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Welcome back, everyone. The next speaker on our agenda is Mr Reef Jackson, and he is a pediatric surgery trainee. He's also part of acid Council, and he represents trips, which is a trainee association for pediatric surgery. Thank you very much. Hi there, everyone. No, thanks very much for the invitation to speak today. Very excited to talk about pediatric surgery, as I'm sure all of my previous, uh, counterparts have been for their specialties. So as I was saying, I'm Rafe and the national Pediatric surgery training representative for trips but also working currently in Birmingham Children's Hospital as an ST six. So what I thought we could do for this talk is, um, firstly, have a chat about what pediatric surgery is because I know a lot of different surgical specialties will sort of Dublin have interest in in pediatrics. But pediatric surgery is a distinct specialty, but quite niche as well. So a lot of people don't know exactly what it is that we do. I'll go into why I love it and why you should love it, too. Go through a few pros and cons about specialty, and then how to get involved in the end. So, uh, first of what is a pediatric surgery? So, uh, it's the really the only surgical specialty that's defined by the age group that we treat. So, uh, we go all the way from fetal medicine and management all the way up to 16 year olds. And so this is a vast range of different conditions that we therefore look after. But I think more importantly, a vast array of, uh for example, weight range is so the smallest, uh, infantile operation was about 760 g and the largest Probably about 120 or so, um, and a fast range of congenital versus acquired conditions as well. I heard it best described by a general surgeon who called it the last bastion of truly general surgery. And that's because whilst we look after patients in that age range, there are a variety of different what would traditionally be called different specialties or subspecialties within, for example, general thoracic surgery in adults, which we would look after. So, um, whilst I suppose everyone would think that we potentially operate in the in the abdomen and pelvis, we also do a lot of urology transplant work. Gynecology comes under our remit as well. Um, vascular surgery for those rare instances where we have to get involved with those thoracic as well. A big sub specialty with in pediatrics. Um, and, of course, in the naval and fetal surgery, some of the interesting conditions that we come across this is by no means exhaustive. Of course. Uh, put on the upper left hand side a baby who's born with his bowels on the outside of his body condition called gastric isis. Um, just the right of that. A baby born without a bottom without an anus, Uh, group of conditions called interictal malformations. Um, bottom left is a picture of very fairly common pediatric condition called Chelorex stenosis. You may have. You may remember that from your medical school exams is a favorite question regarding the, you know, the metabolic complications. But that's what the operation looks like. And we do also rarely sometimes treat conjoined twins. Um, and so all of this and more is under the kind of ream it of pediatric surgeons. So why then? I think, um, when I ask colleagues and when I think myself about the reasons why pediatric surgery um, obviously a lot of people will talk about kind of generic surgical type things. So, you know, if your surgeon you're likely a person who likes working with their hands, uh, perhaps using used to fast results and that kind of combination of diagnostic and practical elements that's generic for any surgical, especially that holds true with pediatrics. But the specific things with pediatric surgery that I hear most often are unique to specialty. In a way, UM is number one, the variety, the communication skills and the communication challenges that we come across and the pediatric environment. So the the hospitals themselves and the awards themselves, the environment that we operate in so go into more detail than a variety. I've already touched on this briefly, already fast array of different conditions that we treat things that, prior to doing pediatric surgery I had never heard of and didn't think possible. This is just a photo of my log book, and this is just taking a random moment when I was preparing the slides and I just wanted to highlight the variety that you come across on a just a random set of weeks that displayed on here So, for example, uh, here, we've got, uh, so vascular access. Big part of what we do. A thoracoscopic surgery, Gastric isis that condition with, you know, the baby with the bowels on the outside. It's more vascular access and appendix circumcision, Another thoracoscopic procedure apiece aren't so a procedure where you create a new anus for a baby. So really operating in all parts of the body and all different sizes and ages, Uh, and for a variety of different conditions, So incredibly challenging along with that becomes really challenging diagnostics to decide which operation is best. So communication. So I think initially, this can be a little bit daunting. And maybe you might be surprised to see communication here as one of the big sort of positives of pediatric surgery. Uh, but I think it is amazing challenge and a real privilege to be in a position where we're having to find the words and the, uh the kind of, uh, drive and to convince particularly, um, Children and parents, that they need an operation and that you are the correct person to do that procedure. So you can imagine if you're a parent yourself, uh, with the weight of the responsibility of giving your child to a stranger essentially to perform an invasive procedure. But if you're not a parent, imagine you have you know, your most precious object. Whatever that may be, may be a car or, I don't know, computer. Whatever a dog. Okay, so imagine. Multiply that by 1000 million, and then you kind of have an inkling of what it's like to have a child that you you have brought into the world yourself and then imagine, particularly at the start of that journey. If your new parent or or you just have had this baby, your then told that not only does the child have a horrible diagnosis, but that an operation is needed something horrible and invasive. And so that's the challenge that we have to convince these parents, who obviously come from their own backgrounds, their own socio economic situation and will each have a different relationship with themselves, with the Children with the word stuff, all of the all of that. And I hope I'm not putting you off. But it is a wonderful challenge to be in that position and have to find the right words to convince the specific parents or patients that are in front of you So pediatric environment. So going into hospital if you've had a pediatric placement you will know is uh, so much fun. Pediatric Hospital's are made to be welcoming. Place is to be fun places. And, uh, particularly the, uh, separate pediatric hospital's like Birmingham or a lot of centers have separate kind of physical buildings. They're designed from the start to be welcoming two Children. And so some of the things that we have, which you wouldn't see an adult hospitals include llamas. So that was taken a couple of weeks ago. And we also have a couple of golden retrievers that that like to come around and show the kids up. We often around Christmas time, get visits from Santa Claus. I've had R two D two and our Vader as well. The middle photo is Aston Villa visiting our ward. Uh, so football teams love to come When I was in Manchester is phenomenal because Manchester City I'm actually united, would come on different days and kind of out compute each other as to how much how much presence they could give on the far right is a cartoon that was done around over time just to explain to the Children that would be wearing these gowns and things. But we're all there to to kind of help them and protect them. And so everything is made and that kind of when it's it's just a fun environment being. And it kind of translates to how you behave and how your colleagues behave not only to the Children but to each other. Another note on the pediatric environment I have to say I've had very good experience is with with adult nurses. But pediatric nurses are incredible, so they're they're really good. They're really on it. They're really dedicated. I think it's quite competitive from the nursing and an allied health care point of view to get jobs in pediatric hospital's. And because of that competition, they tend to be really dedicated. Um, and as I say, you know, certainly not say that adult nurses aren't, But in my experience, it's just one step above. So going through the pros and cons, then so you know this is my opinion, and people will maybe think differently of some of these things. But, um, in terms of pros I've put it's, um, really interesting, varied cases. Uh, there's a really high emergency and semi emergent caseload. So up to a half of the cases that we do our our class as such, it's really challenging, diagnostically and communications. We've discussed the communications, but diagnostics wise, you know, it's not quite like, um, I don't know, you know, insult any specialties. But it's not quite like general surgery where you can just ct everyone. You really have to have a lot of clinical acumen, really. Listen to the story and think of different investigations that don't give you a straightforward answer. Uh, you know, a lot of X rays. A lot of contrast studies, um, to come to a diagnosis. We've already touched on Children's hospital environment, But remember that these hospitals are also big hospitals. They're big centers. So tertiary, quadrennial level care. Uh and so I did all of my training in big hospitals, and I suppose that's the environment I'm used to, and I really enjoyed, but not for you. If you're a d G H type of type of person, high quality nursing staff, we've discussed really high percentage of female trainees. I think We're the second best, um, in terms of gender parity. And that's really important. Clearly not only if you're a female, but if your male as well it just makes it a lot more accessible to be able to do things like L T F T. And it's a small specialty. Everyone knows everyone. And so if you're good and you get your name out there and you declare yourself as interested in pediatric surgery soon enough, people will be talking about you and thinking about where you fit in the service terms of the cons. So it is demanding because it's quite senior lead. Even as a registrar, you will be in hospital during your own cause, perhaps doing things that in other specialties s H O s would be doing. There are some challenging social situations. Uh, it is quite competitive, and our training is organized into consortia rather than sceneries. So we don't have dinner based training. And what that means is practically for most people. Once you get your registrar number, uh, you will need to move okay. And to talk a little bit more about that. Are training is like this, so most people will be will be aware of that. I think there's a few run through posts available normally associated with an academic posting, but very few most people will go through this route where you have themed CST posts in most Dean Aries. Uh, and then ST training. Uh, S T three s, t eight is usually organized into these consortia, which are groups of the MRIs. So I'm in Birmingham Bristol card. If BBC as it's affectionately known, the London Diarrhea. The London Consortia, as you can see, is absolutely massive and so you can be placed in London, Uh, knowledge. Cambridge, Oxford, Southampton, Brighton. The Northern dietary equally is really big, including Newcastle now as well that they changed the legions. Manchester, Liverpool is another degree in Edinburgh. Glasgow is the is the other one. And, of course, our Irish colleagues across the sea. Most people would then after there s t eight, go on to do some specialty fellowships. Uh, and those lasts between one and two years. So how to get involved? This is a tricky slide to to write about because it really depends on your individual circumstances. Um, first off, if you are interested, the first thing you should definitely do is sign up to the trips mailing list. So you just email that email and usually me or one of my two colleagues will pick it up and we'll add you to our mailing list is mostly aimed at ST sort of level to the number of trainees. That s t level. But you're more than welcome to come. And you know, the more you're in the world, the more you hear about opportunities, the more your name gets out there. Okay, the first step, if you haven't, if you're interested. But you haven't already had a kind of an idea is identify your closest department and go there for taster days. Observer ships staff great positions. If you're thinking of F threes and research projects as soon as you crack the barrier and as soon as you get that first research project and present it, people start to know your name. It's such a small specialty that, you know, we're always looking for keen. People are always looking for good people. Okay, so that's my talk, Really. I've left the email upon their happy to to take any questions. I can't see any questions up on the chart. I think we're Let's see. Yeah. Blow. Never. In a way, I think with with the brilliance of pediatric surgery. Thank you very much, Ray, for that really informative talk, I'm sure are delegates will get in touch with you even now or via the trips email. I think we've got a question. Oh, yeah? Is it disadvantageous to not get a pediatric surgery theme? CT post? Um, so there are at S t level. You do get more points if you have had a year of pediatric surgery at that kind of CT level. So in that sense, and it is a competitive application. So in that sense, yes. But, um, you know, there's a degree of, uh, depending on your dinner, you can sometimes change jobs and and get that even if it's not technically a theme to pediatric surgery post, I would say, uh, in general, Yes, but it's not so disadvantageous that you can't progress to S c three if you don't get a theme to post uh, some info about run through p surgery programs. So the best of my knowledge, there's one that's offered in Southampton. But that's an academic post. And that's a separate interview with, uh, there's a consultant there, Nigel Hall, who's really, uh, involved in research. Uh, and so there is a run through program there. There was talk about introducing more, but the best of my knowledge that hasn't come through yet. Great stuff, Rafe. Thank you again, and it was good to see you.