Pathway to Paediatric surgery training in the UK



This teaching session explores the pathway to pediatric surgery training in the U.K. It is relevant for medical professionals and will discuss the accessible process of training, the scope of practice, and some of the considerations to make when deciding to pursue a career in pediatric surgery. Mr Kringle, a UK-trained pediatric surgeon, will talk about his own 8-year journey and offer tips for a successful career. There will also be an opportunity to ask questions at the end of the session.
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Teaching session on pathway to Paediatric surgery training in the UK.

Learning objectives

Learning objectives: 1. Understand the training pathway for pediatric surgery in the U.K. 2. Learn about the scope of practice for pediatric surgeons on the U.K. 3. Recognize benefits of the U.K. training system compared to other systems, including processes to ensure fairness and safeguards against harassment. 4. Appreciate the range of surgeries done by pediatric surgeons. 5. Acquire knowledge on the process of applying for higher surgical training.
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Computer generated transcript

The following transcript was generated automatically from the content and has not been checked or corrected manually.

Good evening, everyone. Good evening. Any everyone? Can anyone hear me? Okay. Thank you, Lewis. Good evening, everyone. Welcome to this section on this teaching session on the pathway to pediatric surgery training in the U. K. Um, Mr Kringle would be taking us through this, um, lecture today and then I'll be handing over to him shortly. Thank you, buddy. Me? Thank you, everyone, for joining. We should be starting in a minute or two. And just before we start, I'd like to say, if you have any comments or questions, Uh, just so we don't interrupt the flow of the tea, just, um, type it into the chat box, and then we'll take all questions and comments at the end of this session. Thank you very much. Uh, it's like being a physical. Take over now. And thank you so much for agreeing to do this. Thank you so much. All right. Good evening. Good evening. How are you doing? I'm fine, thank you. Babe. You can hear me. Okay. Yeah. Yes, we can. OK. Loud. Okay. Green. I'm a bit new to middle. Um, if I'm share ing my screen, what should I You? Yeah, I can I can see you present now. Yes, I think it gives you an option to share skin. Yes. And it gives an option to share your slides, I think. Okay, Jesse. So I think there's an option free. And after that, the radiation to share is from this place. Yeah. I should go with chest slides. Yeah, brain, is that correct? So it says chef screen first. I think after sharing your screen, then you can share slight. Yes. Gotcha. Gotcha. Gotcha. Fine. Let me let me know when you want me to. I think I've done a bit of practice. Okay. All right. Please, go ahead. You can start whenever you're ready. Please. Uh, can you guys see green then? Um, not yet. Okay. Yes, we can now. Yes. Yes, yes. So you can see pediatric surgery. Yes. You can think that. Yes. Yes, we can see it. Tell me what So good. Hello, everybody. And thank you for for having me on this platform. Such a privilege to share some thoughts to me that I hope our time together will be productive. Okay, uh, so to thank you again for doing this. Uh, so I'm just going to run through with about out properly, too. Pediatric surgery to use it. Similar journey as most a few years ago. You know you're not seeing my slides, okay? Yes. And we can hear you clearly because I can Awesome. So a little bit about me, uh, finished. Met glory. And how's the job over you, Uh, in Cassina. I've always known I wanted to do surgery. Uh, so I started to replacing Laurie. I did, uh, 14 months and I, like many people, would understand that I just got tired, and, um, I wanted to explore trading abroad, so I was so desperate. I just got out of all the money. I I just I decided October 2013, Uh, and I decided that by January 2014, I must be out of this country. Um, because I was due to write my part 1 April. So in my mind, once I write my part one I'm not I'm not staying back. I'm not leaving anymore. So So the quickest way for me then. You know, masters so signed up for masters and can storage. I didn't want to do public health. Everybody was in public out, uh, left to 2014 January. I moved to the UK, started with masters, and, uh, I'll talk about that as an option. Later on, after the Masters, I I started to route my clubs during Mask, and I started walking initially just as a non training job. In fact, I started with general medicine rather than surgery. I'll explain why later on. So I got into court such a course surgical training, which is, uh, an equivalent of junior residency. I was quite lucky. Uh, it was quite difficult at about about that time, but when I came in 2014, I did not know any single person that was in training. Indeed, I'm not saying surgery training. I mean training, I'm sure where? But I just didn't know anybody, but thankfully, thank God I crossed. Insist. Side surgery training in the UK uh, in Chef Fuge, uh, hospital. I'd always know the eye surgery. I did a year of pediatric surgery as a junior resident and then two more rotations as a core surgery in my course surgical training. Um, as I will explain later, you would have to apply for higher surgical training. Basically, you lose your job after you call surgical training. So I didn't get it the first time. So I had to apply for a D day. Non training, surgical job, pediatric surgery job. And then I got higher surgical training. Uh, I'm currently ST seven, meaning that I've got one more year in my train to become a consultant. Uh, and I walk at, uh, Children's Hospital Evelina Children's House between London. So yeah, it's been a journey. Uh, so memorized. I'm talking about eight years journey too far. Um, why Pizza? Audrey, I do like like pediatric surgery, because I think there is a fantastic I picked interest in it right from when I was in Nigeria. I did general surgery, and, you know, you know, people died from different reasons. You know, the the supportive care was terrible. So we did fantastic surgery, and we come and war drug and Mr X Y Z is dead. Why? We don't know. Great. We just carry on. Um but you see that I saw it differently in pediatric surgery. They results were great. If the child is sick, fix what's wrong in it with them, and then they're ready to go. So even tumors cancers are treatable. Um, most of our solid tumors are manageable, and life expectancies do that. That's good. So that was my first interest in it. And we are the only true general surgery nowadays. Uh, things have been quite divided. You get trained, I will show you my next slide it quite a very broad. Specialties I do like to be. Must be, you know, a little bit in the chest a little bit in the abdomen a little bit in a growing neurology and all that. Plus you treat from pre Tums, actually minus 0 to 18 to it in as an adult, uh, zero. So you see quite a range of cases, so one is a broad range of region. You're treating your treating quite a broad range of cases as well. Uh, and last, lastly, get a bit of life. Uh, general surgery is math easy? Uh, so I wanted to be general searcher, but I just want to sleep in my house and have a bit of a lifestyle pediatric surgeon towards me that if you think about it at 028. 17 that needs surgery. Yeah, the general surgeons or other surgeons will manage 18 to 1918 or whatever. So population wise, the amount of you have and they're giving. Population is about 1/5 of the whole population, and then the amount of sick Children even smaller. So, um, it's not too busy. It's busy enough to get you going as a surgeon that but it's not too busy to to To to mean you just, you know, around the clock in the hospital. Is everybody still hearing me? Can you still see my slides? Yes, we can. We can. We can see the slides and we can calculate it. Brilliant. Thank you. So And this is the cope of practice of a pediatric surgeon in the UK. This is one of the things that interest me in the UK as well as the Nigeria in, In, in, in, in other other other developed countries. I know we do. We do a bit of head and neck. We do target Celsius lumps. We do lymph node biopsies. You're trained in thoracic six. Um, so I do long receptions throughout disease Fabio, surgery. We don't do cardiac. Uh, you do thoracic everything. The abdomen is us bow solid organ, part a biliary. Um, two months. Whatever you can think about it, you're trained in urology as well. Um, so kidneys your Etta's, uh, post Papadias. Uh, it's also part of our, uh, our scope of practice. We are the pediatric gynaecologist as well. So, you know, variances. We manage variant or version? Um, we don't We don't do obstetric. So it's a 15 year would get in and has such good complications of their pregnancy. It's not in the scope. And in general surgery, lump bombs scheme. Uh, and in vascular, so we do with big vest use. So, uh, vascular assets access lines is all in the school of school for, um, So this is one of the re This is my This is I I do like to be broad. I do like to be true. Pained in quite a wide range of specialties, right? And moving into the UK specifically, I imagine a lot of you are either just be in the UK or planning to get into U K uh, early career at early stages of your career. Imagine the good thing about the UK actives and pathway and training is that it is very recognized in the world. Um the only place you can't walk as a UK trained doctor or surgery that is satisfied is America. And so the only way place you can walk without writing an exam. Uh, it's in America and vice of, uh, Americans to kind of walk here without writing eggs. And I guess it's just a beef between Americans and, uh, returns. But everywhere else you can just walk in, apply for a job and say I trained as a pediatric surgeon and you and you can get into theater next day. So it is quite recognize what? Well, and it's robust. I mean, the trainee is you know, I did a bit of residents in Nigeria, and you just fun things, you know, Uh, how do you switch or you You just start. How do you learn to do? Laborious Could be just start and things that doesn't come. You know, things that don't come into your falling into your path. You don't you know you don't you don't know them, but it is quite structured. Everything is broken down to curriculum and in stages one after the other. You you know, there is a lab where you are taught basic things like securing the lab where you're taught in, how does laproscopy work? And it is quite robust. You, you they really you're grounded. You're not just somebody that can cut. And so you saw somebody quite granted in research and grounded in organization there, so, uh, put away accessible in the sense that it's it's fair. That's the right word I want to use compared to other systems. A lot of my colleagues that candida, um, up onto the last year or so, I've just not been able to get into anything. Um, even family medicine, that is, people are struggle because they just blocking out these African aid Ian's. These are for non Canadians. Um, but you would do some work, but it's accessible. You can get it. You can. It is fair. Um, I saw a paper recently about, uh, surgical residents in America and how they've been bullied and how they've been harassed, and they can't say much about it. Um, of course there is some. But there are a lot of safeguarding mechanisms to protect you. Um uh, racism in America is sometimes in some places, can be black and white, you know, like, really full on. I didn't say I'm not saying there is no racism in UK, but at least it's a bit certain, and, uh, there are sort of mechanisms that protected. So that's what I mean by accessible. You can get to anything you want to do, and the last thing I put there is training on training. Fact that you can. You can walk in UK as a non training doctor so you can come in and start walking and start working as a surgeon or whatever without having a training post on, like in America, where every doctor is either important or a resident. So it means you have too much. And I think that creates a transition, you know, for us, um, also creates multiple entry levels anybody that is going to America with no matter how many years you've had an experience experience, you've got, if you getting it from, um, Year one intern, even if you've been a consultant in somewhere for years. But some of those experiences can be caught can be accounted for in the UK pathway, and you can even Hunter and at a higher level some somebody says, Well, the cons about it is this long system, the from graduate from day one that you graduate to when you become a consultant, all being equal if you if you don't miss any step, if you get everything on time, it's a 10 year training. Um, from, uh, F. I want to become a consultant to become a surgeon. There are some other specialties are less, um, but it's not so in. It's it's shorter in in, uh, in other other other countries. There's a lot of people work as I will talk about, and it's not run through. What do I mean by that? At every different gaps you have to apply and re apply for the job. So if you finish intense, apply for residence. The junior residents finish course of your training, which is also junior residency. You have to apply for hire special history. Uh, and those John's could take you some time to get to cross over. Uh, so that's what I mean by that. Are we still altogether? Everybody's still following me because all I can see is only my screen, so I just want to be sure you guys are if I really I think I don't leave my immediate, Uh, sorry. Okay. What? We see the Kanye. It's really good. Really. I just want to do That's fine. Um, I just want to give you an idea of the surgical training structure, and you give any of you might have come across this and, um, you finished medical training medic school, and you go into what we call foundation, which is quite broad. Uh, it is the equivalent of our internship, Uh, so used to do medicine PD. I find it now, So if you want to do surgery, you don't have it. Can streamline your help. Job sort of rotation. It's two years so that you, uh, what we call cold training the equivalence of junior. Um, so this is also where what they call S h. O. Uh, so it's a national application. We apply. It's two years now, if you have an idea of what you want to do, if, for example, you want to do pediatric surgery, they will make sure you it will try and get you a year's water political training and then do two more reputation. So added one year of Patrik surgery six months adult generals or you have six months of adult urology, but that was so we're going to more unlikely Nigeria where you do everything for 33 months. And if that two years, you're most two years past your m r. C s. Which is the quick story, which is the villa token. Now, apply a specialty training, uh, which you announced that the They're in the knee. Uh, S t three. And this is, uh so that we Did you see Yes, which is equivalent part, too. And then after that, you get a certificate of completion of training, too, and then you appropriate consultant. So basically, this is how they work. There is, uh, an alternative party where you can rather good rather than good. Three four miles in. You can go through from beat gathering. You're competent. A little bit of what spec particular about pediatric surgery. Um, there are only 20 Venter's in the whole of UK, UK and mean England, Scotland, Wales, and Northern Ireland that do pediatric surgery. So it's a very regionalized, um, system, for example. Um, I know a lot of your Nigerians. It's not every state, for example, that will have a pediatric surgery center. Uh So, for example, you know, out West might only be covered by center in Ibadan and in center in Lagos and every other person any other towns will have to transport. Now, the general surgeons there would do a little bit, but anything that needs more specialist center would transport. So it is a small community. There are only about 250 pediatric surgeons in the whole of the UK, so it's a it's a it's a small nish. And the map there shows you, um uh, the, uh, the the the distribution of the centers. Um, so I book I'm just in centers soon. There are seven centers, So actually under one quarter or 1/5 of all the, uh, all the PD address or do work. Um, what does that mean? What that means is that they need less people. You know, it's not even on like, um, get the surgery out a general. So your orthopedic where, uh, every general I do need one. Every general surgeon needs a video saw a drain, so it's largely, uh, fishery centers. And there is to enter into ST three. That's the highest training. It's sometimes wanting a petition. Basically, there are 60 applicants, six jobs. It's a national application, and everybody will be around or 60 applicants. Only 10 jobs they're about. When I got in, there were only 10 jobs. Um, um, so it means the application is a bit stiffer to put it in context. Uh, nationally, they are 130 jobs for orthopedics. About 120 jobs for general surgery. And we're talking about just six or seven for pediatric cetera. So that's where the challenge comes in. But it is doable. Uh, anything is possible. We talk about that, uh, the consultant. So each of these centers, we call it consult. Just so you Scotland and covers one consult from Scotland has Glasgow. And so everybody, for example, but in, uh, in Venice or Aberdeen will have to be referred. Dave, they need Pridie, especially video surgery. Seven. As as the, uh, the trick any, uh, you have to, uh, let me Can you all see? You see, you know, are you able to see my custom movie? You can Yes, Brilliant. I can't. I'm only be seeing my school. Uh, the charts, actually. Maybe I can see if I can. Uh uh uh uh Oh, yeah. I'm not sure, but my, um yeah, it uses that advanced. Okay, so I'm back to my screen and Michael down. Sorry. Me. Okay, so I was talking about Consultant, for example, this is one region, so you can start your London south and East Oxford. Uh, let me look small, but in reality, you have to move in. Sorry, Um, was a year in Lagos and in those another year in, um uh, probably I would say more realistically a lot, Um, and then back to, uh, sort of such geographical distributions. Um, so it's quite wide regional. You might have to move either. You commute to families, right? I think this is what most of you guys are getting. How do you get into it? What's your what's What's your pathway? I just want to start by emphasizing that nothing is impossible. Um, when I came into the country, uh, eight years ago, when you tell somebody I want to do surgery, they say, forget it. It's not for foreigners. Uh, that's untrue. That's a lie. And, uh, have been broken down. Uh, it will mean to take some work, you know, just it's gonna walk in, and then somebody knocks in your give you a training number book. But it is possible, and that's the first thing. And if it's if if you if you don't get anything from this talk, just take that in nickel, I want to do it. It's possible, no matter. Specialty. Um, estrogen is one of the most competitive specialties. Surgery is the most competitive specialty to get to and Peter in, in, in, in in surgery Pts surgery rank seconds. The neurosurgery is the most competitive, and the surgery next characteristic is about a power as Peter surgery. But it's possible, Um, you just need to instruct you to know what are the advantages available? What are the pain to resource? Every well, now there is information everybody knows or has a friend that is a broader in Sorry, that is in UK that is in training. So it is much easier now, unlike it was years ago. Um, when, uh, like I said when I came in, uh, I know knew anybody not even doing GP uh, everybody I knew it just was just walking in a non training job And unfortunately, there was this, too, Uh, self fulfilling, professing so you can't get in. We're not even trying anymore. But now there is information, you know, In fact, some of have more information than I do because I'm not trying to get in the UK and so I'm I'm not really researching your things. And the second big and vibe visa before they used to call it a two. They work permit visa. They fuck him in or up to three years ago. Um, before they give any non UK doctor a training post, they must have made sure that there is no qualified UK or use a person that can feel that post. So basically, we only get leftovers. Um, so for, let me put it in context for junior residency. Core training application in In surgery, there are about 600 jobs. I mean, the whole of surgery. Um uh, all specialties. And they're about 800 applicants. I mean, UK trained applicants so or people is more than the number of jobs. So there is no chance on the converse in, For example, in general medicine, if you want to do Internet medicine, there are about 1200 jobs, and there are 1000 applicants. So there's 200 slots that foreigners can complete with four. Um, but in surgery it was almost. There's nothing left, but this is change now. There's this new health and care visa here to welcome it. It means you can apply just like any UK train doctor for training. When you be you be considered. And I think that's the biggest news. There's, You know, there's no more with onto leftovers until there is a rare chance of them. So I think that that is an encouragement to you, and it's you guys and that that makes it more accessible. Um, once you you come into as, uh, as any doctor. So you there's no limitation. Like I said, he needs hard to hard work. How do you get in? The first thing is to get a G m C. Registration, and and there are a few ways to do it Club. Probably the most common communist route. I'm sure many of you are wealth, the club exams and how to get to bed. But the other way is especially for those that have had a few X few years of experience in surgery, and you're sure you want to do surgery? Is MRCS Just write the MRCS exam. Um, and you get a JMC registration to practice surgery. Vince's for lab. You can practice anything. You know, you can do certain DRI medicine, Pedes GP. But MRC is, uh is streamlined, uh, sort of, uh, registration. And, you know, for those of you they're quite, uh, convinced that you want to do surgery. You can do for that, but I think it would make sense if you're in residency or have you just finished it training country? Uh, and I will, because if you won't do surgery, you will need to write that club MRCs. Anyways, So to progress into ST three, you must right MRCs. You must have passed MRCS. So, um, it might not be be a bad idea to just write it and use that to get your registration, and then you start to get a job. M t e. I is another way. Basically, it's medical training. So a hospital or a college would sponsor your visa your your your register in from the g m c um, for night for western Nigeria, you must have a West Africa College of Surgeons. So part two, before you can sponsor you, I would not any certain PT yesterday. I would not. We be, uh, throughout that that come through m t r intermediate e surgery there might have been, But I've seen more in, uh, with orthopedics and general treaty larger specialties. So because why to get em. So if you have a f f works, for example, the hospital to agree to employ you and with that you go to GMC and say the hospital wants to take me and give me the registration. And unfortunately, when you meet hospitals, do you say no? You get it, get the registration force, then we employ you. So it's quite tricky. Um uh, would, uh, it's not a It works well for pediatricians and the physicians in medicine psychiatry, because there is a lot of shortage. Uh, they need a lot more people there, so hospitals are quite keen, but in surgeries a bit tricky. Um, it's okay to show. And I think the next thing is to get in to get a job and get into the country. Um, that's the benefit of the UK part where you can just apply, um, uh, from your from your room and get interviewed and get a job. So I would strongly recommend trying to get into an NHS job. And if you want to do pediatric surgery, get any surgical job. General Surgeon Pa. Said, you just be broad. Can't get any subject jobs and get into the country. It's until you get into the country. That's something that counting for you. So, um, I wouldn't be so fast about Oh, it has to be Pete surgery. You know, just get any surgical job. And once you have a decision just going to NHS jobs and betraying in applications and between the applications and apply, uh, so I think get into the country first gets a better chance. It's unlike G p from neural practice. You can be in your room from Nigeria, plan and get into general practice training because we're talking about 3000 applications. Uh, sorry slots per year. But for core training or for surgery, higher specialty training is a bit tricky. Um, the numbers are not great, and you will need something that you can only get in the UK by walking in UK to score high and rank I to get a job. So my my advice would just get a job, get get, get a job, get into the country. Uh, any job, pediatrics, Any whatever. Would I just think for 10 years, which is, like the private sector quite keenly sponsor you quite well, get in quickly. Um, that's an option. If you're struggling to get an NHS job now, get into the country. I think it's old school to spend a little money coming to do masters. I went through a eight years ago because the information available now wasn't there, but it wasn't wasn't there back then? Um, it's a lot of money. Uh, 15, 10 to 15,000 lbs. Plus, you're going to spend a year, uh, walking in odd jobs because, uh, it's until you start working as a doctor before you get any pay, that's reasonable. I came to the country and I I had to pick up odd jobs. Um, just survive. So it's a year of I would not recommend it if you that will give you scholarship full scholarship. Wow, of course. Take it. Come in, do it. Get and you can use it to, uh, you know why you're there, right? You're perhaps. But I would not. I've seen the people who just people just wanted to get into the country and signing up with masters. I think it's painful. You can if you get your registration. You can walk into a job that would support you and your family. Be comfortably, um, year of pain. Now, once you got got your reservation, you got into the country. How do you get into the train into training as a CT one? Um, which is generally it's a national application. Um, that opens up in vem Burr, uh, interviews and in February and the job starting August. So it's like a Keurig. It's a It's like a national session going on. Some of you that's had have hard to know. Nigerian surgery have more than 18 months experience after house job if you want to start getting to court training. So if you've had more than 18 months experiencing, so any surgery general orthopedics, you would not be eligible. And that's why when I finished my masters, if you remember, my fourth job was as a S H O in general medicine because I done a month of, um, surgical training Nigeria, and I didn't want to miss that chance. So I did, uh, generally an antibiotic cost of medical training job. Now, for those of you to have had a bit more experience if you if you have more than, um okay, sorry. Or if if you've had more internet in another country Nigeria, for example, um, I would say at least two years of extractions of put of some post surgical training, I don't mean, um walking in private practice of surgery. I mean, pools graduate. Such good training. I mean, residency. The MRC, as you can enter here at S C three level, which I think is quite, um also, if you because of your training, maybe the application is quite difficult. You can do two years of surgical non training job and right here, LCS get some consultant and some competition, and you apply for s t three. Yeah, get get. And so, actually, that it's a bit commoner where it would just come straight into s a three out more commonly and that's how you get trained. Now there is something called an alternative pathway which is called Cesar Pathway. Basically, you just do non training box and you gather your people walk, uh, you apply the completion of training Pretty some things that you just sign, you know, for you without even ask, um, if you're any formal training program. But, um, you have to do more those things. One after the other one after the other. Now, I have a full of people that have done it in pediatric surgery. Um, it only recently. And orthopedics, I mean, the largest specialties they Yeah, that pathway. But the attrition rate. If I hope people set out to want to go through the pathway pathway, only about 25% 2025% will be successful to get that on the converse. If 100 people become a surgeon, 90% of them will get there. So a lot of them either just give up on Oh, yeah, the specialty. Oh, great. Basically, you are like a registrar know a consultant. It can be quite term force straight in lifestyle. So yeah, that way I wouldn't recommend it, but you know, if that's where you are, good to go for it. Information information is gonna available. There are more people going through that as well. So the reason why it's difficult for people to progress, maybe because there's lack of information now, you probably will see more people progress quicker. What can you are doing now? So for those of you still in Nigeria, like I said, and, uh, this is a very paperwork based system they believe is for be a surgeon. It's not just only know how to do a laparotomy and cotton, so you to be grounded in academic. To be grounded in leadership, you need to be doing research, and so you are scored on those things. You depression is based on how many points you have inducing. So take a snapshot about this, and these are things you can start doing. Can you get an extra degree online? MMSC in something. I know if you colleagues that have done that, Um, while you're there, if you think it's going to take you a while. I came in to doing masters, and my master's called me this point at this point, but honestly, I would not devote one year of your life plus 15,000 lbs just to get an extra degree two or three points. Um, you can get points as well, so you can look into that MRCS if you you can start to write in your MRCs. Uh, if you've passed your club or if you want to go the alternative pathway courses. Um, there are things like basic surgical skills cost. I know that it's going on in Nigeria now. There are just a few courses, to be honest that they recognize. It's not just I went for an update cause, of course, and the total some sweet. I don't think that counts that much, but if you read around it pathetic. Basic surgical excuse course. Advanced life support. Um, do those things count pediatric life support courses? If you can get onto that, can you write a paper? Yes, you can. I wrote my first case report as a year one, uh, resident in Lauren, uh, saw a case. Uh, my consultant said it's quite nice, and I wrote the summary paper so you can write, publish a paper case reports you can participate in the research going on and be an author on that paper. You can write a review. I did orthopedic surgery and they were really days, you know, some classifications in the weeks. And I went and watched all the class questions, and I somewhere was like, Oh, this looks good. Wrote a paper on it. I got it published. Um, I sat down in my room one day. Uh, you know, signs of free peritoneum, uh, gastrointestinal perforation. And I just I looked reading around science, and I found a few signs. It was it was good. Put it all together, put it, and I published in the paper. So you can't publish even without working in a research center. Those are points. All of these things are points, and that's that's what will be needed to get into to get you across, uh, to get you across that bridge presentation. You know, uh, I also as a junior resident in Nigeria, I presented it, pay a research work we did at an ent conference in Ilorin. No, I didn't actually know that was coming to you. Get to be honest, I was just trying to get involved and, you know, do all the groundwork for my boss's. But these things turned into into useful things. I counted all of those things into my points, and that helped me. So what? Um, teaching. Now I know many of you would pull medical students aside, you know, as a house officer, as a resident and start teaching or many of you have thought some other things. But it has to be one. It has to have evidence for them. There has to be evidence for them. This is a rough week of how the greed is. So you get three points for each and, uh, medical education. I wouldn't recommend spending massive amount of or three points for that. If you have a on a faculty on a course, you get two point. You have regular involvement in teaching your score rooms. New involvement. Score zero. So I think push for teaching. And how do you How do you get evidence anyway? They they ask you to comment in your presentation printouts, feedback papers and give them to give me feedback. And that's why you can put together as evidence if they ask you to do a presentation acts. Can you give me certificates that, uh, that I can show somewhere that I you know that I deliver this presentation and this teaching. Um, um, if there's a cost you can set up, there's, You know, when I was as a core core surgical to engineer, So I just saw some medical students coming from wardrobe. So I gather them together, and I created a basic surgical skills course. Uh, I spoke with some other departments that had some stuff. So on paper, on on plastic, I was teaching them out to see, uh and I you know, it was my course. I started the cost. And, uh, I got evidence for that. Um, whatever it is, try and get paper for it because it's all evidence in spaced prizes award having they say you are the most outstanding copper doctor. India in the in the village. Just can you write me something for that? You know, give me a certificate for that. I got a, uh, an award as, uh, when I was serving in Katsina as one village called Casada, uh, for my Aditi project. And I got a, uh, an award for that Said don't know, give me a certificate. Don't just say, because everything would be presented as paper if you scored. If you If you want a price. Or if you're a medical student, if you can get a price, don't just don't just collect the money. Ask your university to give you a certificate. The best student in pharmacology. Best students in the obstetric. Get a paper for it. House job. You know, you said you are. You are the best internal in the department accident. Please give me a follow those. These are all points and even non non medical things. If you do any extracurricular things and you, you get an award for it, get get paper for it is all paper base work. And you can start putting your paperwork together right now knowing that this would be required. There's something called Audit which I think might be a bit tricky for some, but I don't know, maybe, maybe not. But we can talk about that. And what can you start doing now? Get as much surgical exposure as you can. Surgery, surgery. Peritonitis is very united. And it will add up not only to your practice and, um, start getting you up to get as much exposure. If you're doing a job, make sure you get it. Just make sure you are assisting cases. Make sure you access suturing things get involved. Um, if you work in a private hospital, uh, setting be the first person to want to assist in surgery if you can, you know, get a job that would, you know, be more surgically involved. For example, if you're working as a medical officer and you can choose whether you work in medicine surgery, choose surgery, get as much such an exposure. Uh, and make sure you keep a log of every procedure you've done, even if it's incision and drainage. And you honestly don't have to have any special thing. Just, uh, XL shit date. Uh, hospital number of the patient. Don't put the name of the patient or switching. The more the patient and, uh, diagnosis procedure Did you assist or you performed it And make any a little comment. Just put all that in the Excel sheet and save it. That can be your log book. And when you finish that job, get somebody clinical director or head of department to sign on it and say you have done this procedure's. Those can be added to your, um, to your, uh, package for dinner. I did my house job. You know, you had the assisted a few surgeries. I even lead on some. I wasn't a survey, so I didn't The log book. Um, so But thankfully, I did surgical, uh, residency where we could book. So I used some of those things because some of you might not so start. And they asked, Some online Softwares are quite cheap if you just google, uh, log books and you can use that as well. Um, yeah. Get as much exposure. Document all those things. Get help if you are. Now, when you're applying for a job, get help with your application, packaging and interview prep. Don't just go on to NHS job and fill it in. And let me tell you this I've been I've sat with people that are training people's application for jobs. I mean, by reading. Do what you what you've written. That's the point where it is craned up to 60 70% of people. Uh, and the reason why some people are not getting interviews is because they've just they want you to if you can't think like a doctor that is working here, and it's quite difficult if you're not in the country. So speak to somebody. I'm sure you know somebody somewhere and say, Look at my application, Make advice, you know, sometimes just terminologies, You know, For example, you know, you might internship, uh, service National Youth Cup in, um, juggling Go or Taraba our But just reading the names to, say internship. Call it F Y. One, because that's what you understand service. You call it F y, too. Putting it in the context, you understand, helps an interview prep. If you get an invitation for interview, don't go to that interview without speaking to somebody that is working in the UK doing surgery. If it's a surgical job or whatever specialty that is relative if it a pediatric surgery that doesn't to be a pediatric surgeon person, but somebody, they give you an idea of how to talk. Many people have lost opportunities because of that. That's what you can start doing now. Final thoughts. I would say Try and get as early as you can. Um, the all that not don't use what All that there, the more experience you have in Nigeria having to come back to start again, the more more difficult it is a lot of the people that I've met that have not been able to follow to achieve their dream of becoming a pediatric surgeon is even do the fully trained back home because they have spent seven or eight years training then coming here, you're looking at another 89 years ahead. He can't be Downton. So many of them just say, man, I forget it. If you are early carrier doctor and you think I want to go to UK to train, I would say do it as soon as you can. Um, really, Um, I don't think there's any benefit Nisshin your residences or training Nigeria and then coming here. Um, some people say I want to pass that one. I don't think it adds much to be honest, Um, my getting as they can't last be keep you read everything around it. Do you know you can have more information than I have now? Everything is online. That's that is the benefit of this system. Everything is online, and you can just just be Googling. In fact, I'll be wary of some of the information you get from people, especially some of more things that are a little bit more advanced in, Uh, you know, I've worked eight years ago or so. So some of the information I have now might be outdated. Um, so you there might be newer ways of getting in. There might be an opportunity. Spend every Don't let a day pass with that. The same way most of us would scroll Facebook every day. Don't let the day pass without you googling something about pediatric surgery in the UK if that's what you want to do. Um, and you see your opportunities. You see scholarships. Um um, finishing my training currently. And I want to pick up a fellowship in Candida. And I'm now in the hoop in that in that stage, and I'm scrolling every day, you know, reading about it, knowing what do I need to do? What opportunities are available to me. You can get everything on online. Um, you don't have to speak to anybody particularly. I wish you all the best. This is my email. Feel free to write it down and contact me. You want to as many, uh as I can to help with advice and whatever. I think that may be necessary. That's all I've got guys. Any questions? Sorry, I lost track of the truck. Um, I've not been following the charts. Uh, thank you. Uh, yes, yes. Thank you so much. So if anyone has any comments or any questions, uh, please type it in the chat box so we can do that in the next 2 to 3 minutes before you stop sharing. I guess you can, sir. Mhm. So we'll just wait a few minutes to see if anyone has any questions or commitments. Thank you so much for being, uh, able to put into words. I mean, the reason why I was, uh, want to actually drink. And I'm just help fall. I'm just, uh, working on the, um, on the things we need to make the journey easier journey to train it easier. And he says, uh, much. Thank you for, uh, also it exactly for, uh, for those comments and questions. Questions, uh, before what did they mhm? Okay, I think. Do we have our first question