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Okay, So our next talk is, um, from Mr Leo Watson again, who is back talking about life as an s d three. How to excel in, uh, in the as a registrar, um, in real life. So I'll learn straight over to him, and, uh, and any questions again, just keep popping them in the chat. Um, and, uh, Ms. Martin will obviously come to the chat to hopefully have a look at some questions as well, but yeah, over. Celia. Thanks. I'm just just uploading these slides now, so give me two seconds. Here we go. Right. So life is an X s t three. How to maximize your training opportunities. So we're trying with the through this reason the quickly just, you know, 10 minutes a few tips. Most importantly, you're gonna have to take all this to yourself, so everyone will have their own different style as to how they are. So take it with pinch of salt. Uh and, yeah, tailor it to your own personal style. So, as an s t three, what do you get? So you get a bit more responsibility. You certainly get a degree of autonomy, and you become more of a leader. You know, you will often be doing the ward round leading the team, and it's a bit of a jump to have to get used to that stuff. What do the consultants want that you work with? Well, they want you to be safe. They want you to be proactive, to go and look out and find. Find your own training opportunities, and they want you also to understand your own limitations. So if you see it on the right hand side here, this is about the degrees of competence. I'm sure you have all heard about all this stuff before you start being unconsciously incompetent, and eventually, when we're all wizards, you'll be unconsciously competent. And there's some steps in between. Now you will recognize that this is, uh, this. This degrees of competence is very specific for different tasks, so you might be unconsciously competent in taking some blood. But you're probably not unconsciously competent in doing a laproscopic right hemicolectomy. So be aware that this is different for all sorts of different stages. Uh, depending on what you're doing, I think the most important thing is that as s H O s, we hopefully our getting past the unconsciously incompetent phase of most of our practice and entering the consciously incompetent and consciously competent phases of lots of the stuff that we do. And I think that this is the most important thing. When you're starting out as an S t three that you recognize when you're undertaking a task, where am I? Here? The most dangerous area to be in our new, responsible autonomous job is being unconsciously incompetent in a scenario. So be aware. Hopefully that wouldn't happen too often, but just have in the back of your mind, so been a busy slide. This how to actually maximize your training? Well, what training is available and where do I needs lie again? I'm sorry. I've taken very much a general surgery approach to this, but you can easily twist this to your orthopedic vascular pediatric surgery. Max facts, whatever. So for me, where do my training opportunities arise? Well, Ward rounds either doing them myself and then having a chat with the consultant afterwards or going on supervised ward rounds like a post take ward round being in the clinic. Sometimes we do these fast track telephone clinics, which I do myself and speak with a consultant at a distance if required, or go to a consultant clinic. Remember that you're a trainee. So even if you are scheduled into clinics and they're busy, you should be having training opportunities and the opportunity to sit down and discuss cases and then formalize all of that using your portfolio. The MDT is obviously a great opportunity to go and learn all sorts for me. I've been to the Colorectal and ET loads. I'm presenting Patient's in the colorectal colorectal MDT and being encouraged to make decisions with senior support right next to me about what? What we should do for these patient's endoscopy X ray meetings, obviously theater opportunities, our management of the emergency take and then the other stuff like audit, quality, improvement and research. So you'll see on the right hand side here that where where do my needs, in my opinion, at least lie? Decision making, decision making, decision making, decision making about all sorts of different stuff? And then there's obviously the technical aspects to, you know, reading CTS and my radiology operating on patient's endoscopy, that stuff. But at least in my opinion, as as a junior registrar. I just want to be with supervision, making decisions the whole time, seeing things, learning things, getting familiar and comfortable with this decision making so that I should go three registrar years. It becomes second nature e unconsciously competent. So how to get good training? So, um, there's there's different different types of training. But how do you actually get the good stuff? Well, prepare yourself as Ms Markham was talking about. Be professional. Go to your first ST three job your first placement with a plan. Use the tools that are at hand. So use the personal development plan. That's on I S C. P. You know, sit down for an hour if you want to or do it for 10 minutes over a few different days with a cup of tea, whatever it is and properly think about what do I want to get out of this job? Not just all the generic stuff about what I want to be competent and independence, or what have you think about? How can I become competent in doing appendix? What support do I want or don't I want sometimes how much autonomy would I like to get? And this is going to be entirely dependent on what your experiences in the past get in contact with your supervisors early. So before you get to the placement, I called up with the secretaries, the colorectal secretaries at York and said, My my supervisor is gonna be Mr Woodcock kind of get in contact. Can I have a chat with him over the phone before hand? Kind of get a meeting set up early. So I actually met him on day one because I was a bit proactive. And then try and identify who is going to train you. And what are they going to train you in? So my academic sorry, my assigned educational supervisor is a bit of an old school, uh, inflammatory bowel disease. Colorectal surgeon. So he does lots of open stuff for inflammatory bowel disease. So lots of groans type stuff, a bit of pelvic stuff. So me as an S t three, do I want to be doing complicated redo, redo, right. Hemicolectomies know Because how much opportunity am I going to get to get my hands on? Is that the right learning for me just now? Probably not. I want to be doing slightly more straightforward stuff. Hernias, gall bladders. And then, you know, maybe a right Hemi. Obviously, all experience is good experience, but you have to try to tailor it to yourself. How do I find out who's going to be doing what? Well, word of mouth. Have a chat. Do you know anyone who's in the hospital? Have you worked in the hospital before? Can you find these people on Twitter and find out what they do? What they get up to what they're interested in? Find them on LinkedIn. Any resource that is available to you to try and work out, right? Who is going to be the best person for me? They've got a robot in York. I'm a bit interested in a robot or found this person on Twitter. He does this. He does that. We go there with a plan. So yes. Meet these people early. Meet you wrote a coordinator. So in some places, that might be an administrative person. In some places, that might be a clinician. Express what your aims are. I would like to go and do as many hernias and gallbladders as possible. I would like to do this. I would like to do that. And they will say, Okay, this person has come with the plan. They want to do this, and therefore, I'm going to try, as best as possible, coordinate the rotor so that they can go to this operating theater to this endoscopy to this clinic. And what have you people need to like you, Um, For you to get yourself where you want to be for you to exploit as many opportunities as you can. So do the little things. Go meet the secretaries on day one. Introduce yourself. They're really important people. Get yourself integrated into the team. So meet all of the consultants. Go and shake your hand. Say hi. I'm Leo, one of the new S C threes. It's nice to meet you and they say, Okay, high. And then, you know you'll meet them in the water and your relationship starts building really quickly because before you know it, your placement will go past it. You know, in what seems like seconds, meet the nursing staff who are on the wards. Obviously, they are hugely important people, and the better you can get some with them. The the easier your life will be and the faster you to do things to go and exploit the opportunities that you want to work together with your colleagues. So your other register our colleagues whether there'd be trainees or non trainees. Get on with them, operate together if you want to. So we often in York have done multiple. Reg is doing gall bladders together appendixes together on the emergency take. It's all good for our log book. You get to learn different things from your own colleagues as well that you might not learn from a consultant or you might not learn from a junior member of the team. So working with Reg is is also really good. A few extra points aim high, so don't just go there being I'm an S t three. I want to crack on being an S t three. Go and present yourself as someone who is pushing to be an S t five and S t six already. You know, do your WBS properly Sit down when you've got the odd, you know, afternoon, where it's a little bit quiet to sit down and go through the evidence that's relating to rectal cancer or or hernias, which mesh should we use? Why should I use a lightweight mesh versus this versus that? Why should we do laproscopic mesh repairs in recurrence? All this stuff because you push yourself to learn your trainers will see that you filled out this big long, you know, procedure based assessment or whatever it is, and I'll go. Okay, This person is taking this seriously. They really got the bit between their teeth here, and you will start to stand out that people will recognize that and they will take you under their wing and you will get better training as a result. I appreciate that it is hard work, but that's what we're here for. We're here to work hard, and we're here to learn so operating specifically cause I know everyone's going to be interested in this. How can we try and get the maximum amount of each time we step into the operating theater? So prepare as thoroughly as possible, Know the patient, know what the pathology is, know what their radiology is if they have it, if you can be for cancer cases, for example, or benign cases who have been through an M. D. T. B at the M D T as often as possible and you'll get you'll get to know these patient's be at the clinic that they attend. Whether that be, you know, with regard the MDT for cancer cases or for hernias or whatever it is, Get to get yourself to clinics. Try to get to know these patient's properly read up beforehand. So for the vast majority of places they'll have an electronic system for the theaters. You can see what's going to be happening next week, the week after. If you're going to be doing a laparoscopic hernia repair, watch a video on YouTube. Know the anatomy. All these little things know the different approaches that you could have to a right Henry. You could do the lateral. You could immediately do inferior know all these different things so that when you're doing the case with the consultant, you can be talking about all these potential options and again they'll go. Oh, yeah, this person really knows what they're up to, and they'll feel more confident in letting you crack on a bit more because they think you're safe. Set your expectations before the case starts, so if you have the opportunity have a coffee after the brief with the consultant and explain to them this is what I've done before. This is what I'd like to get out of the case today. Be specific about what you're going to get out of the case. So let's say you're doing an open hernia and you've not done many before. Just say, okay, I've not done many open her knees before, but I would like to be able to dissect down and get into the inguinal canal. Happy days. If you do that two or three times on that list that day of your open hernias, then you've come out of that day feeling really confident in being able to get out, get down into the hernia before, you know, the the consultant might then take over with the dissection and repair. Be realistic again. It's entirely dependent on what your previous experiences. But don't go into day one saying, Yeah, I want to do this. Uh, this in theory reception today, please. Uh, I've done I've seen two before because they're just gonna say what you're talking about, mate, and they'll switch off to you really quickly in the actual operating that you do be predictable and be systematic again. This is about the consultants who are supervising you, wanting to make sure that you are safe. So when you're operating, be really obvious as to why you're going to do some dissection here. Why you're using a diathermy here and make sure it's obviously in a safe place. And make sure that the person who's supervising you knows why you're doing something so that they can then start to relax a little bit and feel comfortable with you. And they will let you do more be systematic in doing your dissection along this plane here and then moving somewhere else. But don't go bit here bit there bit here a bit there because again, that looks like you're being unpredictable. And it looks like you don't know what you're doing. After the case, do the follow up. So do the discharge summary. Little bits like that do the referral to the M D T. If they're a cancer case again, go and be at the M. D. T. S present the case at the M. D. T s. I did this the other week, actually, for an emergency case, who had operated on over the weekend. I went to the Copaxone DT the following week, and one of the consultants was looking through or uh, something about There's something about that I said, Oh, I know this case operated on last week. Everyone listens to you on the S t three and in the back of this MDT. But actually, I've now become the most important person in this MDT for a few minutes. Um, I have the insight in knowing what it looks like inside this person's belly. Um, so it's really useful if you could do that. So just very briefly to summarize your training that classic, you'll get out what you put in. But it really, really does hold true that the more you put in, the more you'll get out, your actions will be recognized. So if you work hard to to do these thorough work workplace based assessments, people will notice them. You're training is driven by you, so you have to go and exploit the opportunities you have to go and find the opportunities, whether that be operating or otherwise. And the greatest influence on your training will be you. Um so it's up to you to go and find those opportunities. Good luck. Good luck for your interview. Is good luck for when you start S t three. The only one thing I've not written down in here is don't be limited by your rotor. So obviously you have your uncles all that kind of stuff. But, I mean, you wrote her in your day job. So if you have got an afternoon where it's a little bit quieter or the list has gone down or whatever, find out what's on the emergency list. Go and have a little pop in and say, Oh, you know, Is there any Is there anything I can help with? Whatever. Obviously you want to be careful to work closely with your colleagues not to step on toes, but go and have a little sniff around. You know, get yourself in the mix there. If there's a laparotomy, can you go and help? Can you just a bit of retraction? Can you go and see something? Learn something more, get yourself into endoscopy. Just there's so much opportunity that's happening in any hospital at any time. Um, you'd be a fool not to try and take up those opportunities if you want to. So that's everything. Brilliant. Thanks so much, Leo. That was an absolutely fantastic talk. And and I hope everyone learns a lot. I learned a lot from it as well. So, uh, thank you. Have you got any questions for Leo? Based on this talk just now. Got a couple of minutes left anyway, so hang around for any questions, and then we'll go for a break from 10. 20 to 10. 35? Yeah. We've just got one question. Um, did you attend any categoric general surgery courses that you found helpful? I didn't actually, I'm supposed to go to one that I was ill, unfortunately, but one of my colleagues did go to, uh, cadaveric course, and he said it was really useful. It sounded like a really good course. It was run through the Yorkshire scenery. Actually, it was done at one of their cad. Some labs. Um, they did, you know, splenectomy knees. They did getting I/O of abdomens, but it splenectomy. They did some right Emmy's. So I think that it depends what is involved in the course. Um, to be honest, most courses are going to be useful to some degree, whatever it is. So I would really recommend. Especially if if you're a training already and you've got study budget where it doesn't actually cost you anything. Okay, there's the upfront cost before you get reimbursed. But I would I would really encourage you, um, to go to these courses, get it into your portfolio as well, Because when you come to the a r c e p, you look like you're being proactive in wanting to learn, So it goes down really well. So, yeah, I would advise it if you have the opportunity to get to them. Brilliant. Thanks. Next question is what were some challenging experiences that you faced when starting s t three. And do you have any tips to get through them? Oh, good question. So I remember my first week on call. Actually, it's an s t three. Um, and one thing that I struggle to get to grips with a little bit was being a bit more of like your your leading the team. Um, so, you know, I have quite an outgoing personality the best of times, but I found it a bit difficult to be almost like instructing people, please do this. Please. Can you do that? Because I think you're gone. You know, shouldn't I be trying to help them out a little bit? But actually, you know, when you're the region call, you're a really important decision maker. And so for things like blood tests and stuff like that, with the greatest respect to some of our other colleagues, that isn't the thing that you should be doing you shouldn't be worrying about, You know, can someone do a venous gas again for this person in an hour after this bag of fluids, you need to delegate those tasks and you have to be, uh well, you have to use your judgment to recognize, you know, am I able to trust this junior clinician? Do I think that they're going to do what I've asked them to do? And obviously you'll check up on those things. Um, but but being that leader and being able to then delegate responsibility, I did struggle with for the first probably the first few days on call until I realized this is not sustainable. I can't micromanage and do everything myself. I have to leave this stuff to other people. Um, so that was probably my greatest challenge. My first on calls. Yeah. You still need to the bus. Sorry. Um, thanks. And so what are the procedures that one needs to be confident in as a as an STD three, Reg? Um, well, I think necessarily you don't actually have to be hugely competent in anything, so don't worry about that. So there'll be some people who have, you know, shot through their career without any breaks in it and won't necessarily. We talk about pending cyst anyway, because that's one that's on the on the general surgery. Reg Person spec. Um, there'll be some people who have only done 10 themselves with some supervision. There'll be Some people will be starting the rest of the three jobs. I know one guy has done research. Paul, who will be on here later? He's in the interviewing, You know, he's done hundreds. So there's a massive spectrum of people, so I wouldn't worry too much about what do you need to be confident? What would we like to get to him? There's an S t four kind of benchmarking criteria that you need to have electively done. I think It's about 40 goal, and I think they've reduced, actually, 20 gallbladder's now. But things like gall bladders and hernias electively and then for an emergency, an emergency perspective. Getting into an abdomen Doing a laparotomy is a really important skill to have, um, saying for laproscopy, doing appendix is really good, but but don't worry about it. My supervisor, at least, all the consultants I've worked with when I've done out of hours appendixes have always said, Look, if you're not sure about if you're not happy, I will come in from the start of the operation, I'll come in halfway through the operation. If you prefer to have your own autonomy, I'll do whatever. So it's a bit of a developing conversation with your trainers, But don't worry about it. If you feel like you need help and certainly be on the safe side and ask for help sooner rather than later. Brilliant. Thank you. Um, so another question is, are you happy to still answer questions or because it is time? So if anyone, I'm perfect. Thanks. So if anyone does want to take a break now, we're back at 10. 35. But if you want to stay on, obviously, for the questions, then that's that's absolutely fine. So there is another question about intervene ary transfers. And can you tell us a bit more about that process if there is time? Thanks. Yeah, of course. So, um, everything about intervene? Ary transfers is online, and in fact, I just texted a friend only the other day. So I'll try and load it up while I'm explaining. But basically, if you get a job in a region So my first choice region was the Northwest. That's where I live with my fiance and the two dogs, so I didn't really want to move away. However, understanding that there is the possibility to get him into the injury transfer, I took my training post in Yorkshire. Um, there is a process called the inter scenery transfer, by which you can move from one Dean ary to another Dean Arri. So when I took up my job in Yorkshire, it was a six year contract. Uh, and I would be expected to stay there and move around the Yorkshire rotation unless something changed. Um, there are a number of different criteria under which you can apply for an Inter Dina re transfer, most recently in August. They just opened criteria. Five. So previously. Criteria 124 of ascending importance were changes in circumstance that would be from the time at which it accepted your job. You have to have a change in your circumstance to then apply to transfer Dean Ary criteria. Five. Is no change in circumstance required. No information otherwise required. Just I would like to move, please. Um, so there's no there's no massive paperwork involved, but that's number five, and it's the least important. Um, so there's a couple of things that have to happen. There has to be a place come up in the Dean ary, so a trainee has to leave the rotation. Um, and then after that, you have to be the most important person so that you're allowed to apply. Apply twice a year. So for their August and February changes. So I applied in August, ready for the February rotation change, and once you've sent in all of your paperwork, there's a central team that looks after it. Also, they look at the numbers within each Dean ary. If there are any vacancies in the Dean Ary and then who is the most important person? According to the criteria, 125 that could go and fill that space. So I'm very, very lucky that I applied in the criteria. Five. And on my first application, there was a space for me to go into. Um, so I do know some people. One of my friends actually is an ent Regine, Scotland, and she's been there for 2.5 years and it's just come down now, so it can be a little bit difficult. Um, but it's possible. I think you have to get a little bit lucky. Um, the other thing to say is, let's say, if there were two people who had the same criteria, whatever it be 345, whatever, they essentially toss a coin. So you have to get a bit lucky in that circumstance as well. But it's doable. It's doable. Brilliant. Thank you. That's really, really useful. Another question is, Leo, would you say pre population of I S e P W s or gold standards in brackets Marker of motivation versus defeating? Uh, yeah, I mean, it's it's a good point. You will speak to some consultants who say they think it's a waste of time. They're not bothered, right? Two lines, you know, I'll sign it off. Whatever. There are some others who will be the complete opposite of that. Admittedly, it's a bit rare, but occasionally you'll have some consultants who really do engage thoroughly with it will want to sit down with you and talk through the evidence relating to I use the example of rectal cancer or whatever it is. Um, in my experience, you learn so much if you have the value of an experienced consultant sitting down and going through these WBS with you properly, Um, but given how stretched everyone is in the tiring available, it doesn't happen that often. It's up to you how you want to approach it. And I appreciate that it is a lot of time, um, to fall to to fill out the bits of paperwork. Um, it's up to you how you want to approach your training. You know, you might say, Well, okay, I'll identify the ones who I think you know might not be that bothered and identify the ones who I think are that bothered and, you know you can then gauge how you want to approach you w B A s. But on the whole, I think the more thorough you are, as I mentioned before, people will recognize it. Um, And you will come across as a much more thorough and motivated trainee if you do these in detail. Brilliant. Thank you. Um, quick question. More relevant to your previous talk on the preference ing slash ranking jobs. You can rank lap jobs as part of the ranking. Where do these stand on the training pathway. And what are the advantages compared to looking for a trust grade instead? To be honest, I don't know. I don't know. I didn't really look into them. I have never had a locum appointment for training job, so I don't know. I presume that given that they are, you know, formal jobs through the training pathway, they should hold up, you know, just the same as any other job. But I don't know. So I won't even try to 13, I'm afraid, Val, No worries. I think that's everything. Um, so thanks so much for your time, Leo. Really, really appreciate it. And we'll see you this afternoon for the mock interviews Um, and Ms Markham is still, um, answering some of the questions. So if anyone has asked a question and keep an eye on the chat, But in the meantime, we'll come back in five minutes time. Thank you.