal cancer would again be pain hematuria with a mass, potential mass in the higher up and urethritis and uti it, it's unlikely to be effective because they've mentioned nothing about any infective symptoms. And um it's just less likely than a kidney stone. So I would just go through the options, all of them. And uh I basically think which is the most likely and see in this instance is the most likely. And if you're ever unsure, just um if you're stuck between two options, which I sometimes am read both options um and try and convince yourself why it's one over the other and what, what, what the reasons behind that are. OK. Uh Next slide, please. So M CQ, this is probably is actually an SBA, not an M CQ, I should say. Firstly, so single best answer. So it means that uh you single best answer means that you don't necessarily have the right answer there, but you need to pick the best, the single best answer associated with um the question. So nine year old boy Ed, one day history of intermittent diarrhea and central abdominal pain, which is now moving to the right iliac fossa. He's parial with guarding in the right iliac fossa. So this is sort of screaming as a spot diagnosis, appendicitis. And the best investigation is an ultrasound for that first off the bat. So I just without thinking, press circle D um in this instance, have I learnt to go through the options? It's not gonna be an X ray. So that's not gonna share as appendicitis CT. We're not gonna radiate a nine year old. It could be an MRI, but it's not first choice, not first line now as first line and I have never heard of a white cell scan. So I wouldn't pick this option in this scenario. However, if they say they didn't have ultrasound abdomen and they only had these four options. Ah, it's the most appropriate investigation with the list, it's the single best answer. So you have to go with the next best thing which in this instance would be an MRI. So you've got to think what the most appropriate and what the single best answer is. Not necessarily what the the correct answer is because sometimes they have correct answers that the correct answer isn't there. So don't just just bear that in mind and don't get upset on the exam when that happens if that happens. OK, next slide please. Ah So we've gone through the questions a little bit and covered a bit of exam technique and um what the lay out of the paper on the day and how you're going to approach the paper and how you're going to approach the questions. Let's talk a bit about the preparation itself. Um I, this is what I did. So then I get like talk to other people and, and take this with a pinch of salt. But for the clinical problem solving side, I use two question banks M CQ Bank and Parm, I would say for this examination, I would just start doing questions. Um It's, it's an exam that's very revisable by just doing questions. Um I started off doing pass med which is a bit more difficult than the exam, but it was a good textbook and it's important that when you get a question wrong, you read why you've got it wrong and uh revise the textbook in that area just to plug the gap. Um And then I moved on to M CQ Bank, which is very similar to the exam. So what I mean by that is it's very, sometimes the clinical side can be very vague and very short, there were some questions in my exam that were one line like literally one sentence question scenarios. It's not, it's not a paragraph. So it's quite good to get used to answering these very short stem questions. Ah, and for textbooks, I used the passed textbook as sort of a reference guide rather than reading it directly. And I also consulted zero to finals, which were my finals sort of textbooks that I had lying around. And they've got quite a good website as well that explains things quite well because the clinical side is an end of med school knowledge level. Um And then for the professional dilemmas, I did uh M CQ Bank only for this. I found past med a little confusing, um and not necessarily the best. So I wouldn't recommend past med for the personal dilemma part. And I read through GMC good guidance, which helps you sort of get into the mindset of um the, what sort of questions they ask and what are they looking for when they ask that question? So I would not necessarily learn it, but just, just read it a few times and just be aware of what the GMC would guide you to do because that's what a lot of the questions are based upon. Um There are also foundation ST questions they got rid of it recently. But on Stud O, there's, I think there are four pass papers lying around that are quite good practice. And there's also one pass paper or half past paper on the website for both the CPS and the PD and this is the best resources. So the most similar to the exam that, that you're going to get. I saved this paper for, I think it was a couple of weeks before the exam to make sure that um it was sort of as a confidence boost and also to make sure that I was on the, on the right track. Um Next slide, please. Sorry, I got something in my eye. Um So revision structure, you guys have roughly how long like a few weeks, anywhere between 4 to 8 weeks, I'm guessing. Um Yeah, around 4 to 5 weeks, 4 to 5 weeks of the applicants and then eight weeks with the GP site trainees. Ok. Ok. Um So you still got quite a bit of time. I would say that you're an adult learner and uh you know, your own revision habits best, you know, if you work better in the morning or the evening, um and try to optimize your revision time to, to your own revision habits. However, I would say that it's very difficult as a medical professional to study for exams alongside work because work is obviously very taxing. And the last thing you want to do after a shift is sit down and revise. However, I would say that doing little and often is helpful because you take small steps to climb what can be a large mountain and what I tried to do at least was on days I had off, I would try to do a full, full days of revision and then stop in the evening. And if I was working a normal day, I would set myself a target of roughly 2030 questions a day just to keep things ticking over between these sort of longer day revisions. Um, but just make sure it's reasonable. You're not going to get home after at six and manage to do 100 questions in the evening. That's very, very difficult. Um And can you go, sir? Hello? Hello. Uh II can hear you John. Yeah, it, it seems my um audio is not working at the, at the moment. Uh I'll try to come back and go back in. Ok. Um ok. Um And I would say that the bulk of the knowledge is from the sort of clinical side and I spent a lot longer preparing for that, that side of the side of the examination that I did for the situational judgment. I think I probably said around two weeks just before doing the situational judgment and spent the bulk of the time um revising the clinical knowledge because if you don't know the clinical side, you won't be able to answer the question. Ah, however, I felt quite confident on the situation of judgment as I've done quite well as a foundation doctor. And again, I would say tailor your vision to what your strengths are. So if you think that you're not going to do so well. In the situation of judgment, you probably need a bit more work than what I put in for it next slide, please. Ok. Uh Does anyone have any questions at all? Thanks for listening. Um Right. And we'll, we'll go through the questions after Joyce has gone through her topic. Um But thank you very much for that Bobby. Um I'm pretty sure everyone in the room, you know, seeing the m sra fast approaching. Um and I'm sure they have some questions regarding this, but, you know, for the benefit of time, um we'll move on to the next topic and then we'll go through all of the questions um at the Q and A segment if that's OK. Sure. Yeah, of course. Thank you. Thanks. Um Right. So for our next topic, um I'd like to introduce um our next speaker which is Joyce Kiss. She is a plastic surgeon or a plastics registrar in Bristol who will talk us through the interview stations and basically how to approach this certain type of um or how to prepare for interview specifically. Um Just looking for your slides, Joyce. Um Could you check if your microphone is working at the moment? Can you hear me? Yes, I can. Good. Um Let me just look for your slides here. There it is. Right. Um So without further ado this is Joyce, she will talk you through the interview specifically for CST. Um but I think it will benefit anyone, you know who is applying for a training that has some sort of interview process. So it will benefit you as well. Um And here are your slides. Ok. Um at the floor. Thank you John. Um again, I am Joyce, I'm a plastic surgery registrar in South Main Hospital here in Bristol. Um So this will be just an 11 slide presentation of how you should approach or top tips in terms of approaching your interviews. Um Next slide, please. So we'll talk about the timeline quickly on the sessions. Next. So for those who have applied, I reckon you have all submitted your application. This is just a copied this from Oreo. So by, by mid February, you will be getting your interview period, but the aim would be in general is to balance your m sra uh remission along with your interview preps again. Um Bobby mentioned that we are all adult learners. So it's up to you how to do it. But if we go to the next slide, yeah, grand. So for co surgical training, there's three stations. So it will be clinical stations for clinical station. There's always a LS and crisp. We'll talk about those later on clinical governance um which would include your audit, teaching research and there will be a station for your portfolio from memory. It's 10 stations next slide, please in general. Um Everyone should know that preparation is the key. You don't go into a battle without preparation. So you need to prepare um the advice I give people nowadays is that you need to have scripts or it's ideal to have some bullet points in a piece of paper or powerpoint. So that when you revise for the topics you can go to to it system uh systematically. And I have spoken to one of my former registrars in general surgery who um who interviews uh for core training. This person has advised that you need to include a three line summary of the important key points within a case. So you will have from my experience a couple of min two minutes, if not five minutes to look at the station before you go into the room and then within the, within the time given to you, you should highlight what's important within that case. And for any other interviews, you should follow an a to approach. And please please include any medical condition as part of your differentials. Because most people, when they, the information I was given is that when people go to these interviews, they're like, I'm applying for surgical training. So everything every patient needs surgery, but that's not always always the case. Um Next slide. So let's say we have this case. Um So it's a 55 year old male in a motorcycle accident, unknown speed brought in by ambulance complaining of pain on the right leg. And then the other patient involved in this accident was transferred to a trauma hospital, apparently needing amputation. So this uh first bullet you need to be thinking what are the important points? Um comorbidities of the patient hypertensive on beta blockers, Nonsmoker. And the observation from this slide, you should have bullet points, important things. So if we go to the next page, when you go uh to interview, they would say, OK, go proceed. You could say my concerns for this patient is that patient, patient is in a stage two shock. It's a high energy trauma with leg pain. You would want to know clear compartment syndrome, but you're not telling the consultants interviewing you that these are the only problems if you go to the next slide. So I would say I would approach this patient as for ATLS protocol check for catastrophic injuries, A two E assessment. What you don't wanna do is to fall into the trap. A is for airway. I would check this. But if you, you go, I would check for airway, see spine control, high flow oxygen and go for breathing chest expansion check for flail segment. And then you go through ac but you don't have to say A is for airway BS for breathing C is for circulation, just bullet points, GS blood glucose and then you have to strip the patient head to toe for to look for any signs of um any other injuries or signs of bleeding. Next slide. If I am going too fast. You have to let me know. And then next one, you have to do focus examination of the leg because the patient has complained of leg pain and check for any signs of compartment syndrome. Once you have, once depending on your interview, the consultants will give you information and then you will have to go through the head to toe check for your secondary survey, your ample history, which is your allergies, medications, past medical history and last um the last meal of the patient and event. And then always highlight that you need to continuously reassess the patient because an injury is ever evolving. Next slide from the initial slide, you would now know, have an impression but you need to verify your injuries or what your patient have. You need to tell the consult during your interview, say for investigations, I would do these things. Don't go back to bloods or group and say because you have mentioned that in your c you, you just need to include other tests that you need to do trauma ct for this patient and for management, what I did during my interview was manage the patient, divide the management, acute management of the patient and the injury and definitive management. Of course, you will inform your uh registrar, you won't be managing this as an essential by yourself. So acute management, you would, I, what I've done during my interview is that I give them what do you call this um II sign post. So tell them for the patient, I would give the patient pain medica adequate pain medication, this reassess um keep the patient nil by nil by mouth, discuss what's the findings consent? The patient involve other teams. Um And then for definitive management, patient would need to go to theater. I would grab my registrar to explain other things. And then we will inform the consultant on call. Apart from that, you would need to inform anesthetist and theaters and if the patient needs IP then you wouldn't say that as well. All right, next slide, please. So that's for trauma, for clinical governance. There's a lot of topics. Um There is a book for medical interviews. I think most people would have it. My advice would be to go through that for each question. Make sure to listen to the question cause sometimes people have this thinking, the feedback I got from my former colleague is that people think they know the question. But if you're not listening, the consultants or the examiners are there to redirect you. So if they say um for example, they ask you what's your involvement in audit? And you keep on giving examples of audit. If someone redirect you back, what's your experience? It's not that those people are distracting you. They're trying to give you as much points as possible. So just listen and make sure you highlight your achievements. Always say my experience in a I've done for example, seven that may be an exaggeration to audits completed cycle. This um the benefits for me professionally, the benefits for the patients and potentially the benefits for the trust you can put it that way. Um For surgery, the most common questions for clinical governance would be a takes never been near miss. For example, a case given to me before was a patient came in for surgery, amputation of the right leg and it's not the right leg. What you would do. So you could give first that this is a significant problem. This is a never event. I would um escalate properly, speak to the patient, explain to the patient that your documentation says this. You say something else you're saying we are amputating your left leg for example. But all of your documentations are saying right? So what needs to happen is we would need to look at your notes thoroughly, look at your imaging, discuss it with the consultant and then we'll get back to you. The important thing is to apologize to the patient and al always offer pounds for patients. All right. Uh Next slide please. I didn't include the slide for um portfolio. The key thing for portfolio is that it needs to be organized, you need to prepare your evidence um n neatly uh make sure you have everything um in my interview I put in that I was doing my MBA but it wasn't finished and then the question arise was why is why is your MBA not finished yet? And then I said I moved countries. Um It made them laugh a bit. But then the reason why I put in my MB, there is that to show that I am actively doing something outside clinical practice to support my future progress. But just make sure you have all your evidence ready. It took me roughly about a month organizing reorganizing my evidence. So just make sure everything's ready. So just to recap having a structure for your interview, um clinical or nonclinical, you need uh you just need to be organized. If you're unfamiliar with the topic, just think A to e or my seniors would explain it before. If for example, you're presented with the patient with POSTOP complications, for example, post appendicectomy, the patient came back four days after complaining of rightsided abdominal pain, having fever. So you would say this patient is septic and I would approach it according to Chris Protocol following the at assessment again, your A um and then you have to highlight important investigations and um imaging and then escalating you to register and consulting and practicing is the key. This is like M CS. You can either depending what type of learner you are, make sure you have the right information for your revision. You can either practice in your head first and then practice out loud and practice with other people the most important thing for interview is that you have to build your stamina uh for the interview cause it's real uh 30 minutes. So if you're just revising with friends for 10 minutes in two or three sessions, that won't cut it, you would be tired with nerves and um with nurse and without appropriate practice, um you will be tired by midsection of your interview and that wouldn't be good. And the last thing is that if you haven't had a TLS, a TLS or cris, I didn't have a TL sr cris during my interview, but there's always videos in youtube, which I found very helpful because I was able to um answer the questions and prepare accordingly. That's all. Thank you. All right. Um Thank you very much. Um Joyce, that was a lovely presentation and definitely a lot of help for those, you know, applicants that do have some sort of interview with their specialty um application, right? Um Let's get to it, the Q and A segment. Um There are a couple of questions here um And it will show directly onto your screen. Um So let me put that there. Our first question is, can you please repeat how to score the SAT? Uh OK. Sorry, I didn't actually cover how the exam is scored very well or at all. So what happens is your overall exam is marked and they preset a certain score as the average, which is roughly around 250. So it, it doesn't matter how well you do in the exam, it's how well you do in the exam relative to the other people who are sitting the exam. Um, and a standard deviation is around 40. So, if you're, if you're getting closer to 302 50 in the exam, in any, in any section you're doing quite well, ah, and it's also important to know that it's actually, I think it's harder to get a high, like the difference between 2 92 91 versus the difference between 2 52 51 is a lot more. So it's important that you prepare for both papers and do equally well, both of them so that you're getting the easy to get marks on both of the papers. Um specifically with your question about how to call the S JT the ranking question, you get given four options and you're asked to rank them from 1 to 4 if you get a direct hit. So let's say option A, you ranked as one and you got, and it was indeed the best option. Number one, you would get four marks just for that, just for that. And if you get all four of the questions correct, it means that you get a total of 16 for one ranking question if you get a near miss. So if let's say you ranked option a second, you would lose one mark and you would only get three out of four for that particular question. And if you are two away, so let's say option A was the best option and you ranked it third. Um, you would lose two marks for that. And then it depends on how well you do with the other rankings, ah, to determine what score you get on each question out of four and how far off you were for a score out of 16. However, your best strategy, as I said earlier is to lock in your best choice, the most appropriate and the least appropriate because that means that even if you get the two wrong in the middle, you can only lose a maximum of two marks because if you write one and four correctly, you went 1324, you would still get 14 out of 16. Um And with the EQ si believe you get four marks per correct answer. So I believe they said there's roughly 10 options and you pick three. So those questions are actually out of 12 and you get 14 marks for each correct answer. Uh Does, does that answer your question? Yeah, just, ok. Well, we'll, we'll see, we'll, we'll see if he responds to your uh answer, but we'll move on to the next question, which is, how long did you prepare for the exam? Ah, so I know that I'm quite a slow learner. Ah, so I started what I thought was quite early. And a lot earlier than a lot of my colleagues and some people who did is equally as well as me. So I wouldn't use what I did as necessarily as a benchmark. It's just that I know as a learner that I take a long time to learn things. So I start a lot earlier than some of my colleagues. For example, I started in, I think it was October, but I wasn't really doing it that properly. I would say I was just doing a few odd questions here and there for about a month. Um I think I only probably did around 200 questions in that first month. So I wasn't, I wasn't really going that hard at it. But then I think halfway through November and all of December, I started going a bit more hard at the revision. So I would um sort of use the majority of my free time um preparing. So I'd say probably six weeks proper revision is what I did. But I would say that's very durable in the amount of time that you have. Now, if you start studying hard, right? Um Well, it looks like we don't have any questions coming in, but this question is for me, um you know, particularly with the M sra fast approaching within, you know, four or five weeks. If we're um counting from today, what would you say would be the best way to approach, you know, with that limited amount of time. Um, you know, just starting from now, what would you say would be the best way to approach it? Ah, I would say questions is the best way to approach it. Um, I would just start because the knowledge you should have in your brain, somewhere from medical school, you're not actually learning any new content for this exam. Um, I would just start doing questions and I would probably start by doing around 3030 to 40 questions on each specialty. So they saw the 12 ones that I showed you that then obviously, the ST and I would use that to identify your weaker areas. So if you're getting, let's say 90% in endocrinology, you probably don't need to be spending more time to try and get a little bit few more marks in endocrinology. Whereas if you're doing like a lot worse and getting 50% in urology, that's where you need to spend, spend more of your vision time and do a bit more reading. So I probably in this limited time, just do a quick triage to work out where you are in each clinical specialty. And then I would then sort of tailor my exam revision to, to the specialties that I'm weaker on. Um I would broadly say that you probably need to spend a bit more time on the clinical side than the situational judgment. But then again, it sort of depends on what your strengths are. You should be able to answer most of the situational judgment based upon your experiences as a doctor working in the NHS. And it shouldn't take too long for you to be able to get into that headspace. So I would, I would probably start the clinical side and get the bulk of the work done. Right. So, basically assess what you're good and not good at and kind of focus and, um, you know, go towards those specialties that you're not really the best at, at the moment. Um I actually like what you said earlier, you know, uh if you're working in the A&E or working at a current specialty, it's probably not the best to go through the topics that you're always kind of experience and seeing anyway. So I think that helps as well. Um Right. So it looks like we're not having any more questions coming in. Um But if there are any questions from the audience, please, um, put them on the chat box um for the remainder of the time, um Kevin, would you like to um plug our um poster for the 14th of December? Yeah, if you could get, if you get up, get that up. So guys, today's um uh I'm Kevin, be General Surgery registrar, uh working with a lot of my colleagues who Filipino Doctors of either UK graduates or international graduates. Um And we're doing a series of education uh events including today uh in the New Year we will be doing a mock interviews for, for surgery and the I NT depending on we can. But, uh, what's upcoming in just under two weeks is a sort of, uh, welcome to NHS type of uh face to face teaching, which we're um funded by the Royal College of Surgeons of England. We're gonna be hosting this at the college at the kind of beautiful LLY library if you've ever been there. And essentially, it's almost like um uh so uh the idea is that uh it's, it's a place where people can exchange their ideas in terms of uh working in the NHS of their IM GS, whether there's any um changes in practice culture shocks, um have an overview of NHS structures and relative to sort of careers in interviews, to be able to talk about career pathways, whether training or nontraining and uh tips on or on. I improving your portfolio. Uh not just for interviews but kind of the longer term as well in terms of uh uh building that education interest, that leadership interest, that research interest. And uh well, more probably more relative to your interviews coming up are sort of um talking about governance, uh governance topics and uh difficult scenarios that uh that uh might one might need to navigate uh during an interview station, uh particularly relevant to core surgery, uh which I can talk about from experience. Um but possibly other interviews as well. I hope to see you guys there. It's only for a Tenner and lunch will be included. Yeah, see you there. It's actually quite a good deal, you know, Tenner, um lovely um venue and lots of helpful, helpful stuff for anyone, you know, that is new to the NHS or is wanting to learn a or to to, to maximize their portfolio and to get into speciality training. So hope to see you guys there and the link is on the chat box and there is a helpful QR code as well on the um the slide right here. So see you there on the 14th of December um for any more questions regarding, you know, m sra or interview um prep um just because of, you know, we've run out of time. But if you do have any questions, there is AQ and a thread I've placed on the chat box as well. Um So we can basically go through the, your questions after this event and hopefully someone should be able to answer them. Um We're also leaving a feedback form on the chat box. So tell us what you like, tell us what you think needs to be improved and basically let us know what you think. All right, and anyone want to say anything just before we left or we left, uh we leave, sorry rather, right? OK. So thank you everyone for joining us and um well, you too, have a good evening and yeah, see you on the 14th of December. Bye. Thank you, Bobby. Thank you, Joyce. Thank you, Kev. Yeah, thank you to our speakers. Thank you very much.