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Life. Uh Good evening everyone. My name is Pfizer and I'm the es lead for the academy, which is the training arm of the AGB. Welcome to our online webinar as a part of our career part series. My co moderator is Michael Wong, who is our led lead as well. Um He will be monitoring our chat box, so feel free to um any questions, just fire them in the chat box and we will do our best to answer them. We have got uh today, Mister Nick Wilson and Mister Alan, as with us today, talking about the national selection ST three general surgery and how to improve your chances of getting into the training program by enhancing soft skills into the interview process. So without further ado, I will hand it over to you, Nick. All right, that's great. Can you, can you hear me? Ok. Yes, we can. Yeah, lovely. Ok. Well, look, thank you very much to the Moynihan Academy for, for inviting me this evening. Um As Faye said, my name's Nick Watson. I'm the UK lead for general Surgery ST three recruitment. Um I'm also the vice chair of the General Surgery sac I'm one of the general surgery training program directors for the East Midlands. And you see, I've dug out my A S GBI hoodie. Uh I'm also on the A S GBI S education and training committee and the Congress organizing committee. And just while I've got people's attention, I'm just gonna take the opportunity to make a shameless plug and highlight to you all that, the abstract submissions for the Congress in Edinburgh. Next may um have just opened a and will be open until the 27th of January. But that's not really what I was meant to talk about. What I was meant to talk about. I is national selection. I just, I'm just gonna say at the beginning of the talk, I cannot answer people's specific questions if they're along the lines of what score will I get for X or Y. But what I can do is try and help you understand in broad terms, what the process entails uh in terms of making a, a, an application and going through the process. And so to do that, you know, you need to understand what the background of this is. So when I was appointed as a registrar 20 something years ago, it was all done locally. Each deanery did it themselves independently and it was the TPD S who kind of had ultimate power as to who got jobs. Um And that was great if you were in with the TPD, but not so great if you weren't. I mean, there's quite a lot of bias in that system was potentially quite nepotistic, potentially even quite unfair to some people. So round about 2012, I think it was um we moved to a national process, uh and what that looked like was that everyone who was eligible um through long listing got interviewed. So absolutely, everyone got an interview. There was no short listing. They all got interviewed in person in London and there were five stations in the interview which at that point included a, a test of kind of technical practical skills, which usually was a laparoscopic box trainer. Um a little bit of teaching and there was a portfolio station where people physically bought their portfolio and went through it with the um interviewers. Um and there was a specific communication skills station and that worked fine and then COVID happened and then we couldn't do face to face anymore because COVID. Um so it now I absolutely, the, the, the team that were administrating selection at the time did an incredible job just to keep it going. But what they did was bring in a shortlisting process and initially asked people to self score their applications. So it's really important to acknowledge that was an emergency measure for that one year because of COVID. Um They then thought, well, actually hang on, we better check um that, that people are scoring themselves correctly. So, introduced a verification step at where the scores were checked, but they didn't check all of them. They, they only checked a proportion of them. Um, and what we found was that actually people quite often wildly over schooled themselves. There's a surprise and actually, indeed often people underscored themselves. And so actually asking people to score themselves is not really very reliable. So we had to do something about that. Um, and II, in doing something about it that also gave us the opportunity to kind of refocus the process on that. This isn't, this isn't a thinly veiled attempt to get you to subconsciously associate me with the Dalai Lama that I thought neatly represents our philosophy. We want to recognize and reward quality over quantity. And, and what I mean by that is well from COVID onwards, shortlisting had kind of got to the point where it was emphasizing volume of activity, particularly things like audits, publications presentations and it was over sadistic period with one audit got you one point, but it didn't matter what effort quality impact had gone into that audit, they were all kind of rewarded the same. And that seemed to me philosophically wrong. So now last year, we revised the process where so we've undertaken that we will score every single eligible application. So we look at everyone's application, not, not, not the top however many percent and we have two people look at them independently. Um But we limit what we ask for to people's best efforts in, in each category where appropriate. And that lets us look much, much more closely at the quality of people's evidence. Um And that's now where we're at philosophically and I II don't see that that's going to change any time soon. So what's competition actually like? Um, so the left hand column there, the these figures are the published figures fairly recent from hee. Um and we had 681 applications to general surgery last year. Um, for what ended up being 100 and 81 post. So a competition ratio about 3.8 to 1. And you can compare that with the, the second from the left column which was anesthetics. They had 640 and TN 0 er 522. So TN O only got three quarters of the number of applications that we do. And in fact, when you look at all the specialties, medical specialties, all the rest of them, what you'll see is that all of all the, what they call round two specialties, the specialties that recruit at ST three level and above, in fact, general surgery is the most applied to specialty. And just, just as a note that final column on the far right, that's the number of applications we had the previous year before that, which was 515. So we had a 33% increase in the number of applications last year. So that sounds bad, but actually, it's not quite as bad as it looks really when you understand what the figures are. So that headline figure of 681 that includes people who never submitted any evidence in the upload window or submitted incomplete applications. Um and it also includes all of the people who turned out to be ineligible when looked at in the long listing process. So the actual, the actual number of applications that we short that we score and we score all of them is just, that was just under 600. So it's a bit closer to 3 to 1 than the nearly 4 to 1 that the published figures suggest. And then of course, by the time you get to the interview, well, we interview just under 300 for usually somewhere around 100 50 OD posts. So by the say, if you get an interview, almost sort of 2, 1.5 to 1 even, um that you'll get a post. And then the other good news is that we haven't changed this person specification at all this year. We're very mindful of the um that's kind of non financial cost of training, uh document that as it put out and people not wanting um things changed massively year on year. So we, we really haven't moved the goalposts this year. So the actual process itself, well, the first thing that you'll do if you want to apply is that you'll go to the oral website and you will make your application through that website and everything else is done through that website. Um And that initial application will be the information that the recruitment team need to check that you are eligible to be appointed an ST three in general surgery according to the person's specification. So that's in effect kind of long listing. There's then a kind of brief gap and then you have a month uh which is the evidence upload window and that is when you will download complete and submit seven templates, um which have all of the information on them that we actually score. So we don't score the application, we score the templates and the evidence that you upload with the templates. When we shortlist, we then we will meet face to face. It's got a couple of days in the diary towards the end of January where I'm hoping that I'll get enough colleagues to, to be able to do it um where we will go through every sh completed application with completed evidence. Uh and that will enable us to rank everyone um and then allocate the interview slots according to how people rank um the interviews. So it's, it's usually about the top 300 will be invited to book an online interview slot. Er, and interviews will be over a three day period, three consecutive days in the middle of March and then we combine the scores. So the shortlisting and the interview test different things, they complement one another, they don't repeat. Um, and those scores will be combined to give an overall ranking, er, and that determines how the posts get offered out. Now, I said to phase earlier, I've regretted putting these slides in because one might accidentally get the idea. I've, I've kind of assumed gen, I've, I've made a sort of gender assumption which is not my intention in my house. It would be me on the left there that have tried to make some IKEA furniture without referring to the instructions and got it all wrong and it put the wife on the right who's nice and happy cos she's got all of the kit laid out neatly in front of her with all of the instructions neatly followed and, and so don't be like the ladies on the left. Um What if there's one thing you remember from this talk, please? We spend weeks and weeks on the applicant handbook, which is made available at the time that the applications go live. Um And it explains everything in great detail about how to complete the templates. What additional evidence is required with the evidence in the evidence, upload window. Uh If I can make a plea to people, please read it from start to finish and then read it again before you do anything else and keep referring back to it as you as you're kind of your evidence populating the plates. And then finally, once you think that you've got it all again through the handbook before you, before you press submit, um, that is really the, the take home message, read the handbook. Um, there are lots and lots of Fa Qs at the end which we've updated this year substantially. Um, with what we've learned from last year that cover a lot of the really commonly asked kind of questions and things that people are anxious about. So what we don't want is, you know, the the digital equivalent of shopping bags full of information that we haven't asked for. Um, we don't want applications that just, yeah, it's a mess. I it doesn't present well. Um we want everything nice, neat, succinct tidy. Um, nicely presented, there are other surgical specialties that deduct points um for poorly presented evidence and I think we will do so in future really. Um So what do the shortlisting templates cover? So there are seven of them, as I've said, there's time that you spent in sort of clinical general surgery. There is time spent in other specialties which includes emergency medicine and critical care, intensive care. Uh There's the number of appendicectomy that you've done, which excludes assisting. There's got to be SST S and above. And then just your two best publications presentations, two closed loop audits and then one further audit, which doesn't, the third one doesn't have to be a closed loop audit. Um And you if you'd rather submit a quip. Um, you can do that instead of the third audit, but you must submit to closed loop audits and then if you've got a higher degree. Um, so it's quite simple compared with, for example, plastic surgery. Um, so some notes on how the templates, I say we haven't changed anything, but there are some sort of cosmetic differences. Um in terms of the time spent in general surgery and the time spent in other specialties, we do need to see clear evidence that the posts, um, had, have both an elective and an emergency component to count. And that's because, yeah, think about it if you're a research fellow, um, but you covered urology out of hours. Well, that's obviously not the same amount of experience as someone who was doing urology full time clinical, which included elective clinics, elective operating as well as the on call component. You just wouldn't have the same knowledge, skills and experience as the person who'd been doing a full time clinical job. And so you shouldn't get the same reward for that. Obviously, um, the appendicectomy question. Uh my 16 year old, my, my wife wasn't very impressed with the Drake me. I don't know if she knows who Drake is, but my 16 year old was actually was. So that's got me some dad points. So last year above 45 appendicectomy, the number of points that you got tapered back down. Um This year we're not going to do that until you hit 80. And the reason for 80 is that 80 is the number of appendicectomy that you need for your CCT. And we cannot have a system where you require, you know, that, that rewards exceeding the CCT requirement. A a as a kind of entry criteria for the training pathway at the beginning. Um But what I didn't want to do was disincentivize you from going to theater to do another appendicectomy because you were worried that it would count against you in shortlisting. You know, we were meant to be encouraging the next generation of surgeons not putting them off. Um Where do we go? So these again are just the other templates and so there's not a lot to say, cos we haven't changed that much. Er, the publications template will now require you to put the impact factor in yourself. And that is unashamedly that's just to make our life easier. Cos we were spending a lot of time in the shortlisting trying to looking these things up and you can do that for us. Um That would be much appreciated. And then uh five and six the, the presentations and audits and to an extent seven, these aren't changes. What we're doing is we're just going to much more strictly apply the wording of the, you know, that was in the handbook last year and, you know, more strictly apply the scoring uh than we did last year. And that's cos last year, it was all new. So we were trying to be um generous, I suppose. So, presentations made just at departmental or hospital level will not be scored. Um We've also done away with the distinction between national and international conferences um which I didn't put on the slide, but it's worth mentioning it, they'll be treated the same. Um I a bit fed up of, you know, arguing with people whether, whether AAA meeting was truly an international or a national meeting, you know, what you find is that people will say, well, you know, you can, you can, your mate can set up an online meeting, call it the international meeting of upper pole of the left kidney conservative management enthusiasts and just cos it's got international in the name. People would claim it was an international presentation. It's not. Um but we, we've done away with that and then this is the other really important thing. OK? Aside from reading the handbook, one of the other really important things in this talk is that your closed loop audits must be closed loop audits. And that means you must have had a really a meaningful role in both part, both cycles of the audit loop. So what we found is a lot of people were putting closed loop audits in were actually when you looked at the evidence, all they'd done was come back and re audited something that would be done, you know, a year, 25 years previously where they hadn't had any involvement in that first cycle of the audit loop. And last year we scored you for the half that you had done. Obviously you wouldn't get any points for the first half, but you get points for the second half that you've done. Now, this year, closed loop means closed loop. So you have, have to have been involved in both parts. Um, the interview stage, I'm gonna go very briefly cos I think Alan's probably got, got a few tips for you. Um, with that suffice to say, you know, be professional, treat it like the, the sort of serious job interview that it is might be the last interview you have before you get interview for your consultant post. The things that are absolutely critical are you've got to have reliable in, you know, stable internet access. You must have a camera and you, you will be asked to move that camera around to show the entire room that you were in at the kind of document checking stage, um, with, with the admin team and that is just to prevent people cheating. Um, because cheating, regrettably has happened in other specialties previously with online interviews and if people do cheat, um, that is a very serious probity issue that will be taken, you know, very seriously, including speaking to your responsible officer, um, about it. Um So yeah, try not to be Robert Fox. I don't know, people, people probably remember who's a guy who was a North Korea expert, given an interview for the BBC, um, whose kids burst in, er, during the live interview. So don't be like him and don't be like these guys on the right, having an interview in your local Starbucks Costa and all other coffee shops are available, aren't they? Um, if you have, have to have it at work because there is just no other way. And I suggest you find a nice quiet room that you can lock yourself away in. Um and just get make, you know, make sounds obvious, doesn't it make sure you get rid of your bleed, turn your phone off. So the interviews themselves, there's three interview stations that we have. Um there is a clinical scenario which is five minutes reading time and then 10 minutes of questions of discussion, there's a management scenario which is, it's really kind of situational judgment you, you know, your ability to prioritize and recognize issues. And that again has five minutes reading time and 10 minutes of uh of discussion. And then there is a 10 minute portfolio station which is so it's called a portfolio station. But really what it is, it's a, it's an opportunity for you to talk about leadership, teaching career development because it, you, you'll have seen those things aren't covered by shortlisting. So it's not a, a review of your entire personal portfolio. It's not going back over stuff that shortlisting is already covered and you have to bear in mind that people um who are interviewing, you won't have any a won't have any access to any information. They can't see documents at this point. So really, it's kind of leadership and teaching um the interviews, it's a shotgun start for anyone that plays golf. Um So that means that you can start on any cos it's much more efficient to administrate that way, which you, so you can start on any three of those interview stations that you go round, proceed around them in any order, but you will have um two interviewers per station. Um They will be different for each station and the people that you go into won't have any knowledge of the scores that you've got had in the previous station or stations. So there's no positive or negative bias halo effect if you've performed really badly or really well um previously. And although there isn't a specific communication skills station, um that is something that is explicitly scored throughout the other three stations. So what we don't do, so we don't as, as a sort of selection group, we don't determine or dictate post availability. That's a sort of separate process. So as a T PDI get asked by the Deanery, how many newer NT Ns we can take in August? Um they've already asked for an indicative number for me from the East Midlands, but I looked back through my emails and the final date that I needed to tell them how many people I actually wanted in August was um the first of March this year for the interviews that were happening in March. So we, we won't know until almost of the time of the interviews happening, how many posts have actually been declared as vacant. And the other thing that we don't do is we obviously we don't do the direct allocation of who gets which post where the kind of matching takes care of that. Um What we do do is we determine a minimum appoint score. So we tell hee that anyone whose cumulative score through the process is, is below X is not appoint. And you know, that is just in case, let's just say they had say we interviewed 300 people and then they turned around and said, actually, we can take 300 registrars. Well, if, if everyone's appoint, that's great, but there might be some people at, at that sort of point where, where they their performance through the process is below the standard that we'd expect for an ST three, irrespective of how many posts are available. It's a theoretical thing in practice. It's never, it's, it's never come into play. It's absolutely never come into play in practice. Um ok, but you don't, you will know your overall score um but you will not know your ranking. So what about what about quality assurance? Well, there, there is some data which is currently embargoed from the J CST, which I've seen, I don't think it's breaching that embargo to tell you that when we've looked, well, when it's been looked at independently last year, gender and ethnicity had no influence at all on whether people were successfully offered a post or not, which is good to know. And then, you know, we're not badged by UEFA, but we are this year inviting um both the Moynihan Academy and asset to send independent observers to both the shortlisting and the interview stage. And that is in addition to the existing permanent lay reps in the steering group for selection. We have Martin King who's another co-opted member of the steering group, um representing postgraduate doctors in training, uh who is a past president of asset. And then we have multiple um lay observers um for the interviewing itself and, and internal quality assurance as well. So it's a very robust process. And then finally, just to say, spare a thought if you will for the people involved in the process, um you know, it might might or might not surprise you, but this is essentially, it's essentially voluntary work. We, we don't, I don't get paid for this. It's not in my job plan. It's just a thing that I do cos someone has to do it. And the same goes for all of the people who give up their time to do the shortlisting and do the interviewing Um So yes, spare a thought and then finally just sorry, it's a little bit blurry. Those are the timelines for this year. Um Those are all finals next and that's me done. I think um I will face, I will stop presenting and then what would you like to do about the questions? Should we have them at the end or do you want me to, should I address some of these questions? I think we can do it in the end. Ok. That's what I did in that case. Thank you very much. I hand over to Alan and mute myself. Thank you very much, Nick for a uh fantastic rundown of what the uh interview looks like and the changes that have happened. I'm hoping everybody can see the screen there. Ok. So the er Mr Watson has very uh kind of concisely and eloquently gone through what the interview actually is. Uh Well, first of all, um hello, I'm Alan Scarry. I'm one of the upper gi consultant and bariatric and general surgeons uh based at Luton and Dunstable Hospital. And I'm also the A S GBI S early career consultant network and had the pleasure of being in the Moynihan Academy previously. Ok. We'll very briefly talk about uh what the stations, not so much what they are, but what, what are the kind of things to expect? Um and there shouldn't really be much much in a way of surprise there, to be honest, because the handbook and colleagues have already gone through it and Nick himself has just outlined to you what the stations are going to be. So there shouldn't be any doubt we'll talk a little bit about it. What's really important actually in these, in, in the ST three interview. And I would argue at all interviews, even a consultant interview and certainly at the FRCS and even the MRC S exams is really the technique, how you deliver your answers, not just the contents of what your answer is, and we'll talk a little bit about why that's important and briefly talk about some do's and don'ts, some of which I'm sure you already know, but there's some key things um that I think we need to make everyone aware of, but unfortunately, some don't that people still still do. Um And we'll have a little bit of a discussion time for questions. So the interview, as we've just heard is a multistation is designed to assess a variety of attributes and skills. And even though your clinical scenario, yes, it's focusing on clinical scenario and how you manage somebody medically surgically, et cetera. But it also is actually testing you under the Bonnet as it were on how you prioritize things and how you organize things, what kind of character you are, how flexible you are. So this high level kind of cognitive um thinking and cognitive level decision making. Now, whether you think the um exam is fair or unfair. I mean, and, and Nick again has just outlined all the painstaking work that goes in to try and make it fair. Um Ultimately, the exam is the exam you've got, it's the same exam for everyone and with uh no, no exam or no, sorry, no uh interview is perfect. No exam. Uh structure is perfect. But like Nick says, II, unfortunately, I am still old enough to remember the days where um somebody or others favorite um trainee got more of a job interview than, than others. So it's certainly a far more even playing field than it was before. I tend to think of it more as an exam rather than interview. Um Because ultimately, the portfolio station is the only real station that's directly about you. Uh The other stations are actually nothing to do with you in terms of the uh manufactured scenarios to try and test how you react to that. Uh But whether we think it's an interview or an exam, the approach is pretty much going to be the same. We'll go through that. Now, we'll also talk about when should you start. And the real answer is it's not already de definitely ASAP now, uh it does take more planning than you think and that's not to scare everyone. It is something that a lot of people do succeed in uh achieving every year, but it doesn't happen by just putting together a portfolio and turning up on the day it does need more work than that. Is there a secret? There's no real kind of secret handshake or wink or whatever that will get you through. There isn't so many secret key words. It's ultimately about the candidates who look and to present themselves in a structured fashion, who are able to answer the questions directly, who know what is expected of them and, and rise to meet that challenge? OK. So you've heard that it's three scenarios, uh three stations, rather a clinical scenario manager scenario and portfolio review. Now, the clinical manager scenarios, um I have heard uh ST colleagues who have been successful and some colleagues who haven't been successful come up to me and say, oh, it was quite unfair cos they start asking me clinical, you know, a clinical question in a management scenario or a management one because, well, yeah, that isn't unfair because ultimately, that's what real life is like. As I'm sure Nick who's more experienced consultant than I am will attest to. There are very few clinical scenarios that doesn't involve you making at least some level management decision or how to utilize your resources or your team or communication or some other factor that you wouldn't think of as purely clinical and equally the management scenarios that you're gonna give them. They're not, they're in context, they're not in isolation, you know, they're not gonna say we're gonna imagine you are the sho in a car manufacturing plant, it's gonna be about a clinical scenario or, or something has happened to a patient. So the, the two are intertwined. It's just there's gonna be slightly different emphasis on each uh on, on different aspects, depending on whether it's clinical or management, but don't be kind of thrown or fooled or get into a rigid mindset that this is the clinical scenario. They can't possibly want me to talk about all this out of hours and managing my team and so on. They do and equally for the management room, the portfolio er review again. Yes, it is about you. But actually it's more important, it's about who you're going to be. I think that's the key thing it's about and we'll, we'll talk a little bit when we come to that about how you can get the, you know, how you can get your answers to get a higher number of points and why some people get average points or just slightly average but never get the top marks even though they have done the same thing uh in terms of the, the kudos, if you like, it's the way they are answering in the insight and we'll talk about that. So I'm not gonna go through 100s of clinical scenarios. II just wanna tell you what the clinical scenario structure is kind of like. Now people always get really on, not, not I say always, but a lot of people I've spoken to get really bogged down in trying to memorize every single possible clinical scenario that could come up. So an anti resection is a leak and it's an upper gi um fund dation and somebody who has difficulty swallowing or it's an appendix. But and they're trying to remember, memorize every single thing, every single possible avenue that they could ask there, that's a total waste of time. There's no way you could cover that and it's not helpful. Ultimately, it doesn't matter what the clinical scenario is, they can give you an orthopedic clinical scenario. Literally, the structure is the same, the clinical scenario is almost always going to be some sort of acute disaster. It's either somebody's coming through the GP or A&E on take or it's the middle of the night and somebody's four days post the lap Coly or something and somebody comes in or, or, or a right hemicolectomy and it's a, a leak or sepsis, a bleed uh pe M I something like that. It's gonna be something acute. No, irrespective of the clinical scenario, whichever one it is, the structure will be the same. The first thing you want to do is come. And this is what I mean about answering in such a way that demonstrates you've got a one an algorithm in your head, a clear way of thinking. You're structuring your answer. You have a plan and, and a, a method of thinking rather than you jumping to. Oh yeah, I do blood cultures Oh, I better call the registrar. Oh, I, you need a structure and that's where most people go wrong. The vast majority of people that I've kind of coached, um, including colleagues who are, um, who are on last previously and currently are in my hospital. Very rarely. Is it the case? I mean, I know what they're clinically like anyway, because I've been on call with them and I've worked with them but very rarely is it the case that they don't actually know how to treat appendicitis or somebody who's got a leak, they do it day in day out. You guys are doing it every single day. You're treating these emerges, they're not going to give you an emergency scenario that is so far outside of your specialty. Um I would argue that even if it was, you could still get a lot of points just by structuring answer. So first of all, acknowledge what the task is and that doesn't mean just repeat back to what the, the, the little sheet of paper they gave you the piece of paper they gave you and say so I am a sho you don't need to go through that. Remember, time is ticking. It's gonna go by a lot quicker than you think you need a succinct sentence that summarizes that you and, and conveys to the examiners or the interviewers that you understand what the task is. And by some saying, something like this is a potentially very clinical serious uh a very serious clinical scenario. It may be one that you faced before. So you can say I have previously faced this kind of scenario before there are multiple facets to it, including of course, the acute clinical aspect, the management uh and administrative aspect working in a team um communicating effectively to this end, my ma to to this end I mobilize a variety of human material resources. My main priority being or my main concern is initially that this is an anti, this is a, a leak after elective, right? Hemicolectomy or these are my differential diagnosis. My first priority would be to and it's always clinical the patient and that's where your ABCD E comes in or your atl S and sepsis six. Now you haven't got the time to sit there and say, yeah, put on some oxygen, then I would check the pulse and then I, you gotta say that you're gonna do those things, but you've gotta practice it over and over again to say it in such a way that you will save time. But also allows the examiner or the interviewer, sorry, I keep saying examiner but allows the interviewer to know that you are going to be safe if you were their sho or their sorry, their ST three rather or their ST four, whatever the the if you were their trainee, you are going to be safe and they can rely on you to do it So, one of the things you may say is after you said it's a very serious scenario, you're worried about sepsis. I would simultaneously assess and resuscitate the patient as per the sepsis sepsis six protocol which involves the administration of oxygen IV, fluids, antibiotics, taking blood cultures, bloods, blood gas, urinary cal and organ damage A CG. And that's it. However, my ultimate, my ultimate investigation of choice would be to obtain a CT scan er immediately to determine if there is in fact a leak as this may require a return to theater simultaneously. You want to talk about your multidisciplinary team approach. Remember, yes, they're giving you a clinical scenario but they just don't, they don't want you to just say or just know that actually you're gonna be giving antibiotics and fluids and taking a blood gas. Remember you are what you're intervening for. You're interviewing for a surgical trainee, a higher level surgical trainee. So you've got to demonstrate that you're gonna immobilize your fy ones, maybe other extras. Some places have more than one extra, your sh OSF Y twos, um clinical fellows, whatever you wanna call them. And also informing the consultants, you want to say that you would be speaking to the anesthetic team, the uh the nursing team, the theater staff prepping the patient for surgery and filling in another and consenting these, these are the kind of wider uh holistic and part of the man management of the patient that will score you higher marks. Not just about, yeah, I think it's a leak. I would give him antibiotics. I call the boss, he or she would come in to do a laparotomy. It needs to be demonstrated that you've thought about all the aspects. Yes. The clinical one is the most important but all the things come, come with it, including talking, you know, you may have a scenario that's takes you to post post operatively and the patients in ICU having physiotherapy, for example, getting dieticians involved working with ICU staff, remembering the staff, the situation, task action result in reflection can be helpful, not even, not just for things in the past but also prospectively as well as a basis. And the way that you're going to be able to get really slick at this has got to really practice it over and over again. Please, please please demonstrate that you're empathetic and holistic, do what you would do in real life. You're gonna speak to the patient, you're gonna take consent. Um If it's consent for you, you're gonna say that, speak to the next of kin. These things are important if you have to counsel a patient because they uh they were meant to have uh a laparoscopic appendicectomy. But unfortunately, somebody's bleeding to death and they have to come in just make sure that you're gonna say that um we're gonna, we're gonna, we're gonna give you food. For example, we're gonna give you mouth from tomorrow because you're stable. These are these kind of little things that you do on a ward every day. But you may forget to say in the, in the interview management scenarios, it's a similar set up again. I would argue that people get bogged down. It's like, oh, it's, it's a, it's a Datex one. It's an anaphylaxis one. It's the wrong drug being given. And I didn't expect that the scenario, the flare of scenario would change. But remember all these scenarios are exactly that they are platforms to try and elicit how you think about things. That's what they are. The I Yes, of course, you gotta be safe and you got to demonstrate that you can handle this. And sometimes you gotta remember that some of these scenarios are given. It's not gonna be just handled by you. It's gonna be handled by your consultant by the CD, by the MD, by the coroner. Who knows what? Um So you gotta be aware of that kind of multilevel um hierarchy in the NHS. There is to plan. We talked about when is a good time to start. And I said right now because there is some background reading you need to do, you cannot go into the sense of you not knowing what the steps of an audit are. And as Richard Fireman who was a nuclear physicist and one of my kind of favorite all time teachers, he was a fantastic teacher. Uh obviously, I've never met him. I, I'm old but I'm not that old, but from, from all, by all like historic accounts, he was a superb teacher. And he always used to say the, if, if there is a concept that if any concept you can't explain to a 12 year old, you don't know well enough. So you need to be able to explain to somebody of even somebody who's not medical, let alone in your specialty. Tell them exactly what an audit is in very simple terms. Same with all the others. You need to know some definitions. Why do you use data is? What's a near miss? How do, how do you resolve conflict with patients or between colleagues? And again, the scenario given you're gonna acknowledge a task is a challenging scenario. That's got several ram ramifications, team communication, maybe even legal ramifications or it could be a scenario given as it could be a quality improvement one, this is an opportunity to improve the service. I'll be delighted to take part in this one and the supervision supervision of my consultant because I believe that what so she has proposed is, is, is an excellent idea that's much, much needed in our department, et cetera, clarify what your aims are. Remember, you're gonna say I'm gonna put a team together. You don't have to do everything yourself, communicate, multidisciplinary, teamwork, prioritize what the objective is. So your main aim is this and what other series of steps that you need to do. You need to take. Now, if you're giving you, you're being given a near miss or a kind of patient safety. One, your priority objective is all your prior, your first priority and your main objective is always, always, always going to be the patient. So patient has been given contrast and radiology and allergic to contrast in the middle of the night. Yes, you're gonna do latexes, you're gonna do all that. But you, and you're gonna say that that's why that umbrella statement is really important. There are a variety of there or there are several key aspects, clinical governance or you could say that you would however, you wanna label them uh training issues. However, I would like to first address the clinical one because that's my first priority and that is going seeing the patient making sure they've got IV access oxygen steroids. If they're having anaphylaxis and salbutamol nebs, whatever the the the scenario is, make sure that you're the one, your plan, you need to speak in the first person, whether it's the clinical one or the the the management one I will do this, I will not we what, what they don't want is statements like um well, th this could be done or you know, people will do this or I have seen this done. You need to speak in the eye and again, be holistic and involve the whole team, your portfolio one, this is your time to shine, demonstrate who you are, what you've done, but also what you want and why, where do you want to be? Why do you want to do this? Have you thought about the pros and cons cos let me ask you, what are the challenges is, do you think about surgical training and you need to have some good answers? You, you can't say there is no, no and general surgery is absolutely perfect. I mean, you're being call and call as a general surgeon. There's nothing that goes wrong with that. You know, it, it, it's a dream come true all the time. Yes, of course. There are some fantastic things about the job, although none of us would do it. But equally, you need to have insight that actually it's not all roses. Now, when they ask you, tell me about an activity you've done, they're not really asking you about what you've done. That's just step one. What they want to know is what? Yes. What have you done? How did you do it? What did you learn from it? And more importantly, what are you gonna do for me? I mean, not necessarily me personally, but if you were my ST 3456, whatever, how, how are you, how are you gonna demonstrate to me that you've actually learned something in the past and applied it in and you're gonna apply in the future? So that's what you need to say, well, when I was at fy one, I undertook this um training session or this series of audits or training sessions and by putting team together and I learned this and it really developed my skills in this. And I'm hoping that I would use these transferrable skills. These, this is a key buzz word in the future during my ST training to do this. That's what you want your past experience, what you've learned from, not just I did some audits, it was great. The results were all good and that's it. They want to see that you've actually progressed technique as Nick Al already said, you know, doing it from your local mcdonald's when everybody's screaming and shouting is probably not a good idea. Have a calm, quiet environment, check your sound, your video, make sure you're dressed for the part, you know, your body language, smile, be sure that you understand the scenario, answer what they're asking you, read and reread it, not what you want to answer. No, no. You know what is the question? Not, what, what is, what is the question? Is it that you want it to be? Are they, what are they really asking you? Uh And they're mainly asking you not just directly about that scenario, but actually how you'll behave in a similar scenario or how have you have behaved and how you will learn from that and, and develop further decide uh on management plans. Don't do anything well outside, nobody's gonna ask you to tell me about how you do a robotic pelvic floor reconstruction. You know, then that's not what you're there for. That's not what they are, they are asking you, but, but they will expect you to know a certain thing, certain level, they will expect you to take the, the, the actions of a day one registrar. Yes. OK. You may not be able to do the laparotomy by yourself. Nobody's asking you to. In fact, you probably should, shouldn't say that you would do it by yourself, but they would expect you to know what involves consent. The patient antibiotics, resuscitate the patient, speak to colleagues, inform the team, get the patient ready, speak to the next of kin pros and cons. They will expect you to have an opinion on that and demonstrate that you've got empathy, ok? Um that you're working in a team that you are honest, open, that you know your own limitations and that you will use your resources that are not just material and human, but the everything else really include what my resources. I mean, your own knowledge and even also recognize your own gaps in your knowledge, which will, you know, will you will fill in over time although you never fully get there. Of course, because all everyone is always learning, deliver a concise answer, answer the question directly. You've got a few minutes and those five or 10 minutes, I promise you it will go by really, really quickly and you spend the first three minutes talking about putting in a cannula. The bell's gonna go and you're gonna get very little in the way of points. So make sure you do practice so that you become more fluid and how you deliver that. I'm not advocating that you skip entire parts of essential management for, for a patient's care. But you have got to, in your own words, in your own style, you've got to be able to come up with a way to deliver the answer that makes the examiner confident you've understood and you are safe but equally not spending three minutes explaining oxygen and sepsis six and, and lactate do familiarize yourself with a checklist. It's all there. There's no excuse when I did my core training and SD training. Actually, there wasn't much guidance. It, it wasn't quite as long as Mr to what uh when needed it, but it, it wasn't, it was, it was still a decade plus ago. So things have changed, you know, it, it is a lot more open now. They will tell you what, what is expected of you. You will know this, you know, you, you will know what you need to, you need to do definitions. Definitely tell me about what, you know, you'll see some people going to New Zealand and the first thing I was saying, OK, tell, tell me what I'm understanding what it is. And there's like, uh, oh my God. Uh, you know, I've done lots of orders but I can't tell you what it is kind of because the, and, and they stutter, not because they don't know what it is, but what, you know, inside your head and what you're able to vocalize takes a lot of practice. That may sound like a ridiculous comment. But when you come to do the Frcs, you'll know exactly what I mean. You know how you will know how to do a procedure like the back of your hand because you've been doing it for 67 plus years. And then when somebody says, tell me what you're doing there and all of a sudden, unless you practice that you're stumped. So please practice every week, choose different partners, different groups. Don't go with people who just say you're amazing. There's nothing to improve and equally don't go with people who just say none of that makes any sense. You're rubbish. I don't know what you're doing here. You need to have some kind of balance people. You feel you're confident with you trust, but equally not people who are just gonna be nice to you, cos your mates, they need, you need to be honest with each other cos you're not doing each other favors if you're making really big errors and, and nobody's correcting you because they're trying to be nice and not hurt your feelings. Um Do use, make use of other ST trainees who have been uh through the program uh through the interviews and, and who are coming out to the end, especially those who've only done in the last couple of years. Usually your consultants start working now months in advance, especially your portfolio. If you're trying to put things together, you cannot try to jam a portfolio together the weekend before. No, some of these things, activities take weeks, months if not longer. So that needs to have already started to happen. You need to start practicing your answers. Now, if you haven't already, literally several times a week, one hour in the evening, twice a week, you need to start practicing leading up to the session. You need to do it more and more. Please do, look after yourselves. There's no point not getting any sleep the night before. Cos you have to, er, er, read, um, the, the latest White Hall white paper on, on, on, on the NHS. That's, it's way too late. You need to make sure you're getting enough rest, but also you need to make sure the times that you're setting aside to do the work that you're actually doing it. Let your charisma and your characteristics and your personalities through. They're not looking for robots. There is no surgeon type. Ok. And it, it's all rubbish. It's nonsense. There's lots of attributes that we think of that is favorable in surgery. There are some attributes that I'm sure what's will attest to them, take it to an extreme is not so favorable. So, arrogance is not a good idea. A good thing in surgery. Despite what some of you may think, confidence in your own ability. Yes. But also limitations. Surgery is about working together in a team. It's about knowledge, it's about communication. It's about learning things and there is no technique that can't be learned by anyone. Everybody just focuses on having surgical hands. I don't know what they are because um I don't think there's any technique that anyone can't learn. Yes. Some people feel slightly quicker than others, but you could tell, teach. Uh and most of my seniors who mentored me would, would, would tell you the same thing as well. So remember, it's about being yourself in terms of the, your best characteristics, having the insight and honesty to identify the things that you could do better and taking steps to them rather than putting up a firewall and saying no, no, there's nothing wrong there. So don't get into a mindset that you get into conspiracy theories and rumors. Oh, they're slash the number of this and they're giving it all to north east, north west south, you know, central kind of, I don't know what trainees, these are all nonsense, don't get engaged in that. Focus on your goal. Your goal is to get an a, a training number in a place that you want, you want to get the highest score. But that does not mean you can, can, uh, you know, don't confabulate, don't lie. Don't over exaggerate. Don't, don't cheat. Of course, you will get caught out. And even if you don't, you'll be doing yourself a disservice. Don't leave things too late. Start planning head. Now, don't ramble. Although you may think that actually Mr Ascari, you've been rambling for the last 20 minutes, but don't ramble. Don't respond defensively under no circumstances. And please, especially near far CS when you get there, don't argue with the interview or the examiner. It just, you know, it, it's just that I can't believe we have to say this, but unfortunately, some people still do use that don't over focus on one station. A lot of people will just hammer down my portfolio thing. It's an interview to me. Yes, it's important that, you know, your portfolio and you're able to go through it concisely and methodologically. But remember there are other scenarios as well, there are other stations as well. Don't chase time on, er, don't chase activities that are really time consuming but low yield, you know, trying to get one extra point here by spending three months. It doesn't make any sense when you can spend that time getting three points somewhere else. Now, in the long term, you may want to fo follow that, that, that, that activity that you really wanted to do, but for the next kind of 345 months coming up to the exact to the interview. Please focus on what you need to do. There's lots of resources out there that I've had no involvement in all resources and I all courses. Uh So you can have a look around. I'm not gonna, there, there's lots of good ones out there. I'm, I'm not gonna recommend one or say one is bad or good. You can make up your own minds. There'll be colleagues who will be far better versed, who've just done the interview, who will be able to tell you however, you can't expect to go on a course 234 weekends before and say um Right, I'm ready. That's why not you. The course is really to, to test what you've done and what you've learned and where you are at, if the course and they will, the course organizers themselves will tell you that there is no substitute with doing practice and starting. Now you're gonna hate it because you're gonna fumble your words and you're gonna stutter and you're gonna say silly things we all have. But it's through that process the first three or four times of excruciating and then you'll get better and better until you get to such a point where anybody could throw any scenario at you. And one of the things we used to do is especially for the e even for the Fr CS exams was get a get AAA hat or whatever, write a bunch of um scenarios or situations and pieces of paper, scratch them up and take it out, go and that's the best way to do it. So, you're not picking all your favorite things that you're good at. Cos that's, that will be the tendency subconsciously and all the things that you're not so good at it is a stressful time but stay positive and always think everything's all. Yeah. You know, it's gotta be the really bright ones to get it. You, you guys are the bright ones. I mean, remember what they told you? Oh, it's competitive. Yeah, it is. But so is medical school. That's what? And you guys got there, right? So of course it's competitive. It needs to be competitive, but that's fine. Why shouldn't you be competitive plan? Practice, practice, practice again. Please do not leave it to last month or you need to do it this side of Christmas you need to start. I cannot stress that enough because what I just told you and those answers and having that slickness and that time constraint, it doesn't just, it's not the gift of the gab. It's practice. It comes with fumbling stuttering, pausing dozens of times and then it becomes more fluent. Focus on the answers on the question and answer it. Don't just answer what you want to answer. Do the background reading on some of the things to get the knowledge. You know, the what is, what's the difference with research and audit or how would you plan an audit? That doesn't mean just the steps, it means getting a team together, getting data security, getting patient involvement, potentially other teams, all the other, what resources will you need? How long is it gonna take? Having a time scale? How are you gonna keep tab of things? How are you gonna re audit and recycle uh redo the cycle? All these things are important. That's my email and that's my uh, Twitter X, uh whatever it's called now, um, handle if anybody wants to stay in touch. Um, and I uh II think that's it for me if there's any questions, um, please do, uh join the discussion. I'd be happy to answer them. Thank you very much. OK, thank you so much and thank you so much, Nick for giving us your time today. We've got a few questions. If you have got time, we can go through a few of them in the Q and A section. We have tried to answer a few of them already. Yeah, I, I'm, I'm happy for far away. Sure. So first questions from Ems and, um, her questions was, would that mean that someone who is in the department where is separate from elective and works primarily in emergency. General surgery will not be able to utilize that rotation for application? Yeah. So I think that's a, that's probably a question about me saying that you have to evidence a, an elective and emergency component to a post. Yes, you would because emergency general surgery is now a, a module option in phase three of higher surgical training. So it is a, it is a, it's an option in its own right. And, and in fact, everyone takes emergency general surgery plus another specialty unless you do both breast modules or, or to the transplant modules. So, yeah, if you're doing full time, it's about whether you're doing full time clinical work. So if your full time clinical post is an E GS post, then yes, of course, that counts it. What we're really intending is to, you know, you can, you cannot claim that you've got four months of ent experience because every third time that you were on call for general surgery, you also saw someone with a nosebleed. Mm OK. Yeah, that makes sense. OK. Um The next question is from Sar and she asked, can we count the same projects in question 45 and six, if we have that completed presented in public? Yeah, that's a great question that comes up really frequently. Absolutely. You know, if you have, if you have done an audit and it was good enough that you got it published and you presented it somewhere and that, and they, and it's your best audit and your best publication and one of your best p presentations by all means. And that's always, that's actually always been the way even when it was back in, you know, face to face interviews of everyone. You know, we, we we would count everything. So yes. So just that II would actually encourage that. Look, there's a lot of time people do, they do a month to month of work for a poster presentation or conference presentation and they do a great job. Everything's ready. Why not just write it up? You've done all the work. I know it's a little bit of extra. But why stop there and not get that extra kudos. You've done the hardest part of the job, just get it written up and publish it as well. Absolutely. Absolutely. So, next question, you're right because, but philosophically, you see it's each different bit of, you know, each one of those three things is equipping you with a different bit of knowledge, skill experience, isn't it? You know, you've, you've got a, you've got a, you've got a distinct amount of it, it knowledge and experience from going through the process of submitting an article for publication which is completely distinct to, you know, your knowledge needed to complete the audit in the first place. So why, why, why wouldn't we allow people to be scored for those? Yeah, I think you're absolutely right. I mean, from in terms of effort, just one little bit of extra effort gets you all that extra knowledge and experience that you could then transfer to other things, not just to get you points on the scoring system, but I just think it's a waste that you put in so much effort and it's just that last mile to run, you know, to get that extra, a bit of experience and knowledge and a lot of people don't do it unfortunately. And they, they go to a different place and the whole project runs out of steam and it dies of death. It's happened, doesn't it? Um, so I would encourage everyone when they become trained, you know, even from now to, to, to do that to get out of that project, not just get schools for an interview like this, but to get that full array of personal skills development and experience really. So next questions is from uh Gemma uh a presentation at Tertiary Center. They're not counted ie it, it must be presented at a scientific meeting or conference of some kind to be counted. It ha it has to be a, a at least a something that something that would benchmark at at least a regional meeting. Thanks. Um Next is uh Momma, he has asked, may I ask, what was the minimal uh appoint school for self assessment and for interview, please? Um So the giving you the exact score relatively meaningless without context, but it's in broad terms, it's usually around about 40 to 45% of the total available marks for the entire process. You know, if you've been through all of the shortlisting and the interviewing and you've, you've only scored, you know, four out of every 10 available points. That, that probably is about the level where you, you need a bit more time at core level before you're ready to be an ST three. And it's, it, it, it's different each year. So telling you what last year's was, if I could remember it off the top of my head wouldn't matter of this year. But it's, it broadly, in broad terms, it's sort of 40 to 45% and there are, there are more than enough people that score 50% and above of the available marks to take the posts that are available. Great. Thank you. And next questions from Eleanor, you mentioned no points for indicated degrees. You stand alone undergraduate degree before starting medicine be recognized. Yeah. So if I understood that question, the question is there's no points for intercalated degrees. Yeah. What about degrees that aren't intercalated? Well, there are points for those aren't there? I think it confuses people. So if you've got again, II no, I understand I'm being a bit facetious. I understand where she's coming from. Uh Yes, because you know what if you had a phd in um you know, Astrophysics and then you decide actually, I want to be a doctor. Well, you've got all of the knowledge, skills and experience that come from successfully completing a phd, the fact that you did it in that sequence rather than qualified as a doctor. Then did your phd in Astrophysics is here nor there. You've still got the knowledge, skills and experience. The reason why we're not allowed to include intercalated degrees is because that is what the GMC say to everyone in every specialty. That is not my rule, that is the GMC S rule. It was to do with. Um they thought that there was some, you know, socioeconomic inequality in regard of opportunity to collated degrees which may or may not be. But yes, you don't answer to your question. Yes, of course. Thank you. Uh Next one is sorry, I lost track of it. The publications have to be during surgery only to be counted. No, no, I'm always fascinated to read publications that people have done that aren't in general surgery. Of course, they're not, you know, particularly at foundation level. Well, you might just not have been in, you know, if you've got a great publication in child and adolescent psychiatry again, it's about like, you know, I should make a disclaimer. I want to make a disclaimer. So Alan bless him is in, is in no way affiliated with the um steering group yet. Although from his talk, I think we might try and have his arm up behind his back to join us at some point. So a Alan's not affiliated with the group at any point, but his talk was, um, you know, he seems an opposite choice uh for, for kind of speaker alongside me for this and Um, yes, it's, as you have got from what Alan's saying, it's about what you've learned as a person and about how you can take that knowledge and apply it going forward and a lot of that will be generic. And yes, if your, if your publication in nature is about, you know, cell biology of a nematode worm. Fantastic. Yeah, I can, I can, I just, um, n Nick has a lot more eloquence in how he talks than I do. Uh uh I'm more of a metaphor, blunt kind of guy. Ultimately, you got to think guys, what do they want from me when they ask you a question about um you know, when you're asking list your publications or whatever, what do they, what do they want to know what they want to know? Is, have you got the skill sets? Do you have the knowledge and how are you going to apply in the future? You can have a publication and engineering. It's the same thing as having it in transplant surgery. The, the, the, the science is science, the methodology is the same. It's equally painful getting it to a reviewer and, and, and getting it at a conference and everything else. It's about the process. What they want to know is, does this person have the good experience in this? And I have, if they haven't or if, well, if they have, are they going to demonstrate they're gonna do more of it in the future and grow that skill set further and further. It doesn't mean they want you to pu publish 600 papers a year. It just means that when they, when you become a senior trainee and then ultimately a consultant, somebody comes to you and say we should definitely do. This is the greatest evidence uh anywhere you actually can make up your own mind and read the thing and that's what they want, they want to see evidence of skills that you've translated into your future practice that you're going to develop. That's it. What you did, what you learned from it, how you're gonna utilize it to make yourself better in every single question. That's what they're getting at. Mhm Thank you. The next question is for Michael, I have two publications in a journal which is not P ME index but has an impact factor of 0.1. Is it counted? Uh So that'll be, that's unfortunately, and it is somewhat arbitrary. They have to be in P index journals that's made really clear in the handbook. It is a bit arbitrary. Um But that's how it is and that is very much in line with the other surgical specialties that recruit at ST three level, sorry buddy. And, and for ST three training, going to your t it will be a similar story as well if you're doing same, if you, it'll be the same story. Uh Mohamed is asking if I have a MSA with thesis and also a PG cert medicine in medical education. Would I get a score for both or just for one? Yeah, so no compound points for higher degrees, you just get the score for whatever the highest scoring thing is? OK. And next question for Khadija, if the first cycle of the audit is completed and is presented at as at as like acid, would that get any points? So I, so just, just to really ii try to make this really clear um in the talk, but just to make it really clear again. So that template asks for three elements to closed loop audits and your best other closed loop audit or quip. And this year, the closed loop audits, you have to have been involved in both cycles, which includes both cycles being presented. So you could submit that as your third. So actually you can, you can kind of, I suppose not submit the first two. Um So you could count that as your third, which does not have to be closed loop, but they do have to be two closed loop. And the reason why we put that in is because actually by the letter of the law, that's a requirement of completion of core training or a requirement for obtaining a crest form, which is a certificate of equivalence. So actually, everyone should have done too closely ordinate as a minimum. OK? And again, you'll, you'll, you'll need to do that for higher training as well to get the CCT as well. Yeah. Um, mom is asking one has completed training in general surgery outside UK or Europe would not, uh, with the cases done outside will be counted. Um Yes, why not? Um, you just, you do need, so you need verified logbook evidence. So if your logbooks aren't countersigned by someone and that verified means a signature and eligible printed name and a professional registration, unique identifier. So in the UK, your GMC number or the equivalent overseas on every page, then yes. And please do make sure that, you know, you, it, it's all very clear in the guy, but your logbook pages must be consecutive. So there can't be any gaps that are um, appear to be gaps from your employment history because what we don't want is people to game the system. You know, if you've done 100 and 50 appendicectomy, you think? Oh, hang on, I'm gonna lose points. So what I'll do is I'll just leave a chunk of them out. II, if you've got gaps in your logbook that don't fit with your employment history, then you'll be awarded the lowest score in that category, irrespective of the number. So you just have to be really careful about making sure that everything's appropriately verified and that the logbook um pages are consecutive and of course redacted of any personal information. One of the things that we find often with logbooks from overseas is that sometimes they're handwritten and sometimes they contain patient identifiable information such as names, initials, dates of birth, etcetera. Please do make absolutely sure that they're appropriately redacted. Um Thank you. Next, next is a question from Mohammad. Can we publish two case report and both will be recognized as research? Yeah, so it doesn't. So there's no template for research. The template is for publications. Um and a case report is a form of publication and we were, I was keen to last year, you know, we've included things like case reports which weren't previously included because, you know, it's about, it's about letting people have appropriate recognition for the best that they've got. And if the best that you've got is a case report, then put it in and, you know, we'll, we'll score it. But, you know, as a rule, they won't generally score that highly. Generally, there will be exceptions. Um But if that's the best that you've got and it's in a pub bedding index journal, then, yeah, put it in. Of course, I was gonna add, you got to make sure it's PUBMED for it to count. Um, the restrictions on kind of in higher training towards CT afterwards, um has been relaxed a little bit more, but before case reports didn't used to count. So, um yes, it does count now for the purposes, providers of PUBMED. But um it, it's not obviously if somebody's done something, you know, you, you can't rely on case reports forever and ever going forward after that. But yeah, it will count if it p thank you. Anil is asking. Does my DNB general surgery degree count? Do I need to validate it? That's the diploma of the National. Um, no, I don't think it would count for anything. I'm not necessarily familiar with that, but it's, you have to have a, a, it's the higher degrees are university awarded higher degrees that are not done as a, as a kind of either an intercalated thing or as a routine part of your training pathway. So, you know, if it's, if it's a requirement of progression through your training pathway for you to have done something like that, then actually, that's not the same as someone who's taken time out of training to do a specific research kind of higher degree that is, you know, optional and extra and over and above us, I guess. Yeah, it's, it's like the MRC S isn't say it's not going to count as a higher degree because you have to do it. It's part of a drug. If you, if you did a masters or PC or phd MD, then then yes, because you've actually done that additionally, it's not a requirement of your training ad MD unless I'm mistaken is very much required part of the training um in some parts of the world. So I don't think that would count. Yeah. Yeah. Yeah. Yeah, that's absolutely right. Alan, we would, we would treat those as ae essentially equivalent to an intercalated degree. Yeah. Questions, questions. Next is from Mohammed. He's wondering whether working as a lead trainee, uh, men and men in the would go against the, um, applications. All right. I don't, I'm not sure. I understand the question. No, of course not. Well, you ii don't, I mean, it's just, it's, it's, it's month spent in general surgery that would count towards the month spent in general surgery question. But it wouldn't negatively impact. We don't mark people down for things like that. Well, I was a lot training. So, so, so II was going to say I ask, are you going to get for being join first order? Yes. So there was a a, so actually this year, yeah, I think the, you know, again, I don't, II can't be bothered arguing with people about whether to, if, if you were first author and yes, if you're a joint first author, it, it's likely that you'll get the same number of points. I mean, you just have to show yourself if there's, if there's something on a publication that, that say the little star thing that says, you know, so and so, and so, and so the journal recognizes these people as both first authors. Whoever's alphabetically come first, makes no odds. Does it, we treat you the same? So, OK, thank you. And next question for Asia. And um, if we have oral presentation at regional level and poster at national level, which one counts more. Who knows? Cos it would depend on a whole load of other variables. Um Think about the Q. So that is, I'm gonna, I'm gonna rephrase that question into a broader and more frequently asked question, which is, how do I know what is my best publication? How do I know what's my best presentation? And what I would say to people is that if you are really struggling to decide between two, then the answer is highly likely to be, they're both the same, it doesn't matter. Um But in, in broad terms, I mean, obviously you get w what I, what I, what people would do well to think about is how much did I actually do for this? How much of this is my own work? How much effort can I evidence that I put into it? How, what was the, you know, how good was the output and how articulate can I be about um what I learned from it? And you know, how can I make this about how I'd be a good ST three? Um So, you know, the typical, I'm gonna take two extreme examples. If are you guys? OK, for time, if I go on about. So, so if I take two extreme examples, you have a lot of collaborative publications. So it might be that you are one of 1000 plus people who contributed some data to a collaborative publication but that got published, cos they're good, they're often very good, aren't they? So it got published in a really good journal with a really high impact factor and potentially has quite a big potential impact on clinical practice. So you're gonna get not very many points for, you know, the amount of contribution you've made, but you might get loads of points for the impact factor and the potential impact of it or are you better off saying? Well, actually I published this thing, but the journal only had an impact factor of 1.5 and it was just me and one of my friends and we, you know, it's a case series of 20 cases. But actually, you did all the work for that and you can talk about, you know, ethics approval on the, you know, the kind of research governance um around it and it's, you know, you presented it or it's, you know, you're the first author actually, probably that's, that's, that's probably a bit more meritorious at an individual level than just putting some data in a big collaborative study. The reality of the way that these are scored is that there won't, there won't be a massive difference between the two. But I pick the one that you can talk the most about what you did and you'll see that on the templates. There's quite, there's a box for like 303 150 words for you to explain what you've done or what you've learned from something. OK. I, if the most that you can put in that is T 20 is by two sentences. Uh Well, I II just, I, you know, I found some people that had this condition and I entered their data into a big national database and eventually it all got published. And how's that gonna look compared to think about what you would write about The other example. And if you would write more, if you would use all of the 200 you know, if you use 202 150 words to write about what you learned from it, that's probably a better exam, better thing to represent yourself than something where you can only really think of a line to write cos you didn't really do very much. But yes, the, the, the short answer and I've waffled a bit sorry is if you can't choose between two, it's very likely that there isn't a lot in it. You can always show, show them to someone else, show them to a consultant, see what they think, but there probably isn't, don't agonize over it. It should be a nice problem to have. Yeah. Yeah, exactly. Exactly. Sorry. Carry on A R is asking or holding a CPH Q certification positively impact my application score for ST three, particularly in the context of quality improvement and patient safety. So that, so that's not something that I'm specifically familiar with, but it sounds like a, you know, in some, someone's talking about with a higher degree section, um it has to be a university awarded higher degree or, you know, or, or post graduate certificate. So if it's not, if it's not a university awarded postgraduate degree or, or, you know, post graduate certificate, then it probably won't get recognized. Sorry. But that doesn't mean that you won't be able to use it or get recognized for it because that sounds like the sort of thing that would be fantastic to talk about in the portfolio station in the interview. So there are opportunities don't be too dishearten if you've done something and then you think, oh, I'm not gonna get any points for it because it's the, like I said, it's like I said, in my talk, they're complementary processes and it's the sum of the parts that goes towards making the whole. And so, you know, just think, OK, actually, I can talk about that in the portfolio station in the interview. So can I just jump in there? There's a lot of questions kind of coming through the, the just, just in the interest of having those questions jumping in. Sorry to jump in phaser. But guys, there's a lot of people asking, I've got, am se I've got APG Cert, I've got a diploma. I just add them up and get 55 points. Do I? No? OK. Take your best degree and you get only that point. So you can't get a point for your M SE for your PG, Cert, for your phd and then whatever and get like add them up. It doesn't work like that. You have three higher degrees. Fantastic. Which one is the highest? That's what you get a score for. There's no compound scoring. Cos again, colleagues have been asking, I've got a master's degree and APG CERT. Well, in that case, go with your master's degree cos it's higher than APG cert, you won't get scores for both, irrespective of what the degrees are called. Your highest degree postgraduate is your score? Sorry. No, got to. Ok. Um Next question is, is there uh it's Mohammed Bila, he's last year's crest form valid for me or do I have to produce new this one, the new this year? No. So someone asked this when I did the co online teaching the other week and it was, it sort of took me a bit by surprise. I II don't see why. I mean if you've got a crest form, you've got a crest form. II don't know why you'd need to get unless they've got, if it's got an expiry date on it that says valid until then, yes, you need to get another one. But if there's no expiry date on it that says valid, you know, like an ATL S certificate, if it hasn't got an expiry date, then no, if it has got an expiry date and it's expired then. Yes, seems a reasonable answer. Um Thank you. And next question from Mujahid, is there any restrictions or requirements for changing surgical career as coming back for general surgical training from another surgical training? An IV. Yeah, that's the questions I think to rephrase whether there's any restrictions or limitations. Uh if someone changing their career and coming back to apply for ST three training. Ok. So like you're, you're a current ST five in orthopedics, but you've decided that you don't want to just hit stuff with a hammer for the rest of your life and you do more. That's probably my understanding. Yes. Not, not that I, not that I'm aware of you just, your application will be treated on its merits. Same as everyone else, I guess. Um, I think the last I think we have, I thought, oh, yeah, we've pretty much, but I was gonna, so, so the only, so some of the, some of the other, so the other thing I say is please, the applicant handbook, almost all of these are covered in the applicant handbook. Please read the, read the handbook, someone asked about a link to the applicant handbook. It's that time of year when I spend like two hours, three hours a week in meetings with the hee people. Um, and we've finally signed off the final version of the hand. It's kind of gone to the printers as it were. Um, like this week just gone. So it will be available soon. Please do make sure that when you're doing your actual application, then you use the current version because as I said, there are some small changes, I'll just go really quickly. There are a couple of other kind of questions that people sometimes ask me that I think are are useful ones. One is, well, I if I don't have any evidence, do I still need to submit a template? There's a bit. So typically question seven. So say you've not got a higher degree last year people, some people thought, well, II haven't got one. So I'm just not gonna put a template in other people. Put in a blank template. Potentially, you could say the same for publications or even presentations this year. It's really clear the handbook, it's really clear on the templates. We want a template for every question, please. But you will see that the templates now have a little box at the top where it's applicable for you to say I haven't got any evidence to submit in this category, tick sign move on just to make it just to standardize it. So yes, we need all 710 plates. But don't worry if you haven't got a higher degree. So will lots, you know, lots of other people won't have a higher degree as well. Just tick the box saying I don't have anything for this category and move on. Um And the other questions are, will it ever go back to face to face? I can't see it happening. We argue till we're blue in the face with the powers that be the MDR S, the G MCI. Think the reality of it is they spent the money on other stuff now and there isn't the money in the budget for it or the appetite from the administrative teams. Um Why is there no technical or practical s assess skills assessed when it's a surgical thing? But a the logistics of it b actually when you looked at the old, the original everyone being interviewed process, actually, the in the technical station was a pretty poor discriminator er when they did all the stats on it funnily enough. Um And then when the the other thing and I think someone has asked a question which phasers tried to answer just a bit of clarity about when things have to be done by. So your publication has to be published by your degree has to be awarded by your presentation has to have been made by the end of the evidence upload window because that's the day which you until that point, you don't have to press submit. Ok. So it's, it's the middle of January. So actually, if your presentation is first week of January or if your degree award ceremony is end of December is, you know, in December, it's not the application window. It's just the long listing information checking when you're eligible, the actual things that you want to be counted, you've, you've got until the, until the evidence upload window closes to have achieved that. But it has to have been achieved by then. And that's Thursday 16, January 2025. That's right. That's right. That's right. So you've got, it does give people we just, and again, we've made that really clear on the templates this year. It's really clear in the handbook this year. It's not, it's not the, it's just the terminology that she used to refer to the application and then the evidence upload window. But, but the reality of it is it's when the evidence upload window closes. Um And that's it, I think, yeah, I think we have all the questions are understandably understandably, you know, it's really, I do feel for people. There's a lot of anxiety. It's really important, isn't it? It's a very high stakes thing for lots of people. Um But we just, you know, we're not, I said Alan's talk was excellent. We're not there to catch people out. My, my philosophy in this process is just trying to design it in a way that lets people try and show themselves at their best. That's, that's what I want to do with this process really. Um You know, and that's, that's what we're trying for. But yeah, thank you ever so much for inviting me. It's been been good. Likewise. Thank you, Alan. Thank you. So much pleasure. And um Michael and Fs if um if colleagues have got some other questions that they want to send you an email or I don't know med or chat or something, we can collect them because I'm sure some of the questions may be similar. But please guys like Mr Watson says, do read the handbook, do go on the website, look at what the requirements are, you need to know these things pat uh because there are several questions that have been asked by people that are the same thing, you need to know what scores and doesn't score. And you need to really know that before, you know, before your application ends, let alone before going to an interview, you can't really win a game. If you don't know what the rules are, you'll get caught off side all the time. You're not, you're never gonna win no matter how good a footballer you are. So please do know the rules, do know what it's about. They are quite clear. Um And the thing with the other degrees outside, if you've got to talk about the equivalency, um you know, if it's equivalent, then it will count to a university degree. If it's an international conference you've had somewhere else, not in the UK, it's still an international conference, it will count. So it's about the equivalency that's important. Um But if there are other questions that are not necessarily covered by the handbook, if you want some clarification. If you guys can put it together, maybe you can send it to myself or Mr Watson, we can both try and um write, write back some emails or something to you. I, I've left my email address and um I can call it and then pass it on to you and then yes, we can do that. Thank you. Thank you so much. What Michael said. Really? That's a nice way to finish, isn't it? It's quite right, Michael. Good luck, everyone, please. Thank you so much. Bye bye. All right. That was, that was, oh, just, I think just a leaf just and br.