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Overview to CST Application and Intro to MSRA

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Summary

In this on-demand session, Char Satna, President of FT SS East Midlands, guides participants through the Core Surgical Training Application process. Topics covered include general advice for interviews, portfolio tips, details about the M SRA, and job rankings. The session also covers the three hurdles to getting into training - submitting the application, the Multispecialty Recruitment Assessment (M SRA), and the interview process. The session will also be a huge help to those preparing for the M SRA, as it is the first in a series on this topic. This course is ideal for those planning to apply for core surgical training and will also be valuable for those applying in other specialties.

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Description

Join us for a comprehensive MSRA series covering high yield concepts from the core specialties in the exam to support you for your preparations for core surgical training (CST) applications.

This recording is our first session providing an overview to the MSRA, we will talking all things about getting into CST!

After this session, we will be tackling the content over 4 intensive crash course days but don’t worry breaks are included with 15m break in morning and afternoon as well as 45m lunch break!

  • Day 1 (2/11/24) - Resp, Cardio, Ophthal, ENT, Palliative
  • Day 2 (3/11/24) - Gastro, Renal, GenSurg, Urology
  • Day 3 (16/11/24) - OBS, GYN, MSK, Endo, Rheum
  • Day 4 (17/11/24) - Paeds, Neuro, Derm, Haem, Psych

We will also be running a session on SJT - stay tuned to find confirmation of this date!

Learning objectives

  1. Understand the process and timeline of applying to core surgical training.
  2. Gain knowledge on how to maximize portfolio scores and provide relevant evidence during application.
  3. Learn how to prepare for the M SRA examination and understand its relevance in the core surgical training application.
  4. Acquire tips on application strategy, such as simultaneously applying to multiple specialities and managing the administrative burden.
  5. Understand the significance of the job ranking process and how to effectively navigate it during the application.
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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.

Hi, good evening everyone. Uh My name is Char Satna and I'm the president of FT SS East Midlands. Er Welcome to the session today on core surgical training application. Er, we'll have two main parts of this. Really, one is about specifically about core surgical training advice. The other is about the M SRA. Um Hopefully um I can see a lot of people are joining now. Uh this session is obviously directed at people who are more interested in applying for course surgical training. But if there's anyone here who's just here because of their applying and they know they're taking M SRA this session may also be used to you. Uh even just the bits on the core surgical training portfolio just because those parts may give some general portfolio advice that you may find of use. Er, today, I'll be presenting, er, we also have Mario Anto with us who's an sho in Kingsmill, who will be presenting for you and gov who's another course surgical trainee er will be there to answer questions with us as well and the Q and A at the end, we'll give people a few more minutes to join. Um I'll put a poll up to as to whether you're applying this year or not. I'm just gonna see. We've so far had three responses. So I'll just give it another minute or two for people to join and then we'll get started. Ok? If there's anyone here who's, uh, are gonna be sitting, MS sorry? But they're not applying for surgery. Just don't have interest, uh, let us know in the chat, um, just out of interest to see if there's anyone. Ok, I think we'll get started just to make sure we try and finish on time. So, objectives that we have today are to give you an overview of the time and process of application to core surgical training. Uh if you're not applying for core surgical training, but you're here because you know, you're sitting at M SRA and you have that interest. Uh this session can still be of use to you because we'll give general advice for interviews, portfolio tips and then we'll be talking about M Sra. Uh Additionally, this is the first session in a series about preparing for M Sra. So at the end, we'll give details on the intensive days that we're going to have with sessions about the clinical topics. Um So that will be there at that end. You can also see us that on our social media for the FT SS East Midlands. We'll be hoping to give advice and tips on the self assessment. Well, that's what it was formally called or your portfolio score. So how to maximize your portfolio? The M sra as I mentioned interviews and also talk about job rankings. And finally, we'll do AQ and A at the end to answer your questions, thinking about the timeline of things. There's three hurdles to getting into your training. The first is submitting your application. I regard this as a hurdle because actually you need to get a lot of things together before your application, you need to sort your portfolio out and there's a lot of things to sort out and that has to be done before the deadline of the application because things done after won't be admittable. Also as with anything, there's a lot of admin, so you need to make sure that's done all correctly before the deadline. The second hurdle for co surgical training is the M sra examination, the Multispecialty recruitment assessment. This is an assessment that was first put in for GPS, um applying to GP training. But now a number of other specialties including CST have started using that to select the applicants for interview and Marrett will talk more about that later. The final hurdle is the interview process. And after you do your own interview, actually, before you hear anything about the outcome, you will be ranking your job. So that's the kind of final hurdle and with anything everything going correctly, hopefully you'll be starting your training posts next August. So regarding that first hurdle your oral application process. Hopefully by now, you'll have created your account. So you have this bit sorted, but you need to create an account in order to apply for training. And you can either create a new account or you can update the account you've previously held. If you've made all applications, anyone who's uh gone to the foundation program here would probably have done this. So they should have an account just because you already have an account. It doesn't mean you can't create a new one. So if you have an account, some people still choose to create a new one. What you need to do is you make sure you make it with an email that you check because you do get email updates. Now, the next thing obviously is obviously start your application but also ensure to submit it by the deadline, there are no limit to the number of applications. And what I mean by this is you can apply to core surgical training, but you can also put simultaneously applications to radiology, anesthetics. Anything else in or you can apply to that you are eligible to apply for. Uh just make sure that if you want to do this, you apply by the deadline, it won't detract from anything. Obviously, you have to be aware that you'll be taking on the administrative burden of whatever else you've applied to with oral. It will ask the kind of that information that you'd expect of any application. Now, there's the personal information, but I'll mention here that if you need to include documentation about right to work, make sure you have that in order so that you don't unnecessary have stress towards the deadline, they will ask you about a full employment history. So this is something that's always useful to maintain, you know, the dates you started and finished in positions and where and that should be there for the previous three years. Obviously, if you're an F two straight from medical school, you'll only have two years. And what you do is then you mention what you were doing in that year before. If you can't give a full three year employment history in terms of the training history. Again, there's a lot of standard questions. The important thing to mention here is that they do ask for references and ideally that's your last three clinical supervisors. So make sure you have the contact details for them, make sure you can get in contact with them and that they're happy to give you a reference and you have a good relationship with them and having advised you of this, now you can get in contact with them. So you have that done beforehand. Don't leave it to the night before the deadline for the application. Again, the same thing applies that they may ask for the medical school reference and make sure you have that sorted. You talk to someone and say, can I put your email down for this? Now, like saying is the self assessment, this is now actually changed because rather than self assessment, they're moving towards having a portfolio station. So if you're familiar with how it was previously done, you would actually go through the domains and you give yourself a score. Now, what they've actually done is they've removed one of the domains which is training qualification. So there's now four domains and you grade yourself. Most of them are A to E grades, but all bands, if you like, some of them have a slightly reduced number of bands, which is A to c how things will be assessed this year, at least course surgical training is in the interview, they will have an additional portfolio station where before you see your interviewers, they'll have a 10 minutes to go through the evidence that you've submitted. So as in previous years, you still do have to submit evidence and a long in line with their guidelines. But then there will be a 10 minute face to face station where they ask you two questions for each, which you have five minutes to talk with them. The importance of mentioning this to you is if you're including something, your portfolio submitting it, it should be something you are well versed about and you're happy to discuss because otherwise they it is possible that they can question you about it. Now, as I said, training qualification domain has been removed. But I will mention something about this later. We'll go through each of these, these domains just to speak about them er for someone who's not applying this year and is thinking about applying next year. This is something that you should definitely then be able to prepare for and optimize your score. Well in advance, even if you're applying this year, there are still things you might be able to do to just get those final few upgrades. Please note that specific achievements that you're using can only be used in one domain. But the relevance of this is that things like audit, presentations, publications and your teaching, it can sometimes overlap and you have to be aware that an audit that you're submitting onto the audit domain can't also be used in presentations of publications and certainly be some teaching that you've done couldn't be used in either the other two domains. Well, it's also worth noting that you have an idea what specialty you find you want to be in. Consider your ST three applications. This is really applicable to anything even if you're not applying for surgery because ST three will have a similar thing where there's a portfolio and to avoid duplicating work. If you make sure the activities and the achievements you have now are up to the standard required for the ST three, that means you're banking the points now and I'll give you the example with audits it's often easy to get into the trap of you do an audit with the department and it fulfills the two cycle requirement you need for co surgical training. But that department has actually used their local guides. They've made up their own standards. Ideally, all it should be national standards. And for ST three portfolios, they sometimes specify that. So it's worth making sure that everything you do achievement wise is something you could actually use for your ST three. And even if you don't know the specific specialty, just look at a few of them if you think you might be interested. Now, looking at the self assessment domain, er, for course surgical training, er, there's two things in there, there's involvement in cases, your operative experience and your in your surgical experience, they have removed the conferences section now. So that's gone in terms of the cases. It's very straightforward. It's 80 E banding based on how many cases you've logged as assisted or higher. Now to clarify assisted is basically any time that you scrubbed in theater and how your evidence that this is using the E log book, the Pan Surgical er, e log book. Er, hopefully you'd all have this if you're interested in surgical training, er, to find that it's just sur surgery, e log book into Google and it's one of the first results you can freely make an account on this. Er, I don't know if there's anyone who's a medical student here or who made their account when they were a medical student. Er, if so, you can make a new account with your GMC number and get all your previous records transferred over. So this is a quite achievable target to get the 40 plus cases in terms of evidencing, not something you need to worry about now, but what you do is you make what's called a consolidation report, which is an automated output report from the log book. And you can tell it to just include the assisted and higher involvement cases that you've been in. And then you need to get a consultant to sign that put a signature on each page with their name, the signature, the date they signed it and your, their GMC number later on. I'll be giving an example of my port for evidence. So you can see how I evidenced it when I applied and got into CST for the surgical experience. Uh This year, they're allowing for three possibilities, which is evidence of a taster, evidence of elective or evidence of placement. Er, tasters have a minimum of five days electives I think are four weeks or they'll specify in the evidence and placements is just like a foundation placement. The evidence for this is just a letter, it's all included in that guide. Uh Please bear in mind if you're not applying this year, next year, they're actually removing the placement. So your only options here to evidence to get the points for surgical experience will be a taster or an elective. It's a good thing to note that it's easy to get uh surgical cases while you're on at or elective. So, if you're yet to do that, you're yet to apply, you're yet to do that, make sure you make maximum use of your taste or, or elective to get your involvement in cases. Now, in terms of the audit domain again, for the Q I or clinical audit, it's graded er A to E so E is gonna be no nothing. But here you have, you were the lead and a surgical audit for two cycles. You were for ABA lead just in an audit for two cycles and being lead means you designed the project, you were had a lot of involvement. Er, you collect the date, you did the analysis, you did all of it being a contributor in two cycles is just rather than having that leadership role, you had a good amount of involvement. Finally, involvement is very similarly worded to contributor. Er, but it's only one cycle. So that's really, it's the difference is the number of cycles you've partaken in that differentiates those two in terms of evidence. What you need is a letter from the consultant involved. Again, all evidence letters should have their signature name position, their GMC number always make sure that's included on the letters of evidence. Now and you also need a copy of the audit presentation. Now, audits obviously is we could do a whole presentation on audits. But what I will say is that audits don't have to be necessarily the most revolutionary to get you the points you need in this section. My audit was just about referrals to the, the final center in d um other easy things to audit, which would actually be against National Guidance or things like the respect forms or consent forms. And these are the kind of audits that actually you can do fairly quickly. So don't get bogged down in doing work that you don't necessarily need to, it's, it's good to do good audits. But if you're pressed for time and you need to get two cycles in, remember that simple is sometimes better. Now, if you've been a contributor or a higher level in terms of your involvement, er you can also get extra points for presentation of the audit and this is banded A to C based on whether you p presented multiple cycles, just the one cycle or nothing. Uh This is different from previous years where it was the level of the meeting where it was regional local. For example. Now it's about how many cycles you presented evidence for. This is either a letter of acceptance saying that, you know, you're presenting this and it has to specify you the title of the project, all of that stuff or you can have the program from the meeting. It's worth noting that only a single project. So you had to use one project only to get all of this. So you can't say a project where you were the lead and then for a different project, you were involved in the presentation points. It doesn't work like that. It's your single best project. And this is a pattern that you'll see in many of the other applications for specialty training, for presentations and publications. This is what it looked like when I applied on a last year, they have made some slight changes, um, to make it graded A to E. Now, I'm not going to go read this all out, but this is how you get into those various bands. E the grade E being you've got none of this. Now, essentially, then the way to get the top prize would be to keep submitting things that you can present to a national International meeting and hopefully you will be able to get in and present and that would actually get you what you, er, you get, you at least to A B. But if you can get a prize, then that will get you to the A, uh, what you should bear in mind is that a good way of doing this is ask your consultants if they have anything. So, one example of this is when I was with general surgery in the Derby Hospital, er, I got the opportunity to take part in some of their video editing of cases where you would narrate the case and you would submit it for a presentation. And actually I got a chance to then present it at what was, uh I think a regional national meeting and win a prize doing that. And that was because you just make your consultants aware that you're interested in doing this kind of thing and they will have existing things that they might be able to just get you in on. And sometimes, you know, you're just narrating something you're not, you're not obviously doing a surgery but you get to narrate it, they tell you what to put and then you, they guide you very much to the process. Er, note that all these meetings that they talk about in the er, portfolio, they talk about a competitive selection process or being selected to do. So that means it can't be something where you paid a fee to get, uh, presentation. Er, often you may have a fee to attend the meeting, but this is something you have to have been selected for, for any publications. Of course, they have to be public cited. Sometimes they will accept these letters of acceptance. If you're in that stage of things, there is an appendix in the guidance. So look at that for the precise definitions and rules. Um, in terms of the evidence, you need things like presentations, you need a copy of the presentation, you need a letter of acceptance or a letter saying you've basically done this and you need your certificate of attendance at that meeting for prizes. On top of that, you need to have the letter showing, you got the prize and other things you need the letter or the article that you've done. Er, I probably should have mentioned this at the start but there, at the moment they haven't, I couldn't get, gain access to the PDF that you normally get of Oreo. So I've been using the health education in England, the website guidance. Usually on Oreo. When you're doing an application, you can download a PDF that nicely outlines all this in a file. Now, going on to the teaching experience uh domain. This is graded A through D and grade A is for organizing a teaching program and all teaching programs are defined as having four or more sessions minimum and grade A is for a face to face program at a regional level. And the new thing this year is that for all the levels of teaching program that you've organized in addition to organizing them, they insist that you've also taught at least four of the sessions yourself. So that's a new thing that they put in. So it's not, not something to organize that you had to teach at least four of the sessions. Now part B is be, is rather than face to face, it's online. And this, it doesn't specify, I couldn't say a specified level, but it could be, they say local level with online, you have a national reach even. So it's not really a concern, which I think is why it's not specified for grade C. There's, there's two ways of doing this. Um you can design just a local program, they just said like that or you can be having some kind of regular teaching which essentially defined as four or more sessions finally. And this is worth noting, they've also included this line about undertaking educational activity focused on learning to teach. So while they have taken this training qualifications domain out, so it's not there anymore, they have folded it in there. So if you had already prepared for the training qualifications domain by doing something, it means that you can get the minimum grade here just by that. Now, in terms of evidence, you need a letter saying you've done this teaching from your consultant supervisor, you also need to have evidence of form of feedback. This is either analysis of the feedback forms. So it's always useful to have. But the other way of doing it is making sure that in your letter, your consultant talks about having reviewed the feedback with you often with these kind of letters of evidence, it's worth just draft it yourself to save the consultant time and then they give it to them. And if they agree with it, they can sign it. And that way you can make sure it's worded so it meets all your needs. Now, with this, as I used a tip, even now, I know it's a very short press, but it's quite possible to organize a teaching program. For example, for surgery, you could organize a series of skills sessions that go through knots that go through suturing different techniques and then go through something else. And if you did four or more sessions, which you could do weekly, now, even if you quickly organized it, you could get, you know, up to, you could get easily what you need here uh at a local level, making something online is quite simple. And finally, if you're having a lot of time to prepare the way to make something, you know, you can do a session online, you can do a session in a lecture theater, but then stream it for a majority of audience and that will actually get you a lot of points because technically you've done a face to face thing, but it could be reasonable because you've streamed it. Now, I've included this slide as a legacy just because it's worth remembering that there are different levels of evidence for training qualifications. And while it's no longer at core surgical training level, it can come into play later for ST three. So what you've done is not useless if you have done stuff. Uh obviously, there's the learning that you've done, but also it can be used later on. Now, these are some QR s. Um these are my old manual, the kind of guidances that I picked up when I was applying. They should be releasing a new PDF soon. Um On the first slide when I was going to this, there was acr for the health Education England website where they've got the most up to date guidance. I can flip back to that at the end of the talk. Um These are my feedbacks that I got for the self assessment and the interview. Um So you can just look at how, what that looks like. Importantly, I think if you're nervous or, you know, worried about how you evidence things. This is the evidence that I submitted. So you can see the formatting I used and the guidance again this year is you expecting index sheets. So you can see that there and I PDF is a useful site, er because when you're putting all the page numbers or trying to join up these various P DFS together, it's a useful site to have. Um but it can do that all for you for free. So next Mre's gonna talk to you about the N SRA. Um Hi guys, I'm Mario TTO. Um I'm just gonna go through the M SRA exam and what it entails. So M SRA was earlier for GPS. Um That's how it was introduced and then they've introduced into different specialties as well, not to CST was introduced just two years back, but right now, it's quite important because that's where you begin to get shortlisted. So um something to remember when you're booking your M Sary, you need to be quick about it, you need to do it quickly. So they do send out an email that um you know, the booking is ready and you can book. But the thing is the bookings open way before the email actually gets sent. So make sure that you look at the site to make sure that you book it as soon as possible. And other things to be aware of is you need to take study leave on whatever your date is. So you can take this as a professional leave. If you ask your trust, I'm sure they'll have a professional leave set out for people who are writing exams. So you might be able to do that, make sure you check with your trust and your rota coordinator as well as ensure that you have travel uh and uh stay arranged so that you don't have to um panic and be stressed out about it specifically. Um So the exam contains two parts. That's one is the S JT. That's the professional dilemma part. That's a situational judgment test. And there's a clinical area which comprises of 12 topic areas. But um it's not really 12, it's just a few areas that are compressed into one topic, but then you need to study more, all of them. So going to the next slide. So first we'll go through the professional dilemma part, that's the situational judgment. So this is the test that's held in 95 minutes and it comprises of 50 questions. So you need to basically know what an F two would do in different situations and it's judged based on professional integrity, coping with pressure, empathy and sensitivity. So if you go through the GMC, good medical guidelines, um you'll find the, you'll get an idea about how to actually go through these questions, you also need to make sure that you get into the head of the person that's creating the question. Cause each question would be tailored in a way where the best option would be something that's expected of you and which only the examiner knows and it might not always be what you would do in the, in the situation in the hospital. So what happens is there are two types of questions. So one is the ranking questions. So in the ranking questions, there will be 4 to 5 options and there'll be a clinical scenario and each que and each option you'll need to place according what is the most ideal thing to do and what would be the least ideal. So number one would be what would be the most appropriate thing to do in that scenario. And number five would be the least appropriate thing. Um The second type of question would be the M CQ questions. So in this there would be a scenario and eight options and you would need to pick out three of them, which would be done according to good medical practice. So in the first option, it's out of 20 marks. So uh you pick out the first one and you range it accordingly and then you get marks based on what the correct answer is. So it doesn't mean that if you get one wrong, that you get a zero, you'll still get a few marks. So make sure that you rank it appropriately on the second half. That will be out the M CQ part that will be out of 12 marks. So that's just four marks for each right answer. So if you get all three wrong, that makes it zero. So half of them would be ranking and half the questions would be M CQ and make sure that you remember that there's no negative marking. So you have to, you know, at least attempt all of them um next leg, right? So the clinical part of the emissary exam. So this is over 75 minutes and there are 97 questions. So out of these 97 questions, only 86 questions would you actually get marked on? And 11 of those questions would just be trial questions set up by the M sra. So you don't know what these level are, they'll just be randomly put across all the questions and you can never tell us. So then make sure you attend them equally, but then you will only get marked on 86 of these questions. The trial questions just exist so that the emissary recruiters know for the next time if they can include the questions based on the answers you provided. Um So these are the 12 topics that they say is included, but like as you can see in the second one is dermatology and the ice. So that's three different specialties. So you need to make sure that you go through all of them. Excellent. Um, so these are how the questions are based. So, um, there'll be a few investigation questions where they ask you what's the most appropriate investigations or what's the first investigation you do in that scenario, then there'll be diagnosis questions where, um, you'll need to find out what the diagnosis is. There'll be a few symptoms, few signs and you'll need to, um, you know, they'll ask you, which is the diagnosis most commonly seen or with the most commonly seen, uh, the most commonly seen, uh, diagnosis that can happen. So the next is emergency scenario. So, in an emergency situation, what would you do? That would be the next type? Um, and then that's the prescribing where you need to give a drug management, um, where this is a clinical scenario, sometimes they give the diagnosis and what would you prescribe in this sort of a situation and then there's the management scenario. So let's say, for course, surgical training. If there's a surgery question, it, it could, it doesn't necessarily have to be a medicine. It can be a surgery that would be the management next. Um So the clinical part again is divided into two. So that's the EQ part and the S pa part. So the EQ would be one clinical scenario and there would be around 3 to 4 questions on that same scenario and then it will move on. Like then the next question will come and there'll be a next scenario. And then again, 3 to 4 questions on the same scenario. Uh The next one is the S PA which is the single best answer questions. So in this, it will just be one clinical scenario, you'll get 5 to 8 options and you'll just need to pick the correct answer. So again, it, this is also divided in half to half. So what I noticed last time when I wrote my exam was so the EMT part is quite easy to answer because it's just one line and you just go through it quickly and the SBA when it comes down. So for me, the E MQ came first. So that was quite easy to get through. And then the SBA was longer questions and then I struggled with time at that point because um I thought it would just be the same all throughout, right? Again, the same thing to remember, it's divided into half half and there's no negative marking to make sure that you answer each question. Um So another difference between the clinical and the S JT part is in the clinical, there's only one right answer. So either either you get the marks for it or you get a zero. So make sure that you don't do not spend too much time on one question because time management is quite crucial in this exam next week. Um So, so how the uh emissary exam N generate the exam is there is a question bank. So they try and keep each section, each component, they try and keep it like equal questions each. But sometimes it can happen that one section like O BG or pediatrics would have more number of questions, it can happen. So make sure that you go through the all the topics. Don't, don't skip one topic thinking it wouldn't come or it's not important because it can um Right. So these are some uh resources that you can use. So emissary does not endorse any single resource for the preparation of this test. But there are some question banks that have been created online, you can find these online, which actually help with it. So whoever's whoever's created the question banks has obviously gone through the questions and gone through what would be expected of uh F two and what would be expected in the exam and create a question banks out of it. Um There are also courses like EED offers a course. Um which again, it, it's obviously all paid. So because it's paid, um, it usually kind of, it usually means that it usually is a question bank that's appropriate for the exam. Um So another thing to go through for S GT is the GMC good medical practice. So if you've never done an S GT before or if you, you're an I MG and you've just come in and you're writing the exam for the first time. So this GMC good medical practice has a guideline on what would be most appropriate to do in a specific scenario. They also release for S GTs a question bank which you can go through. So at some point, they will release a question bank um which will be put up online uh in the health education England system and you can also go through that next. Um So moving on to the interview section. So obviously, after you clear the em sary, they'll invite you to the interviews and that would be the next hurdle that you have to pass through. So, um these are the two resources that we've um looked at. So uh this, this, so the one on the right is the medical interview. So this is just a generic question bank. So it includes uh tips for all specialties including I MT S STCT S, all of them. Uh The one on the left on the other hand is more uh specific for co surgical training. So in this book, uh the interview questions sometimes come as what word from the book. So make sure that you go through it uh quite thoroughly. Um Again, with the booking, you need to be quick about it. So you get a time slot that is convenient for you. Um make sure that you don't have any um night shifts or anything before it because you'll be tired and since it's an online exam, so last year it was an online exam. Pretty sure this year they've planned to keep it as, keep it as an online exam as well. So, since it's an online exam, you have to, uh, make sure that you're fresh, make sure that you're not, you're not sleepy, make sure that you have a computer that's, uh quite audible and you have a good wifi connection as well. So just ensure that you plan all this before. So you're not, um, struggling one or two days before the actual interview. Um, another thing that, uh, I would advise is you need to practice, obviously, uh, practice is something that's very, very important. So if you can find people who are doing the same thing, find other aspirin, surgical Aspirin, so you can practice with each other. The book on the left is quite helpful for that. And another thing is you can practice with seniors. So when I say seniors, it's important to practice with people that have just gotten through CSD because they would have more of an idea on what the interview structure is. And you can also practice with your consultants or registers. Just find anyone you can practice with practice is obviously very important. So how the interview, so I'm just gonna give you an idea on what the interview actually comprises or at least what it comprised last year. So last year there, it was a 20 minutes interview and the 1st 10 minutes was divided into one section and the 2nd 10 minutes was the second section. So in the 1st 10 minutes, the first five minutes was just a speech on your leadership skills. So that's what was there last year. And you talk about any leadership role that you engaged in or that you think is relevant to post surgical training. Um And the second part was a management scenario that would be just like a situational judgment type of situation where um maybe, maybe someone's uh maybe something happened in work like um like any, any professional development scenario that we would go through in the situational judgment tests. Um The second part is the clinical scenario. So that would be, again, the 10 minutes would be divided into five and five and you would have two scenarios in it. Um Both would be managed usually according to the ATL S and the CRIS protocol, and you go and you go on to like, say what, what you would investigate, what would your management plan be, what would be the emergency treatment, etcetera, etcetera. Next, next, next slide. Um Right. So once you've gotten through the interview, uh before you actually get your results, you'll have to rank your jobs. So there are around 630 to 650 CST jobs across UK. And if I remember, right, it was around 1002 100 applicants that got through to the after the interview stage. And out of that, around 6630 to 650 got the jobs. So what you need to make sure here is that, you know what you prioritize. So, um for example, if you plan on taking uh orthopedics and CT three, you would want to make sure that your uh program is more Ortho themed like a general surgery themed job would not really be that helpful at this point. So again, like if you want to take general surgery or vascular, you would want to take a general surgery, them to a vascular themed um program. I know that a lot of people would obviously prioritize regions as well. So because there's not really much time between the interviews and when you have to rank it and submit it, make sure that you do it well in advance because um and because when it comes to the application, there's no real way to filter it out. You can't really tell what you can't really filter Ortho themed jobs out or surgical team general surgery themed jobs out. It's just a whole list of things and it's quite taxing. So then make sure that you make a spreadsheet, maybe get in touch with one of your friends so you can do it together. Um Right next one. Alright folks. So that's wrapping up the final things that I'm gonna add regarding the job ranking is uh when it comes to thinking about your ST three applications also bear in mind that experience. So for example, for say general surgery or vascular surgery, you get points for having worked in that specialty and you peak at a certain number of months. So for vascular surgery, you peak at having between uh I think it's up to 30 month experience, you, that's the peak number of points. And it's possible therefore to go over this. Now, this would be more relevant for those of you who've worked as F threes F fours or who've come from another country as well because how they count the experience is post F two jobs. So if you did your sho jo you know, sho house office at sho in another country, they count that as the equivalent point of F two and then they count from that point. So when you think about your job combinations, it's very much worth looking at ST three thinking about what experiences do I need to have. And it's not saying never reject a job and call surgical training because it's difficult to get them, but it's worth thinking about prioritizing what you need. And in relation to the spreadsheet, my personal experience was that you can download this Excel spreadsheet memorial, but they keep all the information for each job in one free text. So that's why it's worth getting together with some people to make sure that you've split it up nicely. So you can kind of filter it through. But otherwise it's a very tedious thing to go through 600 odd rows. Time is the most important thing. Don't be doing it the night before. So we hope you found that useful. Um um We hope giving you an over the timeline process, how to improve your portfolio. A brief interruption with the M SRA talking about the interview and job ranking. Now, just to let you know, this is just the intrasession. We're going to have two weekends where we're going to go through in intensive sessions, the clinical topics. Now, obviously, we can't possibly do an exhaustive thing. The M SRA exam is like a ramp up version of finals for Sh Os. But what we're going to get is seniors who are generally registrars or consultants who will go through these topics with you to try and teach. And this is a rough outline. The dates of the weekends are set. So it will be a second done in November and the 16th 17th, November speaker availability might mean that we switch things around we will do our best to let you know. Um this will be posted on the fdss, social media. We will also be doing separate sessions for the er S JT portion of this. So the professional dilemmas and we'll also can we might if we are able to organize a bonus session on interviews. Now, this is the end of today's session as it were. Um this is personal QR feedbacks for myself and Mariotte. Um So this is just useful for us personally. You don't have to fill them out. Um I'm gonna send a feedback from med all to everyone. Now, um, if you, er, I fill it out, that's the one you need to get your automated, er, the cer certificate of attendance because in order to log your teaching, er, it should have just gone out. Um And now we'll take any questions. Uh I'm just looking gorov is also gonna join us in answering questions. Um So I think we've answered a lot. Um So how many percent does the M sra? So it depends on how you view it. Um M Sra is the first hurdle, you need it to get shortlisted for the interview. So in that way, it's 100% once you're at interview. Um The Rings that I was told in my year were, it's 10% M sra 60% interview and 30% portfolio. Um, obviously, the way I'd think about it here is that there's no use uh having a good portfolio. If you flunk the M sra cos you'll never get to the interview stage. Uh catch up content. Yes, this session is recorded, it will come up. Um This next question about the interview will carry more weight this year. But I think that's, that's for every year, every year interview has more weight each in the final score that comes after the interview. But you need to, for getting to the interview, you obviously need MSR. So I'll answer the question about the cut off date. You need to have the activities which are you need to be done before the application was submitted. So before the deadline of the application is when you need to have your achievements as it were. So um my understanding is that, you know, the cases that's the date, any audit presentations, all of it needs to be before that date um in terms of getting the evidence together. Um You actually, I think sit M Sra first and it's only those who get shortlisted, who then get sent information on how you submit the PDF. So if you saw on my next slide that I'll just quickly do, I'll put this back later as well. So on here, if you use my look at my self assessment evidence, I only put that together that document er after I'd sat M Sra and got shortlisted the interview and I think it was er around about that period. So the cut off date for achievements is the deadline for the er application and then the submission of evidence. Don't worry about that so much. They'll tell you with plenty, you should have a few weeks notice at least. So for, for example, just to add into this thing, if you are uh want to get some points for an audit. So the presentation for the audit or both the cycles, everything should be done before the application closes. However, the evidence for the audit would be a letter that you would have get signed by a consultant that you have done this presentation or you have this full audit, which is done, you can that signature on the letter that could be dated after the application. But all the stuff which has been done including the presentation that should be before the application closes. And the same goes for anything else like uh if you have presented anywhere in any conference, they can give you the letter later about it that OK, you here is your presenting certificate, but the conference should be held before the application closed and you should have done it before. One thing I will add to that is if you're getting letters from consultants about things like audits, make sure that if you're getting the letter dated off the deadline of the application, make sure they specify on the body of the letter that you've completed everything before the deadline. Because otherwise when they scrutinize it, they'll look at the date of this letter and it's afterwards. How do they know that you weren't doing things off the deadline? So make sure for all these things you have correctly dotted everything, all the details are there. Um, any one resource you would personally recommend. Um, my personal use, I use past medicine and I use the EED course and question back. Er, I'm not a sales rep for E me. Um, it just happened to work for me. Uh There is a lot of good resource out there. What I would say is obviously some of them are quite expensive. So just be careful not to evaluate the feedback on these things, what other people have recommended or, you know, do your homework on it. Um Make sure you make use to your study budget if they'll allow you to do that and often you'll find that people do like for many other exams like MRC S or Mr, you know, those other ex membership exams, they use multiple question BS. So I think everybody uses past medicine. That's a very standard one people use and then they use another one on top, like past test or E Medica or there's a lot of options. Uh My personal one was E Medica. I like that one. But um as I said, there's a lot of different options. So it depends who, you know, who gives you that advice. Yeah, the teaching. Yeah, Yeah, I was going to say the the same thing. Uh There are multiple sources that you can use uh some sources like it's, it's different for different people. It depends what is your basic knowledge is. And because people do say that same uh concepts and questions from the same concepts come in the final exam. However, the question can be framed differently. So there are few resources like M CQ Bank and stuff like that which give uh questions which has come in MSR in the last years or so. But I have seen in the final exams, they do tweak a question a little bit and sometimes if you have just solved the questions, but you do not have the concept behind it, you, you might not be able to get the answer right in the final exam. So make sure that you have, you know the concept behind that question regarding that rather than just knowing about the answer. And this uh question about the full tea time teaching job, see the teaching job. Yes, that can work. But what you need to submit as an evidence is which they very specifically say that you need to have four or more sessions and you should have formal feedback for it and it should be left updated and signed by a consultant. So even if you're working in a teaching job, you have to get those sessions that have been conducted. You need to put what sessions were conducted. When were they conducted, you should have feedback forms for them who conducted those sessions and a letter by a consultant. So it can work technically, but you have to just show the presentation or show the all the evidence in a way. They have asked just as my addendum to that. Um So when you think if you don't know the specific dates of sessions, if you look through my evidence, you'll see that in my fourth year medical school. I was doing a Cervical society teaching. And what I said was I was doing weekly teaching over this period of time. And obviously, it would make no sense to include all those dates, cos my letter would just be a letter of dates then. So sometimes there are workarounds to that. Um just the teaching to car over a specific timeline. They don't specify that. But remember you what your evidence is gonna be scrutinized. So try to make it, you know, reasonable that you've done a proper teaching thing. So as I said, during the talk, you can easily in the time that's left, you could put together a four session teaching series on surgical skills, but then it has to be a decent thing. It has to make sense. It can't be just a box ticking exercise necessarily. So, you know, do something that's reasonable. And with all that is generally, it's the best idea to have them dated. Plus I do feel like since, since they're asking it in the interviews, now we'll even if you put like a date that's over across a huge period, they will ask you about it. So you need to know what you've done and you need to be sure about what the topics were and what the dates were. Yeah, exactly. I was going to say that because this year, last year it was a self assessment portal. This year, they are adding 10 minutes to the interview session where they will go through your application and give the points accordingly and it will be at the discretion of the interviewee so that the things should make sense and obviously they won't uh they can't just screw you over and can't give you points if you have done genuinely done things. But it should all make sense and why it's happening because there would be a person sitting right in front of you in the session who will be going through your applications with you and giving you marks for it. The reason in this talk that I've emphasized dotting the I's and crossing the Ts and being very specific about detail is they only have 10 minutes to look at your stuff. So you all have these really great achievements. But the people who are looking at who are looking at them are tired, they've been there all day. So you have to make it easy for them to give you the points because they have a set of guidelines that are specific and I'll give you the example with me. I had this when I did, when you look at my evidence, you'll see there's this prize I've got, which is a runner up prize. When we applied, they never specified that it had to be the top prize. They've since changed that, but it would just said prize and actually, then they've gone, they've escalated it and they've rejected it. But point being there's a set set of rules. So if you read the guidance and you follow all those evidence rules, putting, doing things, it makes it really easy to get your points, it makes it really straightforward er about conferences. Um don't have specific conferences or don't have specific conferences. I mean, it's not part of the CST portfolio anymore. Um So you don't need to worry about it for this. Um If the dates activity is within the body of the letter, the letter should always, it's always good in any letter that you ever get as an evidence, always have a date on it. Just general advice, just future proofing it, it should always be dated. The consultant should put their name, position GMC number and signature and all of it. Yes, you can have electronic signatures, but just for your future portfolio, much forward into your career, always try to include all those details on there. Um Teaching experience is it just organizing? So it is both so if you read the portfolio, you have to organize the teaching and at least four of the sessions of that teaching series must have been taught by you. So that's one of the changes this year, I think last year, it wasn't like that last year, you just needed to organize it. But this year you need, they've specified that you need to teach at least for it for at least four sessions to be delivered by you. Do we have any more questions? So I'm just gonna slide folks. So this is back to this example. So we'll stay online for another 10 minutes. Er, so if you have questions, don't be shy, um I hope you found this useful. Uh As I mentioned, there's going to be two weekends coming up. So the 2nd 3rd of November and the 16th 17th where we will have across the day from 9 a.m. to 6 p.m. we will have intensive set of sessions that go through the clinical topics taught by consultants, registrars. Um The actual session, topics are not set in stone just because speakers may need to walk around just to accommodate their needs. But those are the dates the 2nd and 3rd of November and 16th 17th. Um So if you'd like to please do attend, er, we'll also have a session which will inform you the date for the professional dilemmas, the S JT part. And if we can organize on a bonus session for interviews Um Right. We've got some more questions. What's the recommended time frame to? Yeah. Yeah. So there's no recommended time frame. So no one can give you an answer. It depends on how long you think you need. Uh uh like that when you're preparing for it, when you're performing any exam, you get to a point where you're gonna peak for it. So make sure you peak in the time twice. You, well, I say once you don't just make sure that after you sit it, you can honestly look at something in the, this is the best I could have been. So this is not uh to say a specific time frame. So if you want a specific timeframe, think about how long you need to do to finish your question back. Uh Next question is for you, you need to make sure uh in MSI last year, I think the cut off to get invited into the interview in the first score was 531. So II hope I'm hopeful that it would be more than that this year. So yeah, I have to keep you need a high score to get uh interview for co surgical training, er teaching, what else needs to be formal teaching or beds. So bedside teaching would work for the BC. So if you look at the guidance, um there can be in, there's informal teaching, er when we say about organizing teaching, you need to organize sessions that doesn't mean, it can't be, er, bedside teaching but you need to organize some sort of program. That's a reoccurring regular program. Um, if I'm assuming by bedside teaching you're just referring to medical students, attend the walk, you're just doing bedside teaching then and there and it's not organized. Um, the teaching they refer to as organized. It's a kind of a regular series is that you've organized specific sessions, it recurs and then you've had a consult, you've had formal feedback and the consultant can write the letter for you. You just have to understand most of the things that are there in the whole portfolio. The main evidence is a letter signed by a consultant and it should have the GMC number and the position and the letter. So whatever you're doing, you will need a consultant's approval and he's happy to sign a letter for it. So that's the basic thing you need for most of the stuff in the uh board for you. And if you think of it that way, just think this is what the letter needs to say. So I need to do things that mean they can say this in that letter because if the things are not like matching or not close to what you want them to write, uh most of the consultant will be a little bit hesitant to sign that letter. And so that won't help even if you have done like II, you might have done a lot and lot of work, which would have been actually very beneficial for students and stuff. But if it doesn't, if it doesn't match to what they are asking for or diverting to it, then it won't get you points and there is no way around it. They have the very strict set criteria and it should mention the things that they have asked for. Right. Do we have any more questions? Don't, don't have, don't be shy. Now, is your time to ask any of questions if you have about post surgical training about anything? Ok. So if you have thought at bedside, you need to make sure that you have formal feedback for it and how the sessions were organized. If they were like particularly organized, you can put dates on the sessions which were done and uh what topics were taught and which uh of these sessions you taught, it would be obviously four or more that you have taught. And then if the formal feedback has been seen by a consultant, you need to get those signatures and put everything on a letter. And if a consultant is happy, I think it's uh band C this year which qualifies for bedside local teaching. So just to add to that on the website, there's an index with what the definitions are, what, what is regional, what is local. So you can just have a look at the index in the, at the end of the page and you'll get more of an idea on what level you stand. Yeah, to give you a basic idea. I think local, if it's happening at a one trust, single hospital and that's usually classified as a local thing, regional usually involves uh between two trusts. However, uh if suppose there are two set of medical students who are arriving at a single hospital and you have just taught at that single hospital to an audience that would still classify as local. This is the change they made last year about it. So the definitions in the appendix section do read about it and do read them very carefully, word to word. Other thing I'll add is uh I don't know if you're base within the East Midlands, but I'll use the East Mid East Mids as an example. Er the Nottingham Hospital of PMC and the Royal Derby are only, you know, a 25 minute drive apart. However, there are different trusts so it would be very easy to actually do that. So despite their proximity, you can easily get the two different teachings in the diff different places. So you just need to liaise with your other kind of people. It's in one D, it's just two trusts. You just need to liaise with your colleagues in order to be organizing a teaching that covers that. And one of the easiest ways to do that is by using an online teaching. And well, the example I'll give you is actually surgical skills teaching not time. I at one point did that year four medical school and I did that. It was online teaching on surgical schools because of COVID. So it's very feasible to teach something online like that, which you normally do in person or do something in person, which you then stream online to make it regional to catch multiple trust scenarios. If you could always just fill the feedback form, it would be really great. So we can improve on our next sessions if you could see if you could go back to the feedback. So just gonna go back here. So these are our personal feedbacks. We are very grateful if you do fill them for us. Uh and then to get your certificate to log of your teaching, there's the me feedback that you'll need to complete. So we still have people here. So um don't be shy folks because this is an opportunity to ask us anything you'd like to. So if you look at the Ortho ST three, you'll see the requirements and I'm gonna goro actually answer more because he wants the orthopedics. Mhm. So yeah, so general surgery team, if you will look for ST three applications for Ortho, you would see what is the point that they mainly ask for. So the maximum points is like for the or for 10 to 42 months. So if you have done total 10 to 42 months of orthopedics, anywhere that should will, that will count. So, in general surgery theme program, it depends what are your rotations in some, in some deaneries, you might get the rotations like you have uh, 16 months, joint surgery or vascular, things like that and might be having eight months or two with it. So it depends how much you have offered done before. Then in another, you can apply with any team CST for any ST three. OK. That's there is no set criteria that if you have done joint surgery through and CST, you cannot apply for anything else, you can apply. The only thing is about getting the things done because for ST three Ortho in except this experience, there are points if you have done rotations in other specialities except Ortho, for example, if you have done one joint surgery, rotation or rotation in another plastic surgery, vascular surgery ent that also gets you points. So there are maximum two points to work in two surgical specialties except Ortho in ST three application. So if you have a different, the CST program in which you are getting two rotations, which are different than Ortho like one joint surge, one vascular and then one Ortho that would be great. So that will get you the most points in T three Ortho. The main things are getting a DHS or the cases for the neck of femur fracture. So the only thing is if you have less rotation or less time in Ortho, you might not be able to get those things done with regards to the question about the best audit. Um, the audits that I would think of are about, er, respect forms, er, or the DNA CPR forms, if that's what you call them in your trust, I'm not sure where you're based and consent forms. Er, Mara, I know you did an audit on respect forms, er, what you like to tell about that. Um, so I did do an audit on respect form. So what I noticed was that generally in general or usual surgical specialties, the respect forms are not really completed appropriately like they completed. Um, like some sections are not filled up. The sometimes a sign is not there some different areas are not filled up when you compare that to medical specialties. Generally, medicine usually fills it up very well. So what I did was I audited it, I just checked general surgery and Ortho, um, checked all the respect forms and, uh, marked on what our sections were missing and then presented it and to re audit it. Um, so we held the teaching program, like during the induction of the last uh, set of F two, we held a teaching program where we told them this is how you should ideally fill the respect form. And because it's very important for patient care because they need to know what's happening and you need to inform the relatives and we made a whole teaching program and then we re audited it. So we also like, I think so we put out a poster as well just on what the, what is the purpose of the respect form. So as you can see, I think even if you only have, you know, 345 weeks, you could easily do that audit of respect forms. That's National Guidance. And you know, you can do a snapshot of award and you can easily do that audit. Yeah. So another thing I would like to mention is when I did this audit, I did it just over one day. So it was just that I collected all the respect forms on one day in general surgery and orthopedics. So it just took one day to finish one cycle and then then like just present it wherever if it's like the next in the next one or two weeks and you can re audit it again in one day. There are VT audits which are very regularly conducted in most of the tests. Now, VT uh assessments are mandate mandatory to before you start the prescription or any or electronic prescriptions. So in some trusts, VT audits are done by nurses and in other trusts they are not regularly done. So that's a very, very common audit people do and which is quite fast because for any patients who is admitted, for all of the patients you need VTE there is however, a point, I would like to add here uh when you are doing any audits or stuff like that, have a little bit mind what you want to do in T three as well. So if I correctly remember the vascular application, it says that if you're doing an audit that should have at least 50 data points in it. And so you should, if you're doing an audit new now, you should keep that you can use the same audit when you're applying for your ST three applications as well. So yeah, so those things would be helpful if you look at ST three, whichever speciality you want to apply. II have only seen it for vascular. I'm not aware if any other specialties have specifically mentioned these certain points in their uh audits. The other thing I'll also add is many of these uh portfolios say have a wording that says, well, you've demonstrated change. So it's good. So VT for example, we have electronic prescribing, makes it mandatory. So generally speaking, I like to think they were quite good at that. Whereas as Marre mentioned, with respect forms and surgical specialties, often it's very poorly done. So there's a good scope for having improvement. So again, when you're picking these audit topics with the National Guidance, the the best targets to pick are ones that you can do efficiently that have the National Guidance. And also where you suspect that you know that there are good improvements to be made by interventions that are straight forward to do. So it's gonna be something you can do quickly and easily and you know, it will work. So and cause that effect. So think about all those things when you're picking an audit just coming to good point, that's very good point. Because before you start an audit, I like, I also always think, what do you think a potential intervention could be? And do you think that that potential intervention is easy to get approved in your department and that can be done and people would accept it because there's no point in doing an audit if it is very difficult to intervene, like however good your ideas or the change is going to be so good. But if the implementation is not happening very soon or there is not going like people will not be able to accept that change if it is difficult for them, if you are adding performers or work for them, so it will be difficult for people to actually do it. So it will be difficult for you to get a positive change. So losing the whole idea of an audit um coming to the next question. So it's not confirmed. This 23rd November was last year's date. I every year the date changes. Um So for this year, uh it does not necessarily have to be 23rd November. So something I've noticed is that the I MT applications are closing on 21st November. So I think that would be the predicted date of CST as well because last year everything closed at the same time. And I don't know if you, if you people are also aware about the Ireland application I have mentioned in the chart before. So Ireland applications are separate applications on oral. It's not the same from the same one. So Scotland, Wales and England is one application. Ireland is a different application. Uh after you have applied for both of these and after the MSA, you will get invite if, because the MSA cutoffs are also different for both of these applications. The interviews also happen separately for both of these. So if you are someone who is happy to go to the northern Ireland part of UK, so you have to consider that it's a separate application, make sure you have that in mind when you are applying for it. Also, I'll mention this, er, when it comes to applications, er, a few years ago, they did have run through general surgery and run through vascular surgery, er, available in England that has since ceased. But it's possible that the run through programs still exist in other places like Scotland, Ireland. So it's worth just checking because a applying for the CST in England, Scotland, Wales is one thing applying, like Gorov said in Northern Ireland is a separate thing and then the run through programs are also a separate application. You have to put, so make sure that you've checked everything that's applicable to you that's in your interest, er, because it doesn't detract, you know, and all these things, certainly the ones that are similar to ca training, the run through ones will have a similar entry criterias. And actually the run through one, for example, back if, if you had been applying a few years ago, if you, I know you want to do a general surgery or vascular surgery, it's easier and better for you almost to get in the ST one because you don't have to do another application again. But as you'll see if you compare it to ST three applications, it's tougher to get in at ST three or at least there's more of these criterias. So if you know about this run through training is certainly something you should think about if there's anything available still, I don't know if they've taken it off now. So there are some available, I can speak for Ortho in Scotland. There is a run through program that is there for orthopedics. Last year, there were applications you get it directly through ST one. So they have a separate uh scoring system, the self assessment score and separate interview session for it and have a look at it. It's, it's slightly, uh I would say slightly tougher than to get into CST. But the good point is you're directly entering into a run through program that too in Scotland. So that's good. Uh In our, yes, 80. Yes. So, uh, how that's again counted is, is post F two jobs. So when it comes to CST, be careful that you've not had experience more than that certain amount in surgery, um, I'll speak, go what you were about to say. No. Yeah, surgical specialities. So that's the post F two. That was, I was going to say 18 months rule. Uh, I think there's, they have, there's a change that they have made this year. So you need to see what's uh, the surgical specialties, they mean until last year even it was considered as a s for next year and they're removing the it in this year, that's for next year. So they still have it. It is still considered a surgical specialty this year, but they're removing it from next year. Oh, ok. So, yeah, so that, that's a change that's going to come. So, I mean, working in it would be same considered medicine from next year. But this year you have to see post F two, you shouldn't have it more than 18 months. So if you are doing F threes or F fours or you're working otherwise, uh, look at medical specialties, look at any, look at places other than surgery perhaps. Yeah, you don't want to get over qualified and also recall that for your ST three applications that same thing applies MSU OG trainees in B training in the UK. So I'm not aware about the specific Mr CG trainees if there are any separate pathways, but the main pathways for any training that you have to get in UK. So you can either enter into very basic level, which is T one or CT one for which most of the special, special you have to sit MSA. However, there are specialties like IMT for which you don't and for ST three etc, there are separate interviews and portfolio sections for these. So the trainees pathways are set, these are the whatever training you have done behind to enter into the official training pathway, you have to go to the same training system that anybody goes in UK or an IMG. So the UK M is for entry into the UK. So that's basically replacing PLB, it's not. So M SRA is a different pathway. UK Ml Alabo is a different pathway. So PL UK MLA is for entry, you need it for like any job, for a clinical fellow job, anything um M SRA is for training posts. So clinical fellow jobs are non training posts for that. You need UK MLA when you think about M Sra think of this as the entry to training exam. M SRA is sat by only people applying to training programs and it is a competition of all the people applying. So the key here is you need to be one of the performer, the top performers amongst everyone. In theory, I'm not aware of a limit. Um I think the thing to be aware of is potentially that you are if you've applied a number of times, um, you know, you might find that you're building up experience in other ways. Uh I know people who have sat multiple times or done multiple applications for CST, but I think some of theirs were before the era of the M SRA. So another thing not for co surgical training. But I think for other specialties this year, if you score past the cut off in the MSR, you can't really give the September exam for the second cycle of trainees. So that's something to keep in mind for CS D does not apply cause there's just one intake. But for other specialties like psychiatry, GP, that's something to keep in mind. Like I think this time it was around 380. If you scored anything about 380 they wouldn't get, give you another chance to write it mid cycle and bear in mind with GP. Um you don't have any interviews. So if you're interested in becoming a GP, it is solely down MSRA score, I think it's same going for psychiatry as well. So we don't need an interview for it. The other, the things you have to see co surgical training is not the end, you have to get into a specialty training after that or to get a consultant, co surgical training is only for two years and it's the basic training. So if you are sitting multiple times and getting application for CST, you're getting more and more and experience build up. And if you will look at the ST three application for most of the specialties, they actually you have to uh they have a kind of end number. So whatever portfolio you would have, it will be divided by the number of experiences you have. So if you have more number of experiences to get for the same point, you need more number of projects. For example, if you have done like uh post F two, you have done three years of experience, you would need at least like three first author papers to be counted as one. And remember N numbers counted from all post F two posts. So if you completed House Officer, Senior House Officer in another country, those would count as your F one F two and they'll count the N number from there if you er complete, you know, whatever it is. So N number counts from the mo it start, the clock starts ticking from the moment you finish F two. So remember then that getting into ST as go said, it becomes much more difficult to have a competitive portfolio um with audits, it's still use. So when you think about doing an audit, the purpose of an audit is a clinical benefit, it's to improve the service. So if you the first cycle, obviously you're gonna, it's like a, a service that you're seeing what the status of things is and you put an intervention if the second cycle shows that you've not done anything with it, um, you could theoretically use it in, in the, er, application. Er, but what you'd need to do then is, uh, you know, be able to discuss that better would be to do a third cycle and show change. Er, I think, er, you also earlier asked about, you know, what's a quick audit to do that you'd recommend with national guidelines. Something that respect is usually a very easy target because in terms of filling it out, it's actually quite easy to fill out. And actually, for example, when you've had patients on the acute take, often juniors sh Os are the ones who fill it out and they fill it out partially. But once you do an education, for example, the consultants will be in on it and they want to obviously perform well. So it gets rectified. So it actually, you can, you know, it's quite easy, some, with some of these audits, you know, like God said, think about the intervention you're doing before you start the audit. Is it a feasible intervention? Um, try to stay away from that if you can, where you're getting in a position where you're putting intervention, it doesn't do anything good because then when you discuss it, that obviously brings up a whole host of questions which might be uncomfortable for you in an interview. Plus, I think in the portfolio that it meant that it is mentioned that it needs to demonstrate change. So um I think in all the audit sections, that's one that's the final line in the section. So I think it would need to. So yeah, not 100% sure if it would get accepted if it did not demonstrate change. But ideally, it should possibly it would need to. And if you look in this year application, they say there would be two questions on your do domains as well. So they might ask the most common questions are usually about your research or your or about audits. So this change that has happened this year, it's not new previous to COVID uh interviews used to happen like this and assessments used to happen like this. So then before COVID, there were used to be live interviews, people used to get like print all their evidence, get it in a file and get it checked. And on the day of interview, they used to check the uh all the evidences and score the participants, the self assessment thing. This came after the audit when there was difficult to conduct live interviews. OK. So that's the thing that you have to see if the audit has not produced any good change in it. Uh It would like look bad in the interview. But as the CT said, what if you have already done two cycles and it has not produced any change. The best thing you can do, you can think like out of the box, how you can actually demonstrate a change and then do a third cycle, which can show some, some sort of improvement and then that could definitely work. Um So coming to the N number again, so I'm just going to talk about orthopedics. So in orthopedics, there is a number so that it, it's 123, depending on how many months you've worked. Post F two. So if you worked one year, post F two, then your N number would be one, which means the number of audits that would gain you, the maximum points would be divided by one. So suppose you've done two audits, which is the maximum number that you need for, uh, T three and orthopedics that would be divided by one. But if you worked, say three years, I think for three years, the number would be two or like more than 39 months, it would be two, right? Am I right? Yeah. So for 0 to 39 months, it's 1.3. So if it, more than more than 39 months would be two. So then the number of audits for you to get the two points would be four because the, like if you've done four audits, four would be divided by two and the maximum number of points you can get is two. So that's how you, if you're adding the more number and number of experiences just to get into CST, you might have to get that thing in mind that CST is not the end, you have to apply for ST three after that and that is going to get tougher and tougher after that. So the things are added just with the audits earlier, just one last piece of advice, think about your outcome measures as well. Sometimes if you look at how you're measuring the outcomes, that's another way of thinking outside the box to demonstrate the change because you can measure outcomes in a different way that might, you know, think make things more favorable in terms of the end number. Um The reason the end number is there is essentially to say that if you're working, you can't just be stagnant. You have to keep doing audits, you have to keep doing research, you have to keep doing teaching and it's designed to stop people who don't get into training and do multiple cycles. Uh It's designed to make sure they don't just, you know, reapply reapply without having done extra work. So like I said, they have the number of they, you have this number of months and they say this is your N number based on how many months you work close to two, F two and then they just use it as a dividing factor for all your points. Um relating to what you said about ST three, the advice that actually, so I knew someone in orthopedics when I worked with go who had disqualified himself for act application. Er, actually there were two people like this because of the experience they had. And what they said is actually, or there were people again with the similar position who went did Caesar rather than ST training. And what they said is they very much recommended doing things in the proper way, which is going through the program. They strongly recommended they, you know, didn't recommend at all doing this thing where you try to get directly to ST three or directly to c or something, just go through the program. Um Really, when you think about co surgical training and this is the reason I brought up the ST three now is core surgical training effectively only gives you 18 months to get ready for ST three if that, because er, your I'm ct one now it's in, actually, in a years' time, I'm in the position of applying for CT two. So almost, you know, a good six months of my s my course surgical training is of no use to me in having time to do things for my ST three application because I've already submitted it. So in terms of getting into ST three, it's worth doing course surgical training. Um it's, it's definitely something that's worth doing. Obviously, I, you can't say about your personal circumstances, like all the different things that might contribute to a decision. But the advice I've received in the past is do things for the proper channels. The other alternative thing I'll mention to you is it might be of interest is core surgical training, gives you a specific outcome at the end of it, which says you're having this, this and this competencies. There are other programs that certain places run so it's not everywhere, but certain hospitals have created programs that are called equiv they, that they call equivalents, they call surgical training program. Er and at the end of completing it, it's the same length of time. They say that you've done that and you were just in one place about doing rotations. These are, I'm not sure how these are looked at looked upon when you come to applying to SS D3. I'm not sure in theory, at least they're looked at as an equivalent and I know people who, when they were applied to course surgical training, they were not wanting to, if they didn't make it to have to repeat the whole process. So they applied to these jobs. So if you're worried about course surgical training, but you really want to progress first. That's another thing you can look at. Obviously again, the advice I was given is if you can always go to the official training program, but because it's better, I don't know if go or will have anything to add uh to that advice. Yeah, there are, there are programs. So uh it's the same as non training. So it would be non training, co surgical uh programs that we have. Uh there are only few trusts in this country who do this. There are some in London, like guys and Saint Thomas, Saint Barts, some in Newcastle Bristol. So there are few trusts which have run these programs. So which basically you will get a contract of 24 months, two years with, with different rotations, it could be like six months, plastic, six months, Ortho six months joint surgery. So it's very similar to how people have it in the uh co surgical training. They do have all those things like study budgets and study leaves and stuff. So all those things like that. But again, in training and in non training, there's always a difference. The training, you would have a little bit more. Uh you can say uh um when you apply for anything like for study leaves or all those things, your, your voice will be heard a little bit better when you're in a training post. So that's a difference. It does not mean that you cannot do the nontraining thing. I know people who have entered into ST three and all those stuff. After getting into those nontraining, you have to do maybe a little bit more harder work than that. The main idea of getting all these things is in U KS that you should have the experience or your training, you should demonstrate through the different evidence that your training mimic the training of a person who is an official training pathway. It's the same concept behind everything behind the end number behind everything. So like for trainees every year, they are supposed to do at least one audit, they are supposed to do uh at least something in the research. They are supposed to do some sort of teaching in that every year to get progress from one year of training to next year of the training. Same they expect from the people who are in non training if they want to apply for ST three or want to be a consultant or anything that every year they have worked as a doctor in their life, they have done some progress except the clinical work. And even in the clinical work, they have done something and learned something better that they did not know before. Like last year, there are different many pathways in in UK to be a consultant training. Getting into CST one, it's not only only pathway to become a surgeon here, but it is the most recommended pathway in which your life would be a little bit easier than other pathways in other pathways. You might have to, it would be difficult to enter, difficult to progress and you might have to do a lot more hard work than you have to do. But after you have entered into the training, but it's not the end of the world. It's not the only pathway. There are multiple people and like lots and lots of people and consultants I know or specialty registrars. I know uh who have entered into the training or became a consultant without any official training pathway. But all being said, I would still recommend do try for training because that your life would be much easier and you will get that push and bear in mind that things like. So the I SCP, which is the portfolio you use for training, you have to pay to use that. And if you, uh you know, if you're doing a non training job, you're more than likely to still use. IP. So you'll still have all the same expends. But by being in the core surgical training program or you're doing a special training program rather than trying to do Caesar, what you get is that you have protections. So you have a TPD who is meant to look after your teaching. And I know, you know, registrars who they maybe for example, struggled with something. But then the TPD has an obligation to look after them to make sure that they get trained, that they get moved to a different place. If you're in a non training job, you're trying to get through this, you don't have the same set of protections, you don't have protected time where you're meant to be in theaters or have clinics, essentially, there's a, a right or duties. However you want to think of it where you're going to be taken to be trained and that's the benefit of being in the training program. Exactly. Yeah, very true. This is like very small example, if I have to give you, I know people who are in the training posts and who struggle to get the times and all they have to do is email their TPD S or their supervisors that they are not on par with their theater experience and they get allotted theater time, however non training posts, it's really difficult for you to as an sho to say that I want the times, I'm not getting enough the times than the department. It's less likely that department will a lot you at time just because you asked for it in uh in nontraining jobs. But again, I would not discourage anyone about those things. But training, yeah, get, get to training is a better option always. Yeah. So we just, we stay on till 830 then we'll conclude the session at 830. I hope everyone's found this very useful. Um I can still see that we have, you know, 18 pe er, there's a 15 other people here. So if you do have questions, please feel free to ask. Um the session is recorded. So if there's anything that after this concludes, you know, you'd want to ask u us what you want to look at you can rewatch the session. Um My contact details are on the front, the on the front side. Um I'll put my NHS email into the chat now. Er, so you can get to me there. Um So if you have any further questions, you can reach me that way. Um Alternatively you can find us on social media. So the foundation training Surgical Society, er, East Midlands. Uh so we've got a few minutes left. Any final questions? I think there are no more questions then. So I think we'll wrap up. I, like I say a big thank you to go who have given up their reads to do this. Um, so thank you very much. Thank you so much. I hope everyone's found it very helpful. Please put feedback. Er, and everyone have a good night and hope to see you at the sessions on the 2nd, 3rd and 1617 November weekends. Um All right. Goodnight everyone. Good night. Thank you. Yeah.