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Orthopaedic Surgery | Krithi Singhania

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Summary

This on-demand teaching session is relevant for medical professionals interested in a life in Orthopedics. Learn from a current ST6 in Trauma Orthopedics about strategies for improving your CV, such as gaining experience in a variety of surgical subspecialties, working towards the 1800 target operations, taking courses in research and methodology, and getting involved with teaching and committees, both locally and regionally. During the session you will be guided through the timeline of how to become an Orthopedic Registrar, and hear tips on how to gain a number.

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Description

Preparing for a Career in Surgery | Orthopaedic Surgery | Krithi Singhania

Learning objectives

Learning Objectives:

  1. Describe the steps required to progress from medical school to becoming a consultant in orthopaedics.
  2. Summarise a typical weekly rotational schedule as an ST 6 registrar in orthopaedics.
  3. Outline the requirements for the FRCS Orthopedic Exam.
  4. Describe the various avenues used to gain exposure to a range of sub-specialities and obtain skills.
  5. Identify committee and research opportunities to develop leadership, management and research skills.
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Computer generated transcript

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

So, um, for those of you interested, I'm going to talk. You talk to you a little bit about a life in orthopedics. I'm going to give you a bit of a background of my life as a registrar. Um, and then move on to kind of talking you through a little bit of what things you can do and how you can improve your CV to obviously gain a number in orthopedics. Um, so, as I already mentioned, my name is pretty. I mean, ST six currently in trauma Orthopedics in the east of England. Um, and I'm part of Bogota. So that's the mantra that many people think orthopods live by. Eat sleep, set bones. Repeat. But there's a lot more to it, and you are able to do things outside of this window as well. So this is my own timeline and obviously everyone's timelines going to defer slightly, but this gives you a little bit of an idea of how I got where I am. So I was in medical school at Lester, did an integrated BSC at King's, uh, medical and ethics. Just because it's something that interested me. Um, And then I went on and was a foundation trainee in the east, middle and south. So Lester scenery. Um, and at that point, I was still coming, and I Exactly what subspecialty within surgery I wanted to do it was between ARBs and Janie Plastics orthopedics, and you definitely want to do surgery Ever since I was in medical school, but I didn't know exactly where I wanted to go with it. Um, and it was during this time, um, I then decided that core training, maybe the best option, because it gives me the most breath exposure to surgery and will help me kind of pinpoint exactly what I want to do in the long run. Um, and I decided, out of all the surgical specialties, I particularly enjoyed SK anatomy. Um, and I really enjoyed my medical school placement in orthopedics, so I decided that that was the theme job that I was going to apply for. So I then went into core training, got a post in East Midlands north because that's where I wanted to be based. Um, and I was based on both Nottingham and Derby, as in the hospital that I was at, uh, during this time in court training I as well as the end of my foundation training. I did my MRCS part A and B. Um, And again, that's usually the time that most people tend to do it. A lot of people now seem to be going down the tracks of doing their party during the foundation training because they're still quite fresh when it comes to their medical school knowledge, their basic anatomy and things like that. And then when they've had a clinical exposure, they're getting part be done. So I then, while in court training, did a job in plastics for four months. I did a four month job in vascular, and I also did, um, 16 months in orthopedics. Um, and then I applied for my S t three number through the interview process. Um, so this was a national recruitment process, as is most kind of subspecialty training these days. Um, and I got a number in the east of England starting off Adam Brooks. Um, so one of the options you do have because I always wanted to have a little bit of a break. I wanted to go traveling. I've never really done that. Um, but my bosses said to me, rather than taking the entire year out and then having to justify why I've been away for the year and maybe showing them what I did during that time, I could apply for my S t three interview. There was no harm. I may not have got a number I may not have known get some exposure to it, and there are jobs that have a delayed start. So I was very lucky that when I applied, I only put down jobs that had a little bit of a late start to give me that opportunity. And I was able to secure a job in the east of England that started in March. So that meant that I had, you know, a good six months after leaving core training, um, to then travel, do whatever I wanted. And there was no questions asked what I did with my time, Um, so, like I said, I started off at Addenbrooke's and then went to bed for for a year, Peterborough and then currently I'm at Norfolk and Norwich. I'll be then going to Colchester and finishing off in Adam Brooks. So that's kind of my timeline. So How can you decide Maybe what Diener is you might be interested in in applying to. So there is a website which scenery I'm not paid by them. There's no ad, but you know, it's a good website. It has the reviews on various sceneries. It tells you about how big the regions are because that's something I didn't look into before. You know, I kind of said, I want to work at Addenbrooke's. Um, I know it's good, huh? It'll it has exposure to this, this and that. But I didn't really look at how vast scenery, at least of England was. Um it also provides you information, for example, on how people have found their experiences there and again. You can then contact people within those sceneries and maybe ask them a little bit more about the exposure they're getting. So the operative numbers they're getting and what placements they think have been good. Um, you obviously have your s t 32 s t a training within orthopedics. As I mentioned, um, and then you go off and do a fellowship. And nowadays, often people are requiring to fellowships before they can get a consultant job. Some people decide to do both of those in the UK Some people decide to do one here and one abroad. Um, and you may just do one fellowship and then get your consultant job. So you know, again, there's variation in how you can get there. So the way that placements work when you're registrar slightly different when I was a court trainee, so when I was a core training there, obviously four month placement. But as a registrar, there's six month placements, Um, and usually you do them in different subspecialties, and you have one year in a particular hospital. Um, and you have a a r c e p yearly that allows you to progress through each stage. Your subspecialty is that you try and go through. You have to go through our spine, hand and wrist, shoulder, elbow, pediatric, orthopedics, hip and knees or arthroplasty, as well as soft tissue. Foot and ankle trauma. And all those bone tumors are not a requirement. There is some requirements have some exposure to some tumor like cases, but certain places have units that you might be working in full time. The target, um, according to the old requirements, was 1800 operations, and a lot of people still hope that we kind of aim towards that number. But the numbers are not as stringent anymore. But again, that's the kind of average that was decided based on what they felt the exposure required was for a day one consultant. And again, you have indicative numbers that you need to get. So then you have this big test. So you know, you're at the time you think MRCS is big And then you have this massive test called the F. R. C s, which you have to get through, and you usually do that post your ST six a ercp And that's one of the main requirements for obviously CCT. So this is an example of my daily schedule In my last rotation when I was at Peterborough. The top one is when I was in hands. The bottom one is when I was in that ankle. And as you can see, there's a variety of elective exposure in theater trauma exposure and then obviously fracture clinics and elective clinics, as well as some time for administration or study or teaching. So, you know, you have this kind of very calendar that allows you to get a vast exposure to a variety of things you obviously have to do on call still, um, and between, for example, November to October. So roughly a year, I had about 14 nights where I was doing this. Five PM to nine AM shift again. We did have an acid show that undercovered us, because the way it worked at Peterborough is that you also were working in the day, so it meant that it was important to try and get a couple of hours sleep at night, at least if possible. Um, you had weekend on calls, which again we're 24 hours on the Friday and Sunday, for example. So again, you know, you had to kind of rely that your S H O could manage the floor for a few hours in the night when it was a bit quieter. And again you could get some rest. Um, And then when my boss was on call during the week, then I had alternate weeks of day on calls or trauma theater, depending. So there's other things that you can get involved with. Obviously, teaching is vital. So, you know attending virtual face to face teaching through the delivery, which I guess many of you who are already foundation doctors or even called trainees will already be doing. You can deliver teaching whether that be locally, Um, has already mentioned to medical students or regionally, um, at particular events or teaching days. And then, obviously there's opportunity to get involved with national teaching through different associations as well as journal clubs. Research wise again, it's very similar to previous. You should be doing an audit yearly, although again this is not a stringent requirements as such anymore as per the syllabus again, it's something that a lot of deliveries will still accept. Expect. Sorry, and they'll also, um, you know, hopefully expect that you do a couple of closed loop audits get involved in collaborative projects. It's really the way forward these days, and there's loads of massive collaborative work going on within orthopedics, and you can find a lot of these on the voter website or elsewhere online and, you know, submit yourself as a potential kind of get involved, whether that's collecting for them or being a PPI for them, et cetera, Publications. Obviously, we've already talked about and that's a requirement again for your application. And we'll go through that a little bit later. And research and methodology courses again help you to understand, be such a bit better and the application of it clinically so then leadership and management. That's again another requirement for us, the three applications. But it's something we also need to show towards our CCT and going into consultant posts so you can get involved with various committees locally or regionally. So I was part of the East England Training Committee as their communication officers when I was in ST three. Um, I then got involved with the Voter Committee, which is our national association British Orthopedic Trainees Association. Um, and I was the publicity officer for 18 months, and now, currently I am the vice president and coming to the end of my tenure, you can get involved locally with your rotor work. You can sit on different panels and through my Biota commitments, I'm on the J J C s t the I SCP panels, and I can get some involvement with the acid council as well. You can share meetings whether that be, you know, your local journal club or your regional meetings. You can get involved with national international meetings that you can share, and I personally have an interest in the hands have been involved with the Pulver Taft. You can attend conferences so you know there's a variety of conferences within your subspecialty, but you've got the big B. O A, which is the British Orthopedic Association conference. And again, as a junior doctor. You should definitely come along to these events. It's a great chance to network meat seniors and get a bit more of an idea about the orthopedic community. We have the voter Congress, which is coming up in November, and I strongly urge those if you're interested in orthopedics to sign up to this. If you haven't already, um, and then there are courses that you can be doing. So whether that be the basic surgical skills course, the A oh course, the A TLS course. And although now for CST, many of these are not requirements as a tick box requirements. If you go to these courses and you can demonstrate particular things, you learn or skills, then those will count towards you gaining points. So, like with anything you have to obviously work hard within orthopedics. But we also play hard. And there's many, many orthopods who have hobbies outside of work. So, you know, you can see, See sorry in the top left. There is a gentleman with the painting, and that's Alistair Faulkner, who's actually one of the previous Voter committee members. And he's really into art. And he's even had his work displayed in galleries. There's people who enjoy sports, and you can do that at, you know, a kind of more local level, or even people who do this nationally. So we've got, you know, people who play rugby semipro. We have people who are involved as Ironman, uh, in women and are involved in triathlons. Um, you've got people who love to just go traveling or people have other hobbies. You're probably aware of this American orthopod who does a lot of YouTube videos, and it's quite into his musical theatre and singing, Um, and also you may just want to expand your family or develop your family so, you know, spend some time with them. So there are various ways that you can achieve this or that can help you achieve this. So you have out of program training experiences and that you can look into and you can go and maybe do something within orthopedics or even something without. If you can justify that, um, you can now take, um, you know less than full time training, which is now even encouraged, as opposed to look at it as something unfavorably. Um, and you don't even have to provide a reason anymore, which gives you that opportunity to take it for things that you may just enjoy your hobbies. You have the opportunity to do higher degrees, such as masters or PhDs, whether that be in med or particularly in a research project, etcetera, and you have the opportunity to go and do some overseas work or medical aid work. And we have a lot of associations that are linked with Malawi, for example, or other regions across the country. Okay, so why should you choose orthopedics? It's no longer just a rugby boys club. You know, it's really changing the landscape of orthopedics over the last decade. You can definitely see that there are more women within orthopedics. There are more individuals are protected characteristics within orthopedics. Um, and hopefully you're you're going to start seeing more and more role models within orthopedics that look just like you or are from the same from the same background as you. Um, there is very high satisfaction rates. One of the main reasons that I chose orthopedics is that I love the fact that it's significantly improves the patient's quality of life. And I think you really understand the importance of that, because when you see a patient who really is struggling to do day to day things, um, has a really poor quality of life, requires multiple AIDS to mobilize and you suddenly do an operation. And the next day they get rid of those a day, and within a week they're walking without a frame or a stick, their able to get back to their hobbies within six weeks. You can really see that, you know, you make a massive difference. There's a great variety within orthopedics itself. There's multiple subspecialties like I've discussed. You have elective exposure, trauma exposure. You have the opportunity for private practice. There are clinics, theaters, war drowned, mg ts on calls that make up your day to day schedule. So you know you're never bored. There's not much overnight operating. So compared to a lot of my colleagues, there's very, very few things within orthopedics that you have to wake up your consultant for overnight and call them in to do an operation. So whenever you're choosing a specialty A you want to look at, what does the Reg do? But more importantly, what you're going to be doing for the largest chunk of your life in your career is as a consultant. So what you really want to be looking at is, what does the consultant do because that's going to be your life fantastic and supportive community. I found that the orthopedic community is very welcoming, and I'm hoping that those of you that have had placement have had good experience, like anything. Obviously, there will be some people or some traders that you may not have gone on with. But as a whole, the community is generally extremely welcoming the conferences, and Congress is always great fun. There's loads of great socials to get involved with. It's a very logical specialty, you know. It is very much an a plus. Be equal, see, But yes, you can go off peace and there is a lot of things, particularly in the trauma world and you, an up and coming technology that allows you to do that. And if you have good spatial awareness and manual dexterity, then it really is a specialty that's good for you. It's one of the most popular one of the largest surgical specialties, as you're probably aware, and you do get to do bits of everything, you know, we have a lot of overlap with plastics. Some of us even know how to raise. Our own flaps were involved in a lot of the soft tissue handling and particularly in hands. We do very much what the plastic surgeons do, and vice versa. Vascular exposure. So again, when we do micro work, there is microvascular repairs that you can get involved with as an orthopod and even your otherwise, we have a lot of overlap. When it comes to spine, you get to play with a lot of gadgets. Like I mentioned, there's a big chunk of our work that involves arthroscopy work, micro work or even robotics nowadays, and I may be a little bit biased, but it is just the best. So as you can see on this screen here, there's a kind of a plethora of pictures showing the variety of things you may be involved with. So you've got some arthroscopic procedures going on. You've got some kind of hip fixations or hip arthroplasty. You have a little bit of micro work on the spine going on with robotic involvement down below. You've got some hand procedures going on, which obviously show more soft tissue handling. Um, and you've got a big trauma case going on where you can see the patient up in the middle of the screen. These are just some examples of X rays. They just pulled off Google. But you can see clearly that you know you've got people who have really smashed up ankles or hips or elbows or tibias, um, or wrists. And if you look at the pre and post pictures, these aren't my own, you know. These are my own X rays, so I can't take credit for the work. But you can see the massive difference that you making and the complexity of some of these cases. You know, these are things where you really do have to think you have to be aware of kind of your surroundings, and you have to be. You have to kind of think outside the box sometimes and think, How are you going to fix this really nasty comminuted fracture? It's really interesting, and you can sometimes do these cases with another colleague just to make you know, sometimes two minds are better than one. These are some of the elective kind of things you might be involved with, so you can see that this hip at the top has significant arthritis, and you give them a hip replacement, which was actually deemed one of the most successful procedures in the last. You know, century patients have fantastic outcomes, post their hip replacements, and they will literally come back and thank you for giving them a new lease on life. Same with knee arthroplasty down here at the bottom of the screen, you can see in the middle we've got shoulder arthroplasty again for arthritis and at the top of the screen on the left. For me, you have the scoliosis case where you can see that this patient has this spine which has a massive curve to it, and then, by doing spinal surgery, you straightened it for them and you help not only with their kind of ability to partake in activities or sport, but with their posture. And therefore it has a massive psychological element to it. And at the bottom there, you can see you know, somebody with do patrons, for example. They've got a contracture there, and we've released that for them to return functionality to their hands. So what can you be doing? So get involved. If you're kind of at the medical school level, which I don't know if some of you attending, maybe then get involved in the surgical societies that your medical school offers, Um, get involved with national organizations as a junior, whether that be through the b o A. Through voter, like I've already mentioned to you or through bomb. Say, if you're kind of a medical student, then there's a medical association version. Try and attend clinical and theater sessions. So, you know, start on the log book early. Start making a note of the cases that you're attending. You've obviously got your requirement of a certain number of DHS is or nails. But you know, there are other procedures that you want to start building up in your log book to show enthusiasm, get involved whether that be through the jobs that you choose, or even taste of days or taste of weeks network and speak to senior trainees and consultants again, I don't think there's anything that replaces this. The the amount of information that you can gather just by speaking to someone who's already gone through it is fantastic. So, you know, attend these courses and conferences and, you know, chat to these people. Try and find yourself maybe a mentor that can help guide you through the process. Get involved in teaching again. This is a requirement for your ST three application to get a point, Um, but whether that be through regular engagement and you can show evidence of this, um, usually they want to see that it's at least four times a year, if not more, that you're doing something towards it. Um, and ideally, showing a qualification even if you are very enthusiastic about Medicaid will get you further points when it comes to your application. Get involved with projects. Obviously, collaborative work like I mentioned to you is the way forward. But it's important that whatever you get involved, with it if it's published is pubmed. I did like anyone else because that's how you get your points. But regardless, getting involved in a project that has, you know, clinical improvement nationally is a fantastic thing to do. Um, get involved in presentations again. You don't unfortunately get any points for post presentations, but it does show that you're keen and you're trying to get involved in things, and you know that does contribute when it comes to you doing your interview. But national and international presentations will get you points and get involved in audits and quality improvement projects. Again, like my colleagues mentioned, try and do at least one a year each one you do you get. You get points for you to try and find a standard guidance that you feel mainly development or speak to your colleagues at work and see if there's any audit projects getting, you know, going on, or that they're thinking of that. You can take leadership before, um, make sure you attend relevant sessions, workshops and conferences. So things like this surgical skills days. Like I said, 80 s or equivalent course is a oh, and although you may no longer get the point like I mentioned as a tick box for attending that specific course. What it does show again is your keenness and enthusiasm towards the specialty and the skills that you gain from it are invaluable. Have a look at relevant recruitment websites and the criteria and catered towards this. So, for example, you know, when you're seeking for CST jobs, look for something that has more than 10 months in orthopedics because that will give you the maximum number of points. Plus, the more exposures you have, the more confident you will feel entering. As a registrar, I think it's only that you start getting less points once it's about 48 months. So that's, you know, a fair amount of, um, orthopedic exposure before it's negative, marking or before you don't get as many points. Um, and you need to try and get some some specialty experiencing other specialties. So, you know, try and get something within plastics on your research or vascular. Or, you know, there's a list of these on the recruitment website because that will give you again maximum points. So showing leadership teaching research, um, as well as you know, these other kind of sectors will get to the point. You need to be able to get an interview, um, and then in combination, get a job in orthopedics. So this is just an example of the recruitment website. So it's through the Health, Education, Yorkshire and number website. You can go on this, and if you click on the bit that says Applicant handbook or self assessment, scoring guidance and the waiting guidance, you can have a real look at this and prepare yourself in advance. This is just about our voter Congress coming up so you can see there's loads of things to get involved with. This pre Congress course is such as an S T three boot camp or the Medical Student Day. There's post graduate courses for those who are more senior, and there's lots of other innovative things going on throughout the week, loads of sessions that may be of interest. And like I said, it's a great time to network with people. So as you can see, this was one of the covers that I did for joint last year, and you can see that the work force is extremely diverse. Now there are more and more women involved this year, I think, was the maximum number of female applicants of 30% of applicants, which I know is still compared to many specialties is not there yet. But we are getting there, so hopefully you can see your face or see yourself in one of these people. So sorry if I got overrun slightly. But if anyone has any questions, I'll be happy to take them. Um, all right, let's have a look. It says here, I'm I'm I don't know if this one's to me. I think it may be, um, it says if you get a c S t post, can you defer it by a year? Um, so with regards to that, I'm not 100% sure how the exact CST process works anymore. In terms of deferring that I don't know if my colleagues earlier who spoke about the CST program discuss that with you. But I think with a lot of things, you can if you have a justifiable reason. Obviously, you shouldn't probably about apply for the post, um, knowing that you're going to have to defer it by a year. But if you know that you've got a number. And then something happens or something, you know, takes place in your life that requires you to do that. And I don't see why that would be a possibility. But again, that's something that I don't know. The exact kind of logistics of how you go about doing what you can do is, um I know when you go for a Reg number, you can do what I did and try and apply for a delayed, you know, delayed start. Um, let's have a look. So I think a lot has already answered that for you, actually. So that's great. Uh, let's go down here. That's a couple of tools. So I think that's more about the log book. And I think he's also got that, so I can't see. I don't know if this one's for me. It's for publication that was mentioned. An editorial letter. Can this be explained? Okay, I think someone else is gonna also look at that for you. Hopefully, um, any advice about getting a leadership position? F two? Yeah. So for F two, you can get involved in particular organization. So again, like I said, you can get involved in local leadership. So whether that be getting involved with helping with the S. H O wrote or the foundation doctor wrote, uh, you can try and get involved with the mess committee, you can get involved with, um, other kind of local organizations. You can even have a chat with the medical student in school that's associated with your particular region and ask them if there's any role for you to get involved in any of their kind of teaching or careers days, Um, and when you get involved, kind of threw voter. Then there is an opportunity when you become a core trainee to apply for the junior rep position. Um, the current president of the bombs for the Medical Student Association is actually a F one. So again you can get in touch with them and see if there's any particular course is that you can help out with. So leadership doesn't have to be a particular committee position. It can also be showing that you're getting involved in a program or a course at a leadership level. So you know there's things you can do. Um, logbooks, an orthopedic surgery. Sorry. Logging orthopedic surgeries into a log book. I can't seem to find them there. Okay, so again, it's probably been a while since I've done the junior a log book, but I think most people can just sign up to the log book. I don't know if Ryan can correct me if I'm wrong, and you should be able to type in a position. And if not, there are subspecialties that you can select. So under the trauma orthopedic banner, like like we do, there should be procedures you can select into. But if not, you can often free text them, and then they'll find the procedure that's most relevant. And you can select that if you're struggling, even keep a you know, an excel sheet yourself and write down the procedures you're doing and get your boss to sign at the end of the placement. So that's also something you can do if you can't use the online system. I think that's all I can see that I don't have any more questions you are aware of. That's fantastic. Pretty thank you again for your time today and for giving us an outline of your journey. An orthopedic surgery. It's truly been inspirational. Um, and thank you