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Um So hello everyone. I'm uh Val or to most of the colleagues that work with me val just for these of things. I'm a plastics trainee in uh valley and also asset, associate honorary secretary. Um I'm really grateful for this opportunity for the event organizers to present a plastic surgery training, journey presentation today. And thank you to all those attending the session. And I hope you find this useful interestingly, plastic surgery as a field may have a few misconceptions overall, even in the medical community as well as amongst the patients, particularly with the medical community. Majority of medical students don't even get any exposure to plastic surgery in the UK. So this is around 60% on the most recent surveys that have been done across the medical school uh across the UK. However, the field is very, very interesting and vast. So I'll trying to cover briefly what we tend to do on a day to day basis, what areas we cover and hopefully inspire you some to join the plastic surgery field. It is one of the world's oldest healing arts. However, it's more recently become uh uh more established and more advanced in the last 100 years. Uh after the World war, major traumas that have happened, major advancements have been made in the plastic surgery field is the right field for you. If you're someone who's interested in problem solving uh skills, so how to cover uh defects in major trauma patients, how to reconstruct a skin cancer case. What is the best solution for each patient? And you have a bit of an artistic skill because you have to involve a bit of lateral thinking and be quite good at drawing. If you want to or develop drawing skills. Uh If you want to be a plastic surgeon, you get to operate across all ages from young patients with cleft lip and palate all the way to elderly patients that may have uh skin cancers and you operate across the whole of the body. So literally from head to toe. Well, I personally find the most rewarding and the most exciting thing about plastic surgery is that you build really strong relationships with your patients and you are part of their reconstructive uh plastic surgery journey because you for quite early stages in the consultation process with the patient, discuss their expectations, their goals. What are their aims? What is important to them in terms of restoring their function, quality of life? And you come up together with the best reconstructive plan options together with the patient. So that's really nice to be and really rewarding to be part of that journey. Other thing about plastic surgery is ever so constantly involving uh evolving. And there's lots of new technologies and devices that are being introduced uh uh quite frequently and lots of innovative techniques that are being applied into practice. So it's important as a trainee to keep up to date with all those and make sure that you read your uh uh journals um as well to make sure that you're keeping up with the speed. What an another uh interesting aspect of plastic surgery is is that you get to work with lots of your colleagues uh from other surgical fields such as strong orthopedics with open lower limb fractures or uh spinal cases with difficult to uh close wounds or difficult to manage cases, general surgeons with abdominal wall, uh reconstructive cases or peroneal reconstructive cases. So you get to share the experiences and learn from them. Uh So it's really fun and exciting and empowering environment to work in, in terms of the plastic surgery. As I mentioned, we literally operate from head to toe. Subspecialties include hand and upper limb ear reconstruction, lower limb trauma, head and neck complex wounds, vascular numb, these cleft lip and palate oncoplastic breast surgery, craniofacial burns, skin and and sarcoma, pelvic reconstruction and more. And uh you get to develop all of those skills all throughout your training and you get to experience different techniques throughout courses by going to theater sessions, list attending webinar sessions and it's all really fun. And we are a field that tends to adapt quite innovative learning approaches. For example, surgical sculpture course, which helps not only plastic surgery trainees, but more junior trainees to develop their anatomy skills, which is really important given the fact that you operate literally from head to toe. So you have to think about what you can sacrifice, what you cannot sacrifice and how you can best reconstruct the patient in any given situation. The training pathway uh is fairly similar to uh other specialties and that has been touched upon uh today already after you complete your foundation training, you complete your core surgical training or al alternative routes to completing core surgical training. Uh usually throughout duration of two years. And uh the benchmarking for this and completion of uh core surgical training is marked by your MRC S uh completion. Then a huge bottleneck is obviously trying to get into plastic surgery training program. It is typically is for six years and is subdivided into, into immediate and final years of training. Some of the trainees tend to undertake um pre CCT fellowships at ST seven or eight level. And uh the completion of training is marked by your competency, sign off and completion of your Fr CS examination. Interestingly, like just like orthopedics, a lot of plastic surgery trainees tend to undertake post CCT. So post completion of your training uh fellowships to further enhance their, their skills in uh their subspecialist interest areas uh which we've touched upon just before they are mentioned in the slide. Uh Now going briefly through the na National selection uh applications typically open up in November uh December time. This is the application window evident evidence upload for your portfolio is still online and you're expected to upload your evidence between the window of January to February. Uh April is usually the time when the interviews are held and offers are released. Uh April uh or late April or early May. The competition is quite high. Usually close to 50 numbers are released every year and it's 41 competition ratio. It varies from year to year and usually all of the applicants that are going for plastic surgery are uh quite a high caliber, so to speak, so it's never too early to start preparing, but it's also never too late. Uh Your ranking uh in the national selection is primarily based on your V virtual interview which 75% comprises uh uh uh it contributes 75% to your final score and 25%. If is your self assessment or uh portfolio, there's more data available on the competition ratios in the QR uh uh QR link. So if you want to uh investigate a little bit further, uh please feel free to scan. And another thing to note, even though it's quite strict criteria in terms of getting your portfolio ready and going through the interview process, the selection is aimed to ensure that when you actually get into plastic training, that you don't struggle because you have to be ready to be a day one registrar and day one registrar in plastic surgery has to make quite a few independent surgeons and some of the operating uh as well, obviously support is there. But the expectations for a trainee are quite high, but it's a, it's a journey. So take your time to do, get ready and do get ready for the plastics training as you go along. Even e early years of the training, I wouldn't say it's too early to start thinking about plastic surgery as a career. Um uh in medical school, foundation training, core training. But as I said, it's also never too late because there's lots of transferable skills that you can learn from other specialties. And some of the things that you may have achieved will count towards uh your application as well. Going briefly through the domain of the application. Today's presentation is not uh uh aimed at going through these in detail, but things that do matter is the years in practice your clinical knowledge and expertise and uh being able to perform cases with appropriate level um uh in hand trauma burns and uh skin cancer, not everyone would have had all of the experiences in that and still end up getting uh plastics training numbers. So you do get to develop your skills, but you do have to have some knowledge uh about certain fields, other domains that do matches your academic management and training achievements. Um So your management and leadership experience. So any of the uh post that you may have held uh in um national or regional uh training bodies, do you count your uh higher qualifications directly related to medicine or other degrees? Audits, you don't have to have multiple audits. It's important to focus on the quality of them. So uh they ask for an audit uh that would be plastic surgery related is complete cycle and you have to have led both of the cycles and the audit and be the main presenter of that to gain maximum points, other things, teaching and training. Uh uh people applying for uh the roles uh can can have experiences of just running some teaching sessions which will still count. Uh If you're more passionate about uh teaching, you will be equally awarded by getting more points. If you have taken time out of uh training to specifically work on teaching or be an anatomy uh demonstrator uh teaching fellow jobs, publications presentations, collaborative research, principal investigator. Also all counts uh towards um um your application uh score as well. Publications are score based on the impact factor of your journal and your contribution to the research that you've done uh collaborative research. I'm really happy to see that this is being acknowledged in the application process. So this does count if you have proof of it. Uh you can submit it to gain additional points and other things to note down, this is looking specifically at the data of how many years since graduation, the appli successful applicants were at, at what level they were. So as you can see based on the slide, um most of people, so uh 18 of people who got offers for training number actually were six years uh after their graduation. So this is uh how much time they took to get really competitive um applications for plastic surgery training number. So thing to remember, it's not about having sharp elbows uh and just pushing through as fast as possible, make sure that you enjoy every parts of your surgical uh journey and training because all of these skills are going to be useful uh as a future consultant and a future surgeon, useful information is available in terms of um national selection on the QR code given and Plata UK have got really useful junior webinar series uh and uh yearly updates from the sac chair in terms of the recruitment process. And uh I believe they may be holding a webinar soon. Uh So keep an eye out and keep up to date. Uh Now going very quickly through how my personal week looks like as a trainee. So I had a little look at my sneak peek of my next week's rota as you can see quite a few operating uh lists a few clinics and some trauma cover. Uh Usually the training works on a firm based type of structure. Currently, I'm a skin cancer registrar, which means that most of the cases that I'll be involved in will be uh skin cancer excisions and reconstructions with skin grafts or uh local flaps or free flaps if that was the necessary as well as uh lymphatic uh surgery. So lymph node dissection, sentinel node biopsies, uh as a part of RTA commitments, you will be expected to cover uh trauma cases, which can involve anything depending on the unit, uh primarily uh burn surgery, even or uh hand surgery, trauma cases. Uh in terms of on-call cover, it's unit dependent. Usually the on calls tend to be 24 hour cover on calls with out of cover, uh out of hours cover being uh non-resident. And uh usually there's um there's lots of MDT and collaborative work involved overall in general. Uh as you um as you have to talk with multiple different colleagues because they're struggling to manage a wound. You have to come up with a plan how to best cover the defect, how the uh how best uh uh what is the best way to get patient to heal. And uh it's really, really exciting to be able to uh help out colleagues like that in terms of improving patient care um outside of um working and working together with colleagues and maybe your peer registrars as a junior registrar. I strongly recommend you buddy up with uh someone who has got more experience because sometimes when you've got uh complex cases uh and the consultant may be available but not be around, but you don't have that much of confidence, your senior colleagues will be your best buddies in terms of uh uh helping you through the process in developing skills. Uh and obviously consultants uh as well. Um other things to keep an eye on as a trainee, you will get some opportunities to do some microsurgery training. Uh Quite a few units have got uh a few microscopes available to practice your skills in your own time. Uh So simulation training is a big thing in plastic surgery. We tend to uh practice before we go in and uh do surgeries on the patient because it reduces the stress level and makes you more slick and efficient in terms of providing best operative technique for a patient. More information on deaneries and units is available on really nice uh National Deanery handbook uh that plaster has created, it's got more information about specific units, what they can offer, what are the deaneries. So you can have a look how widely distributed they are across the region and see if these are the units you'd like to work with. Uh It also has some summary about the GMC survey results for the trainees. So that may be handy in making your final decision, whether you want to uh train in the specific region, uh work-life balance and the demands uh in general, from my personal perspective, the 24 48 hour shifts, which plastic surgeons occasionally do can be quite demanding. So make sure that you look after yourself when undertaking those shifts and plan your time. Well, uh or prioritize the cases uh as well and seek support early on if you're struggling. Um the decision making can be quite complex. Uh So it is important to get the consultants obviously involved uh early. And sometimes when you're on call, it can be quite challenging because you have to multitask a lot, you'll, you're going to be asked questions uh whilst you're operating, maybe trying to take, you're getting multiple referrals. Juniors are asking questions. So it's important to make sure that you're using your resources very effectively and train your junior colleagues to empower them to be able to perform minor operations, simple decision making with increasing level of uh independence and um uh things to also consider some of the plastic surgery operations can be very short, some of them can be very, very long. So the longest ones uh that I've personally been to lasted for 14 hours and these sort of cases, it's not like 11 man has to stand there for 14 hours or one woman has to stand there for 14 hours doing the case. It's all about having a good plan for uh the case in terms of teamwork uh taking breaks. And even when you go into quite complex cases, prepare, revise uh for your surgeries and have plans A B and C discuss the cases uh with your seniors and seek support. Um And uh reflect on the work that you do because most of us do so much work just running and running through the cases. Keep in mind it's not a sprint, it's a marathon. Every experience that you get, whether it's more difficult is easier, is part of your surgical journey and everyone's journey is quite different. So it's important to have reflective uh reflections, not necessarily on your I ep reflections in that sense, but more personal reflections of your progression and discussing that with your supervisors and mentors and obviously maintain your hobbies uh and make sure that you do de dedicate some family for uh some family and friend time. Uh in order not to burn out and be able to be efficient at work, there's lots of exciting future plastic surgery things going on. So there's lots of research units across the UK. So if you want to have a look uh at what units there and what research they focus on there is useful link on uh bro. Uh other useful thing to be aware of is reconstructive surgery trials network. They run yearly events uh where you can pitch your own ideas, connect with like minded people who are interested in research and uh and become part of collaborative projects. Um And as I said, lots of exciting opportunities. There's lots of tissue engineering for reconstructive procedures, devices, materials, scar treatment, researcher, Sentinel free flaps. Quite exciting uh things that have come out of Oxford. We had uh uh Professor Hell present these a couple of years ago in our um uh keynote sessions uh and asset conference, which was really exciting um and skin cancer trials uh technology use uh super microsurgery lymphatic surgery to improve patient outcomes and how, how to get ready uh some useful associations to be aware of. So, bro uh is the main association to be aware of as someone who's interested in plastics, they've got a conference coming up uh this December in Wales. Uh they've got useful resources in terms of um uh not just mentorship network uh but also uh conference possibilities and also other event possibilities advertised on our website uh plus the case, the trainees association. But as I said before, there's lots of useful free webinars that everyone can attend uh RST N process more for uh medical students. And uh uh as you, as I said, just enjoy the journey, be aware of some of the requirements, attend courses, uh conferences and courses, get exposure and progress your skills and just get involved, be on top of things and that's it. I'm happy to answer any of your questions via email or by messages. Thank you very much. M for taking the time to speak. Today. I know you had an incredibly busy schedule recently, so I really appreciate you taking the time. It means a lot. Um I'm just gonna look on. Um There is one question which I'm sure we've got time to do. So. Thank you for your talk from Yusuf Ibrahim. Is there a good scope of non cosmetic work in plastics? Um If you want, you can either type that a bit later or you can I II can type uh you guys, you can write any of the questions on the chat and I'll uh just uh type the questions there in the interest of time, so we don't overrun. Lovely. Thank you so much, Val. Appreciate it.