Computer generated transcript

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

Awesome. So today I've got my good friend with me, Medulla Keri, she's Act One ophthalmology in London. So she did the M SRA last year and she's kindly have asked, um I'm asked her asking her, she's kindly talked us through her success of doing really well in the profession. Dilemma being a top scorer. So I'm going to stay quiet for now and hand the stage over to her. Oh, thank you. That was very kind. Let me share my slides and then all get started. Yeah. OK. So. Right. Oh, come on, let's go back. Can everyone see the first slide? Could you just put in the comments if you can um you monitoring the comments and if there's any problems with in video or audio, just put it in the comments and we'll, we'll, we'll get on top of it. Fine. OK. Great. Awesome. So, yes, hi, everyone. As you said, my name is Radula Ri. I'm an ST one trainee in ophthalmology in the North London Deanery. And she's asked me today just to introduce you all to the professional dilemmas paper. So the first section of the M SRA um So what we're going to cover today. So, first of all, I'm just gonna explain a little bit about what the professional dilemmas paper is. Um how it's tested or the so called syllabus um of sorry, what is tested? Um how it's structured. Uh We'll look at the diff type two different type of questions. I'm then gonna share with you my approach this worked for me and it's, it might work for you. So I want you to try and give it a go and I've give it, I've also made some example questions as well so that you can try and apply that approach and see if it works for you. Um And then the final slide just quickly on mainly my top tips and what I used in terms of um how I prepared and then we'll have enough questions at the end, uh enough time at the end for questions. I'm going to just for the sake of time, I'm going to leave all questions to the end. Um Ask them when you think of them and I'll come, I'll pick them up at the end. The first thing I want to say is if you haven't already seen yi's introduction to M sra, please go and see it. It's currently on demand on the meal page. I think it's also on the youtube. Um So go back and um have a listen to that, that's really helpful and tells you, gives you a good overview of the exam and so to start. So what is the professional dilemmas paper? So this might also be known as a situational judgment test, which some of you might have done already either in your application to medical school or in your foundation program applications or in other roles as well. And essentially it's assessing non technical skills or as they say in their website to assess your professional attributes which are necessary to be a trainee. Um And in this professional dilemmas paper, it's based on the good medical practice guidance written by the General Medical Council. So if you haven't already read it, I would really recommend reading it. It's not very long, but it's very important and has a lot of key details in it. Uh It's 50 scenarios and it's all based on good medical practice. So a key document again. So what is tested in the professional dilemmas paper? There's three domains, mainly um professional integrity, coping with pressure and empathy and sensitivity. And then these are further divided into kind of these sub domains. So for professional integrity, this includes being honest and open, being able to admit your own mistakes, duty of candor, which is um making sure you explain to a patient when a mistake has been made and explain what's happened with their care and how um you've gone on to solve the mistake that's been made. Uh It also includes treating others with respect and dignity. Others include your patients and your colleagues and talks about professional boundaries at work. There's a part, there's a sections on balancing ethical tensions, especially in resource allocation and the demands on the service that are put on that, that different groups put on the service. Um It also includes thinking about quality and how we improve quality, but also patient safety and managing risk. Professional integrity includes showing yourself as being proactive and inquisitive and give me a second and also taking responsibility for yourself for others in your working. Can you see my screen anymore? No. OK. One second. Yes. Where has it gone? Oh OK. Sorry about that. Mhm Right. I think we're back, aren't we? Have you got you? Great. OK. Hopefully we're back. Um If we're not someone's saying something. So as I said, yeah, it's about taking responsibility for yourself. Um others including your colleagues and your patients and then the wider population talking about health improvements such as smoking cessation or weight loss. Um Finally, it's about showing a commitment to equality of care and then acting in your patient's best interests. So the second kind of domain was coping with pressure. So this includes um understanding your own emotions and its impact on decision making, seeking assistance when you need help managing stress, remaining calm, being resilient, responding flexibly to change, understanding where your limitations and your skill set lie. Um having a good work life balance and being able to balance your differing responsibilities and commitments and then also adapting your behavior to whatever role you have. And then finally, the third domain is empathy and sensitivity. Um So showing that you're caring towards your patients and colleagues, which I'm sure you all are um having the capacity and motivation to understand your patient's perspective of a situation and as well as your colleagues perspective as situation, taking a holistic approach. So thinking about the biological psychological, social, emotional and spiritual needs of your patient, empowering your patient, exploring their own wants and needs, taking a patient centered approach and being generally open and non judgmental. So these are kind of the three domains that the M sra tries to test in a situational judgment type way or professional dilemmas, paper type way. So how the actual paper is structured, it's 50 scenarios and you have about 95 minutes to complete and answer all the 50 scenarios. So that gives you about a minute and 54 seconds per scenario. And each, each question will have a small section at the top kind of giving you a setting a scene of the of the situation you're in. And then it has some options that you have to choose. Half of them will be ranking questions where you have to rank the most appropriate to the least appropriate. And then half of them will be multiple choice questions where you choose three out of eight answers. An important thing to know is there's no negative marking. So it's really key that you answer all the questions. The only way to lose marks in this exam is by not answering a question. So taking the ranking questions, first of all, you would be asked to rank each option from 1 to 4 or 1 to 5. Um One is the best most complete option and five is the worst. There's no tied ranks. So there's no two options that are a number two and there's no empty ranks. So if you were ranking 1 to 5, you wouldn't leave three blank. And the way these questions are marked is by comparing the answer that you give to a predetermined key. So what that means is say your, say the correct answer is ABCD E that will give you 20 points if you write ABCD, E, if you answer a BCE D, for example, instead that will give you 18 points cos you've almost got it right. But you've not quite, so essentially the kind of range of marks you can get on this paper are 8 to 20. So really important to complete the paper because the only way to get zero marks in this paper is by not answering the question. And then next, you've got multiple choice questions. So here you would choose three out of the eight options. Um And it's the best combined response to, to a question. And I'll explain a little bit more about what I mean about that later. Um This is marked a bit more simply in that you get four marks per right answer. So you can get 048 or 12 in these questions. So my approach, um this is one of the many approaches you can take it worked well for me. So that's, I'd recommend you try it and if you like it stick to it, if you don't try and try a different one. Um The first question that I would, the first thing I would do when I'm given a question is I would read the scenario once I read the scenario, I try and identify the theme. So is it about professional integrity? Is it about empathy and sensitivity? Is it about coping with pressure? And more specifically, what kind of sub theme it is within that? Um For ranking questions, I would then choose the first or last option. Um first, so choose the best and worst and then I'd fill in the middle and I have this kind of check or this way of thinking of a check, which is thinking about the word all. So, and I think this will become a bit more clearer when I go through the examples. But essentially what I would think is OK. So a so the first option is the best or if I couldn't do that, I would do the second option or if I couldn't do that, I would do the third option. And this is my little check that I put against at the end just to see if it kind of makes logical sense and also check it against the theme for multiple choice questions. I would identify triplets or cutlets. And what that means is, there's some options that you just don't, wouldn't choose together. For example, you wouldn't tell your patient to go to A&E and tell the patient to call your GP, call their GP. That's just not option. They're not options that you would go to, that would go together. So you, once you're able to identify them, you can then start to choose the best one and kind of eliminate the other ones. I will then make sure I've got three options or that I've chosen three and not more. And then I would use my and check, which is essentially remember what I said about it being a combined answer. So to an I would think, OK, to answer this scenario, I would do this option and I would do this option and I would do that option and I would want to make sure that that makes logical sense. It answers the question completely and it meets the theme that I've identified earlier. OK, I hope that makes sense. Um Is there any questions about this approach at all? Is there any questions just with whilst we're here? No. OK. That's fine. So moving on to some more generic rules that I came up with as whilst I was practicing that I'd like to share with you. Um First of all, patient safety is key. So it's a num it's the number one priority. Um Anything that harms patient safety is not gonna be, um it's either gonna be a low ranking question or it's not gonna be a question that you choose. Um You can either address uh answers that address the problem promptly and directly are better than answers that address the problem slowly or indirectly. Um And they're also better than, than answers that address something unrelated. So essentially you want to make sure that you're prompt and direct, really look at the language in the question. Um kind of more answers which say explore this or discuss, this are more are better than kind of more emotive language such as argue or confront or tell or always or never. So just be like really aware of what language I use um base your answer only on the information given. So don't worry about don't assume any information if you're not given it, um try to solve the problem yourself first. So if you can solve it by yourself, that's better than um getting someone else in your team to solve it. Um And then directly direct communication is always good. So if you have a problem with someone in your team, talk to them directly before talking to their supervisor or talking to someone else and then answers which promote learning from events are usually very good. As well? Ok, I can see the question popped up. Do you want me to? Sorry. We're having two computers here. Ok. Can you please explain the M Qs again? Sure. So essentially with the Mc Qs, you'll get the scenario and then you'll get eight options and you have to choose three out of the eight options. Um And it's the best combined response. So you're saying I will do this and then I will do this and then I will do this. That's what an M CQ is. I have some examples. So it might, it might become a bit clearer when you see the example. What are triplets? It's a good question. It's something I was taught, told to try. Where did I go for it? When, um when I did these questions and they're essentially options, which won't, you won't do together. So if the scenario is a patient has called you on the phone and tells you that the tummy hurts, what do you do? This is not gonna, this is something I've just made up. This is probably not gonna be a scenario. But if it is, what would you do? And then what's 2011 of the option is tell them to go to A&E another option is um, tell them to call the GP. You're not gonna, you're not going to ask, you're not going to tell the patient to do both of those things. Both of those options can't be the correct answer, you're going to choose one or the other. And these come in kind of triplets or couplets. So they come in pairs or three answers. And these, that's what, that's what I mean. Again, I'm hoping that this will become more clearer with the examples. Cool. Is there anything else? Uh Yes, this is recorded, I believe. What does rank highly mean? So um when you're ranking questions, you're ranking 1 to 1 to 5. So the explore options are likely to be more to be um one or two. Whilst the like tell, argue, confront, options are likely to be um kind of horrified. OK, I hope that all makes sense. Um uh OK, we have another question. What does it mean by check against the theme? So my, this is talking about my approach. So when I always try to identify what the theme is, so it will be so it will be one of professional integrity. It will be either related to coping with pressure or it will be related to empathy and sensitivity. And if you're able to identify the theme of the scenario, you can then use that to best either rank your options or choose your options. OK. Fine, great. I hope that all makes sense. Um It will become clearer with the examples, I'm sure. So we'll hand it over to you. So I sent so what I've done is I've created a few questions, scenarios that were similar to ones I practiced from when I AED in the M sra. Um, I'll give you each a minute and 54 seconds to read through the scenario and come up with your answer. Don't put your answer in the chat. Just write it down on a piece of paper to give everyone the chance to have a go and then I'll go through my solution and a caveat thought to this before we start is that you might not agree with my solution. And that's OK. Um I'm not the question writer for the M SRA. So I don't really know how the examiners are thinking. This is just from my experience of doing a lot of questions and scoring well on the M SRA um and this kind of leads on to a key point about unofficial resources. So resources you use that aren't made officially by hee or the M SRA team. And that's that a lot of people me, I'm sure you did as well. And like our colleagues, when we were doing, preparing for the M SRA, we found it really difficult because often rationale would contradict. So rationale between questions would be contradictory or rationale between different question banks would be contradictory. And it, it is really hard when that happens. And I think what, what I would say is take it a little bit with a pinch of salt. Don't get bogged down in the details of the rationale. And the only the only details you should really be kind of concerned about are the official example, questions on the he website for the M sra. Um Yeah. OK. So with that, I've got a timer next to me, I will show you all the first question and you've got a minute and 54 seconds. OK. So that's your time. So I hope you got a little bit of a feel of how much time you have for some of these scenarios. Um So my solution for this was da ce B. So if we go through like my approach, so I would read the scenario, I read the scenario and the key theme I identified here was that this question is talking about empathy and sensitivity and more specifically, it's talking about caring towards your patients and colleagues. So with that theme in the back of my mind, I would pick the best and the worst. Um So I picked D as the best. Um So this is discussed with Dr A their thoughts and feelings about the situation. It shows your ability to listen to Dr A's concerns and gather information about what's happened. And it's one of those things I was saying about discuss, explore, they're always the good ones, they're always going to be high up. So just be aware of that. Um And they then chose the worst, which I thought was BB is tell doctor A to complete their assessment of the patient. So this is showing no concern for doctor A at all. It's not resolving anything really. And it's sending doctor a back into a situation which might be potentially dangerous for them. Um and showing no empathy or sensitivity or caring towards your colleagues. So then kind of fitting in the middle. I went with a being after D um which is clark, the patient for doctor A, it solves the issue of the patient needing to be Clark, but it shows no concern for doctor A at all and you're not doing anything to kind of help doctor A in that situation. Um Then you've got uh c understanding um c which is informed the consultant. Again, this is understanding the ne a need for senior involvement, but which is good. You always get to involve your seniors but you, it doesn't really immediately resolve any issues. Um I then put e as the next um one because you have a responsibility to care for your colleagues um by not doing anything, you're not really gonna, you, you're not showing empathy and sensitivity. And then, as I said, would be this could then you're potentially putting your colleague in a dangerous situation. And so this is why I chose it as the worst. So once I've put all this together, I would then do my a check. So does this make logical sense to me? Um If the best answer I would do is talk to doctor A or if I couldn't do that. I would do, I would clerk the patient cos at least the patient's being clar or if I couldn't do that, I would inform the consultant and so on and so on. Ok. So that's so that's question one. I'm gonna take all questions about this at the end just so that we can get through all the questions and then I'll go back and talk to you and pick up anything about any questions people have. I hope that's OK. Fine. Moving on to the next scenario. Um Here's this one and I'll start your timer. This is a multiple choice question. So that's your one minute and 54. Um So this is a multiple choice scenario. You need to identify three options. So my solution here was BCE. So taking the approach, I take, I would read the scenario, I would then identify the key theme here as coping with pressure. So you're balancing your differing responsibilities of both your work and your normal work life. Um I would then kind of identify cutlets and triplets and I hope this becomes a bit more clear now that we have some examples. So in this question, I first identified that A&E are a cutlet. So cancel your dinner plans or call your family to arrange to meet at the restaurant. There are two options that you just wouldn't, you would not do at both. So you need to choose which one's the best one and out of these, I would choose e because it shows that you have a good work life balance. Um Then the next thing I noticed was to identify anymore. So I got another triplet which was BG and H. So ask your colleague if they're willing to cover, um ask the nursing team to call doctor B for advice if they have any problems or leave the hospital. These are three things that you wouldn't, you wouldn't do together. Um And I think the best option out of BG and H I've chosen is B um because it ensures appropriate cover and ments ensures that handover is your responsibility. So it's not the nursing teams responsibility to, to ensure this cover for your shift and leaving the hospital without insuring cover is a major patient safety issue. So it is a big, no, no. Um You would. So out of those, I've chosen E and B is my best option. I then need to choose a third and out of all the rest, I think informing your senior allows them to be kind of in tune with the situation and maybe also might help um encourage them to help find a solution. D and F um don't really solve any immediate issue. You're calling doctor B to ask him to be quick, doesn't mean they're going to be any quicker and reporting doctor B to his supervisor is probably, is quite inappropriate at this stage because you don't know the reason why he's late. It might be that he's stuck in traffic, which is not something he can control. Fine. So that's that one. Again, I'll, I'll answer any questions to do with this at the end. So next scenario time starts now. Thank you. I OK. And that's the time for that one. So my solution to this was CE DBA. Um Again, using the approach that I take um key theme here, empathy and sensitivity, exploring the patient's wants or needs, taking a patient centered approach, but also taking this a little step further. It's also thinking about the carers and our patients carers. So in my opinion, C was the best and A is the worst. C is the best because it shows active listening, it shows that you're giving importance to the son's consideration and you want to know more, but you're not promising to comply with his request. You're just information gathering. Again, this is kind of what I was saying about discuss, explore, remember that kind of thing about the language of the option that you're given. Um I then said A was the worst. So A was complying with the request of the son. Um This is showing no respect for Mr CS autonomy, his wishes about knowing about his diagnosis, his wants or his needs. And actually, you're not really getting spending time to understand why Mr CS son has this request. So then looking at the middle um which is arguably harder once you've identified the best and West, um I went for e as the second most appropriate. So this was asked Mr C whether he would like his relatives present when discussing his results. So again, we're showing a respect for Mr C's autonomy. We also showing consideration towards the family. But when I think maybe what makes it a little bit less than C is we have the sun right in front of us at the moment and we're not really solving that issue. Um Remember what I said about prompt immediate solutions are the best. Um So if we don't do uh that we then go to um d which I think is the next best option. So this is asking the relatives to leave the bedside so that you can speak with Mr C privately. It's, it's a solution that makes sure that you understand Mr sees point of view, but it doesn't show any respect for his family. Um which is something that you also need to consider. I would then put be next inform the so that you have to respect Mr C's autonomy, which again is correct, but can be seen as being disrespectful and it doesn't solve, resolve the issue in front of you really, it just informs him that you need to respect his autonomy, but it doesn't really say much else. Um And so this is kind of the what I thought and using that or check that I have. So, um, my best option would be listening to the sun or if I couldn't do that, I would at least ask MS to see whether he would like his relatives present or if I couldn't do that, I'd ask his relatives to step outside. Or if I couldn't do that I would, um, and form the sun or, and et cetera, et cetera. Ok. That's how I do the all check just to make sure it makes logical sense in my hand mind. And then using the theme of empathy and sensitivity. Yes, this does make logical sense if I compare it against that. OK. Fine. OK. So now just to the last example that I have um I'm starting now. OK. OK. I'll pause the timer, have we lost my screen and everyone still see my screen. Can anyone hear me? Yes and yes. OK. Brilliant. Carry on. I've re the time is still going. Uh It's full screen now. OK. OK. So you had a little bit longer just because of my technical difficulties, but we're back, it's all good. Um So the solution I came up for, for this one is um the E and F. So taking my approach, I read the scenario, I then identified the theme as professional integrity, treating others with respect and dignity. Um So with that in the back of my mind, I started then identify pairs, cutlets, triplets, whatever you might want to call them that don't really work together so that I would need to choose. So my first one I decided was A and B um advise Miss D to discuss this with the practice manager or ask Miss D to explain it. Further. Information gathering is key is always an important part of the question. So I think this is more appropriate at this stage than redirecting patients to people who might not be actually appropriate for them to talk to. You don't know what the problem is yet. You don't know if the practice manager is the right person they need to go to. Um C and F is another pairing that I chose. Um So this includes explaining the procedure for making a formal complaint to MD and F asking Missus D what MD, what she would like to do. So asking the patient what they want to do, what information they need is really important. It seems quite simple, but it's something that often a lot of us forget to do. So just ask them what they would like to do if they want to complain, then you explain the procedure for making a formal complaint, Miss Dee might just want to be have her feelings acknowledged, she might not want to actually complain formally. So ask them what they want before you go ahead and start assuming what they want. Um Finally, um D GH is a triplet that I identified. So explain to Missus Dee that staff are very busy explain to Miss Dee that you believe the GP partner is a full doctor and reassuring Miss Dee that you do not believe the GP partner meant to be rude. This is a, this is an interesting triplet co actually, I don't think any of these are right because it seems irrelevant to the patient um to explain how she's feeling, it's dismissing the patient concerns. And in a way, you might be seem to be colluding with the, with the GP partner when you don't know any of the details of any of the previous consultations. So I wouldn't choose any of these. And instead, I think the best thing in this situation would be just to apologize to Miss de about how she was made to feel. And that again, will acknowledge that you will make sure that you are acknowledging how the patient feels and kind of giving them the respect they deserve for that. Fine. So that's my example questions. Um Just finally, some tips and resources I would really recommend visiting this website, the GMC Ethical Guidance website. It's got the good medical practice guidelines on it. It's also got a lot of other guidelines, stuff about confidentiality, especially things about safeguarding cases of Children because there will be scenarios about Children in, in the scenario. Um and then uh things like, but it, and then I think there's some, I don't know if it's on this website. Is there some scenarios I'll, I'll, I'll remember that there are OK, there are some scenarios that you can go through on the GMC website which um help you kind of get into this way of thinking. Um I would recommend the way the thing that worked for me was just practicing, practicing, practicing. But as I said, don't get bogged down in the details of the rationale if you don't agree or if you find contradictions and then as you do the questions start writing your own rules about what you're noticing as a common thing. Like for example, with similar to what my general rules were um accept the variation in marked themes and just make sure that your rules and solution align with GMC guidance only based your answer on the questions on the information you're given. Don't assume anything else. Um Redo questions. So we do them timed and group work is a really good thing for professional dilemmas. So being able to do a question and then discussing it with your peers will help you kind of get into the correct way of thinking. And that was it. I can see that there's lots of questions. So I will try and go through them now. So let's go from are official past papers or just example questions, I believe there's just example questions I couldn't find any official past papers. Um There were the foundation program, official pass papers, but I believe they've been taken down now because the foundation program no longer uses the S JT. Um So the only official resources are the example, questions on the hee website from my knowledge. Um Was that how much time in the exam we should use per question? I'm assuming you mean the one minute 54. So that is how much, if you split your total time equally per question, that's how much time you would get you. I'm sure you will definitely spend shorter amounts of times on some questions and longer amounts of on other questions. But it's really important to keep on top of your timing in exams such as these because the main way to make sure you get good marks is by answering all the questions. Um wouldn't e be the last option as it's not addressing the situation at all? I think this was about question one, correct me if it wasn't. Um So e is ignore the situation, continue with work and I put that higher than B so in this to explain my thinking behind it, um I thought B was putting your colleague in the situation which is potentially dangerous to them and that would be much worse than kind of continuing and not doing anything. So for example, if you didn't do anything, then you're, it's not necessarily forcing doctor A to go back to this abusive patient. I see what you're saying. Cos doing nothing, solves nothing. But then, and I guess telling a to go back to their patient might solve the issue of the patient being clark. But this was just my way of thinking again. I, as I said, you will probably disagree with me. Um And to be honest, that's just the nature of ST at, it's hard to kind of determine what is the best answer, especially when you're not, you're not the person writing the questions. But yeah, II completely understand where you're coming from. This was my thinking, but your thinking seems valid as well. Um If we finish the S JT section early, can we use the extra time for the clinical knowledge section? No, you can't. You can only, there is a five minute break which is optional between the two papers. But you can, no, it doesn't cut into your No, it didn't. For me. You thought you is telling me sorry you So basically that five minute is your optional toilet break time. But if you go for 10 minutes, yeah, if you go. So yeah, that's true. So you have an option of five minutes between the papers to go to the loo if you overtake the five minutes, you then will cut into your clinical paper time. Yes, that's right. But you can't use your S JT section time for your clinical paper. Um To identify the theme of the question. Do we need to read GMC? Best Practice? So yes, you definitely do. But my, I'm guessing you're asking about these, these are all from the GE M sra website. So they very clearly lay this all out for you. Can you please? Oh, for question three. Could we go over? Why be right to higher than B yes? What did I say? B ranks higher than B? OK. Um So for me, what I thought was that D um was so, yeah, so D was being a bit more respectful than B because B you're not really solving, you're not, you're just saying to the son that you have to respect Mr C's autonomy. You're not considering his concerns and you're not even discussing it with Mr C. So you're not doing anything that immediately resolves it. Whilst with D, you've got the option of, you're actually trying to talk more to Mr C about his thoughts and feelings and that's why I ranked it higher. What resources did I use? So um am II use, I use various question banks. I, I know a lot of people ask which is the best question bank and which is the most worth it. Money. I, to be honest, I don't with the SJ ti don't think there's any that unnecessarily um better than the others, any kind of practice is good um With Yeah, II don't, I wouldn't say that um I found any particular question bank better than the other. They were all quite similar in my opinion. I don't know if you have a different opinion about the S JT portion. Um It's just really important to practice. Uh, um, I think I'll follow up with Medulla about the practice question in a second, but we're just gonna do a few more answering of the other questions and I've just got a few. Ok. Brilliant. Ok. Awesome. Um, where did you practice questions from? So, the main to be actually going back on that, the best practice questions are the ones that the hee release on the, um, um, official M Sra website. I think there's about 20. They're the best ones and they're the ones you should really concentrate on once you've done those 20 which you'll do very quickly. Any kind of S JT book or, um, M sra book, um, has, um, has the, uh, options, has questions that you can practice from and as long as you're just practicing the way of thinking, um, that's the most important thing. Um, I think if you go up here, how high keep going, uh, how do you approach the, do nothing options? Do you have any rules about that? Um, do nothing is always bad except when there's something worse, which is not really a rule, but it's things like, um, when you're putting people at risk or when you're affecting patient safety, that's worse than do nothing. Um, I hope that helps. Um, no, I didn't say H CGI said hee sorry. Um, so that's health education England were the questions similar to the S JT done at the end of medical school school also are all the scenarios written or were some questions videos all the scenarios are written? There was no video questions were the questions similar to the S JT done at the end of medical school, they have a similar kind of thinking. So yes, but they have they're very specific in that they will be one of these three domains. So that's why it's really important to know these domains. Thank you so much for excellent. So moving on from medulla regarding what I use, so I actually use slightly different resources for Medulla, like someone asked, is it similar to the S JT? And it really is, the domains are more focused on the three domains that is focused on. But overall, it is the same group of people writing the questions. We think we're not sure, but it's all placed on the good medical practice and that's how the MSU T was done. I know it's been scrapped now, but when we did to apply for foundation jobs. So what I use where the practice papers were, the official S GT. So this is what I was going to suggest too, but I tried Googling them earlier this week and I can't find them anymore. Well, you guys are, I actually thank you flashcards before they were taken off. So we didn't practice this. I know it sounds like you were. Wow. OK. So yeah, so it's a free resource we wanted to make it available and not charge it for everyone. So, what I did was basically screenshot it all the different questions that we when the ST people's papers there. And I think there were probably about 100 100 and 50 questions and I just focused on this and I did them to the point where you almost could memorize the answer. But then it just sort of ingrained of how the GMC principles would work. So it's not perfect, but it is the more official resource compared to the other question bags. We're not saying they're bad. But like I said, it is a bit subjective to trying to get into the mindset of how it's quite difficult. Yeah, that's really good. So just to explain for people who didn't do the foundation program or didn't do the foundation program, ST um it's no longer the case that you have to do an S JT to enter the foundation program. But when, for example, me and yi entered the foundation program, we have to do a similar paper. And at that time, there was official papers that were practice papers. So that's what Youi is saying that we are flashcards. I've just had a question about which the official website. So this is it. Heem Sra. I hope you can still see my screen. And if you click on preparing for the M sra, I think you might be on this one. No, all set. Oh Here. Professional dilemmas paper and you click on it and you scroll down and this is where the three domains and all that, all what I wrote about is in. So have a look there and then finally the questions are where the questions go. No. Oh, there we are. Here we go. You the MSR practice ba here we go. So then you go on, you can go on to section one and section two. And you've got questions here and then you've got the answer and the rational, I hope that's helpful. Um Fine, I think we'll call it a day, right? Have a lovely evening. Have a lovely evening, everyone, everybody. And thanks to me for doing her presentation.