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just starting out now, Okay. Hello, everyone. Thanks very much for coming to the workshop this afternoon. This first session that we have is on, uh, pediatric oncology with Doctor um, and a friend. So she went to university at the University of Aberdeen after completing a B S. C. And then she worked as an academic foundation doctor, also in Aberdeen, sitting for a PD, sir, in medical research skills and a master's in pediatric and child health. She then was an academic clinical fellow in medical education and also gained a PhD while working as a clinical research fellow. She's now training as an oncology grid trainee in Birmingham and has a particular interest in palliative care, teenagers and young adults. So I'll hand over now to Amanda. Thank you very much. Thank you very much. I'll be I hope everyone is having a great day today. It looks like a really good session. I am going to give a fairly short presentation because I was hoping that most of what we would do today would be some sort of chatting questions and answers about careers. But I'll talk a little bit about what I've done to get where I am a little bit about what I like about my job. And then it would be kind of over to you guys to ask whatever it is you want to ask. So my career to date. And so I went to college and leads and then a levels, um, the usual work experience route and at the local hospital, which was much easier when it wasn't coded time and then went to uni in Aberdeen and initially did A B S C in pharmacology and then went to medical school During my time at uni, I did a voluntary work, which was really good fun. And I always like to do a little bit of a plug for over the wall who are really fun charity to get involved with if you're interested in getting a little bit of extra pediatric experience. And so you graduated in 2012, which feels like a scary long time ago now and started work as a foundation doctor. So, um, as you guys know, that's the really tough bit of medicine. Personally, I thought, um, I think it's the hardest thing that I did, and but I also really enjoyed it. Academic Foundation doctor, which meant I did a bit of research, but that is very much not a prerequisite at all for doing oncology. I was just a bit of a nerd, and I enjoyed it. I also did a part time masters at Imperial College in Pediatrics and Child Health, which was a quite a good fun. It was mostly distance learning, and but I did go down for a couple of days, a term for a couple of years and met up with people on the course. Things like master stories are again absolutely don't have to have them. They get you a couple of points, most on your applications when you're applying for subspecialties, so don't feel like you've got to do them. And I basically did it because initially I didn't have a pediatric job in my rotation, so I thought it would be useful to sort of keep my eyes on the prize and focus, and it was also good fun. But equally tuition fees have gone up quite a lot since I've done that, so it's not something I would want you to feel a really necessary thing to do. Certainly, if you either don't want to or couldn't afford to do something like that. I don't think it would disadvantage you in any way at all. And after my foundation training, I moved down to leads, which was home for me to do my pediatric training and again sort of started as an S t one. And I also did some academic time there and again, really not necessary. I think that there is a perception that oncology is a very academic subspecialty, and it certainly helps to have some knowledge of research. But there are people who have got no research experience whatsoever. They were very successful oncologist, So just because that was my preference in my route, then I don't want you to feel that you've got to do that. Um also have the joys of passing exams. So as you know, you've got to get your post graduate exams, um, done before you can progress to registrar level. I think there's a little bit more flexibility and that and now with the new change in curriculum, and I did some of my exams earlier in foundation and got a lot of the day, and I think that that's useful, particularly like you have done a pediatric job, but equally, if you are applying for pediatrics this year and you haven't done exams, don't worry about it. It's really not the end of the world, and everyone has to have them. By the time they're a register, they won't have any impact on your subspecialty applications. So I then went on and did a PhD. Um, I think I've said 100 times already that you don't have to do research and you don't. What my PhD gave me was some time off the sort of medical treadmill, and it was really it was well paid. So I was lucky that my funding essentially covered and the equivalent of an unbranded role. So I turned the same amount I would have done if I have been doing a Monday to Friday 9 to 5 job and then chopped up with a couple of locations. So I didn't have to cut my salary at all, and I think that is a really big consideration, and I think the really useful thing. That was what I got out of it in the other time. So I was working at 9 to 5, mostly which meant that I could take on little extra bit I could do. I did Low comes on the oncology ward and got some more experience in oncology, and I went to conferences and networked with other people, and I got to meet lots of other people who had done oncology and spoken to them. And I had more flexibility in doing things like the voluntary work I really enjoyed. I didn't have that hassle of trying to arrange swift shift swaps, and so so I could just take my annual leave when I wanted. Um, I happen to get married and go on my honeymoon during my PhD, and that was a far less stressful thing to organize than if I have been doing it whilst working on a full time medical rotor. So there were lots of benefits to me of doing a PhD, but most of them were not actually the PH. D. Itself, and I did talk about it a little bit in my specialty interviews, but it really isn't a prerequisite. And again, I I think that the specialty is trying to move away from a PhD as being something which is necessary and and at the moment, I think I think I got one more point for having a PhD than I would have done for having a master's. So what you do in that time dictates whether it's a useful thing. If you're interested in research, it is a good opportunity. It gives you a little bit of a break from medical training, and it allows you to CVS, but a little bit. But it isn't. It isn't the be all and end all. And the actual having of a PhD doesn't particularly count for a lot when it comes to your applications. Um, so I spent a lot of time working with on the hematology oncology ward and whilst I was doing that, and then I finally got my subspecialty job just over a year ago and moved down to Birmingham there, so that was quite a long time. I was a little bit unusual because I knew I wanted to do oncology as my subspecialty from pretty early on. So I did some pediatric oncology and actually during my work experience. So in total, it was about, I think, 16 or 17 years probably thinking I wanted to be a pediatric oncologist to start in my great job. But again, you don't have to have decided already. And lots of people will decide during S T two or three that that's what they want to do. And there's loads of flexibility in the system to do that. The application forms are very generic. So, actually, if you apply for a subspecialty, you feel in the same form whether you're applying for oncology or neonatal or renal or any of the other specialties. So you get asked very generic questions like, Why do you want to do this sub specialty? What skills do you have that make you suited to this specialty? And you can just flip your answers to highlight the specialty you wanted. So what is a pediatric oncologist? I'm sure you mostly know because you've come to this talk. And but if you look at the Royal College of Pediatrics website, they'll tell you that a pediatric oncologist is a doctor with expertise in managing Children, cancer anywhere in their body. And and one of the things I really like about oncology is that you look at you look after Children and young people and their families at all stages of treatment from diagnosis right through to either long term followup for palliative care. So it's a really holistic specialty where you look at for the whole family. I get to know not just my patients, but their parents and their siblings really well during treatment, and we are involved with them for a really long time. So lots of our patients will be seen in our in our long term followup or survivorship, as it's called in the United States and clinics. And I see them go off to university and get married and have Children of their own. So that kind of stuff is really awesome as well. So some of the patients that I've seen over the years of stuck with me. So I really clearly remember a little girl called Penny, who was about two very fit and, well, little girl who had come into hospital because her mom thought that she was bruising a little bit more easily than usual and looked absolutely fine. Examination was unremarkable, apart from some bruises. But just to be vigilant, somebody did a blood test and and her full blood count came back, showing, uh, leukemia. So one of the really great things in pediatric oncology is that our survivorship is brilliant now compared to how it used to be. So if we go back to what was our parents' generation and actually this pink curve at the bottom showed that very few of them would have survived into adulthood about 10% of patients we now basically reverse that an over 90% of patients who are diagnosed can get better, and that's like really groundbreaking. And it's the difference between essentially handling someone a death sentence and saying, Okay, you got this. It's a bit rubbish, but our plan is to get you better. You will also notice that things are getting, um, that it's getting more common by these numbers, and these numbers come from the big trials. And some of that is just because there are fewer things around to compete. So over the years that have been fewer other diseases, which can kill Children so we don't have the same levels of infection, we've got better vaccination rates, and some of it is increased recognition. Um, early, so often, historically, Children with things like like the acute pediatric cancers would actually die before diagnosis, or at least before treatment had begun. And so now we are doing better at making those diagnoses another little one. I always think about with Lily, who was a 12 year old who came towards with a brain tumor, and she's absolutely hilarious, and we sat and had a very long chat with her when she was first diagnosed, and I was quite worried about how she was going to cope with what we told her. She was a very bright, aware 12 year old. She knew exactly what a brain tumor meant, and and she asked several times during our initial consultation whether she was going to die. And at the end of our consultation, I sat down and I said, You know, we said lots and lots of things. Is there anything you want to ask me? And she looked at me and she said, Yeah, I've got a question I said, Okay, you got anything you want? She said if you're pregnant and you go swimming, does that make you a human submarine? And I thought, Well, I'm gonna have to specify that when I ask the questions. I mean questions related to what we've just discussed, Um, but I think it's a really interesting thing about pediatrics generally, that you can have the most difficult conversations. And then kids just go back to being kids and want to ask slightly silly questions or slightly weird things and that they've been thinking about. And then another little one I often think about is Joseph, who is really was a really lovely little boy, and he sadly passed away from, uh, neuroblastoma, which is a really aggressive, unpleasant childhood cancer. And I think about Joe a lot for lots of reasons. He was a great kid. His mom's fantastic, actually. After he died, his mom went and retrained as a nurse, having been a lawyer. And But what really sticks with me is his little sister, who was only a baby of a few months old when he was diagnosed and was five when he passed away. And she still wants to be a doctor to help look after Children with cancer like her brother. I think that's another thing that highlights how brilliant and resilient Children our families are, even in the face of what can be really devastating and diagnosis and time for them, So what do I like about oncology? I think I've probably highlighted most of it, but it's full of teamwork. It's properly holistic. I could not do my job without the Radiotherapist and the psychologists and the nurses and the physios and the occupational therapist, and it's really, really nice to be part of such a big team. With everyone working together, Communication is really important, but it's also really fun. So there's always really interesting things about communicating with small Children, and we usually got the time to sit and try and do that well, it's a really science see specialty, so a lot of what we do, if you're interested in that, you can sit and read the Read the protocols on the trials and you can go back to first principles on how and why those treatments work. And for me, as someone who's always really enjoyed the scientific aspect of medicine, I like that. Actually, I can go back and look up which molecules are disrupted or how DNA is damaged and and why are treatments work the way they do? There are opportunities for research, and I said you don't have to do it, but as someone who enjoys research. Oncology is a specialty where you can be involved in research without being a formal academic, and I think that that's really good as well. So it has that flexibility that you don't have to say, I'm going to be a professor at the university. I'm going to give up all my patients and I'm going to sit in the lab. You can do research on the shop floor day today. And of course our patients are the best and they're absolutely brilliant. They make the job what it is, and I absolutely adore all of them. So I think it'd be really nice to just spend some time now just getting thoughts and questions from you guys about anything that you want to ask really about. Working in oncology. I put my camera on so you can see me. That's great. Thank you so much. It's really useful to hear about your journey through your pediatric training so far, and also why you love oncology so much so we'll start off with. Got a question from Caval, who says What makes you competitive as a as an applicant for oncology grid training? Is there any particular advice that you would get. Yeah, that's a really good question. So what I would say is, if you know early on that you want to do oncology, reading the person specifications which are available on the Royal College website is really helpful. So I think I started doing that when I was an S h O U S E one or two. I sat and read through the person specifications and looked at which of the criteria I had, which was the criteria I didn't have. And so they the essential criteria are the same for everyone. And they're basically, like, be a doctor, be trained in pediatrics. And but the desirable things are things like having good interpersonal skills, having a practical skills, having some experience and understanding in oncology. And you can really, um, kind of sway your experience and and you can you can really highlight in your application form what it is that you want to do. And I would also look at when you come to write your applications, which you know is a few years away for you guys and look at the short list in criteria because they will tell you like. You get one mark for experience of this thing and to mark for experience of that thing, make sure that you really clearly state what you've done. So it's really obvious that the team can give you full marks. So I had a colleague who didn't get into oncology the first time she applied, and actually she done loads of stuff. But the way she had written her application meant that it wasn't always clear how many points she could. She should be allocated from it. And I think mostly it's just about being really keen. So certainly my feedback from my interviews was that I seemed to really understand what the job entailed, and I seemed really keen to have done it, Um, but I don't think there's anything really specific that you need to do other than spend some time learning about what the job entails. So ideally, get an S H A rotation in oncology just so that you've got that background. Um, but the expectation is for the interviews. There are some clinical components, and they expect you to function at the level of a new registrar in the District General Hospital. So what would you do if you're working in a small D G H? And there's a new patient presents with malignancy and and a lot of it is very generic. So I had a really long question in my interview about a child who was in foster care. And actually, most of the question and discussion was about who have parental responsibility and who should consent for his treatment. So it wasn't they weren't really interested. But I knew his treatment protocol inside out, like so it would. I wouldn't say it's a waste of time learning those things, but that wasn't what got your points. It was being a good general pediatrician and actually as an oncologist, you become a general pediatrician for everybody who has got cancer. Essentially, um, so I So I think it's more about being an experience and well under general pediatrician and then being able to relate those experiences to oncology. That's great, Thank you. We've got another question, Um, which is saying What's the relationship like between the pediatric oncology team and the pediatric palliative care team? And how would you rate the level of palliative care training within your oncology? That's a really great question. I think it really varies from center to center. Um, palliative care is one of your core competencies. So it is an oncology is a specialty when not all your patients will say that even you need good palliative care. Currently, where I'm working, we have a really good working relationship with the palliative care team. So they come to our weekly MG t s and they're on speed dial on most of the consultants bones. We can get a hold of them and we generally know what they like and what they don't like. In terms of training, I think you can do as much or as little as you want, so it depends on what your interests are. So there are definitely some oncologists who are less interested in palliative care who are quite happy to defer all of their palliative care experience to the palliative care team. And there are some oncologists who have a particular interest in that. I've got a diploma and palliative care, and quite a few of my colleagues have as well and and it's certainly possible to spend rotations with the palliative care team to get more experience of that so I think you can do as much or as little as you want to. And I think the main important thing as an oncologist is to recognize how much you're able to do and to know when to involve the others because they're out because they're sort of out with your your expertise. That's great, thank you. We have another question. Which is How have you found PT training specifically in the Birmingham? Uh, question. And I really like it. So I I can only compare to where I've been before. So I did. I did do a pediatric job in Aberdeen and Foundation and where I did some oncology. But I think at f y two level it's very difficult to comment on specifically, um, what sort of what goes on there And you you don't really get the full immersion. And then I've worked in leads and in Birmingham, and I would say they're both really great centers, and they're both big busy centers, Um, things that you need to think about when you're deciding where to go. Uh, everybody has to have some training in stem cell transplant, and not all the centers do that locally so Birmingham does, so I don't have to go away for that. But if I were working in Nottingham or Cardiff or Cambridge or one of the smaller centers, I would have to give away for six months and to get that experience. So um, that's a real positive. I work in a big center that does. Most things in house are Radiotherapy is also down in Birmingham, which again is nice for a training point of view that I get experience of that. But I think everywhere where you can train in oncology will give you good training, and it's quite highly regulated specialty, and you just have to work out what it is you want. But I definitely have no regrets about training, and I'm really enjoying it here. Oh, great. It's good to hear about the difference is you mentioned in terms of where you work and how that means in terms of the services that are available that I think that our level as foundation doctors, we don't always have that sort of insight into the services. So thank you so much. We've got another question which is Have you found there's more litigation in oncology in comparison to the other subspecialties with in pediatrics. Actually, no, I think I think there are sometimes some high profile cases, which makes the news. So some of you, probably before your med school, will remember a boy called Fascia King who I think was treated in Southampton, who was a boy. I had a brain tumor and whose parents kind of essentially smuggled him out of the hospital because they wanted him to have a special treatment. And that kind of thing really hits the knees and really blows up. But I'm not aware of any of my colleagues actually being sued, and I think I think this probably in terms of litigation and pediatrics, gets relatively little. Um, you do see it when you do neonate because you get all the jobs and dining cases, but in terms of parents actually suing you generally not. And sometimes when people are upset, when they will threaten that sort of thing. And but it's also a specialty where treatment guidelines and pathways are quite clearly laid out. So it's fairly obvious what you should be doing. And in the difficult cases, they're nearly all discussed at national or even international MG T meetings. So you tend not to run the risk of having done something really rogue. That may be different in the US, where the culture for litigation is generally stronger. Um, but I certainly never known any patients who have actually taken legal action, and I think the only the only ones where I've been kind of vaguely aware of it has been more intensive care related cases. So, like you, Charlie Gard are the ones which has been in the news as well. But no, it's not a specialty that has a particularly high kind of rate of being sued. Don't need to worry about your indemnity insurance too much. Thanks so much. We've got two questions that I think sort of blend in together quite well. So someone's asked, What's your work work life balance like? Is there a lot of out of ours work nights and weekends. And then also we've got a question about managing the emotional burden under the highest make up for the lows and the job. Yeah, they're both really great and important questions. So in terms of the work life balance as a Reg in most places as a registrar. Whatever specialty your in your kind of covering the same thing. So you still will do some night shifts. But covering the wider hospital. You'll do weekends, and that varies depending on where you work as to whether you're covering the whole hospital or just oncology. But it's not really any different to what you get in general fruits and in terms of once you see CT and become a consultant, and that is, you will be on call frequently. But it's relatively rare that you'll actually be physically called into the hospital overnight, and so you'll be on call for advice. But it's it's not common at all to have to actually come in and do that. You will have to go in at the weekend and how often that is. Depends on what sort of center you working in some centers. Um, there'll be one consultant on the hematology and oncology, which means that you won't be on call as often, but you'll be covering more things, and so you want to be busier. And then there's places where you've got two people on call, so you're on call more often, but you don't have to do as much as you don't get disturbed as much. Um, I don't see oncology moving to a fully resident consultant system any time soon. I think there's some talk of it in some specialties, but I don't think there's a necessity for it. And and certainly you'd probably be worth looking at in most places, sort of one weekend every eight weeks or so, and then 11 or two nights on call pair fourt night, roughly depending on what kind of roads are you on, but generally not too disturbed with that in terms of the emotional side of it. I mean, I think everything impedes has an emotional side. And, you know, I do deal with things that are very nice, right? I had sent a little boy who have a palliative care home last week. I should have been starting his first day at school, and I was sending him home on the syringe driver, and that is, like, undeniably a really horrible thing to do. But equally if you do general pediatrics, you have to deal with really nasty safeguarding cases and and deaths and that kind of stuff. So I think for me, I think There is a lot less death in oncology than people imagine so far. More of our patients get better than don't and and I think within Peach generally. But particularly with oncology, everyone's really upset when a horrible thing happens and it's really okay to be upset. And I think that that is really useful to work in an environment where your seniors will say, Yeah, you're yeah, like, of course, you're upset because you just send a kid home to die, and that would be really abnormal to not be upset by that. So there's lots of support in place, but then equally, you know, a few days ago. So I'm talking about sending a kid home to die. But then equally, a few days ago, I got a card from a patient saying, Thank you for supporting me. To me on my journey, you've always made me feel great. You know, there was a bracelet that his little sister had made for me. Um, I got you know, I get hugs in clinic on a regular basis from the kids, So I think the main thing in terms of managing the emotional side is just acknowledging that it is okay when things are rubbish that you're okay to be upset about that. And most people will support you in that. And definitely you're not going to get criticized for having a rough time. Sometimes things are rubbish, and that's okay. Go ahead and have a gym. Wise words. We have a question from Sarah. Uh, I think this might be our last question that we've got time for before the next workshops as well. Just it just says, um in terms of your interest in palliative care work, how does that play out in your day to day job? And how did you get involved with that? That's a really good question. Um, so I just really liked it. Um, essentially play that day today in that you you get known as being a person who has an interesting expertise in a particular area. So in the same way that I've got colleagues who are who know a lot about brain tumors and if someone's got a tricky brain tumor case, I go and talk to them. And if they've got a tricky palliative care case, they might talk to them, and I might be more comfortable. Keep doing more of the management of my palliative care patients and getting the palliative care team involved maybe a slightly later stage, and but equally there is opportunities to do that. So as a consultant, there are definitely oncologists who also do sessions with in the hospice, um, or do on calls for the hospice. So there is if it's something that you're really interested in, you can get. You can get a consultant job where it's a more formal part of it, and registrar is a little bit more flexible. Oh, that's great. Thank you so much for giving your time this afternoon to talk to us. We had a few more questions. I'm afraid that we've not had time for. So if you're happy with your email address on the slides, it is on the slides, and I'm just going to put it in the chat as well. Perfect. So yeah, feel free to get in touch. If anyone in the family and wants to come and hang out or go for a coffee, or if anyone just wants to catch up and ask any questions more than happy to check to any of you guys, that's great thank you so much. And we really appreciate you for sharing your story with us today. And your career so far. Thanks very much for your help. No worries. Every take care. Perfect. So if everyone in the conference, if you click back to the main stage, that will be the information on joining the next of the workshops. Thanks very much, guys.