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Hi, everyone. Just waiting one more minute until more people join. All right. Hello everyone and welcome to our talk today. We'll be talking about different pathways to joining the NHS from the Medical University of Sophia. Um Some things may overlap with other Vulgarian universities, but this is specifically for Sophia. So if there's some things that sort of don't make sense or don't add up with your U university, that's probably why. Uh just to tell you a little bit more about our organization, we are the Bulgarian student support network and we support students coming to Bulgaria while they're in Bulgaria. And when they're leaving Bulgaria, we support them in many different ways. Um For example, these webinars uh that we present on transitioning to and from and also um different teaching sessions that might be helpful for the transition as well or throughout your time in Bulgaria, our presenter today is Doctor James Moore. He is in uh I was about to say I mt he's not an IMT anymore. He is an infectious disease in medi medical microbiology, ST three and he is a graduate from the Medical University of Sophia. So without further ado over to James. Thanks Helen and uh welcome everybody to this uh talk. Uh So, uh I've done this talk a couple of times uh before um over a couple of years. So, um some of the um information particularly in terms of my um process of, of, of working in the UK might be a little out of date and things may have changed. Uh But we've included information from um when Helen actually came to the UK and that was a couple of years after me. Um So I've tried to have a look and see if there's been any significant changes uh in terms of the registration process, and I've updated it as best as I can accordingly, but please feel free to ask questions at the end and um feedback um would be greatly appreciated and you'll be given a link to the feedback form at the end of the talk. It really helps all of our speakers uh to um continue um to, to deliver high quality talks and I hope you enjoy. So the GMC registration process um which I recommend starting um as soon as you possibly can. Um It is a lengthy process and there are a number of obstacles, often unforeseen obstacles in terms of gathering documentation. Um and particularly coming from uh Bulgaria, you need to have notarization legalization and these things take AAA long time. So it is definitely a lengthy process. Um So this is my um overview so I graduated late February and then um II went through getting my Bulgarian documents. Um So once you've got your diploma, it allows you to then um with the Bulgarian criminal record check and various other documents such as your health card, um you're able to then get your Bulgarian Medical Association registration and get on the Bulgarian Medical Register. So this is essential if you want to work in Bulgaria. But this was also the process that we needed to do in order to get the GMC registration. And I believe this has, has now changed. This is just an overview of, of, of, of what I did. So once I've got that element done the GMC registration in terms of your license to practice the license, you'll need to have the English language requirements. Um So you'll need to do either the Ielts test or the O ET test for both of the pros and cons. As you can see, there's um a reasonable price discrepancy with the O ET being considered really more expensive pros of the O ET is the writing section which native speakers find it very difficult um is actually medically based. So it's an easier exam to pass, most natives will pass the OE first time, but Ielts can take multiple attempts. Um especially if you haven't prepped properly, particularly on the writing section. It's a bit of a money making um exam. It's not designed for native speakers. Uh So uh it's a bit of a banana skin. So you need seven in each section and a 7.5 average overall and you need a 7.5 in each section if you're wanting to go into the uh stand alone F two training program. Uh So there's a slight change there in terms of your entrance requirements, uh depending on what program you're going into. Then once you've done all of this, uh there was the physical uh ID check uh Granted, this was all before COVID. I think a lot of these steps may have changed now. But yeah, you have to either go to the office in Manchester or London and it's very much a formality. You bring your original documents and then you, you get your name put on the register later on that day. Uh and then uh this uh slide just shows uh how Helen er, went about um getting co so I'll, I'll let her take over this one. Ok. So since James graduated, um my year, I think my year may have been the first year to sort of have this change. So previously you would finish your last exam in November. Sorry, there's a mistake here on the slide. It's not February, sorry, it's November or December, you would be finishing your final exam and then there would be this massive break, you would go home for Christmas, um come back in either late January and now it's even as late as February for graduation and you had to basically sit and have a gap in your, um, employment or a sort of gap in your CV, between November and Febru as late as February while you were waiting for graduation. So we later found out that actually, instead of waiting for the diploma, like the actual degree certificate that the university gives you, we could get a letter to say that we have passed all of our exams and that we are going to receive the diploma certificate. We're just waiting for graduation and for it to be produced. So, um I think it was called the diploma certificate. If you go to the dean's office, they'll know what you're talking about. I think every, every single year after mine has done that now, um also while you're doing this and while you're waiting for this, it's a really good time to get a criminal record check from Bulgaria because you won't need that for your GMC registration. You won't need it for your Bulgarian documents. You won't need it for while you're in Bulgaria. But once you then come back to the UK, you're gonna have to have a DVS check, which we'll touch on later on. Um So you're gonna need it then for your DVS check. So while you're in Bulgaria and waiting for your documents, it's a really, really good time to get this uh criminal record check, which is valid for six months. So you don't wanna get it too early, but you don't wanna be going back to Bulgaria for just for that as well. Um Then after you get the diploma certificate, you start, start your application on GMC. Um, and you need to have your diploma certificate verified by Epic. So I think even with James's sort of root, even once you have your diploma, you still have to get that verified by Epic. But I'm not, not sure because that's not what I did. What I did was I got my diploma certificate and then I had to have that verified by Epic. So it's completely separate to the GMC. They've outsourced it to this American company that verifies your documents. They called the university, there's a representative at the university and they asked them and basically verify if, if all of your documents are correct. So some people were charged for this. Uh Some people weren't. So I think it's up to the university's sort of discussion. I don't know if they're still charging people for it or if they're not charging people for it anymore. But I think what I heard were was that some people were charged like 100 Leva for, for this, for this verification. Uh They asked for a passport photo, so go get some passport photos done. You're gonna need that for your and then of course, the diploma certificate, which is the document that they're verifying. Then once you're verified, sorry, that's my cough machine in the background. So sorry for the noise. Um We'll wait for me. Ok. So once you've got all that done and verified, then you, I think it was, you write to the GMC, you go through the application, it's a step by step process. It's very straightforward and then you write them an email to say that you've received your um epic verification that you're going through that route and then they send you an email back telling you everything you need to send them over. So that's um your ielts or your O ET. And then there was a form that they also send over that you need to fill out sort of outlining your um final year and, and your degree and your education. Um It may have changed since, since I did it. So uh don't, don't take it as long, there might be some updates or, you know, diff differences to the process. But yeah, that was my root. So, back over to James. Thanks Helen. So after you've uh got all of this stuff sorted and you can actually be looking for this even before you've got um your GMC registration as most places will actually allow you to apply without a GMC registration on the proviso that you have your GMC registration in place by the start date. So it, it's good to be looking at um at job opportunities and, and preparing your applications um while you're doing your GMC application as well. So, um the first option is for a job in the UK. So I'll split it into three here. So you can either go straight into locum work because you can have a full license to practice a full GMC registration. So you are legally allowed to work as a locum. Um You could go into a trust grade position. So trust grade positions are non training positions. They're typically offered either in a short term basis to fill into a rota gap. Say, for example, someone's dropped out from long term sickness or for whatever reason, you may have a four month slot or a year slot depending on, on what's available. But they'll be tend to be very restricted in terms of the rotations. So you're not really going to have much flexibility in choosing what jobs you do. It will be very much, these are the jobs that are available and you know, you're just going to have to take those rotations if you want that position, you also have a junior clinical fellow uh role. So JC FS, these are non training uh roles which you can enter in um with a full GMC registration and they typically tend to be aimed at sort of um uh an F two sho type level um and they can be in a variety of different specialties. Um And you often have on call um enhancement as well with those. Uh Additionally, you may have um some programs, um so longer term programs, larger recruitment programs which are aimed at IM GS in particular. Um and these vary from year to year depending on, on demand and, and, and finances within deaneries. And then there are other programs um by uh by companies like Gateway Linked Medics, et cetera. I don't know um too much about them. Um But they, they tend to be um filling um gaps, they have deals with, with hospitals. Um often DG HS and um II think Gateway take a, take a, an amount of your salary. Um But I'm, I'm, I'm sure people know more, more about Gateway than, than I do. Um isn't necessarily an option that I would um recommend um as, as, as your first line. Um I think going out on your own and, and, and getting a, getting a trust grade position somewhere and making your own route in a hospital and not being bound to a third party company, um is ideal really. Uh And then there's the option of uh the F two stand alone program, which would be your first opportunity in terms of entry into training. So, um the first opportunity is a training role. So unfortunately, they don't offer F one stand alone anymore. Uh They'd stopped that um a couple of years before I applied and that was in uh 2020 when I got on to the um F two stand alone program. So, criteria for the um F two stand alone program is slightly different. I touched on it earlier in terms of the application process. So, uh you need a, an IE LT score of 7.5 in each section, not just 7.5 overall. Um And it is a competitive national application. Again, there are limited amount of jobs available. Um So you may have um no jobs available in London, for example. Um So you're gonna have to be very flexible in terms of your location, but that will give you a year's worth program. Um And by completing that, you will get your foundation program certificate of completion, which is a which allows you to enter specialty training. So that's one of your routes into specialty training is getting that foundation certificate. The alternative route is getting a form called Crest signed, which is your certificate of readiness to enter specialty training, but we'll touch on that a little bit later. So in terms of applying for jobs, um So NHS Jobs is almost merged with track jobs. Uh and they are um sort of online application processes. You can upload your profile and you can use that profile for different applications. You don't have to keep filling in the same information again and again and again, because a lot of the, the questions on the application forms are preset, they'll be asking you stuff about audits, leadership experience. So you can actually say preset answers and then modify them accordingly. I would obviously advise tailoring each application to the individual job that you're applying for generic applications. Normally get easy to spot and they're rejected out of hand. So you want to have a decent covering letter and write some specific something specific for the role that you're applying for. So, um, locum agencies, um even if you're deciding not to go for locum agencies, there's pros and cons with them, you're obviously getting a lot more money. Um, you have more vulnerability, um, you're more exposed, you're more, um, you know, dispensable by, by a trust who could just sever your contract immediately. Um So I, you know, for me personally, I didn't want to go straight into working as a, as a locum. I know, I know people who've done it and have done well out of it. Um, but it tends to be less supported as a first uh job opportunity. However, signing up with local agencies does do pose benefits. Um They can often provide you um with a free um occupational health check. So sorting out all of your vaccines, making sure they're all up to date and your DBS check and, and also getting a course, something like uh basic life support sorted. So you can, you can play the game of signing up to a local emergency, getting your DBS check done, getting your occupational health done and basic life support sorted, which is just going to make it easier in terms of when you're getting your first job. And with the NHS, you've already got that all, all, all done. So you can be doing those at the same sort of time. Um Which is what I did. Um So then, uh what's next? So, um, I touched on the uh the standalone F two program um, earlier, uh II, II went into um, a, a trust grade position for four months as an F one. And then I went into um a foundation fellowship program which was offered by Southampton uh which was a two year program. I completed one year of that. And then I opted to leave that program and apply for the standalone F two position um to get me to get me into training and sort of standardize myself. And it was just an opportunity for me to, to move um to a more desirable location as well. So um II went into that. So in, in, in my second year. Um if you haven't got the Ielts score, um and you've worked uh as a trust grade or as a junior clinical fellow or, or even as a, as a local in a long term position, you can get your consultant, your responsible consultant or your supervisor to sign you off saying that you have um English language proficiency, which is what you need in terms of the application. If you haven't got 7.5 in each section, I only have seven in the writing. So I had to um go to my consultant to, to sign me off to say I can speak English seems ridiculous. But it's the, it's the, it's the policy, unfortunately. Um And then you've got your Crest form. So the Crest form uh is that certificate of specialty training? They've just changed it again this year. It's actually far more simple uh in terms of evidence to get it signed off. Um, you typically need to have been working really for at least a year. Um in the NHS to be able to, to legitimately say that you're signed off. Uh for those, those principles. You're saying you're basically saying that you are, you are at the level of someone who's completed F two training and there's no one leaving Bulgaria who's at the level of someone who's completed F two training, that's just not realistic. So I would recommend, you know, filling out that form after a year or doing it during a long term placement. Um If you're gonna go the crest route, otherwise it's stand alone to go into specialty training and then further training because you've always got to be thinking about the future. Uh You've always got to be thinking about the next couple of steps in medicine. Um That's just the nature of the game really. So if you have some idea of, of what you want to do, um whether it's, you know, surgery GP medicine, start having a look at the criteria and the application criteria and what you're gonna need because it's going to be competitive application and you may or may not be aware of the uh competition ratios, but they are horrific and they're getting worse year on year on year. Uh, so, uh, undersubscribed specialties, historically, like psychiatry, I believe, had a ratio of over 3.5 to 1, which is, which is pretty huge. Um, it's almost at surgical levels. So, uh unfortunately, there's an increasing bottleneck at different stages of training. And um this only seems to be trending in one direction. So it means that you're just gonna need to have a more competitive uh CV, you're not going to be able to just walk into training. So, um once you've satisfied those criteria, so either you've got your foundations uh certificate of completion or you have your quest form, um you are eligible to apply for any of those, those programs. Um You have an exam called your M SRA which is um a generic exam covering um covering medicine and various specialties. Um And you based on your score of that, uh you, you get, you get ranked and you can then potentially match a program within psychiatry core surgical training. Uh Now use it GP use it and then you have a niche special even neurosurgery radiology and ophthalmology, actually use this exam uh medicine uh doesn't uh as of yet. So this is another thing you can be preparing for while you're in these jobs. If you know, you're gonna be needing to sit there. M sra then start revising for it. Sign up to the question bank um get into a good habit. Then additionally to that, you're gonna then be thinking about how else do you stand out? So you want to be thinking about commitment to specialty. So you get points for commitment to specialty and various applications. You're gonna want to be signing up for conferences. You're gonna be wanting to write abstracts, you're gonna be wanting to present posters, you're gonna be willing to sign up to organizations getting journals and um really being able to demonstrate um over a period of time that you've got varied um experience and interest within that specialty that you can put down on your application and also things you're going to be able to confidently talk about an interview. Uh and that's gonna serve you well. So you might as well start early um in trying to, you know, get, get some of these things done and spread it out because you don't want to leave it all to the last six months before you apply because it's just gonna be a panic and your evidence isn't gonna be so good at all. So you wanna be thinking about the bigger picture, have a look at the requirements of what you need for course surgical training. It's very different to what you need. For medicine, there are some things where there's overlap. So there's going to be generic points for both of them. So quality improvement projects, um publications, audits, teaching experience, all of these things are going to be generic and they're going to be useful for any program you're applying for and for your career going forward. But for surgery, for example, you get points for having a course like called ba basic surgical skills or um advanced traumatic life support that will get you points particularly for, for course surgical training, it won't be worth anything for, for internal training. So you need to sort of stratify because these things are expensive, you've got limited time, you need to go well, I'm gonna target this, I'm gonna get this done and um and, and, and get in early, um you can do, do a couple of things during your first year. Um by, by the time you're actually making your application, you're gonna have a, you're gonna have a decent application and um you should be able to score an interview at least. Um So then this is more so in terms of the foundation and what's expected of you. So even if you're in a nontraining position, you can get access to the foundation portfolio, which is Horis done separate talk uh going into more detail into the foundation portfolio. So this uh which is just a AAA very brief overview. Um but it's the kind of things to be aware of and a lot of these uh forms that you're asked to fill in during your foundation years, they apply to your higher specialty portfolios as well. The names might slightly change. But I mean, even me as a registrar now I've got, I've got docs CBD S minis um and a requirement of those to do each year. So you get into the habit of trying to fill in this portfolio, even if you're doing it in a nontraining role, it's worthwhile, you know, filling in these forms and getting the neck for it because you're gonna need it in, in, in um in your high specialty training. So, competences um they've been removed from the foundation portfolio now as F ones are expected to be able to do all of these things like venipuncture, arterial stabs, et cetera. Um Because uh now in part of your finals in the UK, you get, have to get signed off on all of these procedures that have slightly changed it from, from how it was a few years ago when you had to get all these things signed off as an F one. So particularly as a Bulgarian graduate, typically, you don't have anywhere near as good as um practical skills as a UK graduate. It's just the way we're taught. Um This can be um an area where you, you're gonna need to focus and it might be an area where you're, where you're particularly weak. So, um II would I would try and familiarize yourself with the procedures and, and get and get as much practice as you possibly can. Um And I can touch more on those people with any particular questions uh there, but most of them are self explanatory, reflective practice. Tab is a, is a, is a an assessment of behavior, team assessment of behavior. So you have to have feedback from the MDT, the quality of improvement projects and then mandatory teaching hours. So this can be uh mandatory teaching hours which can be extracurricular teaching hours and core teaching hours within a program. So to say you need 50 hours of foundation teaching within a year and then you document them in your portfolio. But even if you're not in a training program, ask for access to the horse portfolio. It is definitely your right to be able to have access and it will cost the trust a small amount of money. Um But it's worth starting to gather evidence because you can use this evidence later on in your career, you can download the portfolio. Um physical portfolios now are almost a thing of the past completely. So, so get on the e portfolio system as quickly as possible is my take home from that. So then a day in life of of an F one, what's expected of you. So typical day, it will vary job to job obviously. Um but very generically and you have a, you have a list which would be asked to sort of update and print off. Um, make sure it's all organized, distribute that to your team. You have your morning handover from the on call. Um, and then it will be a ward round which will be then senior led typically. So I consult with registrar led. You may have an ho leading it, uh, in some job, you may be doing your own own round in, in orthopedics. I was doing my own ward round immediately as an F one. and then the jobs from the ward round, you distribute with your team and you complete them. Um Other things you may have to do is admit patients to your particular team and then it will be then doing your, your clerking uh and then common jobs that you may pick up from a ward round. So you have procedures either might be actually doing them or requesting them or delegating them out to other members of the team, uh such as bloods cannulation catheterization. Uh You'll be asked to chase and request uh different scans and, and uh and, and follow up the reports of those prescribing obviously is gonna be a big part of your job referring to other teams, either for their opinion or for a takeover that would typically be um done by a, a registrar level or consultant to consultant. And then there's going to be your communication skills, communicate, communicating with the patients. Um family members next of kin, updates and other members of the team and then discharging patients is going to be a large proportion of your job doing your TT S and your and your discharge summaries and ensuring that there's a safe uh discharge in terms of uh package of care and all of the social element that you have to consider. Uh the key scales are of a of an F one, a lot of those are the um touch and the competencies, but these are things that you can be preparing before um you, you start working, making sure you're up to speed on ECG S, you know how, you know, to methodically interpret um an ECG same with chest x rays and abdominal x rays, uh and blood gas interpretation. This is stuff that you can study and familiarize yourself and, and, and get, get the neck off. So you're not, you know, having an ECG thrown in front of you and being completely clueless, um which is just going to cause added stress and you can easily avoid that by just putting a week's worth of, of work into reading a couple of books. It's not very difficult. Um getting into a stepwise approach of methodically managing a deteriorating patient to the AE assessment, which is uh the, the uh the standardized assessment that's, that's, that's advised. Uh and then uh recognizing when to escalate when you're out in depth, when you need a second opinion. When you need someone more senior to um to take over and give you advice, safe prescribing history, taking, handing over, practicing an sbar. Um So uh uh strategizing your approach of, of handing over effectively and efficiently, so you don't sound incompetent on the phone and then um having a systematic approach of reviewing patients, whether it be a ward round review or an emergency review of a deteriorating patient and that's it. So um a little bit scattered, there's so it gives an overview of the process of applying and um the typical routes uh in terms of your first couple of jobs. Uh but also keeping your eye on the big picture where you're wanting to go and starting to plan ahead for that, um which will serve you well and will reduce the massive stress uh when you approach a competitive national application. Um So uh the floor is open to any questions, feel free to, to write in the chat or, or, or speak out and that's absolutely fine. Ok. Someone asked, do you need a criminal record check if you're already on the DBS update system? Um I'm not sure because obviously I wasn't already on the DBS update system. I'm Canadian. Um But I would imagine you probably do James, you know, no, if, if you, if you're on the DBS uh update system and you've got an enhanced DBS check, that's the, that's the best thing you possibly can. So it costs it costs 13 lbs, uh, a year. Once you've got an enhanced DBS check, sign up to the update system, that's it. That's all you'll ever need. And every job you apply for they will check that DBS update. So you just, you just give me a certificate number. So if you've got an enhanced check, um, that's all you'll ever need for your whole career. So that's, that's, it's, it's an amazing service really. So I would, I would say definitely sign up for that and it's only 13 lbs a year. Ok. We have a very good question from Jemima. What would you have done different now that you know the application process? James, do you wanna go first? Cause I have a lot of things to say. Well, um that's a very good question. Well, II, as I was one of the of probably the second cohort coming from Bulgaria. Um II would have, I would have not stressed so much. I was definitely panicked um with regards to potential issues with the GMC registration which um weren't then problems. And so it was, it was an overly stressful time for me uh in terms of applications, job wise. Uh Once I got my GMC registration, I don't think I would have changed uh too much. I mean, I was naive in terms of my applications um to various jobs uh II typically applied. Um and I did sort of blanket applications without doing personalized covering letters So I there were loads of jobs available in terms of um trust grade positions and I must have applied to about 27 jobs uh before I started to hear back uh about a couple of interviews. Um and it was the, the, the jobs I was then getting interviews for, I had to look at those applications. I go OK, that, you know, that application was a lot better than that one and it was building on the application. Um It was that sort of barrier to get to an interview. Um, not Mo and Trump, I typically interview very well. Every interview I've had, I've, I've, I've got um so it was the barrier of, of just of, of, of just getting, getting an application which, which looked good. So I would say spend a lot of time on the application, the personal statement, get friends, get family, get medical, um medical people, you know, to read it and, and give, give, give opinion uh on, on the personal statement. Um because you, you'll just get rejected off cuff. Um if, if, if that doesn't stand out and if it looks remotely generic, so I'd say that's, that would be my biggest learning point was um not rushing the applications and, and making sure you're putting an effort in even though it seems very tedious and you're just thinking, you know, gosh, I've got all these qualifications but um they're, they're gonna judge you based on your personal statement. So um definitely invest some time in that and uh and, and get and get as much support as you can before we send it off. Ok. So just before I give my answer, I wanted to um share a youtube video that I think everyone in my year watched um that just outlines the epic clarification process. I think she was someone who graduated from Pleven the year before me. So yeah, just, just check that out. That will be useful for all of you. Um So what would I have done differently? Gosh, so many things. Um One chill out. You're not the first person or the last person to uh graduate from Bulgaria as long as you pass your exams and everything's OK, you're gonna get your GMC registration. Stop rushing. Basically, II wouldn't have rushed so much. Um Another thing is um II started to get anxious because there was starting to be a gap in my um in my employment. So find something like someone said, either a clinical attachment in the UK or I speak Bulgarian. Um II probably could have done a clinical attachment in Bulgaria, whether you're doing it in Bulgaria or in the UK. Just have something there like that that you're doing, staying on top of your um clinical knowledge. Um Another thing I would have done differently is make sure you get your documents translated at the same place as everyone else because if you have one or two words used differently like that are synonyms. Um Your GMC application might get delayed, like minded. It took four weeks longer, takes about two weeks for them to respond to one email. So you write them an email 1515 days later, you get a response. So it's really slow if there's anything that's like unclear um or a little bit different to the rest of your cohort, like um just one word on the letter, that's a synonym, that's gonna be an issue. So just find out where everyone else is getting their documents translated and get it translated at the same place. Um Next question. Uh Do you think doing a clinical attachment after you graduate? But before your first job helps fill in the gaps we have, um I've touched on that a little bit. I don't know, James. Do you wanna add anything to that? Yeah, I would, I would, I would say um most definitely, if you, if you can get a clinical attachment, it's, it's gonna, it's gonna help um in terms of reducing that, that culture shock of, of coming of coming to the NHS. Um II managed to get a weak clinical attachment uh in, in the AM U. And um yeah, it was very beneficial. Uh I immediately started to highlight things that I didn't know and I needed to work on, particularly highlighted my, my um weaknesses in terms of my practical skills. Uh So if you can get one. you know, go for it. I think they're a lot easier to get now. I mean, I know a couple of years ago uh when the pandemic was rife, um they pretty much shut down all clinical attachments, any unnecessary people to be in the hospital, they, they, they, they, they removed. So, um I think things are starting up again, you can get a clinical attachment at um you know, very famous hospitals like um Alder Hay or, or UCL and they typically um will charge you a fee. Um So there are fee paying ones, but if you do have someone that, you know, who can get you in, send some emails to hr um you, you, you might be able to get one. If you don't have any contacts, I would recommend just, you know, messaging hr and um and, and, and seeing if you can get anywhere, you will need a DBS check before your clinical attachment. So, if you've managed to get a DBS checked through another route, um that, that's gonna be great. Otherwise that's gonna be a big stumbling block for you is, is the DBS check. So we would definitely do a clinical attachment if you possibly can. Ok. So is there anything you would recommend to make our application stronger? Especially coming from Bulgaria? Yes, definitely. So, uh some of the things that I touched on uh if, if uh there's, there's the uh I CMS uh conference, um get a, get a, an abstract uh accepted there, do a poster uh that will count as a, as opposed to presentation that's points in the bag. So that's something you can be doing. Um getting involved in some teaching, whether it's external teaching. Um A program like, like we're doing with, with B SSN, we're always um looking for, for people, guest speakers to, to, to come and, and, and deliver content. If there something that you, you're passionate about and um and you, and you're wanting to get involved in this will this would come uh massively for, for points in terms of your application showing that extracurricular involvement and initiative um as a medical student is, is, is highly valued. Um If you can get involved in any um research uh in Bulgaria, um It wasn't something that I was able to do. Um I II proofread a number of papers, but I wasn't given any credit for them. Uh But yeah, if, if you do have a link and manage to get involved in the original research, that would be fantastic. Um And other things would be trying to go to conferences if I mean, if you've got the means to be able to go to international conferences or conferences within Bulgaria or online conferences where you can pay to go um as a student um utilize that. So this, so, so everything is so much more accessible now uh with, with um following the pandemic with everything being online. So some of your, your, your international conferences, your big conferences, you can access as a student for, for an online fee. It's well worth getting a couple of conferences down. You can put them on your CV. It makes sure you look like a more um attractive applicant. Definitely that answers the question. Um Just to add on to what James said. Uh um Also, if you have the means to do it doing BL SA LSI LS, um I would recommend doing a A LS because it's, it's the most advanced that also looks really good on an application doing courses like basic surgical skills, um uh analyzing chest ray, it's uh x chest x rays or x-rays, uh any ECG courses, any sort of courses that, that you can do um would be helpful as well, but definitely I LS or A LS would be ok. Um If you currently hold a position within the NHS outside the role of a junior doctor who do we request for English competency sign up. So unfortunately, you're applying to the GMC um from your medical school for, for registration. So you do still need an Ielts or an O et um exam done. Um Their, their reasoning is that they haven't, otherwise they, they don't know whether or not you can speak to patients in English. That's the reason that they told us. It's absurd that, that they're making native speakers take the exam but it is what it is. You just have to sit the exam. There's, there's no other way around it. That's, that's the only competency they'll, they'll accept. At least that's how it was in my year. I would say I would just say just, just touching on that. I mean, I mean that the sign off for the um for the, for the, for the F two standalone. So um yeah, I only had an IE LT score of 7.5 overall by seven in, in writing. So enough for the GMC registration, but not enough for the F two standalone program. It has to be a consultant that you've worked for for a number of months. Um So it has to be a medical consultant signing you off. It can't be anyone else and you have to, they, they have to have been working with you as a capacity as a doctor. So uh yeah, I had to go to my educational supervisor after a couple of months. So can you sign a form? So I have to speak English? Absolutely ridiculous. But yeah, that's, that's the, that's the criteria of the form unfortunately. So you won't be able to get it signed off by anybody else. Um If your last cycle is a non examining cycle, can you start the application process after the last state exam? Um So I was in a cycle that was a non examining cycle. So I had emergency medicine as my last cycle, I went into the student office, they left me out of there. They're not going to fill out any documents until the very last day. I don't know if that changed the year after, but that's, that's how it was. Um when, when I graduated, um how can we get involved in research slash abstracts? So, research and abstract. Very good question. Uh I II would, I would ask around, I mean, if you're trying to do, if you're trying to do it in Bulgaria, it's, it's, it's more tricky. It's not something that I II was able to, I was able to do while I was there. I'm sure it's possible. Um uh I'm not, I'm not sure Helen do, do, would you have any advice in terms of getting involved in research within Bulgaria? Um II, unless you ask your professors if they had any research or data uh collection that they wanted you to help out with. Uh I don't, I'm not really aware of any other ways to get involved in research. The best way is just to ask, um maybe look up your professors, see if they, if they have written papers, ask them if they're writing a paper now, if they need any help, maybe they'll say yes. II didn't get it done while I was in Vulgaris. So I'm not too sure. Unfortunately. Yeah. And then with regards to getting involved uh in the UK. So, um you can you can, you can do sort of a two birds, one stone approach. So you're gonna need um a quality improvement project. Uh You're gonna need a quality improvement project. IDE that's been cycled multiple times. Um If you, if you've got a substantial quality improvement project, uh then you can get this um made into a poster and you can this accepted there's quality improvement uh conferences. So you can potentially be getting your abstract and the quality improvement projects out of the same project. So I would say your main focus um should be getting involved in quips and quips can turn into posters and publications. Um in terms of additional things, uh your best chance of getting involved with things is, is is getting a job in a tertiary center, a big research hospital uh where they have professors and um approaching them and saying, is there anything that I can get involved in here and making yourself known? Um trying to get involved in a project that's already ongoing. They may give you a role um in terms of, you know, a lot of data collection and getting and getting your name on, on the paper. Um I managed to, to, I've got my first publication that I did during internal medical training. Um It took, yeah, it took a lot of work uh connections with supervisors, multiple meetings to, to, to get in and get a, get a, get a title sorted and then, yeah, it was down to me to, to write it and analyze the data. Um So there is an element of being in the right place at the right time, you're more likely to get involved in research if you're in a tertiary center. Um So if you can get a longer term contract in, in a, in a big teaching hospital, there, there will be research opportunities. Um If, if you, if you seek them out, um That's the best advice I can give on that. Really? OK, what kind of things stand out in an application to make it nongeneric? So I think we touched touched on that. Um So any sort of involvement that you've had in teaching, any um conferences that you've been to research experience, uh oral presentations, uh poster presentations. Um James. Do you wanna? Yeah, I mean, if you, if you say it, but I mean, all of those things will make the sort of stand out, but in terms of making it nongeneric, that's mainly going to be in the personal statement. So uh an example, II applied to an F two position uh in cardiology. Um the top cardiology professor at that particular hospital. Um I had actually seen a European cardiology conference. Um So I've seen one of his talks. So I name dropped him in uh the personal statement saying, oh, the opportunity to work with this professor would be amazing. Um blah, blah, blah, blah, blah. Um So it you know, it clearly stood out and immediately I got an interview. So it's about tailoring it. It's because you can have a very generic personal statement for everything saying, oh, I be passionate about medicine, whatever your your generic stuff is, um you need to be mentioning the hospital, you need to be mentioning the department, you need to be looking at the trust's values. All hospitals will have a set of values. Um Mention those um show that you've actually read around the hospital, you've read around the area, you've read around. You know, if a, if a department does a particular type of procedure, if it's well known for something, you know, they're the things that they're going to go. Ok. This, this, this person has actually researched this hospital, they've researched the team, they actually want this job that's gonna get you the interview over some sort of generic wishy washy person statement that you, that you submit for every application. What do we need to prepare for an interview? Ok. Um I II think an interview talk. Uh I'm, I'm intending to do um uh in, in, in the, in the coming months. Um having just done my registrar interviews, uh there are a number of resources available. Um There's uh the book for uh ct uh interviews or ST one interviews, um which is, which is really useful. Um Other than that, it is going to be um your standard, your standard, you know, body language, open questions, practicing uh answering typical questions. Um Having someone watch you answer questions, having mock interviews. Um The interview format has, has changed quite a lot. Um Most, um most interviews now are, are, are not face to face, they're, they're remote. Um My first couple of interviews were all face to face and then, you know, even for specialty training now, um the interviews are, are, are over, over webcam. So it does change the dynamic a little bit. There's less uh influence in terms of um you know, you know, get getting there the night before and you have to spend a lot of money and um you know, getting your, getting your suit sorted and everything. Um Yeah, the top half of you has to look, OK, but, but that's about it and then it's going to be um answering the questions, it's gonna be practice writing out. Um All of the common questions that you, you, you're possibly going to get and the, the interview book will, will help with that. And then on top of that, it will be um thinking about clinical scenarios that you might get. Uh you also wanted to speak to people who've had that particular interview before. Most interviews have a clear structure. So you'll have a nonclinical side, you have a situational judgment side, then you'll have specialty specific questions. Um You may have to do a presentation within the interview. Um But these interviews, these higher level interviews, they will give you a framework of, OK, you've got four stations within the interview and this is the sort of overview when you prep for all of those stations with regard to your sort of entry level jobs. Um with an individual hospital, it may well be face to face and you're gonna get your standard questions, your strengths, your weaknesses, how you prioritize and then maybe a couple of clinical scenarios. So I had one on anaphylaxis for example, and they give you a clinical vignette and you've got a panel interview with a couple of consultants asking you how you manage anaphylaxis. Um So yeah, it, it all depends on the job. The uh I think the individual hospital interviews are a little bit more or a little bit less predictable, a little bit less structured. What was the hardest part of the transition to the hospital system in the UK? So for me, the hardest thing I and still continues to be making referrals. Um Sometimes I, I'm not really sure which team I'm supposed to be referring to if it's a community referral, if it's a hospital referral, um if it falls under uh vascular surgery or if it falls under leg ulcer clinic or it's just, it's just difficult, I think, um for, for me to figure out who, who to refer to, um there's a really handy app, it's called the induction app. So that will give you the bleak number of the loop holder or, or where to call in D in hospitals all across the UK. So if you need to contact the Med Reg, for example, it'll say the, the number, the extension number for calling the Med Reg if you need to call Ortho, it says the extension number for Ortho and so on and so forth. So the app is called induction. So that's really helpful for um, finding, finding how to contact people when you find out who you're supposed to contact. And then also sort of going over your sbar and knowing how to um give information when you're asking for a, for a referral or for advice. So just going over sbar and going through that step by step process of what's most important and what's less important and what to start with and, and what to include in your sort of handover. Yeah, for me, I say the hardest part was uh the, the practical skills. Um I've had, I, I've done very little in terms to say cannulation uh catheterization. So that was a little bit of a complex for me uh initially and um I was definitely way behind the, the U KF ones um who, who had had far more experience during their, during their medical uh school teaching uh than I had in terms of practical skills. Um I would say, II came out probably with, you know, s slightly um a deeper theoretical knowledge. Um But it obviously depends on individual to individual, but I would say the practical skills were, were, were the things ii struggled with. And that took um a good couple of months to, to gain confidence in those. Um And yeah, then, then I felt I was pretty much level pegging with, with, with my peers. So, um yeah, if you can, if you can get some experience while you're in Bulgaria, it's gonna be invaluable and also a clinical attachment. It will help in terms of, you know, understanding um you know, some of the processes which are difficult to get your heads around. Um the different members of staff. Um you know how the NHS works, the speed that's expected of you in the on the ward round. You know, the striking contrast between Bulgaria and the UK is uh the speed in which a war round is conducted um in the UK is, you know, 10 times the pace of, of a typical Bulgarian war that I've been on. So, you know, you have to work incredibly fast on the um a much higher level of, of pressure, more patients and more demand. So that can take a little while to get your head around and be quite daunting. So can we say our foundation program, one competencies been formally signed off during uni uh I mean, you can, you can say what you like. Um you know, if you say they're not mandatory now to, to be signed off. So they were removed from the horse portfolio. They used to have the, the, the 10 competencies there that you had to have signed off in terms of say, cutting up a bag of fluids, doing an IM injection, which are things you don't typically do as a doctor. Um So you'd have to get seen doing this one by, by a nursing colleague or a medical colleague and um get them signed off. So it will be presumed that you're able to do them. You don't necessarily need to approve it. Um But by the end of F two, these things will be expected of you, but you can get away with never putting up a bag of fluids in your whole career. I'm sure you can. Um There's no um evidence that you need to say that you've, you've signed that off. It's almost expected of you uh without saying. Um But I would say if you can get, you know, if you say you say you do an Al, I mean, you know, an al tourist have you do an APG you can get ad do for that. There's no problem in getting ad O for a standard competence um that you haven't done before. Um But you're not really gonna get much in the way of brownie points saying I've been formally signed off for this uh in, in bulk area. I think in your application, you can say I've done cannulation catheterization and I'm competent in doing these um that will add points in terms of um your employability. Um But there's no formal sign off that you need now, that's been completely removed from the portfolio. So, so I'm just gonna share something with you guys here that I discovered recently. So Metal actually o offers a sort of e portfolio thing um or section if you click on your uh if you click on your profile picture on um Metal and you click E portfolio, it takes you to this page that I have up here on the screen and then you will be here. So you can have work based assessments, logbooks and feedback, so you can add a work based assessment. So for example dot S. So if you have done a procedure in Bulgaria here it is just fill it out. Um And then, and then you can add that there there. Um I this isn't, it didn't exist when I was in med school. So I don't really know then how you take this information and use it. But I mean, if, if you are doing the things like for example, I had um the chance to do some surgical procedures while, while I was in medical school, it would have been really good if I had something like this to keep a log book and say, look this, this is, this is what I did uh during medical school, but definitely don't say you've done something. If you haven't done it, like, don't, don't lie or say I've, I've done this, this, this and this and, I mean, all the competencies if you haven't done them, if you done, if you've done something listed. But otherwise, yeah, just, just be, just be truthful. Um, next question. Do we need to fill in the gaps and employment section of the applications? Um, I don't, I, from what I remember every time II filled it out, um It wouldn't sort of let me go forward without filling it out. Um But also leaving it blank, doesn't really look good if you, if you do have a gap. So for example, I graduated in uh well, February and I started working in August. So I had to sort of explain what I was doing during that time. Um Otherwise, you know, it's, it's good to just explain what you were doing. Yeah, I would say gaps, gaps, unemployment. Um You, you always have to explain. Um They don't look very good at all. Um Even even um recently I, I'd, I'd signed up to a locum agency because I sort of in between job. My job started a month after my internal medical, internal medicine training finished, I had a month gap. So I was looking for some locum work uh applied for uh with a local agency and they were, they were scrutinizing me, grilling me on an employment gap. I had from graduation to my first job and there was, you know, it was a couple of months. I was like, well, I was getting my GMC registration and, and applying. Um So if you've got like gaps, you're gonna have to explain them and they don't look good in terms of specialty applications. Again, you, you're gonna have to explain the gap. Um If you're taking a year out of training and you, you're doing a full time locum year, you still have to meet, you know, your CPD requirements. Um uh in order in order to sort of prove that you're, you know, you're maintaining your registration. So, um large, large gaps are, are not looked upon fondly. So I would say avoid them if you possibly can. But then if you've got a gap, elaborate on your reasoning, why? Ok. Yeah. So just to add on to that, um if you, if you did like a local job, you did that for a year. If you did a trust grade job, which you a clinical follow for uh for a job, you still have to do what's called an appraisal. Um So it looks at all all of these sort of things, procedures, attending, training, attending, teaching, doing, teaching, um reflective practice, all, all of those things. Would you say that? 00, sorry. And also just to add about the, the gaps um If, if you are out of employment, just make sure you're doing something like I said, like even do a clinical attachment in Bulgaria. Um Do a clinical attachment here if you can do some teaching, get involved. Um Do do a medical related job, just, just make sure you make sure you're doing something. Would you say that following the old CST portfolio points guidelines would be enough to stand out when applying back to the UK? Um So personally, um uh this is what I did. I had a lot of uh a lot of the CST CST points, like in a lot of sections, I had full points. I had international oral presentation. Um I had teaching uh evidence of teaching. I had uh yeah, presentations, conferences. Um I didn't have res I did have research actually. Um II was scoring quite well on the CST portfolio and it, and it still took me nine months to find a job. So not in my experience. Well, I would say, I would say all of the things on, on the, on the core surgical training um requirements are, are going to be very beneficial and actually putting in the work in. Now, um you can actually tick boxes for later on in your career. So when you apply for ST three or ST four posts, if you've already got some of these points in the bag, they will carry through, um you're not going to lose them. Um So there's a lot of what I call generic points, which can be used for absolutely everything. So you know, putting in extra work and having a nice, you know, having a nice, a diverse CV of experience and, and things that you can, you can demonstrate, um, is, is, is gonna be invaluable and it is going to be time well worth spent, um, you know, doing well in your exams. You know, if you've got over 5.5 or whatever, you've got the, um, the, the, you know, excellent or whatever graduation from Sophia that will get you points, you know, it's all worth it. That's, that's, that's big points in the bag. Um So I would have a look at the framework for CST for I MT um for all of the main programs and they do unfortunately change quite dramatically um over time. Um But yeah, getting, getting um getting stuff done um like audits and research, they're the main boxes on, on your generic application forms as well. So if you've got at least something to say in terms of management, leadership, audit, et cetera, you're gonna look like somebody who's, who's really been making the most of their time at medical school. Uh and, and an attractive candidate for, for the job. So I would say definitely go for it on all of those fronts. Yeah, even, even if it didn't help me with the initial job applications and, and getting, and securing a trust grade job initially, it's definitely gonna, gonna help further down in um specialty applications and it's already helped with my appraisal and with things like that. So it's not wasted time, they're not wasted points. So definitely like if you can do something, definitely do it. Um I think with uh the actual job applications, I think the personal statement is probably where that what's gonna affect you the most and also any relevant experience uh that you might have. So, yeah. OK. I think that those are all the questions for today. Thank you, everyone for joining us and thank you James for the presentation. Um Follow us on Instagram. Um You can find that on our page um to, to, to know about further talks and to see some of our content and stay on top of um what talks we're doing next? All right. Thank you, everyone. Have a good night. Bye. Thank you.