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thanks very much. Um, so yeah, yeah, I just realized the last talk of the day. So hang in there, guys, and I'll try and make it as interesting as I can for you. I mean, I certainly find Max fax fascinating, which is why I'm doing the career. So, um yeah, I'll keep it as short as I possibly can because I appreciate it's been a long day for you guys, but I just want to say I mean catching onto Angeles talk. I thought it was fascinating, and I can't agree more that we all have to engage in surgical innovation. And I think it just I saw a question earlier in the chat box about Oh, can sort of replace us that consultant level eventually. But actually, I think it just makes us better as surgeons. It just makes us safer. It helps with surgical planning, anatomical sort of variation. I think. I think it's just, um, such a fascinating field, and I'll talk a bit about it later in my talk as well. But yeah, I think we all need to engage. We will engage with it eventually. It just has to be done because it makes us better anyway, going on to my talk. So, yes, I'm going to talk about a career in maxilla facial surgery. As Ryan said, I'm debia and I'm a max fax registrar down in the Southwest. So, uh, first of all, what is Oh, MFS So it's a surgical specialty concerned with diagnosis and treatment of diseases that affect our mouth or jaws are facing our neck were very unique in that we require not only a medical but a dental degree. And, of course, we have comprehensive, uh, specialist training. Uh, just like any other surgical specialty we all have to do course surgical training, MRCs and all that. Um so what do we do so often? Were seen as the bridge between medicine and dentistry. The scope of our specialty is quite extensive. We get referrals from dentists and from doctors, and we deal with anything from facial injuries to cancer. And they're reconstructions. We also deal with, um, cleft lip palate and, you know, babies form with craniofacial disorders. I've got some interesting pictures that later, um, from a private point of view, we can also get involved with aesthetics and, uh, things like, uh, face lifts and things like that, Really, the scope is quite vast. And, um, you can get involved in all sorts of different ways, and we are all as registrars, trained and basically everything here. Transorally robotic surgery is an exciting one, which I haven't been trained yet, but I'm excited to get started with that from an innovative point of view. So why do it? I think I personally think that we have the biggest wealth of surgical skills because we deal with soft tissues and we deal with heart tissues. We we do facelifts and handle the soft tissues of the face like a plastic surgeon. But we also use plates and screws and nails, just like an orthopedic surgeon were also trained in micro vascular surgery. Um, just like the neurosurgeons, Um, and there's a huge potential for innovation with trans or robotic surgery as well. It's certainly very intellectually and technically stimulating. It involves a lot of teamwork and a multidisciplinary environment. I mean, surely you can certainly appreciate the head and neck. We, uh, not you know, we not only deal with the usual people like radiologists and pathologists, but also dieticians and speech and language there is because of the virtue of where we're working. Um, as any surgical specialty involves lifelong learning, it's always every day is fun, and I learn something new every single day. Lots of scope for research. Uh, and also it's a very tiny community. There's not many of US surgeons, I think, as a things like 1, 150 consultant Max back surgeons in the country at any one time, something like that tiny community. So it's quite nice. When you go to a conference, you pretty much know everybody, so it's never very intimidating. It's quite nice, and the most important thing is you will make a positive difference in people's lives. As you can appreciate, you're dealing with people's faces. You're dealing with the way they look at themselves in the mirror. There for your face is your identity. Um, when you're when you're working in someone's mouth, you can affect their speech. You can expect the way they swallow, and you can really make such a positive difference in people's lives. And that's one thing that I that I love about my job. So just going into some of the subspecialties, um, trauma is a huge part of what we do. So we deal with, uh, facial fractures. So whether that's, uh, fractures in the mandible arm axilla Or like this, for example, is a three D reconstruction, um, CT scan of pan facial fractures. So someone has been involved in the high impact R t A. And this is this is fasting. As long as the airways sorted, we can usually electively uh, decide how we're going to, um, sequence this pan facial trauma and this is always fun to fund to do together. There's something huge part of what we do. Um, we also deal with oncology. So this these pictures are taken from my consultants give me permission to use it. But this is a patient of ours that had a cancer in the right lateral border of their tongue. And as you might appreciate, you don't just take the cancer that you also take a margin margin of normal tissue around it. And as you can see, this patient has ended up with pretty much half of their tongue removed. Now, maybe in other parts of the body, you can get away with taking a cancer and showing them up but certainly not in the head and neck. You can't just leave someone half their tongue missing. So then the reconstructive side is certainly fascinating. So this patient, for example, had something called a radial forearm free flap, where we took a bit of skin from their their forearm with an artery and vein. We plum that bit of skin to reconstruct and replace the side of their tongue. And then we plunged the artery into one of their into the facial artery in the neck so that it has a vascular supply and a vein for venous drainage. So now this patient in clinic I remember seeing them afterwards, they could speak properly. They could swallow nicely and just imagine what would have been done if we hadn't reconstructed them. So this, um, you know, it's fascinating surgery. It's really fun. Um, and very technically involved, Um, we from an innovation point of view, we do get involved with the three D virtual pants. This, for example, um, is from a paper, but But we do this every day of a patient that had to have half the mandible removed for cancer. So they're talking about different ways. One can reconstruct their mandible, so you can either take a bit of their iliac crest or a bit of the fibula, and you can plan from a three d point of view how it's going to look if you were to put that in, and, um, with with technology and innovation, you can actually plan, where are you going to put your bone cuts? Where are you going to put your screws and how you're going to put your pedicle in to make sure that all reconstruction nicely. So it's really fun. We've got lots of cool toys to to use when we're planning reconstruction of people's cancers. So this is, for example, a patient that had, uh, quite an extensive amount of their mandible taken out. Uh, so this is showing a plate, a metal plate, which we've put in, which screws into. You can't see the whole extent of the mandible here, but as you can see, we've lifted up the skin of the chin to show the synthesis of the mandible has a plate over it with the screws, and it's it's basically screwed into bits of their fibula that's been put in as well as their whatever mandible they have left. And then I don't know if you can appreciate here, but basically, there's a vein and artery that's plugged into their neck. So this is just a day in, day out what we do to reconstruct people's cancers. Uh, and this is an X ray of that patients. As you can see, they have this extensive metal plate going from angle to angle of the mandible and three bits of fibula put in between to reconstruct that we also do orthognathic surgery. So this is when, um, for people that have quite bad under bites or over bites, uh, so we can move their jaws forward and backward, depending on what they need. So, for example, these are pictures taken from a textbook. So we've gone under the upper lip into the into the sulcus, lifted up the mucosa, and we've done bone cuts on either side of the maxilla to pull it forward. So just to say so, this is another, uh, set of pictures from a textbook. So at the top left, you can see this girl has quite a severe underbite, and you can see the picture of her teeth and the third along on the top. She's got a big gap, and she was complaining that she couldn't bring her teeth together. So what we've done is we've brought her maxilla forward and her mandible, and you can see the pictures below. It's brought a much more favorable position of her jaws, um, to come together and you can see that her teeth are coming together really nicely as well. So they said, you know, aesthetically, it's certainly more pleasing, but also have the potential to make a huge difference to people if they can bring their teeth together and and bite like they should, Um, cleft lip palate is also another big specialist subspecialty that we get involved in. Uh, this is an incredibly rewarding field. Uh, you know, I think something like one in 1200 babies are born with a cleft lip palate, um, in per year in the UK um, which has huge implications on obviously their appearance, but also the way they feed their speech development later in life. And of course, it involves the whole family dealing with the parents as well. It's really rewarding. And, um, some, something else that we get involved in and then this, Um this is a little girl with a cold and syndrome where she's had a cranial facial disorder. And you can see on the pictures on the right, where we reconstructed her favorite thing in the in the textbook reconstruct the mandible with some planning to get it in a more favorable position. So we get involved with kids with sort of funny shaped head as well. Um, deal with distractions, osteogenesis and reconstruction. So training. So that that was just a whistle stop tour of, uh, subspecialties that we we can get involved in. But that's just a small minority that it really is a huge scope. But to train NMFS, as I said before, requires a vegetable, dental degree and a medical degree and at least 12 months, of course, surgical training. And, of course, you need your MRCS like any other surgeon. Um, our training is five years long, so it's a year shorter than most of the surgical specialties, and that's because it's been recognized that we take a bit longer because of our duel degree. Um, this is a very busy slide, but essentially is on our bounds websites. That's the British Association of Oral Maxillofacial Surgeons. And it talks about all the different ways you can get into higher surgical training in O. M. F s. Um, I think I suspect most of your sort of med students or junior doctors. Maybe not dentist, so you'd probably be more in the orange side of the pathway. But essentially, you can do as long as you've done your F one and you're F two after your medical degree, which everybody has to do. You can either do what I did and go straight to dental school after that. And then, of course, in between after dental school, or most people tend to do core training first and then go to dentistry afterwards and you can do it in as little as three years. I know King certainly has a three year program for medical graduates, which is the one that I did. But there are other ones in other parts of the country as well. Um, then, uh, this is just showing. I'm sure most people think that we're really old compared with other, um, specialist registrars and surgery, But this is a bit of an old school, but I think it's still true that we're not actually that old, so we're sort of, um we're sort of third along there. And so our average age is, uh, maxillofacial Registrars is just over 37 you can see that most people other than ent most people are average age is sort of 35 above. So we're not actually that as old as you might think, Um, this is and that's because we don't actually take that long. So this is a chart comparing the average number of months from full registration date to registration on the specialist list. Once you fall off and become a C, u, C, ct and Max Max, we actually take the shortest time of all. And I think that's probably because, um, we are a year shorter than, um, other surgical specialties. So most people take six years and we take five because of the things that we've negotiated because of our long training pathway. But also, um, the competition ratios are very good. Um, we don't if you if you apply for an s t three, if you have your two degrees, your MRCs and and, of course, surgical training under your belt you will get a job. Um, competition ratios are almost 1 to 1. Or as I think, I suspect in some surgical specialties that are a bit more competitive. Um, you might need to sort of tread water for a bit as a clinical fellow before you can get your number. So maybe that's another reason why we tend to get through quicker than other, um, surgical specialties. This is a This was published on our website, um, a while ago. So this is looking at competition ratios between the different surgical specialties. So the column and then just after the specialties talks about how many applicants there were in that year, Um, the next column over is how many places there were. And then the next column over talks about sort of competition ratios, and we're actually the least competitive are so you can see we're third down 0.96. That's basically 1 to 1. So, essentially, if you apply for a job, you'll probably get it. Um, and then this is just talking. This is just a graph showing a percentage of consultants who are female within the specialty. We do pretty well. I mean, it's a shame. We're not 50 50 yet, but we're getting there. We're just over 15%. It's certainly a very family friendly specialty, depending on what subspecialty subspecialty roll you end up adopting. It's I think it's very family friendly. Um, you do need to be a bit organized about this field. So if you're going to do a second degree, um, you know, you do need to think about university tuition fees supporting yourself financially afterwards, jury or during degree, since you're gonna have that loss of full time earnings so you can get an NHS Bursary for your second degree. There's always student loans. Bounds certainly offers up to 2000 lbs scholarship each year for anyone that applies. Most people, if you apply for it, you'll probably get the money from bounds. Um, there's lots of other different places you can get bursaries lots of potential for local work. I was very, um, it was very easy to support myself as a dental student because the dentistry was my second degree. Uh, doing lots of a A low comes, um, and that and I was I certainly was fine financially that way. Another thing that's been negotiated in the 2016 junior doctors contract is that we are entitled to an extra flexible pay a premium. So AsthmaX fax registrars, we all get an extra 4000 lbs annually on our paychecks, Um, compared with other surgical specialties. So we'd make about 20 k more over five years than other surgical specialties. And that's because they realize that we obviously spend a lot more money, um, doing the second degree. So ways to learn more information and get involved. So I would suggest to get to know your local unit. I think one of the reasons I went to Max faxes that I find I found them very friendly. I think I think we're a very friendly specialty, very welcoming. If you say if you approach your local you know and say you'd like to learn more, I'm sure they'd love to have you, Um, you can as a as a foundation trainee. I think you're allowed up to two weeks as a career to arrange as a career taster. Unless it's changed now, I'm not sure, but I certainly arrange for two weeks a career taste in my local unit, which was really fun, and, um, really helpful. Um, I was really privileged to teach on Ace. It's pre conference course and all fs. We did a really nice plating course in March in Aberdeen. It was lots of fun. Um, and, uh, you know, I think we're we're we're hoping to run it again next year, and I think we will. So, um, if you're interested, come and come and join us for that course next year. And, uh, we'll play with some max fax toys together. Um, you can also join the junior Trainees group of bounds. So this is a huge group of medical students, dental students and also sort of S H. O S in both fields where, um it's very useful. They think that there's over 1000 members on Facebook, and I certainly make use of it. You ask a question, you'll get 20 responses. So usually there's a lot of support there, and they arranged fantastic annual conferences for junior trainees, um, to learn how to get involved in the specialty. Um, there is also a membership program for second degree students. It changes all the time, so I don't know what it's called now, but there there is one available, and you can also register your interest with bounds. So this is just a screen shot of our website. And if you look sort of second down, you can actually click to register your interest. And you will get useful emails from bounds in events that are happening and how to get how to sort of get involved with other like minded people. And this is just a screen shot of the junior trainees group Facebook page. Um, and as you can see Oh yes, 1.9000 members. So quite a few people, so lots of people to answer your questions if you ever have them. So thanks so much for listening to my talk. I will. I can talk about Max Max all day, and that's my email address if you ever want to get in touch, Um, always happy to answer questions or put you in touch with someone else that's more local to you. As I say, we're very small specialties, so we pretty much know everybody. So, um, anyway, so that's that's all I have to say. Um, if you have any questions, happy to answer them now. Otherwise, please, please feel free to email me. Thanks very much. Thank you very much, David. That was a fantastic talk and really some practical tips and occurring wax wax and how to go about doing it both professionally and financially. So we've come to the end of our first day of our P four CS event, and you've heard from over 20 speakers. And also you've heard from at least 14 surgical specialties. Thank you to everyone who who stayed on throughout the day. And you will receive an email about feedback forms and certificates in the coming sort of a day or so, and our catch up content will be available in the next week. We also have another day of p four CS tomorrow with the focus on surgical training in Ireland. So I hope you have a nice evening and we look forward to seeing some of you tomorrow. Thank you.