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Um we're bringing you this talk with bonus. Um And without further a do, I'll hand over to doctor Little, who's a Clinical Oncology registrar in London. And we'll be giving us a talk on careers and applications this evening. Thank you. Thanks, Miranda. Welcome everybody. Thanks for joining us this evening. So yeah, as Miranda said, I'm just going to be going through why you should do a career in oncology and brief bit on the applications. I don't think my talk is going to be terribly long, but I'm happy to take questions if you just put them in the chat and then we'll go through them all at the end. So in this session, we're going to go through the what pathway to, to become a oncology specialist in the UK, the difference between medical versus clinical oncology. Why you should choose a career in oncology, go through the pros and the cons and tips for getting into oncology. So, first of all, what is oncology? So it's the management of patient's with non hematological malignancies and it's the non surgical management. So that means a hematology deal with leukemias. And for the main part, lymphomas and oncologists deal with all other cancers, but the surgery is done by our surgical colleagues. So it's the specialist assessment and management of patient's with cancer. Um And typically we discuss treatment options of patient's supervised their therapy and manage any complications of the disease and the treatments that we give them. Um sorry, this is uh the difference between medical versus clinical oncology. So we work very closely together medical oncologists. Um deal with all systemic anticancer treatment of which I think if you saw my talk on emergencies, we briefly went through is all these things in the dark blue. So it's chemotherapy antibodies, small molecules, immunotherapy and hormones. Um clinical oncology deal with all of that and radiotherapy as well of which there's lots of different types now just put some there. So external beam stereotactic, which is the high dose to a very precise area, breaky therapy, which you can put seeds inside the prostate and you can deliver radiotherapy by rods to the cervix and radioactive isotopes. So an example of that is the radio iodine which you use in thyroid cancer. Um So the main difference is um so as we said already, um medical oncologists do not give radiotherapy, but otherwise we both give all the same treatments. Clinical oncology training is therefore longer than medical oncology. So it's five years versus four clinical oncology. We also do more exams because we have to do some um special physics exams to do the radiotherapy. So we have in the oncology, we have clinical oncology, we have 33 exams. So we have two sets of written papers and then a practical that's similar to the paces of M R C P. Whereas medical oncology, we just have one exam which is written. Um the clinical oncologists are members of the Royal College of Radiologists and the medical oncologists, uh members of the Royal College of Physicians. And in terms of the patient load that we treat actually radiotherapy cures a lot of cancers. So we have a lot of radical patient. So curative patient's um whereas chemotherapy and all those systemic treatments on their own tend to not cure cancer. So lots of what medical oncologists do is palliative treatment. Um but they also give treatment before and after say surgery which would be neoadjuvant or adjuvant. It's very broad overview there. Um I've just done a very typical timetable of, of what the job involves as an oncologist. So I've done it for clinic, but it would be very similar for medical oncology. Um So as you can see, it's quite varied, we have a little bit of ward rounds. Potentially we have um space for admin and clinic preparation and some clinics in clinic. We would have um where we go through all our radiotherapy plans in a, in a meeting together with the other clinical oncologists. You look at it as a team and you'd have slots to do radiotherapy planning. I might have some more teaching were very, have lots of M D T s where we discuss all the new cancers patient's as well as patient's have progressed on their treatment. And we come up with a plan for what we should do next. And in that meeting would be the other members of the M D T, which I'll go through potentially another planning and admin session, another M D T for metastatic patient's perhaps another inpatient ward, round another clinic and another clinic and another admin slots as you can see, it's quite outpatient based. Um and and different from other medical specialties and quite varied in terms of medical oncology would be very similar to that, but they have more clinics in the slots where the radio therapy plan is. So in terms of the M D T, this is just a picture of everyone involved. Essentially, it's a weekly meeting and every single patient with the new diagnosis of cancer has to be discussed in that meeting. And you'd also potentially take patient's two cases to the meeting if you wanted opinions of the rest of the MDT. So the core members of the MDT would be the oncologist. And usually you'd have both medical and clinical oncologist in that meeting, a radiologist, a pathologist and the surgeon. And then around that you'd have potentially some other specialties as well, but they're the main core. So in terms of what we do in clinic So we have a few different clinics, so potentially have a new patient clinic. So this would be patient's who should have already been told they've got a diagnosis of cancer um that it might have just been broken to them, potentially by C N S. So they come to clinic, you'd go through their diagnosis again, you'd assess how fit they were for treatment, decide on the management plan, which is usually already decided by the M D T. But you just confirm that you didn't need to change that based on the specific patient, you'd explain the plan to the patient's. If it was chemotherapy or radiotherapy or any of those other systemic treatments, you talk about the risks and benefits of the treatment and you get them to sign a consent form. Then after they've gone, you'd prescribe their treatment right up your notes and do a letter patient's that we have other clinics for patient's that are already on treatment. So if that's a systemic um anticancer treatment, we see them prior to each dose and we asked them how they found their previous dose. We assess their side effects from that check the blood test, they will have had and adjust the dose of the next cycle. It's called if needed, if they had intolerable side effects or if they're bloods aren't right. Um Potentially in this clinic as well, they might have had a scan and we'd go through the results of the scan if the scan showed things were worse, then we'd have to stop that treatment and talk about a new treatment and as well as the side effects of our treatment, we had also assessing that clinic, um, this the symptoms of their cancer itself, whether they've got any pain and we, we can give them pain relief for that or potentially give, consider palliative radiotherapy or a variety of other things dependent on the symptoms. We also have on treat clinics for radiotherapy. Patient's there, side effects tend to get worse as they progress through their treatments. We usually see them weekly in the second half of their treatment if they're on a six week treatment for instants. And again, we dysesthesia side effects and give them medications or creams or whatever was needed to help with that. So stuff we do aside from clinic. So in terms of the clinics for radiotherapy, um I think I showed a bit in my emergency talk, but every patient would have a radiotherapy planning scan, which is essentially a CT scan. And on every slice of that CT scan, you draw around the tumour and you draw around the organs that you don't want to treat and that's called contouring. That's a big part of what we do. Then, uh that would go to physics and the radio radiotherapy planning radiographers who would make a complex radiotherapy plan so that the highest dose goes to the tumor and safe doses go to those other organs. Once they are happy with the plan, it would come back to us as the clinical oncologist to check that plan and sign it off. So that's what we do in our radiotherapy sessions. And we also have to do a prescription for that I showed on my timetable. We also have meetings for the radiotherapy. So once you've approved a plan, you'd also in the meeting, take that to your other colleagues and check that they're happy with it as well. And then you have to review patient's who are in the radio therapy department who are unwell in terms of the other cancer treatment. Um Things in the non outside of clinic, you'd be prescribing their chemotherapy and again, reviewing patient's who were unwell on the day unit, some of our treatments require special funding which you have to apply for. Then there's the impatient. So this actually makes up a very small proportion of our workload. Only about 5% of oncology. Patient's are on the ward. Most of our patient's are well and as outpatients, but the inpatient, unfortunately, our, our sickest patient's and often are palliative dying patient's, there's a lot of family discussion's there. Um And I think it's important to note if you do a job on the wards as an, as an S H O on oncology, it's all quite can be quite depressing. Whereas oncology, I would say that is definitely positive overall. So don't get dissuaded by the impatient work because the broad uh part of our job is actually outpatient. Um there's also the Acute Oncology unit which should be in each hospital. Um and that's where patient's on treatment can be reviewed um in a day case unit. So again, they can come in with side effects and you can see them on the unit and assess them and you hopefully send them home or admit them if they need to be admitted. So it's kind of like a triage area. Then again, other admin we'd have, so we'd have letters to sign off and check and emails as per other specialties. And usually there's lots of teaching opportunities for research and quality improvement projects as well. So why should you consider oncology? So I think it's a really fantastic career. Um There's loads of new oncology treatment and research happening all the time. So our job is constantly changing and there's constantly new things coming through. There's lots of opportunities for research, I'd say due to the nature of the work, most people that do oncology are really nice and supportive. And so it's a really nice team to work in. Also, you get to see your patient's regularly in clinic. As I showed there, you see them before every treatment and you usually see them from diagnosis, either to cure or till they pass away. So you really get to build rapport and get to know your patient's, which is quite a contrast to other specialties where you're just seeing them, perhaps one off cancer is becoming more and more common with our aging population. So we need more oncologists. And as I alluded to my timetable, it's really very interesting job. So you have the clinics, the ward work, the chemotherapy, prescribing the radiotherapy, the day unit work and the M D T s. Um it's a really nice, as I said, nice team, not just with the other oncologists, but also you really get to work with a wider MDT. We work very closely with our um CNS nurse specialists and the radiologists help us a lot of clinic pathologists and it's really definitely a team working environment. Um And I'd say it's suited to people if you potentially like, I really didn't like core medical training and found it quite stressful with sick people all the time and rushing for emergency to emergency oncology on the whole. Really isn't like that. It's mainly outpatient bass and a, a different vibe I'd say from general medicine. So it depends what you like. There certainly are the emergencies if you do like that side. Um Currently, I'd consider this a pro maybe some people can. We're not on the medical registrar wrote us. So we're totally separate and our night shifts are usually on the phone from home. We normally do a 24 hour shift and we stay in hospital until nine. And then we have our nights from 9 to 9 on the phone usually, which I prefer to the, the nights in person also. Um, certainly for the South trainees. Um, there's, uh, for the first year. So as your S T three year, there's a weekly teaching that all the South trainees go to in the country on a Friday. Let's run at the I C R and that teaches because oncology's quite specialized. There's lots of new stuff to learn that you won't come across before that course teaches you that and it's a good opportunity to meet your other colleagues in a really nice social day. Mhm. Um The downside. Um So it can be quite an emotional job. I think there's, although it's not the main part, there certainly are quite a few um family discussion's breaking bad news um which can take its toll. Usually they're the impatient, but we do have that in clinic as well. And I think as well, it's quite an emotive um you know, topic and the NHS is really stressed at the minute and often there are delays and delays in cancer tend to make people angry. Um A miscommunication can lead to problems. I think it's a problem with every specialty at the minute, but perhaps particularly patient's are more upset in the cancer setting. Um Usually for oncology, you're based in a tertiary hospital. Um but you would cover the mor peripheral D G H S. So you might have lots of satellite clinics in, in different D G H s in a wider area which potentially could be a downside. And I'd say there are for clinical oncology, we do have more exams than other specialties. I think hematology rival us as the same amount. But I think that the pros outweigh the cons I'd same um in terms of the training pathway in the UK. Um So first of all, you do two years of foundation training, then you'd apply for internal medicine training. Um Now, actually this is oncology, both medical and clinical oncology is a group to specialty. Um So that means you only need to do the two years of internal medical training. And then you can apply for your specialist oncology training. You don't need to go on and do the third year, which is the year they're getting you to be a junior med reg. Although you can do that if you wish and then apply after that. But even if you did do the three years, your specialist training would not, it wouldn't deduct years from that. So after I M T, whether you did the two or three years, you'd apply for your oncology training. So it's a separate application for medical and clinical oncology. Um Lots of people do apply to both and see which they get. Um some people only apply to one. Um So the medical oncology is four years, as I said S T 32 S T six and the clinical oncology is five years. Lots of people go out of program during their specialist registrar training. So lots of people would come out of program to do an MD or a phd. Pretty much all medical oncologists would do that, I would say. Um, and lots of clinical oncologists do too, but it's not the majority. You can also do years out doing teaching, which is what I'm doing this year and you can do fellow years where you, you do a year's potentially abroad or in a specialist um subject in the UK. So for clinical oncology, you can do special breaky therapy fellowships for instants. Um it's really to get more experience in a specific treatment. Um and you can also do years out in management. You can basically apply to do whatever you want, but lots of people do take time out of program. Um And then following that, you would uh C C T so complete your certificate of training and apply for a consultant job. Well, one of the other differences, medical and clinical oncology, which I didn't say is medical oncologists often. Um we all are involved with clinical trials but medical oncologists often take the lead and often run a lot of trials, particularly phase one trials. Um So that's why the research degree is um pretty much across the board. You don't have to have it but, but lots do particularly in London. Um This was just I was looking at so most specialties. Now, our group, one specialties in I M T and so do have to do that year as the med reg. But both medical and clinical oncology along with these other quite random specialties have got a way of being group too. So you, you don't have to do that third year. So in terms of the application for oncology for the S T three, so it was, it's basically very similar for the medical and clinical oncology, which is why people have tend to apply to both because it's not that much extra work. But basically the first thing you have to have done two years of I M T or equivalent. Um and then you fill in this self assessments, you fill in the application form which would have a self assessment score and that has all these different things that it scores you on. So firstly, its commitment to specialty, which is worth potentially 10 points, we'll go through that later, then postgraduate qualifications, which is worth up to four points, which includes phd's md's Masters and potentially postgraduate diplomas or certificates, additional treatments are up to three points. So if you've got an honors or a distinction in your, in your initial medical degree or undergraduate degree, or if you've got some sort of international national prize, particularly that's related to oncology, you can get the full points, having full MRCPI gets you eight points. So having done completed part 12 and paces, but you'd have to have completed that before you got it before you started S T three. So it's um, it gets you points for this, but it's also, you wouldn't be able to start S T three until you've completed them presentations. Get up to seven point. So that's including both poster and oral presentations. And you get the maximum points. If you've got an oral presentation at a national conference, as the first author publications get you up to eight points. Again, first author pub med cited research, get you the most case report also gets you points. Teaching is up to six points. And the most points for that is if you've organized a teaching program, which you've regularly taught over three months with feedback, having a PG set or diploma gives you points, quality improvement project five points if you've completed two cycles and then there's a thing for leadership to having a national regional leadership role for six months that's made an impact. And I think these are the same for most medical specialties I've put in pink. There are the ones that I think I would focus on. Some are just totally unachievable. Like, unless you're very lucky, I wouldn't worry about getting a phd who, who and or distinction your medical degree or I'd really focus on the things that are easy to get and try and do those. So I think what is potentially achievable is certainly a poster at a national conference. Which you can be first author on um and doing some teaching, potentially doing the PG cert, although that is lots of extra work as well, actually, if you can just organize some teaching for the foundation years during your I M T and do that regularly over three months and have feedback that would get you the most points. And potentially it could be clever and do your quality improvement project, do the two cycles and use that as your presentation at a conference. So I think I'd sort of, my advice would be to look at the application form in advance and pick out a few things that are achievable to do in your I M T and try and do them. Wouldn't worry too much if you don't have lots of these. Um I didn't have all of them by any means, but try and get them, try and get the easy points if you can. So following that and you'd have to upload evidence of all those things. So they'll know if you can't lie. Um So following that, you'd go, they'd long list people that meet the eligibility criteria. They'd either interview everybody or if they had too many applicants, they'd shortlist those for interview and then you'd be invited for interview. Um So the interviews are both on all on team teams. Now, they're all online. This is the medical oncology interview. So it's four questions, ones on a clinical scenario, ones on professionalism governments and one, one's on academic and research and one's on suitability and commitment. Um And then you've got two interviews for each and each gives you a score out of five. And then basically, they'll decide based on the score whether you're considered for offers or not in terms of the clinical oncology. Again, it's really similar, but this time you have to clinical questions, then an ethical communication and clinical governments question and then two questions based on your portfolio and experience so far. So um that would be asking you about everything you'd put into your um self assessed questionnaire. So your posters and publications and everything like that. I think the main difference is that medical oncology has that extra question about research. And that's because as I said, they tend to be lead the way with research in terms of preparation for interviews. I'd recommend this book which has been going for quite a while. It's not specific for oncology, but it has uh basically list all the standard questions that you can expect in that. Um So in the portfolio and experience or in the um suitability and commitment in the medical oncology. So they'll definitely ask you, why do you want to do oncology? Why do you want to do medical rather than clinical oncology? What are your best qualities? What are your worst qualities, that sort of thing? This book has good things you can say for all those general questions, it won't be specific for oncology, but it's got really good tips in there. It also has tips in there on the Ethical Station and the Governance Station, which tend to be again quite generic across the board. Potentially a stational capacity consent D N A R could come up. The clinical scenarios tend to be quite straightforward, but I'd go through oncology emergencies, make sure, you know, the management for those and the acute oncology stuff. So, you know, what would you do with a patient? That's breathless for instants. And so, um in a patient with known lung cancer, for instance, you might want to think about just general things such as they might have pneumonia, they might have a blood clot, they might then think about more cancer specific. So they might have SPC oh and that sort of thing. But they like you to start um general. So don't go straight in with the oncology emergency, but go in with, I'd want to check the usual things. So, um as for any medical patient, um I think the main things is actually to remember that a lot of your is not what a lot of the, how you come across is not on what you say, but on how you say it. So I'd practice with a friend or family member, um talking out loud, um sounding confident and having good body language because I think that is actually a huge part of how you come across Um So the commitment to specialty is a, is part of both. I think the self assessment form and potentially could be a question you asked. I think you can include basically anything in this but things that I would potentially do so that you could answer this question in advance is try and get an oncology job in your I M T. Um If you can't get an oncology job, try and get a palliative care or hematology job because um positive care is very relevant to oncology and hematology. Lots of them. Um The hematology malignancies would still give you experience of chemotherapy as well. Um If you can't get any of those, then do a taste today in oncology and come, come and see us, come and sit in, in on a clinic in terms of saying why you want to do medical versus clinical oncology, sitting on a medical oncology clinic, sitting on a clinical radiotherapy clinic. Um come to some radiotherapy planning and see what that's like. So you can talk about how you've seen both and you preferred one to the other. In terms of the, if you want to do clinical oncology, you can actually ask us to have a go at doing some radiotherapy planning won't be what we use for the patient. But if you have a go, we can take a print screen and you can put that in your portfolio as evidence. Um again, for the commitment, try and do your projects, your posters or your quality improvement projects in a subject relevant for oncology. Um and then present an oncology conference even if you can't get a poster as an oncology conference, just attending oncology conferences. So the Marsden run lots of small conferences on just topics such as pain relief and cancer. For instance, that you can attend, they're not very expensive. And um the I C R run one, there's loads of different conferences out there that you can attend even if you're not presenting. And that shows commitment specialty, you should be able to get study budget for those as well. Um I'd say communication is a big part of oncology. So if you go to advanced communication skills workshop and I think the MPS run some of those for free so you can attend those. Um And the European Society of Oncology also run a course called Oncology Basics for beginners. But I just have a Google as to what courses or workshops are out there on oncology and attend it, get a certificate and you can use that for your commitment to specialty. I'm sure there are lots of other things, but they were my ideas for that question because I think it's a bit hard to know what to put in that. And that was really um my overview. Um This is the link for the feedback. It's been quite quick. So let's have a look at any questions. Hold on. No questions so far. If anybody has any, please put them in the chat. I'll just keep the feedback link on there. How do you see A I altering your work as a clinical oncologist over the next 10 years? Um It's a good question. Um So I think a I, they're trying to get a I to do the contouring for us now. Um So it's in drawing the cancers, drawing the organs. I think it's um it's not quite there yet. It's quite good at doing some of the organs at risk. So, like drawing the bladder or the bow, but even still, we have to adjust it, although it is much quicker adjusting an ai contour. They're not, I think the problem with it contouring tumor is that every single person's tumor is different. So it's not very good at contouring things that are going to be different per patient. So, I think, um potentially it could be used. I think it's a good thing. I think it could save us a lot of time because we're actually getting more and more cases and we don't have enough oncologist to do all the work so it could save us time. But I think you always need a human to double check what it did because, um, often they make mistakes, but I think it's going to get more and more sophisticated as we go on maybe. But yeah, I think you'd always need to double check it. Mhm. Um, but yeah, overall everyone I'd really recommend oncology as a career and as I said, don't be disheartened by what you see on the wards. Actually, what we do in clinic, both clinical and medical oncology is really positive lots of the time. And I think it's really varied and it's really enjoyable. So I'd really recommend it. Um, and for those of you that, that hate, I m t, don't despair. I hated it as well. Um, but there is light at the end of the tunnel and I think oncology is quite different from all of, from I M T and from all the other medical specialties. Sorry if you can hear the rain. Great. All right. Well, if nobody has any more questions, um, we'll end it there. But thank you so much and hope that was useful to everyone. Um, yeah.