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Next up, we have, uh, Miss Chloe Roy who is a registrar, pediatric surgery. Um, hey, Gloria, are you there? Yeah, hi. Uh, are you able to share your screen at all? Fingers crossed it w last year? Can you see that? Yes, perfect. The floor is yours whenever you're ready? Thank you. So, hi, everyone. I'm Chloe. I'm one of the pediatric surgery trainees in Newcastle at the Great North Children's Hospital. Um, I appreciate this is the last talk before lunch time. So hopefully everyone can still stay awake and pay attention. I'll try to make it interesting. Um, so what is pediatric surgery? So it's one of the smallest of the surgical specialties. We treat a really wide range of conditions and that's one of the things that I think is really inviting about it. Um, it involves the general surgery of childhood. So there are a lot of the really common elective conditions that we treat, like, understanded testicles, foreskin problems. Um, lots of really, um, common things that sometimes adult surgeons will manage to. Um, but we also have a really varied emergency on call take, which can be anything from neonatal laparotomies to removing foreign bodies, trauma, everything in between and a lot of consults will also take on subspecialties alongside their uh general emergency take. Um And those subspecialties include oncology, urology, hepato, bi colorectal and thoracic. Um and pediatric surgery ranges from tiny neonates of 500 g, up to 16 year olds, adult side adolescents. So again, that gives us a really wide range of practice and a really wide range of pathologies as well in terms of training. So everyone obviously goes to their foundation training. There are some pediatric surgery rotations um within foundation posts, but also doing general surgery posts, urology and also pediatric medicine can be really useful. Um as part of your foundation training, just to start getting some experience with Children with neonates, core training. Uh there are limited pediatric surgery, the posts. So there's a few guys around the country, there's also non the posts that have pediatric surgery rotations in them. Um Again, just to get you a bit more hands on experience with pediatric surgery because it isn't something that we really cover very much at medical school. Then we go into uh training from ST three. So that's all done based on national selection and that's a six year program and you rotate within one of the consortia. So the six altogether, uh the map on the left there just shows them kind of broken down. Um So we've got Scotland, the north which goes from Newcastle down to Leicester, Manchester Liverpool, Birmingham, Bristol Cardiff Southeast, which includes a huge area including all of the London Hospitals and then Northern Ireland as well, which has got Belfast. And that gives us 24 centers overall that have a specialist pediatric surgeons in them that um offer training positions. And more commonly now, people are going on to do fellowship when they finish their training. So there are some UK fellowships but people are often also going abroad um and doing a Subspecialty with that fellowship, if that's what they want to do. So, in terms of exams, we've got a MRC S. Um obviously everyone, everyone needs to do that and that's before you apply for ST and then we do our Fr CS er, when we get to ST seven. So you have to have been signed off um with your A C PST six to be able to sit that, er, part one is an M CQ and then part two is a VR um session. So national selection, like I say, that goes from ST three, we previously did have a couple of years of run through as a pilot. So people starting from ST one but that, that was uh stops after a couple of years. Um Each year there's usually between 10 and 15 posts. Last year, there was actually a few more than that. Um but the competition ratio last year was uh 4.1 and it's usually relatively high, um goes through oral as with everything else and the first part of it is doing your self assessment and then your self assessment gets you a score, which hopefully gets you into interview. Um, when you've done those two components, you get to rank all of the posts that are available in the UK at the time. Um Importantly, there's not always posts everywhere and, er, with the slightly strange way that the system sometimes works, sometimes posts will come up in consortia later on in the process when there weren't any there in, er, in the beginning. So it is a bit of a, of a long game to play. Um, your interview and your self assessment, give you your final score and that's ultimately what gives you your ranking, uh, which determines, er, kind of w where, whether you get a job and which job you might get. So, just for some context, um, I'll tell you what I've ended up doing to get to where I am now, particularly to show that it isn't always a linear route. Um, there are lots of options and there's things you can do if you're not quite getting exactly where you want to be. So I decided quite early on that. I wanted to do pediatric surgery and I did do a, a themed foundation training job that had some pediatric surgery in it and that was in Edinburgh. I did some other general surgery and a bit of A&E as well with the idea that it's just good to get all of that general experience. I then went off to Australia to Perth for a year. Worked in A&E didn't actually do any surgery that year but had always planned to apply for core training to a pediatric surgery themed post while I was out there and I came back and did a pediatric surgery at core training in Newcastle. So that was um with some pediatric surgery and adult urology and CT one and then solely pediatric surgery and CT two. I then applied for an ST three number that year. I didn't get a number. So I stayed in Newcastle and trust grade clinical fellow, Ros, a registrar and I applied again for a number that year, but again, didn't get a number. And one of the things that people will have already mentioned for other specialties is that as you do more of your specialty before registrar training, you start to lose points on your um self assessment going forward. So I actually ended up doing some neonatal intensive care and pediatric intensive care um time. And then I applied and finally, um got my number in Edinburgh, which was my top choice that year. So I was really happy with that. Um And I've actually ended up doing deary transfer this year to come to Newcastle. Um So as you can see, it's not all linear, you don't get exactly where you want to be straight away necessarily Um, and in pediatric surgery, it's actually very uncommon to get a number first try given that there's so few of them. Um, and just to highlight, I suppose, obviously throughout all of this, when you're going through the motions of going from job to job and trying to progress through that, um, we've got to focus on all of the boxes. We've got to take in all of the experience that we need to get aside from our clinical experience. So keeping going with the audits, trying to get some publications, getting involved in projects and doing the important courses like ATLS, APLS um and other skills courses. So in terms of national selection, I think the main tip that I will give everyone is to look at the self assessment early because this, if you look at it as early as possible, then you know exactly what you're aiming for. In terms of the boxes, you need to take the experience that's gonna help you and that can just make sure you can plan ahead for that. So um it's really easy to find this online as a quick Google. But there's essentially 13 areas where you can gain some points, gaining points, you can get um points for doing general surgery out general surgery, neonatal unit, experienced pediatric intensive care. It's not a lot of points, but I think every point counts because that could be the difference between you being appointed and you not getting a job at all. Um, if you do more than 29 months of pediatric surgery after fy, then that does start to lose your points. So, as I said, that's why I ended up doing some neonatal unit, um, work and some pediatric intensive care unit work. So it's just important to think about those things and again, courses, um AP S ATL S publications for your first author, first author presentations, quality improvement, teaching and having higher qualifications of some sort that also gains you some points too as I'm sure it does with all other specialties. Um, but just important to be thinking about these things early on and then your logbooks. So the main thing from that, that, that, um, can help you is appendicectomy and you doing them as the primary surgeon. So surgeon trainer, scrubbed or uns, I think it's important to consider where you'd be happy to work. Um, and how much location actually matters to you because as I said, each year, you're not guaranteed that there will be a job in the place that you want to be. Um, so if you can be flexible and want to be flexible, then great. But if you don't think you can be flexible, then that's fine. It just means that you might have to wait a year or try again or any of those things. And it's just important to think about that early on to and how much that actually matters to you um that is the link to doing the um to the self assessment. But as I say, you can find it very easily online from Quick Google. So what is life as a pediatric surgeon? And what do we actually do on a day to day basis? So pediatric surgery is a tertiary specialty. So, consultants coming out of training will generally work in a tertiary center. Um Often they'll also do some outreach to dis district general hospitals. Most consultants um will do the on call is split between the week and the weekend. That's obviously variable between centers. But that's pretty standard from the centers that I've worked in. The ones I've seen and they'll do their, their general on call, but they'll also have their special specialty interests within their elective work. So they're doing their um some, some general general surgery of childhood cases and seeing some general surgery of childhood in the clinics, but they're also doing their specialist interests alongside that too. Um And P surgery, another thing that I think is really um invite you about is that there was a lot of MDT involvement. So we work really closely with pediatricians with other surgical specialties in their pediatric capacity, neonatal intensivist, pediatric intensivist dieticians, physios, there's a whole huge team that um we work closely with and I think that's um actually a really nice part of the job. Um So I thought I would just show you a bit of what I, my week usually looks like. So this is a week when I was, um, doing some on calls. In my sense, we do a 24 hour on call once or twice a week um alongside doing some elective activity. Uh So what do I do in an on call? One of these days we were doing some central lines. So, uh pediatric surgeons will generally um cover central lines uh in most centers in the UK. Um We also the closure of gastroschisis. So that's quite an interesting and it's very, very pediatric surgery operation to be doing. Um And alongside that, we are reviewing patients from the ICU. We're dealing with gastrostomies, we're dealing with catheters. Um I had, we needed to dilate someone's a baby's neo anus. So that's a following operation for an an rectum malformation. And then we, we see a lot of abdominal pain loss and testicular pain on a very regular basis. Um My Wednesday on calls, we had a patient with upper gi bleeding who needs an emergency endoscopy. We did that alongside the gastroenterologist and we had a neonate with a perforation. So we needed to take him for a laparotomy uh appendicectomy. We do lots and lots of those and other closure of gastrosis, which although it's not very common in this particular, we have to do two of them. Um And again, more testicular pain, abdominal pain, we also deal with lots of urology things and we have a renal abscess as well. And on my Thursday on call, a particularly an interesting case was a laparotomy for a type four gal atresia. So that's very uncommon. And I think the only time that I had my consultant had seen that um pathology um before again, appendix is testicular pain um and dealing with complications of things on the ward. So we had a baby who'd had an esophageal atresia repair and they had an ANAs technique that we used to deal with. And then I finished my own call and was doing some extra things on Friday. So some general surgery in childhood, like I mentioned, Orex Hernias, inserting gastrostomies. Um And just to highlight obviously through your working week, you've got your day to day shifts, but you're also thinking about the admin that backs up from doing your clinical work. Any projects that you've got going on starting to revise for exams reluctantly, um, and keep you on top of your portfolio. Um So just a few little quick photos. Um If anyone hasn't seen anything to do with gastroschisis before, uh gastroschisis is one of the two conditions where a baby's born with the bowel outside of their abdomen. Um Sometimes we try and get it back in uh as a primary closure when the baby's about a day old, but sometimes that doesn't work. So we have to essentially put on this what's called a silo and we gradually reduce the bowel into the abdomen and then close it. Um And this is just a diagram of church atresias, which um I think is quite interesting. So you can see type four down there. Uh lots of little sausages of bowel stuck on a fibrous string. And this baby that I was mentioning actually had a meter of bowel that was just little sausages that we needed to resect. So my consultant, what does a week for my consultant that like this is just my supervisor. Um One of his weeks. Um So again, doing some general surgery of childhood, uh very routine cases that we'd often do doing outreach in the district General Hospital on the Tuesday. Um We have departmental meetings and uh academic meetings on a Wednesday and then on Thursday, he was in theater for a day. So one of his subspecialisation is colorectal. So he was doing an anoplasty on a baby with an anal rectal malformation, essentially forming a neo anus for them rectal biopsies. So we do those to exclude Hirsch's disease and then some more routine general surgery of childhood things. So PPV, ligation for hydrocele, a laparoscopic first stage orchidopexy for an intraabdominal testis. And then he had three days on call the weekend. So lots of variety here. Uh common things, appendicitis, scrotal expirations for testicular torsion, but also some more uh pediatric surgery, bread and butter. So stoma formations, um trauma laparotomies for a child who was in an RTA laparotomy for an incarcerated inguinal hernia and a baby. So there's lots of variation there um for us, again, slightly odd photo, but this is just a representation of a baby without bottom. So b or imperfect anus, which is something that we see quite often. And there's lots of variations of vena rectum malformations. And this picture is showing you an intraabdominal testicle. So you can see the testicle there and that's the deep brain uh just at the top of the picture. So there is opportunity for academic activity and work as a pediatric surgeon. Given that it's such a small specialty. Multicenter collaboration is really important. And so there is quite a lot of that going on. Um p research in pediatrics in general is quite difficult from an ethical point of view so that it does put some limitations on it and it's difficult to get good big studies in pediatric surgery. But we do, we do try to and there's plenty of opportunity for involvement with those kinds of things. Our, our um surgical specialty association is Ba Ps British Association of Ped Surgeons. And we've also got special interest groups for urology, upper gi colorectal um and oncology. So where is uh pediatric surgery going? So as I said, it's um it's a small specialty, but we also have a number of a small number of centers doing rare operations. So there's been an ongoing debate about whether some of this should be centralized and we should have fewer consultants doing these rare operations. Um In terms of innovation, we are a little bit behind adult practice in terms of minimally invasive surgery. So there's a couple of centers in the UK who now have a robot and are doing some robotic urology. Um And that's all still uh progressing. And we're using more fluorescence guided um uh techniques at the moment, particularly for oncology and hepat. And interestingly, some of the team in London are doing tissue engineering uh to produce esophageal replacements. So for babies with um esophageal atresia where we can't actually get the esophagus back together. Um and having a tissue engineered esophagus uh for them instead. So that's some really interesting work that's going on. Um So how can you prepare if, if this is, if this is what you're, what you're wanting to do? I think my first question for everybody would be make sure it's what it's the right specialty for you. Um There's loads of options in surgery and you may not have had experience with all the specialties. It's very difficult to have done that, so speak to the registrars and consultants um around you. Um People are always very keen to talk about their own specialty, uh get involved in your local department. So it's a small specialty. I have worked with consultants um as a registrar who I met as a medical student when they were, when they were a registrar. So it's a small world um, chat to people, get involved with projects, try to get to theater, get some real experience with it, um and get involved with society. So I'm one of the trips representatives, trainees in pediatric surgery. Um, and we are running a course at a, um, at the conference in March in Belfast. So please sign up. We'll be doing some interesting practical skills and we'll also be talking more about p surgery as a career. Um And then ba um is, as I say, our, our specialty association, they've got loads of useful stuff on their website about training about um courses, um and everything to do with that. And then as you're progressing through your jobs, uh try to get some experience. So even if that's not necessarily uh p surgery jobs, um try to get jobs that could be um good contributors to that. So an adult general surgery experience is really useful because it gets you that hand on operating experience. Um getting to grips to pediatric is also really useful and then getting some neonatal or pediatric intensive care experience as well is extremely appetible to ped surgery too. Um, like I said, look at the person's specification and look at the self assessment early on so that you can plan and, and work out what you, what you need to do, how, how you're going to spend your time. Um I think it's really important not to say yes to too many things take on too much stuff and then realize that you've not actually ticked the boxes you needed to take or gain the experience you wanted. Um But think about audits, quality improvement, um getting involved with the with projects and then going on the courses that will be helpful for you. So, um APLS is one of the requirements for us as registrars, but it's also helpful for the applications, basic surgical skills and there's also um a basic skills in pediatric surgery course that the Royal College of Sessions of Edinburgh run um biannually. So that's also a really good one to get involved with. Um And as I said, it's, it's not necessarily uh linear progression and if it's really what you want to do, then commit to it. Um and keep going. Uh Thanks for listening. I'd be happy to take any questions. Thank you so much for presenting Chloe. I really appreciate you taking the time to come today and I can definitely empathize with you. I don't know that if it's definitely something you want, you've just got to keep going for it. You've got one life at the end of the day, don't fall sure if it's really something that you want. Not everyone gets things first time around, second time, around third time round however many attempts it takes is what you wanna do and you're passionate about it.