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Hello, everybody. Hopefully we're live this evening. Um, uh, the button says we're live. So that's a good start. Uh We've got one person in the chat. It would be great if anyone's here, um, start letting us know that you're here in the chat. We'll, we'll give it a few minutes just before we kick off and then we will get started because I don't want to take up your valuable. What night is it? Tuesday evening? We've got a few, there's a few people coming in. Hello, everybody mode's. It looks like according to the medal feed, it looks like the audio is working like Grant. Thank you. Hello. Thanks, Charlotte. It's better to find out at the start than at the end if there's a, if there's an issue, but we'll, we'll give it till, until four minutes past and then I'll get started. Yeah, that, that's really important that, um, doctors if, has just raised in the chat that we do have moderate Aces on hand tonight. So, while I'm going to be giving the talk, uh, if you have questions or comments or things that you would like, um, advice or help with, uh, there are points in the talk where, where I can try and deal with them. But throughout the chat, our moderators will be a go to, to try and get some speedy answers and make sure that everyone can get the help that they need. Okay. Um It's four minutes past. So I think let's make a start. Um And we'll welcome anybody new as they arrive. So welcome to this first, this first lecture tonight in a series uh that goes by ready set burst. I'm going to actually put my slides in front of me so that I can see this is in a very simplistic sense. This is a multi part series. It's four online lectures, the dates of which are on screen now and it's all about research excellence. That really is the best way of thinking about it. Uh We've got some really fantastic speakers lined up and tonight I'm going to be taking you through the first session, which is all about essentially what happens after medical school. What's going to be the beginning of your medical career and understanding what comes next. That's really going to be focusing on early years and perhaps middling years, medical students or those who are later on in the course and don't have a good handle on what's coming yet. Um And then the later sessions are going to be much more practical about how to do the things that are gonna score you points and get you academically where you want to be. So we've got sessions on audits which are very important, collaborative research and publishing, which is something that everyone realizes is important. And then a session on critical appraisal, which will be a panel session and critical appraisal is one of the most important skills and academic medicine. You know, anyone can put a paper down in front of anyone, anyone can write a paper that says anything trick is in knowing if that paper actually makes sense and if it's good. So my name is Ali for some context, I'm an academic fy to doctor working in the northeast and I'll talk about more of the specifics of my journey and a little bit um coming to the end of my foundation training now in my final rotation with my, our C P next week, which is a very exciting time. So just to jump in, what is medical school to me ultimately about like, why do we go there? What, what are we hoping to get out of it? Why do students go to medical school? Well, the thing is right, medical school isn't this kind of magical machine that turns people into doctors? That's not really what it's supposed to do to any straight degree. It's, it's not a case of saying, you know, can, can we put a random person into a medical school and they'll come out as a, as a competent practicing doctor. It doesn't really work like that medical school is a bit like a boot camp or a training ground. And it's about giving you those basic skills on which you can build, right. So in order to be able to break the rules and form clinical practice, you have to know all of the rules um or to analogize, you can't play a board game right? Until you know all of the rules, you can't start to play more specific versions or variants of a card game until you know all of the rules and you have to know them well enough to operate within those rules, even in situations that don't quite fit. And that's what medical school is really about. It is a very, very broad as you all know, foundation in the fundamental basic sciences, those being anatomy, physiology, biochemistry, pharmacology, pathology. Um However, you subdivide it and that's important because on these foundations, you can build any kind of physician or surgeon. So if you want to be a cardiologist or you want to be a neurosurgeon or you want to be a pediatrician at some level, all of those doctors will have a standardized minimum set of knowledge and skills and the fact that they all have that same standardized skill keeps patient's safe because we know what it's reasonable to expect doctors to know and that sets a minimum, safe standard for practice. That's what medical school is about. Tonight's talk is what comes after medical school. What happens when we get after this phase and the details of this, I don't think are especially important. I think it's about broad principles. But given that so many medical students, certainly myself, I was, they tend to be quite goal oriented, right. They want to know what's coming next. They want to have something in the distance to point out and to work towards and say yes, I'm going to go and be a dermatologist. I'm going to publish a research paper. I'm going to go and do an elective in Portugal. However, they tend to be quite goal focused. And so I think it's very helpful to a large group of people to understand what can exist in the future, what comes next. And fundamentally this to know what your options are uh is to borrow a phrase from, from Simond Fleming the orthopod reg who is, who is now recently CCT uh his orthopod consultant. You can't be what you can't see. And so we need to see everything that there is to know what comes next and we'll divide this into the broad pathways that most people will follow and then where the opportunities are to move away from those pathways. Now, people get a bit uncomfortable about moving away from pathways. But um actually, it's really, really common, very, very, very few people will deviate, very few people don't deviate from the traditional path I should say. And I'll talk more about that as we talk about specialty training. So this is going to be the big fundamental thing, right that hits you when you come out of medical school. The foundation program, this is a program that consists of 64 month rotations taken over two years, which comes as a package set of six programs. So you don't get to decide. For example, I want to do four months of cardiology, then formance of respiratory, then formance of surgery, Then I'd like to do for months, pediatrics. It's not mixing and matching, it's not picking and choosing it's this package of six, I like better than this package of six. So you're applying for a package of six programs in most places, there are some exceptions to the rule, but they are very few. So for most people, this is how it all works. You're applying for this package set of six. Uh they come over two years, obviously F Y one and Fy to, they have slightly different expectations between those two years. But another way you might look at this is that you're going to spend three of your four month rotations as an F one with one set of roles and responsibilities and then 34 month rotations as an F Y too with a slightly more senior uh set of roles and responsibilities and be expected to do slightly more as, as an F Y two. That's the start of being the S H O of the ward senior House officer. Now, foundation year one. This is the important thing. Your first year of clinical practice. This is what's required to get your full GM see registration or your license to practice as, as we often call it. In order to be independently licensed and work as an autonomous medical practitioner, you need to be fully licensed practice. And that includes working at hospitals outside of your own trust. Effectively foundation year to uh is then required in order to enter specialty training for UK graduates. Uh I think I've included a bit for I MGS later, but I'll make sure it's addressed if I don't. Uh So to give an example, we have Doctor Smith who graduates from Manchester Medical School this summer in 2023 she will then go and complete the following foundation program which is four months of acute medicine for months, general surgery, then pediatrics, then trauma and orthopedics, then general practice in the community and then finish with four months of accident and emergency medicine. And this is a really key thing virtually all and I say virtually all it will be like 95% but there is some wiggle room. Virtually all programs will include exposure to a mix of things that that's what the foundation is supposed to do. It's supposed to expose you to lots of different areas of medicine with at least one rotation in an acute medical specialty. So either a Andy or acute internal medicine and that's what's called being on the acute take. You should be seeing an undifferentiated acute take that is seeing clerking, admitting, forming a diagnostic and management plan for new unseen patient's that you will see and examine yourself and then discuss with a senior. I think it's probably the most important rotation that any of us will do in the foundation program. Uh It's a bit unlike anything else and then you'll do at least one community specialty as well. This can be anything most commonly, the ones that you'll see it uh As our general practice, obviously, it's community based specialty and psychiatry as well is very common. So that's where I'm doing my community placement in our second example. Uh We have doctor Rossiter who will graduate from U C L Medical School as an example in 2024 she goes on and complete the following program, Formance in HPB surgery, four months of acute medicine, Formance, Arenal medicine, four months of older people's medicine, Formance in E N T and Formance of hematology and oncology. Uh And again, this is a perfectly reasonable foundation program gives you a good mixed range of specialties, lots of medicine to different surgical specialties. Uh I haven't actually put a community rotation on there. Let's say that the older people's medicine is a community community Jerry's rotation. Um But again, that's the point, broad strokes mix of specialties. Uh and you'll all spend or you should all spend at least some time carrying a cardiac arrest bleep off phone as well. That's one of the really important experiences that you'll get during the foundation program. So, like I said, you're building a generalist base in acute and general medicine and in surgery. So you can handle a very wide range of situations. If you're presented with them later, virtually, all of you should become als qualified at some point during this process. So my co holded it in Fy one and als or advanced life support training means that you're capable of leading a cardiac arrest situation at least until senior help arrives. So you're you should be able to recognize and initiate treatment in a cardiac arrest situation uh until med ridge or anesthetics or someone comes to help. And of course, the other point is to prepare you to apply for specialty training for what we call core specialist training. And as you move up the training ranks, you will take on additional responsibility. So not only will you be setting off in your specialty training journey, but you will also be responsible for supervising Fy One and Fy two doctors and those lower on the training ladder than you. It's a continuous process. Obviously, you go higher up the ladder, you help bring people up the ladder below you. Now, there's a portfolio to deal with just like you'll be used to a medical school. Uh We use a system called Horace the Horace E portfolio. Which seems to be pretty standard for the foundation program in England. Uh And this is just an example of what it looks like. I'm not going to go into it, but just as you are expected to fill out, perhaps reflections and supervised learning events, maybe procedures dots is um case based discussion's all of these things that you're used to, you will be expected to maintain a portfolio. That is what we call contemporaneous that is that it's timely. So you update it as things happen and you update it throughout the year, not just at the end of rotations or not all before your final A R C P, you keep a diary essentially throughout the year and that is how you pass your ERCP with no issues. Now, that's the foundation program. One of the, the alternatives that you can go down at this stage is called the specialist Foundation program or the SFP. Now you do this at exactly the same stage. So you finished medical school, you're going to go on and do two years of further training before you can apply for specialty training. But this one is the specialist foundation program used to be called the academic foundation program. And the way it works in the broadest terms is one of your rotations. So one of your six remember package deal rotations is exchanged for an academic or a specialist block. Now, usually again, not always, I'm going to say that a lot throughout tonight's talk usually but not always, there are no hard and fast rules in medicine ever, especially not in medical careers. I'm just trying to cover my own back because there will always be an exception. Usually these are themed in either research, leadership or education as in teaching, but not always. Sometimes they're completely unspent lysed and you can do whatever you like. Sometimes they are incredibly specifically themed and you will be working on a very specific project with a very specific supervisor. They may be themed around a specific specialty, uh which is something to bear in mind if you have a particular specialty in mind. Uh they often come with funded qualifications such as post graduate certificates, um which normally cost about several 1000 lbs. They can be funded as part of these uh specialized programs and will count towards your specialty training applications. They are seen as prestigious for better or worse. I'm not, I'm not 100% sure that that's a good thing necessarily. I think that S F P S are a great thing for the right person. I don't think they're the right thing for everyone, but because they only make up about 5% of all foundation program places, um it goes up or down each year, but it's about 5% because they are highly competitive, they are seen as prestigious. And therefore, again, you can use them as evidence later on. But because you're swapping one of those rotations for your academic or specialist block. And you only have 54 month rotations of clinical experience. That means that you have less time in which to become as good as your peers. You have the full six rotations and that's up to you whether you want that kind of pressure. Um I've not found it to be too significant a problem, but you do have to try, you, you can't be complacent about this. And you also need to understand, especially if you're an early years medical student. Now you're thinking about the specialist foundation programs. It's a very different ballgame to some degree. The point of the foundation program is all about eliminating differences between graduating doctors and turning them all into a kind of big homogenous mush that will go around the country and fill all of the rotors that need filling and everyone should have a broadly similar experience. So it doesn't really matter where each individual goes. What matters is that all of the rotors are filled and to some degree, that's the function of the foundation program. The SFP is kind of the opposite of that in that it highlights differences between individuals. So it's much more looking at uh skills in research, education, leadership publications presentations, whether it's posters or oral spoken presentations, winning prizes, having interesting experiences, all of these things valued. And the question is what makes you stand out, that's really what the specialized foundation program is about at this stage, it's what makes you stand out and how can we take those skills, those features that you have and how can we allow you to build on them and excel in some other way? That's, that's really the point of the specialized foundation program. Now, the process for these two is the same whether you choose to do the regular foundation program or the academic specialist foundation program, but you must submit a standard foundation program application before you can apply for the SFP. The only reason why that's important is that if you are not successful in getting one of these specialist posts, it means that you will fall back into the standard foundation program recruitment process and you will still have a job, which is obviously the most important thing. You will then be competing with everyone else for foundation program jobs in exactly the same way as everybody else. Whoops. Um There are these things called white space questions which are kind of like mini personal statements of about three or 400 words. And they'll usually ask you for your thoughts on it might be something like what is a big unanswered question in medicine? Or uh tell me about your leadership experience or tell me about when you did research or tell me about when you solved the problem, kind of like mini mini interview questions. And you also have to upload and submit a portfolio which is publications or research articles, journal, papers, presentations. So if you've spoken at conferences or meetings and prizes, so that might include things like academic prizes, merits distinctions from your exams, research grants, bursaries essay prize is, there's a million things that can, can go under prizes and lots of people will have a few things you can only submit to too academic units of application. I'm not going to go into the weeds of this, but basically with the foundation program, you'll broadly apply to all of the big geographic areas in the UK. So it might be, you know, the Northeast Scotland, uh Devon Peninsula, that kind of area London or North London or whatever it's split down into. And you can apply everywhere that you want for the standard foundation program with the academic foundation program or specialist even you're limited to. So you have the possibility of interviewing for two of these jobs. And obviously, if you're successful, you'll go on and do one of them. If you're not, again, you will, you will re enter into the standard foundation program. The major difference is that the specialist foundation program will require you to pass an interview which will test your academic program and your clinical uh your academic knowledge even in your clinical skills. So expect a clinical interview. Uh they usually done online or at least they have been in recent years, but I would expect a clinical Viber because you have to be good uh because of course, you will have less time than your peers to get clinically good as a doctor. Uh It's successful with one of these specialized posts. You'll find out much earlier than everyone else where you're going in early January, February. Uh It will be more April May for people doing the standard program. Now, there are two other interesting choices that you have um when you leave medical school. Now, one of which is the foundation priority program, which is a recent thing that was introduced to recruit graduates to underserved areas or specialties that don't get enough applicants every year. Um And the way that they do that is they come with a perk of some description. So usually that might be a funded qualification uh or something as simple as an enhanced salary package. So for example, I know some of the doctors, I work in Newcastle, some of the doctors that work in Carlisle, I think receive something like 7000 lbs a year additional salary simply for working there because it's recognized as an underserved area. I think it's a really progressive way of solving that problem. Uh It's less competitive than the SFP, but it comes with many of the same perks in that, you know, where you're going to go, you know, where you're going to be working for two years. Uh You'll find out early on what you're doing and you get one of these perks without all of the rigmarole of portfolio and prizes and everything else that you need to do. Um It is however, the major drawback with this is because it's about recruiting people to uh to underserved areas. It's only available in certain parts of the UK. For example, not very many in, in major metropolitan areas where lots of people want to go and work as doctors because that's obviously kind of the point of this. The other one is the Psychiatry Foundation Fellowship Pff. This is a program that's intended to essentially give very focused support to those graduating doctors who want to go and do psychiatry. So you decide, you know, at the end of medical school, hey, I'm interested in doing psychiatry. What it does is things like provide you with specific ring fenced funding for going to conferences, funding for projects and regular meetings with a psychiatrist to supervise you, make sure you're progressing and help you get into psychiatry. Now, the interesting thing here is that there is no tie in. You are absolutely not required to apply for psychiatry at all. If you don't want to, after you finish this program, gives all of the same competencies as the foundation program because it's all delivered on top of the standard Foundation program. So, you know, for anyone who wants to do psychiatry, it's clearly a great thing for anyone who maybe is not sure whether they want to do psychiatry or not. It might be worth it to get that extra degree of support, funding, access to research opportunities and things, think about it. It's, it's not something that I would rule out early if you're at the stage where you could apply for it. No. How would you choose a program or they're all challenging for different reasons? Uh This is a historical slide that I've taken from an old presentation and I'll talk about it in a minute. The S J T or the situational judgment test has played a significant role in where people get allocated in the country. That's this national examination that tests your clinical judgment skills or it's situational judgment really rather than clinical, just like the one you would have taken when you applied for medical school as part of the U cap. Historically, this was given in combination with your academic performance at medical school, what we call your diesel. Uh So those two things are important basically to, to allocate where people went in terms of their geographic preferences. If you wanted to be in London, you would need a high academic performance throughout medical school to get high decile and you would need score. Well, on the S J T, the specialist Foundation program doesn't use the S J T at all. Um But as we said before, it requires strong portfolio, good interviewing, good clinical knowledge, good networking, all of these kind of academic soft skills. Now, this is a really important thing for you guys watching for 2024 onwards. So that will be people who are going into selection, who are entering into the selection process for foundation this September or whenever the process starts. So to start in summer 2020 for as new doctors, the way in which all of the allocation is going to work is set to change. The details have not been published at this point in time. I've just explained how it used to work. It used to be basically how strong was your academic performance at medical school and how well did you perform on the S J T example that everyone in the UK sit, we're moving away from this model. It seems like towards a preference informed model where you would instead rank maybe your top five dean Aries, your top five geographical areas. So you might say my top five might be London, Oxford Cambridge Bath and um the West Midlands or whatever because apparently this results in more people being happier and getting a choice that, that they're more likely to like than basing it on these points systems. It's out for consultation. A final decision has as far as I know, not been made yet. So I'm really sorry. It sucks for next year. We don't know how it's gonna work. Nobody knows. Um So keep your eyes peeled for that. Everything could change how much will you be paid and we're going to stop for a break in a minute to answer any questions. The foundation trainee salary when you come out of med school is about 29,000 year just over rising to about 34,000 and F Y two. Now, obviously strikes stuff notwithstanding, you can expect anything between kind of 5 to 8000 year higher as that is our full time equivalent. Uh salary adjusted for 40 hours. Obviously, we don't work a 40 hour week. As, as doctors, we tend to work anywhere up to 48 on average. Um So you will learn additionally as a lot of those hours will be predominantly antisocial, including nights and weekends as an F Y one, it depends on your specialty. All of this is very dependent on your specialty in your workload. You can expect maybe 2200 ish after tax as an F Y two. I found that it's about 2400. Again, depending on your rotor. When you graduate, you don't get paid usually until the end of August. So watch out for that, especially as you'll have big financial outlays with moving house, renting a new place, deposit on a new place, etcetera, anything that you do that reduces the hours you work will reduce your pay. You can undertake bank work, which is the equivalent to locum work inside your own hospital. As an F Y one, you can do full locum work in any hospital you choose from Fy two onwards. And that's the time where we're going to take a break because I am very ill and I need to let my voice recover. Um So we're just going to hold it there for two or three minutes and I'd be very happy to take any questions or comments on anything that needs commenting on. It's a lot of information. Okay. Thanks narrow me to, I've been off work today. Uh So just been resting my voice all day, ready for ready for this. But you can tell I'm sure that I'm a bit muted compared to my normal self. Uh Charlotte is saying with locum shifts, are they done on a national system or do you have to apply individually to the trust? That's a good question. It does vary and it, it really depends. So where I am, um I do all of my locum work through what's called the staff bank. So I get emails from essentially all the departments at the hospitals where I've worked, which is two or three now. And they'll say, you know, we need a doctor to cover this department on this day. This is the rate for these hours. Can anyone email be back? Uh And that's the way it works here in different parts of the country. There are often locum agencies. So, so sort of apps um and things called like low comms nest is an example of one. So you sign up through this app and then any of the hospitals that, that locum agency serves will, um, will go out to advert on the app and you would sign up on the app. So it really depends what people are doing kind of where you are in the country. Um, like I say, where I am, it's mostly, it's mostly done by word of mouth. Um, yes, let's see what, what Doctor Joseph just commented there like that seems like a really good system. Ours doesn't work anything like that, that seems really efficient. Um So, you know, it varies that they're different amounts of organized. Um, the only thing I would say is that organizing stuff directly with your trust will often get you more money than going through a locum agency, right? Because the locum agency will take cut of whatever they charge the trust for your labor because that's how they make money. Um It's far easier for a rotor coordinator or a trust to employ you directly and give you an escalated rate than, than it is to go through a locum agency which will cost them more to get you the same doctor. So, being friendly with rotor coordinators is very helpful and, and if you're reliable as well, um if you, if you're known to be flexible and able to carry to, to pick up shifts on short notice or to change things around, you'll get called more often you might, um um, in the America, you, you've just asked about how the S F P S will work from 2024. It's a good question. We don't know. I suppose the, the thing to say is that death Siles won't necessarily go away. Obviously, they're just generated from the data that, that medical schools already have. So, um SFP processes could still use Death Siles if they wanted to, even if those diesels weren't going to be used for the foundation program. But they, because they can choose basically each individual academic unit for SFP can choose to do literally whatever it wants. It's a wild west. So they could still say, you know, we're still going to use diesels and we still expect fourth decile or better or whatever. Um As London used to do. But yeah, I agree with you, Charlotte. It's very frustrating. Um None of it as far as I can tell as evidence based in. Anyway, I, my, my firm opinion is that it's all cost cutting. I think that's what it's all about. It's the only explanation that makes sense to me. It's how can we process this very high volume of people as cheaply and quickly as possible. Anyway, let's have a move on. We're into the second half now and the second half is much shorter. So we're nearly there. Uh Just to, to illustrate for you what I've done thus far when I left medical school because I think people find it helpful to understand what people have actually done. Not, not just saying this is what you can in theory do. It's, this is what people have done, this is what they do. So I've done an academic foundation program in medical education research, which again, super niche, there's probably a handful of med research programs um that exist. It's a niche within a niche. So it's, it's not about teaching, it's about researching the Y Behind teaching, which is very interesting. Um So that's my themed academic foundation program before it was renamed to the, to the SFP. So I'm hanging on to that. I was the, my cohort with the last cohort of academic foundation doctors. Um In my F one, I did four months of transplant surgery which ruined me. Uh four months of academic rotation with general medicine on calls than four months of acute medicine. So that's on the acute take, carrying the cardiac arrest bleep. Then in my F two, I did four months of neurology which I really enjoyed. Then four months more of academic because again, just to show you how unusual things are. If you do the Newcastle Specialist Foundation Program, it comes with two academic rotations. So I've only done four clinical jobs in two years. Um And then finally, I've ended up on an academic psychiatry job, which is very strange, but I work on a clinical trials uh unit for psychiatric in patient's. Um So I've done, I've done probably getting on as much research in this non academic psychiatry job as I did in my academic jobs because just because of how the job is and how the atmosphere is and what am I doing next? So these rotations have set me up very well to go and do my F three if you like or a non training year in neurosurgery down in London, which is exactly what I wanted to do. So I feel very privileged and uh yeah, that's where I'm at. That's what I'm going to go and do next. So you can see how all of these pieces fit together. Now, we're going to spend about 10 minutes talking about specialty training again at the very broad level. It's just so you understand what's coming, what is specialty training about? Like why do we do it? This is the process by which you turn a generalist physician, which is what we're all trained as into a specialist. One, someone who instead of knowing a little about a lot, which is, um which is doctors in general. Um It's turning that person in someone who knows a lot about a little into a specialist physician. And we have to remember that general is um itself paradoxically, is also a special is um so just because people working in general practice or in acute medicine are extremely good generalists that, that is the virtue of their specialty, that is itself their specialty if that makes sense. And in the UK to enter specialty training, it requires completion of the foundation program. So that's the important thing for UK graduates now, for international medical graduates, this is what I was talking about before. You've got a few routes into specialist training. You can either complete the foundation program if you can apply to it directly. Uh you can undertake a standalone fy to post. These are quite competitive but they are available which again give you the same certificate of completion or you can do what's called the Crest form, which is a certificate, readiness to enter specialty or specialist training. And the important thing with this, I don't know the details of it, but I can tell you that it does not need to be signed by UK consultant. A Crest form can be signed by a consultant practicing in a country outside the UK. So if you're wanting to come and do training the UK or work in the UK, um a quest form may maybe the way that works best for you. So it's just important to have a read around understand the options and see which which one is going to make the most sense. They come in one of two forms, one or two flavours, specialty training programs the most common. And that is to say that most specialty training pathways are like this are what we call uncoupled. That means that they consist of two distinct phases. You have a core training phase and a higher training phase with entry to both of those stages being competitive. Pardon me? Entry to that higher stage of training usually requires having passed your collegiate exams and being a member of the college. So, in fact, I'll go through an example insect. So let's say you want to be a cardiologist, you'll do your F I one F I to you then need to do internal medicine training. What used to be called core medical training. But now it's called internal medicine training. And by the end of that time, by the end of those three years of internal medicine training, you must have passed your M R C P, your membership with the Royal College of Physicians Exams and Paces, which is the clinical exam. And that would make you eligible to apply for ST for cardiology training. Uh And then you do that from S T 42 S T eight and then you'll get your cardiology CCT certificate of completion of training and you can become a consultant and many specialties. Now, uh will dual, you'll dual qualify in your primary specialties that might be cardiology, neurology, respiratory, whatever uh your deal qualify in that and general internal medicine, um which is a relatively new thing. But so you get two qualifications basically to give a surgical example, you want to be a urologist, let's say given that this is uh this is being done under the purview of burst. Um You'll do your F Y one F I to, you would then need to complete course surgical training or CST, which takes two years. Uh So two years is a surgical S H O. You would then by the end of that, so by the time you uh reached the end of CST, to, you would need to have passed your mrcs member of the Royal College of Surgeons, part A and part B. Um That would make you eligible to apply for an S T three post in urology or the surgical specialty that you're interested in. And again, you would carry all the way through until S T eight where you would become a, a single CCT urology consultant. And that's the way most surgical specialties work. Anesthetics is really complicated and I'm not going to go into the weeds of trying to work it out because I don't care, but it has a core phase which is taken up either by court anaesthetics or A CCS, which is, it's called the acute care common stem pathway, which gives you a bit of experience in kind of emergency medicine, anaesthetics. Uh acute medicine. Basically the address all of the adrenaline junkie types of medicine. You do that for three years. Um Having it does I T U as well, uh you need to pass your primary F R C A exam and then that would make you eligible for higher anaesthetics training and working towards becoming an anaesthetics consultant. With the option to do A C C T in intensive care medicine if you so wished, this is obviously absolutely not an exhaustive list, but most specialties work something like this. You have a lower phase of training which is more generalized and less specific. And then you have a higher phase where you become a registrar in one specialty and you work towards being a consultant. The alternative is what are called run through training pathways. These are essentially the niche hypercompetitive specialties and the reason that they're like this is that you go straight into them after Fy two. So instead of doing multiple phases and multiple rounds of selection, you apply straight after Fy two into ST one specialty training. And once you're in, so you have one entry process once you get in and you get that ST one post, you are in training until you reach consultancy. So you go all the way through the program usually for eight years. Uh it depends on the program. However, these only exist for a small number of specialties. So it's things like radiology, pediatrics, ophthalmology, neurosurgery, cardiothoracic. So the general principle is if the specialty is so niche that learning, generalist skills are not going to be helpful or are not going to be a good use of your time. You know, if you think about court surgical training, it's not going to be useful for a neurosurgical trainee to spend six months doing knees and hips and then six months opening up abdomens with the general surgeon it's probably not a good use of their time. Given that 90% of the time they only operate above the neck and specialty selection is the point more or less now where your portfolio really comes into its own. There are really broad domains that are important to be aware of those being audits, presentations, publications, prizes, experience in teaching and training and teaching, which are not the same thing. And increasingly we're seeing a trend towards the MSR A or the multi-specialty recruitment assessment being used for selection which surprise, surprise has an S J T in it, wouldn't you believe it? Um It's basically a G P exam. That's what it was designed and developed for. However, because it's cheap and easy to mass deploy and it generates a bell curve scores. Um More specialties are using it now um including surgery and that that was a real game changer last year. I'm not going to talk about any of this stuff in tonight's talk, but that's what the rest of this series is all about is helping you with this stuff and about excelling in the academic side of your portfolio. Why do I go for help? This is a big question and you will need help. Very few people can go it alone in medicine. I certainly can't, the place to start. And the only answer that anyone will ever give you is check the person's specification and the score ing matrix because if someone comes up to me and they know that I do neurosurgical research and they say like ali, I want to get into neurosurgery. What do I do? I will say, well, the first thing I'll say is pick something else. The second thing I will say is you just have to Google the point scoring matrix for the most recent round of selection. That is, that's all anyone can ever tell you because it varies by specialty. There is no one size fits all and it varies by year. Things change often in the weeks running up to when specialty selection opens, the rules change last minute. Um So the answer that I give or that anyone else gives can only ever be as good as the point scoring matrix. So, so just look there. Um One of the last things I want to talk about is the academic clinical pathway, which is something that I'd like you to all be aware of. And the point of this is that in order to make sure that we have enough people doing research in the future, clinical academics, we need doctors, physicians and surgeons, driving academic research in situ. Um in vivo as it were, we need doctors that are trained as scholars and scientists. And the clinical academic pathways is basically the way that we ensure that we do this as a profession. Um And it combines your clinical training. So you're, you're years as a registrar with academic study and work usually in the form of A phd, these are appointed in a slightly different way, but the most major difference is that they're run through even in specialties that would not normally offer, run through training. So um Mr Nathan, for example, um who is going to be around later in the series, I believe one of these talks, let's say that he finishes Fy too and he applies for an academic clinical fellow post, an A CF in urology. Um despite the fact, remember that you can't normally apply for urology until S T three, you would have to do course surgical training first. His A CF will be given to him uh immediately if he's successful, he enters as an S T one. And that means that he does not need to reapply for urology training S T three. His A C F post means that he's guaranteed two things. He's guaranteed phd and research work an academic time during his clinical training and access to the academic pathway. And once he's got his training number, it's his, until he finishes training and becomes a consultant. Um So for those of you that are academic and want to do a specialty that does not offer, run through training, but you want that security of doing, run through training. And A CF is perhaps the most simple way to do it. And then finally, the path less traveled and this is where I'm going to wrap up my talk and we'll have a few minutes for questions. Very, very, very few people complete training the traditional way anymore. Foundation program, core training, higher training consultant. And it's often not because people don't want to do that. It's becoming impossible to do this now because of how competitive everything is and the training bottlenecks, everything is becoming more and more and more competitive, the government is unwilling to fund enough training posts. So everything is backing up and up. So people have to find other things to do. Now, f three years are very, very common. People go abroad, people teach for a year. People do research, people do junior clinical fellows. That's obviously the type of thing that I'm doing. Um You can do an out of program experience at any time in your training anytime until you're a consultant and agreed period of time out of your program to do something. Um You might need one or two years out to do that. You might do a master's, you might teach for a year, you might do something else. People take time out to do phds and mds. If that's what you wanna do, you could go and work in industry and farmer consulting, go into medical politics. If that's what you like, there's uh mps who are doctors on both sides of the political aisle do locum work. Um Fellowships are very common. Um That's where you take time out of training or as part of your training to go and develop some very sub specialist experience in your specialty. Often people go abroad to centers of excellence for that increasingly common is less than full time work. Uh So 80% less than full time that is you're doing uh 40 hours instead of 48 or the adjusted equivalent four days a week instead of five, that's now available to any trainee in any training program for any reason. Um In England, at least I don't know about in Scotland and Wales, Northern Ireland, but that's something to be aware of and SAS careers as well. Rob Fleming, just Google his name. He's done all of the work that you need to know on this. But Sass is basically an opportunity to develop your own career as a specialist uh without rotating effectively. So developing your competencies and building seniority in the same unit with a supporting department in a specialty of your choosing. And there is a national contract that has been agreed for Sasse doctors for specialty doctors and specialists, doctor's to protect their pain conditions that not enough people are using. So be aware of South Korea's and that brings us to the end four minutes before the hour. Um Are there any questions? I realize we've covered a lot uh tonight and I'm very sorry that I say I'm not, I'm not up to my, my usual uh animated self. I'm very weary as I think you can tell So, uh, thank you all for attending. You've been very attentive and I'd be delighted to help you all if there's any way that I can do so, I'll put my email in the chat as well. No one wants to get in touch. Thank you. Burst for having me as well. I'm very much not a urologist or know anything about bladders or testicles. Um, true. Yeah. Neuro does rhyme with your, oh, we can, we can be confused on the phone at any time. To be honest, you guys that are at medical school when you're in S H O and you're either the neuro or the, your O S H O. There's no greater pleasure than, than picking up the phones, um, for a referral and then two seconds in they go, oh, no, no, sorry. Your neuro I wanted your, oh, sorry. And then they hang up and then you can sit back and go back to sleep, I think. Uh, not my problem. Mhm. Yeah, exactly. They'll have given you the full rundown. But if, if there's no questions, I'll close at eight o'clock. Well, see it the whole hour. All right guys, I think we're about that. There's no questions forthcoming. Um Thank you all very much for watching. Thank you, America. Have a good night, everybody and make sure that you come along to the next sessions. The links to register for the next sessions are out. All of those events are ready to sign up, so be sure that you do and uh there will be more interesting than this one, I'm sure. So take care. Thank you everybody.