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Well, everyone. My name's David Insulin. I'm a speed it register at the role London on Do is talk to you about orthopedics, What it's like to be in training Protopics on also to discuss how you guys could apply. But what peaks after you have to, um, I'm going to go mainly into at that point in twos, the into the process at CT and not really into registrar training. Because it's quite far. I'm sure that the, uh, situation will have changed by that time. Just a zit. It's changed so much since a lot of sense when I applied. Um, cool. So this is fat in it. If you have any issues or any questions, just fire them into the chat on. Hopefully, the guys would have put me out. Point them out to me. We can answer them as you go along. Eso this just quick. Run through of what I did. I had my foundation, your training at the in Essex and Princess and just Oh, I did my orthopedic training in f y, too. Um, and that was really when I kind of decided that will feed it cause what I wanted to pursue Some would have said it was quite late in that point to make that decision on. It's really good if you guys want to start doing that now. Okay? Yeah. Just let me know if my voice is coming out. Yep. So that I took a year out after after two. Because that was some of that was planning on doing, um and I want to, basically, sometime traveling. Did six months at the Royal. Lived in doing a renal transplant job on. Then I went. Teo did like a round the world tour for five months. Uh, having just having a good time on there Now came back, did my core training in these Midland's and moved Catherine and Lester on Did plastic orthopedics and general surgery there. And then again when I reapplied on, Got a job at the roll under the rotation. And I've been in London ever since. This is also just to demonstrate you do move around a lot, so every six months to a year in training, you'll be meeting hospitals just for those You don't know what the role of limitation is. S o. Each area has a training Diener e, northeast Thames is a bit unique and that has four rotations within. It's Dean. A ring on one of them is a role. London Our base hospital is the role in the hospital in my chapel. It's the business trauma center in Western Europe. Apparently, it's definitely business trauma center in the UK on the hospitals that we cover in that mean that when I say cover, I mean, I could potentially move to on be there for six months to a year, go from South End to the Royal London and then out, too Broomfield on Harlow. So it's quite a big area on. Sometimes you need to be commuting. So working South and for here I was going back on our on because we're limited in pediatrics on it's the best commute got Ms 10 Minutes cycle. So it kind of goes up and down. So just a general start. What is orthopedics? It's basically we are. Specialty is a musculoskeletal system on we as a specialty, we save limbs and we restore function. We don't necessarily save lives, not like vascular surgeons in general surgeons, which is a good thing about thing. I mean, if you want to go and do kind of the really intense stuff with the form of things. Then really, general surgery and basket surgery is where you want to be heading to see that if you like to be like the intense up high pressure things, but also means you're gonna be up a night on coming in a long time where it's going. Generally, it's good that you can, um, come I/O on bone steak ages to heal. So I can you still hear me? I've got problem with my mike. It was hurting I/O, but it's better when you just spoken. Now it still seems to be cutting I/O of it. So I still don't think we can hear you. I still, you know, way back. Yeah, yeah. Oh, no. Um, I think it's cut my head phone service or it's with this hour. It's hopefully it'll work for a little bit. Um, I'm actually Let's carry on. We'll see how it plays out. That's good. So, yeah, uh, Phoenix is good. That that you generally better, you know, take a while to heal. So you don't need to come in immediately overnight. But there are situations when you do have to, um, there are two aspects to orthopedics. There's a true mass spect, which is the acute condition, too. You got the fractures 10 and ruptures, infections and joint dislocations. And then we've got the elective side, which is more the chronic conditions, perceptual osteoarthritis and after a congenital diseases on. That's where we kind of get involved, too. Might the joint replacement and Reconstruction so on the top, right, you can see that. Ah, fractured tibia. I'm at the intramedullary now that we used to fix that on. Then at the bottom, you can see that's a total hip replacement, which would be used to treat osteoarthritis. So within orthopedics, we've pretty much every bone below sea. One is within our remit. All the skull surgery is done by the neurosurgeon. And then generally, now we'll subspecialized. So your subspecialty will start with either be spine. Um upper limb said. I'll be shoulder and elbow or hand and wrist and then powerlessness Tablet, um, hip or hit the knee or just the knee. And then for some ankle. And then you have pediatrics on trauma specific surgery, orthopedic surgeons. So there's pictures. The top right on top. Left is a frame that would be used for, um the the trauma or deformity correction. You got a rest creating that we would use in trauma. Um, the bottom left is some images from shoulder arthroscopy. On the bottom, right is an 80 reconstruction. There's a lot of variation within orthopedics on. Even within your subspecialty, you have a wide range of practice, so that that keeps it very interesting. Generally areas of works and we a training. Um, we are moving between anywhere on call, either being clinic so that clinically to be following up fractures or in are elective clinic, which will be kind of look reviewing patients have been referred from the GP with chronic conditions. And then we're in theater and would either be in elective theaters, which will be those chronic conditions being treated or will be informative. But we're managing fractures on fixing them on D. Just to give you an idea of what shift work we do so during the day, if you're in a day, shift your on a normal day shift, you'll do your eight or five. If you're on called it during the day, you do 88. That's 12 hours, and then should of nights. You'll do 8 to 8 overnight. Then, if you're on a classic kind of my traffic weaker, Yes. So you're either being Kinnick so I'm kind of doing pediatrics. So we have, uh, two clinics on a Wednesday. Um, when we see our elected patients, then we operate on Thursday. Doing are elective patients, and then Friday would be a fracture clinic. My other two days are between trauma on calls on admin, but I'm sure not just firing of females. That aspect is fellowship, where we will cut where we get opportunity after you've completed our training, where we then we'll send 1 to 2 years visiting other locations around the world, learning new techniques from professors and then the Amos to bring them back to the UK to have augment that experience with in the chest. That's really good opportunity to go and you know anywhere in the world, and you have you organize off your back, our challenges in training. So there's exams. There's that that's always that's that's something that you that you have to do it do in that kind of comes up and down So your effort MRCs you doing ct one and two on, then your efforts? Yes, you do. At the end, that's next exit training on that. Something you do around ST seven Total that about six months time commuting is a bit of an issue to you. As I said, you'd be changing jobs every 6 12 months on that Obviously is quite can have a bit of an impact on relationships managing a family on. But then you've also got, uh, trial it funding on and had to pay for that. Um, it can be competitive, but I don't think that should put you off on. There's a lot of extra curricular work that you do have to unfortunately, outside of what you get paid from in 95. Um, but it is Ah that that is all kind. Like a part of trying to maintain a good pork failure on Unfortunately, not really much of a person not getting trying to avoid it, because those things are have how you score points in your interview. Um, but there are there are ways of getting around it by working smart, which I'll get into further on down the line So what's good about Speed IX? My level with Videx is you treat everyone across ages. So currently I'm treating kids who are between two on 18, and they're a lot of fun on. Then you could be treating people well into the well into the old age with the next few months. Fractures a swell. It's athletes with a cell ruptures. Um, yeah, Pete Skiers s. So that's that's a really good interesting aspects of job. There's a lot of kits. So what? That picture is down there that say, Ah, robots put it putting spine. So putting screws into the building since someone's back. So there's a lot of technological advances that we are picking up. We're going along on there. They're gonna becoming, uh, in much sooner. Well, there's a lot of equipment to play with. There's always new kits. Um, so you should be two seconds. Five different. Make friends. Sure. Thank you. Try this. That's just looks all right. Is this from work? Yeah, that's a lot clearer. Thank you. This was working, so Yeah, there's a good aspect of problem solving, So whenever you're fixing a fracture, it's almost like a jigsaw single pill um, altogether on hope, put some kind of fixation device to hold up on, and there's always different ways of fixing it. So you know, there's not a single way of doing it, so it's not purely procedural. And that's why I enjoy about the discussion a true meeting where you have different people having different ideas basically experiences on their technical skills. There's always different approaches to attacking. Same problem. It's also it's also very satisfying because you have an opportunity to make a large impact on a patient lifestyle on. But it's really great, for example, of total replacements and new placements. They are one of the top procedures to improve someone's someone's a lifestyle in the NHS on Do you have patients coming in walking with pain and then they come in. You operate on them to come back and see us in like, 12 weeks, and they're very happy with the outcomes generally, Um, and this was a lot of variation within ah, orthopedics to do teaching and research on management as well, kind of looking into the future of orthopedics. We've got a machine learning and a I, which you're gonna be coming in in the next 5 to 10 years. Government's doing a lot of that. That's really gonna be something that's going to be impacting medicine across the board. To be honest, it's not just orthopedics on that. Something that I would ah, we can only to keep an eye on. And I'll know the next kind of 5 to 10 years. Ah, we've also got augmented reality, which is an image of that is down and bottom left so that guys wearing a hollow lens, um, it's stuff that I I haven't seen in the NHS, but we've had some industry people start demonstrating it, and it allows you to do is kind of like project your CT image of the patient over it like overlays over the patient. It almost gives you x ray vision on. Then you call. So play around with this stuff cost you in theater, it's we'll sterile. Um, evil sport. The robot robots are on the bottom, right? So these are kind of the make oh, robots, which the moment they can't, they guide you're bone cutting device is Have you do a total knee replacement? You have your bone cuts before you put a prosthesis in and that kind of guides your hand. And if you're going out of the planned direction, it stiffens up and give you a bit of resistance. Means your cuts are better. There's Theoden. Scurry really isn't demonstrating that they are better than the surgeons. They give better CT. So the objectively on the X ray, they look better. But actually, does that have an does that improve patient outcomes That's still up for questioning. Um and then regenerative medicine is something that will be coming in event coming in inevitably. And that will be, ah, kind of enough How that's gonna work regenerating cartilage, how that's going to treat arthritis. We'll have to see how that how that goes. So how did you become a orthopedic consultant? So Ah, this is the kind of direction I've put the salaries on because I didn't know what the hell I was just gonna be owning. Ah, when I was a med student. I think it's important that we ah, everyone aware of it. So you spend 56 years in med school. Then he spent two years in your foundation training. Um, then you do two years called training on. Then you do it? Spent six years doing your orthopedic specialist registrar training, and then you spend 1 to 2 years doing fellowship us that on. Then you are consultants the next 10 to 20 years. This is the classic model. Now there are jobs that are started This called Circled, run through training on. Instead of having that interview between C. T two and S t three, you just do one into you and you start instead of CT. When he starts ST one on. Then you just stay in the same place for eight years rather than And you kind of like you bypass that that second interview, Um, on That's really ah, it's really a good option. Um, but it means that you'd want to get that job that run through job in the place where you're happy to spend some time and because you committing yourself today. Years. So for the orthopedic application, that's the classic. So if I put this, these are roots to become a consultant. So the classic route is, as I said with the one that I followed. Then you've got the run through training. Um, you go. There's now a kind of it's called Cesar, which is a you Ah, your ast Many been used by overseas applicants, so these are people have trained overseas, and then they've come to the UK on They essentially have to make their own portfolios that we naturally do through training over the course of eight years on, they have to formalize it on. Then they present that to the rule colleges, surgeons, and they kind of say, yes, this patient's been formally trained. There are now people who are doing that to our UK trained because they don't want to go through the training pathway. Um, and that's only some of this really started being don't know. The last 1 to 2 years that I've seen, um, it does is a possible training route, but you will always be playing second fiddle to the trainees on. So if there's a choice between the trainee being put into a certain role or to work for some consultant, they will always take priority. So it is an avenue to pursue. But there are pros and cons to it. Um, and then there is also a few people that ah, bypass cool surgical training. Onda. They just apply directly to specialist registrar training. I've seen a few people do that. Um, there may be overseas trainees who end up doing a master. So the rule London. You could have a master's at Queen Mary and you work a role London ondas in a state so on that gives you the, um, experience in the NHS on also give you the theater time to then prepare for your your specialist training restaurant is kind of like a course surgical training scheme, mastering a masters. And I've seen a few UK graduate to do that as well. Where it's so did not apply a ct one and two. And they've applied for, you know, a clinical fellowship rolled essentially on get all of their poor Philly requirements and then just apply it directly to specialist register our training. So there's that kind of the full, full paws up the mountain. Um, just to run through anyone go. Any questions at this point? Because this we're going to then move on to Z, um, orthopedic. We're going to just run it, move on to the come like course surgical training application. Okay, cool. Right. So, um, this is all gonna be coming from the course Surgical training, self assessment form. This is a form that is released every year, and it's basically the way that the portfolio is going to be marked for that current here you should already do. Is Google Search UK course I call training self assessment form on the year. Make sure that you're looking at the U. K. One because I was looking at the Northern Ireland one for a little bit before I realized I was looking the wrong one. So you just double checking. It should say the NHS the top. This is thesafeside Oh, ring method that is used for the CT one pathway or the run through training for ST one. So the first part of your portfolio is based on commitment specialty. So you need to have passed MRCS party. Um uh, school, my son points. Then you need to have attended for or more surgical courses. And these courses have to be, ah, national or run by colleges. They can't be under graduate courses. Ah, and then you have the, uh, operative experience used to have 30 to 39 cases. Um, this can be spoken to some of the core training to have just applied on. They say that actually, these are these could be There's no time ah, definition on it. So these are cases from med school on foundation year, but actually that may change along the way, but it's important that you should. You should start on the log book, which are are discussed later because you can start tracking the cases you attend on. They need to be cases that you've assisted in or that you've performed with a supervisor present on. If you start collecting them now, then you'll start clocking him up earlier on then surgical conferences. So three or more surgical conferences to earn the maximum point I'm going to run through the maximum points because it is so that you can you can see that there's, uh, lesser schools that you can you can get. But it's not as you're aiming to for the top, then hopefully your maximizes sores. Then, if your search to experience you can get maximum points doing surgical elective, which has to be four weeks. So that's something to consider when you if you guys are planning a surgical electives at the interview medical, I don't know how to do it. That varies depending on which medical you get to you about when you do that pre or post exams, then post right degrees. So if you if the PH. D um or if you got you school, the max. But then it's kind of your indicated. Agrees. You get first class on us, um, as well as, ah, other degree that you're a grad student before climb. So you get You just kind of have to mark those up. Then you got prizes. So these are you getting a map? If you if you have any prizes, then they have to be from recognize surgical institutions or conferences. So again they can't be under graduate things done within your medical school. That's what Just getting a distinction, your final, your undergraduate level. So, um, that's that's how you get. That's how they school the prizes. Now with order this you have to you have led all the aspects for surgically themed chemical order. I don't know what they mean by such 15, but I guess has to be either looking at the surgical department, but that there are that I couldn't find a specific definition for that. But you can't be something specific to medicine. Um, but you have to be involved in all the stages and you just have to present it. So you can't just have collected the results, have to then present it locally to back to the department that you, uh, did you order it for? That's a question of timing. A swell, because sometimes there's a bit of a lag between you completing an order it on, then presenting it locally. It can be, You know, you have to wait for that ordered meeting to happen. Is that something that you need to consider when you're applying that you have given enough time to have presented teaching experience eso To get max points, you need to have organizing designed teaching program and has to be a maximum four sessions off that teaching program as well. There's contributing, do teaching of full sessions. And in order to provide evidence, you've done those sessions you need to have feedback. So it's sutures. At the end of each session, we can do, uh, some ideas. I create Google forms and then you quickly give him a cure code scan um, and getting toe do that right there, and then the next one is to train training and teaching. So you have to You can get it. Can do extra masters or PG cert outside to try and get get these points. Obviously, that means it's a bit more challenging because this takes time out of your training. You can do part time masters as you're going along, because that that adds your work late now with presentations. So more points given toe or or presentations, a national international level, Um on then posters you have to be 1st, 1st author of tool. More to be presented to get the next next double publications they have really locks down on, um, make it makes it a lot more challenging. So you can't say case reports and editorial letters and no longer included. You have to be pub cited. That means that when you use the me to have to have a pub med I d. That's really important when you're submitting your papers, too. Um, certain journals just check that there pub midcycle, and you can find that on. Uh, you can find, ah, their own out public it, um, and you can find out What journals they are they land surgical message. This that's simply just to check. Is your going along? You can also write chapters, two books again That takes long time to do research and publication. Is is the hardest thing I think to score on. Um, mainly because just the time lag on publications is it can take six months. So, you know, you can spend 23 months on the projects writing it up, and then but you submitted the journal, But then I could take, you know, six months before it actually gets published. So there's some of the you to start early on if you're planning on paying on scoring points on it. You also see that the collaborative waters of your part starts urge or covert search. They don't score asshole Eylea. But they are a lot easier to get on you. In order to score, you get three or more public sighted. Perfect. A shins would have lasted record leadership management. So you need to be holding a national leadership well manager role from 16 months on demonstrate positive impact. I'm not sure what they mean by that. Um, maybe that's one Feedback Or if you've tried to create a project, hum big and you can try Try get evidence of that through letters. Um, and then you could maybe a little regional, um, body should manager role if you're involved in, say, um, say some kind of. So if you'll get be a representative off on a foundation program, we're on your ah, so you can be kind of go between between the foundation program on thea Other the foundation doctors. That would be an example of regional regional role. Where is the national roll be, say, the B m A l B. That's another O r a l part of like a sit. Uh huh. It's on the core surgical into day. It's comprises of a 20 minute interview made up of 2 10 minute sections on These are back to back on. Did you present the same panel? Currently, it's virtual do take over it. When I did, it was face face and we did it in the Strand in a return strand. I don't know whether it's going to change for you guys in the next few years, Um, but we'll have to see the portfolio cut off school was 47 this year, and it was 36 last year, apparently the reason for the difference in points of because again, they adjusted the self assessment the stations that you'll have our splicing to. So the first one be a clinical station. You get two questions, Um, and generally they're on the on this line of a deteriorating patient, So this is a neither a patient with POSTOP the fever. Maybe in the scheme, Iqlim may be post up compartment syndrome, or they might be asking you to assess. A patient who's a trauma call says that you're 80 less principles. On the next station will be a presentation station where you present for three minutes. That title below reflecting your experience on leadership is part of a team, and how this will be useful is, of course, surgical training has been used for the last two years. And you well, I have prepared that presentation, and I recommend the practice it many times because even if you think you know, it went until your san front of three strangers, you can start stumbling that point on. Then they will then quiz you about the subject about your experiences and what you've discussed, then they'll be another question about management. So this is kind of your management and ethical dilemma. Question. So either will be Got. Two patients who got the same name on one of them has got her the scan, But it's for the wrong patient, so you kind of have to discuss. You have to go new, apologize the wrong patient. Also, make sure that patients safe on then ah, get that scare patients is sorted first and then deal with the patients who got the rocks Wrong scan on how you would apologize and a lot stuff I got a question was about a patients relative accessing there. Accessing their files, says patient confidentiality issue. You might be need to discuss about consenting with consent for consenting a patient who's know got the capacity or discussing DNA ers. You may have a consultant who's come on to the war drunk spending alcohol Oh, you know. And then generally the's kind discussions were then bills on to, um, protocols. So, for example, if you're consenting or there's issues during the wrong lip, wrong side limb surgery, who then start discussing the W. A checklist and such any of the in two day. And then after that you'll get ranked according to a school, and then you rank load of jobs and Oriole. It's free to 300 jobs and then depending on your position in the pecking order what you'll get things. Get your, um, your allocated job self see the first person that comes top gets there first choice that works out. That and the second person in the queue. Then choose a schedule. So it's important. Surgeon. It obviously scores high as you can. But the if there are two patient to two people candidates that have the same school, then the system will then randomize you, um, which can and thie spread off. Scoring can be quite narrow, so that could be maybe, like 100 people with any difference of 10 points. So that does make it. There is an element of randomization in there. It's pretty much the same for Specialist for Your S E. Three interview. It's just a bit more in depth portfolio station, clinical station leadership station. There's also a operative station, so you have to demonstrate some manual skills stem. Sure, you're not dying capabilities perhaps, um, putting on a plate left questions about basic surgical skills you'll have to communicate with a patient on, maybe deliver some bad news, take history on. Then there might be a hand over operating this protestation where you will be at hand over. You were given seven patients you need to go and review immediately. They're all immediate immediate issues you meet. You pretty have one that used to get a surgery, a compartment syndrome ischemic limb, a kid with super condo, a fracture and it's ah, it's an impossible situation, Um, but the idea is that you need to prioritize it and justify your decision making, um, on thin. They evaluate you on that. So it's the same as a CT interview. It's just there's a little bit extra that they you need to add, but that's based on your experiences. You should have gathered over the two years of your course of croup surgical training. I don't really want to go into more detail about access so far in the future, Um, so it's likely would have changed the time you guys get that. This is just to, um, run through my current situation. So I'm currently year four of six in my registrar training on it's. These are all the aspects that I need to cover Teo over there six years. So I need to have rotated around all of the areas forth pedic sizzle. There's subspecialties got portfolio. I need to have done 1800 cases by the end of my six years. I need to have two publications, so he's still be involved in research. You do six cycles of order it, so you need to be involved in order to, uh, most of the time you need to be teaching. Ah, medical students or course surgical trainees. So so an element of management where you have to join a course. You absolutely 80 less and also you need to have passed your final exam. So it's just it just showed that all of this stuff is a lot of same stuff that you do it. Course surgical training. There's nothing new that comes along. You just need to be accumulating it as you're going along. Unfortunately, the treadmill doesn't really start points. You want to become red straw, so these my tips for you guys are interested in doing orthopedics in med school on. Be honest, This doesn't need to be just four speed X cause for the course surgical interview process. All that port for yourself. If you look at if you want to think if you're kind of like in a dilemma off anesthetic, So what you want to do any a lot? This stuff is a little kind of the same across the across the board. And I'll see you know, you get you get you can go back to the, um what? Some of some of the teaching where Yeah, it would. It needs to be surgically themed, but you still only lose two points if you're doing a project that may have been in medicine. So these are I don't know what the other application process is if they have specified. But, um, you can still school points by getting involved in other aspect, so it doesn't necessarily to be directly involved with orthopedic. The first step is to have a look your portfolio, or if you don't have a port failure, it's just getting older and start. Now you know the areas that you will be needing to target and identify those areas of weakness. Um And if you have got nothing, then it's, ah, good opportunity to target the low hanging fruit or the longest time requirements. What I mean by low hanging fruit. It's like it's if you've got, you know, you could do an audit. Um, if you're if you're in a if you doing surgically orientated um, rotation at the moment. But those that require the longest time requirements of things like the other publications. So depending away a week, this is are you may want to target one of the other, um, Andi. Make a plan so I don't try those areas of weakness. Try and work out where you can sort that way. You can reach those targets. Recommend saying deadlines on objectives just so that you have an idea of how long it's going to take. And also it means that you'll you'll be stimulated to try and reach those headlines. If you just kind of just say only this project, then you have this kind of gold ist summer in the future. It's very difficult to keep track on that and to keep it, keep motivated on it and try and be strategic about it. Well, see, it's important. Develop a network so you can contact your PT department so people to target with any orthopedic department would be the clinical director will fix the professor of orthopedics there or the educational lead. Those guys that kind of will be able to, um, direct if they're not involved in it. They can direct you to the person that you should be speaking to find mentors. So if you've got to speak to those people when you're on rotations and tell them to your keen in orthopedics on the one knee guidance on, they may be able to advise you or get you involved in get involved in projects as you're coming along because, as I've said, it said, we rule as trainees have this criteria that we need to be feeling. We only be doing audits we all need to be doing research on, you know, we need help that so having a medical student on board is extremely useful. Thea other thing is to find people within your own. Your own level is medical students and, as you're going through F y and CT, find people who are like minded and her also keen to do orthopedics or in surgery because it really helps the have someone to bounce ideas off and also to support you within those projects. So forms shouldn't groups join your joining societies? Um, Andi, it was just a quick mention about sit managing seniors. So if you need a letter for your portfolio, write the letter and right explicitly according to the self assessment, What you had done in that project, because if you've made, if you've designed an organized, um, an educational sister in the educational program on delivered four sessions, you need to write that explicit E because that's that terminology is what they're gonna be looking for in the interview on. People have had issues where that terminology hasn't been explicit enough, and so they they don't score enough points also hassle people. So, you know, we're all very busy working in it chest, and we're not ignoring your email because we're being malicious would probably like it's just probably fallen through on Just have been messing with the deluge of emails that we get central daily basis, so I just always just follow up. If you haven't had a reply. Ah, two anemia. Just follow it up in a few days or a week, I'm gonna say, Hey, by the way, just so just wondering if you know if you could get some Ah, get some contact on that or just go in and find them physically because it makes it makes it a lot quicker on, really just just encourage you guys if you're interested. Orthopedics, just tell people that you're interested, um, and demonstrate enthusiasm on. Always ask to get involved. So don't take that no personally, you know, you're not going to lose anything by asking to get scrubbed in theater, Um, or maybe you want to be involved in reducing that fracture. Sometimes you know it's busy or, you know, it's a bit more complex. You may not think that it's complex, but there may be a reason why that registrar or course surgical trainee wants to do that. Wants to do that part of the, uh, part of the operation on something, because maybe he needs it for his own training. But you know it. All they're going to do is say no, you have not lost anything. However they may, because because we're so involved in the procedure that were involved sometimes you know, you can forget that there's a medical student medical seen on the other side on, you know, just saying, Hey, you know, kind of reminds, then they mail it to you. Yeah, sure, you could do this. So, yeah, sees all the options that gap. Just a question on projects. Just question it. Products has always check authors on par bed because if someone says that something's publishable, you want to go with the people that have published on the easiest way to check of people being published is to search their name on public it on day go for the ulcers that have published a lot because they are the guys that know how to get stuff published on have a history of publishing because many people would tell you that this project to get published. But I mean to happen. I've definitely had quite a few projects that were that haven't been published, that I was told that were, um so that's one way of double checking. You want to speak to the educational center about, you know, trading ah, teaching programs for students, me, the other medical students or other trainees. A start of projects always clarify the rolls because I think that it's really frustrating when you do a project and you think that you would be first order and then suddenly gets the end and someone says, Oh, no, I'm going to First of all that so And always put that in writing. So put that in anemia. Ailes. So you. So you've defined roles and it's time stamped and everyone's involved. It's very clear of the start you is going to be first author on That means normally, you know, the first also should be writing the paper so that that also means that you're not doing extra work, and then someone's taking credit for it on because it's on email. It's been time stamped center, everyone. If someone starts kicking off in the future, you can just refer back to this email to say, Look, know we agreed on this, you know, being months ago. This is how, um and also like what I mean by stacking project. So what you can do is, rather than doing five projects on spreading yourself around, just focus on one quality project on just build on it. So you could So, for example, I didn't order, uh, three order. It was something that the department needed. Um, I presented it locally. I got you know, you get a prize for the local presentation. The order was good enough to be published on. Then you present that being present, that pump, that public aid, that publication nationally. That is a lot from one project. I've managed to get prize and order on a publication or from collecting from one single date set rather during Katrina. Create five different sets and putting all the eggs And if baskets trying to find quality projects on build on that project, stack it all up. The other thing is to have when you got a group of you who were all like minded, you can if you all doing that to be all working on each other's projects, it means that you're you know you're helping each other out on. You know, you can have three or four people working on publications on, then getting yourself involved. So you know, you may not be first author, but you'll you'll get your you're getting your name on other projects. So that's part of like working smart. I think next thing is prizes. So there are a lot of undergraduate conferences on a lot from the free. So submit abstract sue them, and they accept that they accept a lot of them for posters. Um, and then ah, and public. And also a little presentations. And there are a lot of s. A prize is so you could check up of the essay prizes on the roll colleges. The rules site of medicine. Um, boater is Thebe Automatic Training Association. And be away is the British Orthopedic Association a sitz, uh, surgical, national surgical. Um, in training, I think it is on the FOS is future orthopedic surgeons. All of these will have annual surprises, Um, and check these websites on. Then you can submit them normally, especially for the rules society, medicine. They have a lot of prizes in niche areas that it may not be surgical, but not many people puts their put submissions for essays on so in competition ratios that much lower for the Zetia prices. So there there's a lot of good opportunity there on the essays are not very long. Then, um, no. 850 100 words. You can only just smash it out within, um, weekend or so operative experience. So, yeah, Like I said, it starts to med school. You can create your own log, but the log work. So that's a website. You, uh, that you go on on, Do you converged? And there's also an e logbook phone app, which I thoroughly recommend, Um, which means that you can in put your data on your phone, you do have to pay for it, but it means that you can do it automatically the end of a list so that you don't forget for the one down the line with regards to the MRCS part A. Um, I think the statistics show that the, uh, parts rates are higher that closer to med school. You do it because, obviously a lot of it basic sciences and things, and the further on down, you'll find that you forget stuff essentially of medical. So the sooner you do it, the better. What should you be doing being between in your foundation jobs. So there's always a kind of a dilemma. Tertiary center versus district General. In a total sense, if you cut served rule in the surgery center, yes, it shows there, um they don't get to theaters. Much is a very busy job, but what they are seeing is far more complex stuff. And when did you get the Attard? You know you're seeing really, um, high level orthopedics. Whether that's relevant to you at that level, I'm not sure, But it is. It is an experience that is rather unique. Working a district general hospital, you can see more basic level tumor. You're probably going to have a little bit of quiet a job, and you're gonna have more access to theater. I think surgical job where they do it, f y one or half way to I would suggest to do it in the FBI, too, because you'll be on the on call Rooter on that experience of doing surgical on calls will help you learning. Prepare you for course surgical training as well as certifying some of your knowledge. Your MRI C s part, baby, because there's a lot of general surgery in there on, like how you should be treating patients in a more clinical setting on. I think that it's a lot easier to remember stuff when you've actually seen it in real life, however, so my colleague. Suppose it's just doing in f Y. One, especially doing. He suggested a urology job. Everyone, because there's a lot of high volume surgery that you could just jump in out, off on. Does his stash in? So that that was he just on the CT interviews? Um, Andi? That that's another option. But I think that is enough. I want your mainly ward based specialty choice doesn't really make much of a difference to see orthopedics. If you do enough, I two. I think that gives you mawr, um, more valid experience for Speed X. Because you'll be, you'll be able to see what goes on in orthopedics. It would be a real struggle to apply for spitting. You've never done it before. He may be in for a bit of a I know, um, and I don't recommend doing it any basement because even though it's not ah, surgically involved, it's just really helped. Your decision making is the doctor you're seeing patients who are unwell or who aren't on well, you really learn that clinical decision making. It really helps. You do lose four months of your life, but it has a while. A massive impact on the rest of your training. Just just being able to have done any Ruth recommend checking the course Surgical training self assessment again When you're in foundation year because of see, depending where you are now medical, that is very likely to have changed. So you're then be able to re evaluate where your portfolio is it that point If you do, Paul A. I think you guys will do a community placement now. I did a psychiatry basement. Um, Andi, it's normally these GP placements and psych placements have a lot of down time as a really good opportunity to revise few MRCS. It is just making a five year plan. When you started the Nephi one, it seems a bit crazy. I definitely thought it was crazy at that point when I was told to do it. It really helps toe plan how your career is going to move and so you can move with intention rather than just randomly bouncing around jobs. Um, and even if you're not, if you don't stick to it, um, it just kind of gives you a little bit of a North Star in where you're heading in office. You can defeat. Deviating adapts to going along. But it really it really did help me when I when I start making a five year plan, the other question is whether to do an f y three job, Um, or, you know, just taking it. Taking around. I thought we recommend it. Um, it makes no impact on you'll application. When I was doing his ago, it only really people just start doing it. And, you know, we were worried about justifying. Oh, but it was gonna come up on interview on whether we had to justify our choices. I've never had anyone being asked about their foundation year the year out, um, on having to justify it on. But I would also recommend, if you are taking year out to still apply for course surgical fuel your interview because it's super useful just to go through the process. Um, you get the experience. You don't have prepared you portfolio. It will just make the next time that you're going through going for the interview, Artie. Year out, ah, 100 times easier because you have that previous experience. A little support would have made your portfolio news to be building on it um, so, yeah, you can do all these things also just locum um, Andi buy houses. What's, um, my friends have done all right, guys. So that's the end of it. It's just Ah, little, uh, the diagram of your feet surgeon. Essentially D i y combination d r y people with Bob the builder trying to good things that Jesus. Um, well, sir, wheeled a hammer like pneumonia. Like sore. Um, the cure code at the bottom, right? Is thie mind a bleep? Um, feedback sheet on. I've been told to encourage you guys fill that out because I think you guys get some stiffness. It's the end if you fill that out. And that's the only way you're gonna get your certificate. Cool. So I finished. Now a Zen. I'm going questions fired off. Super. Thank you so much, David. That was really, really interesting. And really informative. Well, um, so if the attendees have any questions between, the child will read them out as they come, but in just to get kicked off, I'm quite curious. What did you do to build up your import for you? And how did you find the time to complete thumb? eso I did, Thehyperfix you and I would certainly recommend No wonder I basically decided f way to that. I want to do or speed IX. I had done very little preparation for that role. Um, Andi, I quickly had to Ah, get get everything together. So I did my audits in six months or so, and I also need to emphasize that haven't gone through the self assessment. Might. Five years ago, the self assessment was no. Nowhere near is a thorough A zit is for you guys. So I I was able to quickly gather the all of the for failure stuff up. Um, I didn't have any publications. Um, on? Yeah. Managed to get my I get my first choice job. I decided to leave London for course. Surgical training, because the options is for getting to fitter are much higher if you're working in DTH is s. So that's why I left to go do that. Um, but I hadn't done my exam on that really had an impact on my core surgical training, So I was Ah, I was had to do my MRI, C s part A and B in my first year, which means basically disappeared for nine months. So she's doing exams back to back. So again, I third, I commend doing your exams early. It also makes a huge difference, uh, to your course surgical trading. If you've already done your exams because that will then allow you to build on your portfolio, just do audits and reset that point on. Then you know you're way ahead of everyone else. Um, the other thing I did was when I was in my basic surgical skills and why I emphasize about asking, just asking. I was just doing the best surgical skills and I just asked her soul if you had any projects. Um, Andi, he basically just asked me if I if I wanted a job just because we got I got projects through that Basically. So, you know, you know, you never know who you're going to meet on just our ask people. And normally, you know, people just should show if you've shown enthusiasm. Um, they're they're happy to encourage it. So he really went out on a limb, give giving me my kind of like maybe 43 job, having just met me for, like, 30 minutes. But I was very grateful for that. Sure. Thank you. So that, um I write and say that you don't have any publications that before ct one application? Yeah. No, I didn't have any. Ah. Had no appetite. Ah, yeah. 40 to 1. I had no no publications. I just had I just don't lot of audience. Um, that's what s So that's one thing about getting the low hanging fruit. I was also working. DTH is which didn't have, ah, a lot of research potential in the departments. So that's another thing. If you're the the bonus of working and tertiary centers is that that's where the professors are. That's where the high volume data is on. There's a lot of the research is going in the's touch three centers, so it's a lot easier to get that high quality publications coming up. Then that's something that I wasn't involved in do my early training on, and I'm seeing a lot of my colleagues who are junior to be working the surgery centers, and they're getting involved in a lot more. Um, so there. That's where they kind of the one of the process of working totally centers. Sure. Thank you so much on go in terms of your own career, one of the biggest challenges and positives you've encountered in orthopedic surgery. Um, the moving around is a big challenge. That's what that's probably biggest challenge of the uncertainty of it. Um, the that unfortunate part of the job. There's not really much, and there's not really much for much way of getting around. It really kind of have to accept that you will end up moving around. One of the ways of controlling for that is to choose small Dean Aries on that depends very much from where you live. So, for example, you know the East Midland's degree has one of the smallest sceneries on you. Can you can commit for an hour on, you're you're pretty much cover all of the spaces that medical live in Leicester. But, you know, east of England has a massive diener and people commuting like two hours I've heard that's one way of controlling it. So depending on which Dina, you choose, um on But the I guess I guess the other ones that come in you know, the the research on the exams. Yeah, there is. It is a bit of a time commitment. Um, Andi, just his hearing advice that I had from my from my console when I was having that issue just said, Just don't feel it, um, because that that which is a bit of bit frustrating advice. But, you know, if you if you are failing exams, that just means you've got another four months to six months that you've just lost and you can't You then have to allocate that time to revising rather than allocating that time to do it. Audie it or research. And that puts you behind the guys that have passed. So yeah, you just have to kind of just really sit down. And now those exams and then once they're done, that done. So, um, yeah, that I'm not going to know that several training can be challenging, But then most of medicine, you're gonna you're gonna be doing exams in all of the specialties, so you can't really avoid it. Unfortunately, the good things about surgery. I mean, I've seen some crazy stuff since I, um, stuff that, uh, kind of scaly or ah, scary or dinner companions. That means that I've had to kind of tone it down already. Check. Check that. We've everyone's Everyone's finished eating first, um, so that that you do get to see some amazing things. I think, um, and being able to have patients come in who have such serious problems and then watched him leave hospital is extremely satisfying on That's a very unique experience that you won't get, um, in other areas of medicine. Or if you choose to do some it, leave medicine, regain it, working in office and that you don't receive at all. Um, yeah, sure. Thank you. I don't think we've had any questions from the audience. Is Yeah. So I will check in another one on go in terms of your When you said that you were bouncing around from place to place during your course surgical training. Is that the same thing? Is that what happens also during registrar training? Yeah. So it depends on which medication you're on. But I saw him on the roll on rotation on. We generally have Ah, six months to a year rotations. So it's really good. TBD, Ms Doctor. Ah, encourage. It tries to keep it in one place for a year, so that really helps with you establishing yourself with the orthopedic department because normally within six months takes you three months to work out how this hospital works. How your consultants work with the consultants trust you on. Then you find in the last three months that you start getting to do more things more independently. However, if you're there for a year, you know the word gets around within department. It means that your next six month placement you kind of kind of doing it on fast forward. Um, Andi, Generally people will spend they normally commute. Most of our guys live either in East London or they live in Essex on generally, there's no more than in an hour, an hour, an hour hour to an hour and a half. Commit, I found on with this music have to be regardless of which training pathway in surgery. You go down, I think generally, um, yeah, I'm in a car comment for other a car comment. Unfortunately for other specialties, I have no experience with that. But I don't. I don't know how that denies work, but yeah, you will be moving around certain areas, but those didn't res can be smaller in certain specialties. Super. Thank you so much. Um, I don't think we've had any questions from the audience. I feel like you must have gone through everything pretty good job on. So thank you so much, David Speaking. And also thank you, everyone for a 10 day eso. Just another reminder to fill out the feedback feedback for because we'll send out certificates to the email address is that we get from it. And then obviously we'll share everything with you as well. David. Thank you. She is having evening