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Anything else? And when we come to the end of it, I'll just exit. So at the end, you listen to his okay, thanks. Hello, everyone. Thank you so much for bearing with us. We now have a working slide that we can only apologize profusely for the delay. So Susie over to you. Yeah, sorry about this guy's. So thanks for hanging on with us. Those of you are still here uh always through this, trying not keep you too much into the evening. So first of all, quick introduction to myself. So I'm an S T six colorectal trainee. I'm also a wife and a mummy, very important job in my life. Um And I'm also less than full time. So I'm gonna talk about combination of these things today in terms of a little bit of background. Um I grew up in Norwich and I came to Leeds uni to do my medical degree and also to complete a BSC and International Health as well. And then didn't have foundation training in West Yorkshire. I went over to Manchester for a couple of years to do my core training and then return to the homeland in Yorkshire to train as the registrar level. So in terms of an introduction of what I'm just gonna cover, I'm going to talk very briefly about subspecialties. What my day to day job involves what's entailed where the from the acute side, um training progression and how the progress, how the sort of progress works through the training levels. A bit about the curriculum changes that have happened very recently and that we're all still trying to get used to at the moment. Um And then finally, just bit about the competition ratios from last year. And then I'm gonna move on to just talk a little bit about less than full time training. Just last few slides about benefits the application process, the logistics of working less than full time and what typical week looks like for me. So general surgery, there's a few different subspecialties, the gastrointestinal ones and sort of bigger group is colorectal and esophagogastric. You then got the patio pancreatico billary. So split usually into the fatty liver surgeons and then the pancreas surgeons, um endocrine covering everything from adrenals, thyroid, parathyroids, and then breast including on the plastic breast as well. There's emergency and trauma now, which is sort of a a new emerging subspecialty. Um and then all of the different transplant specialties. So why choose general surgery? Um There's firstly, there was a number of things really. Um firstly, for me, it's the large team of people that you work with. It's really really social specialty. There's, you know, ward nurses, dietitians, cancer, nurse specialists, to me, team O T S physios, all the people you meet MDT, all these people you're working with on a daily basis. Uh and it's a lovely mix of different people to be um and specialties. Um, it's very rewarding. And what I mean by fixing not prolonging is that there's many specialties where you are working with chronic conditions and actually it's very rewarding to see somebody that's quite unwell, perform an operation on them. And then, you know, a few days later, they're going home fully better. Um also diversity of the organs that we work with. Again, many specialties have a single organ that they're dealing with. But for us, it's multiple abdominal organs, we deal with the chest, the trunk and the abdomen as well. So lots of different areas to work with. It's very much hands on learning within general surgery. So an apprentice style type of learning where you're in theater, doing hands on procedures most of the time. And there's multiple different skills as well. That's subsets that you can have. So not just open surgery, but laproscopic surgery, which is the majority of what we do in terms of the cancer sections now. Um and some, mostly the Keats as well. There's also completely separate entity of endoscopy, which is a nice separate skill to have on the side. And then finally, the innovation and general surgery. So, and many other specialties within surgeries with the robot and robotic training, which has really taken off in the last few years. Um So we use lots of different imaging modality. So you can get familiar with all these different things. Um So you take billary disease, for example, you can start off with simple ultrasound scan showing some gold stains. You then may need to arrange an M R C P, which is just an example, they're showing some CBD stains, um, then therapeutics as well. So you may then need an ERCP and the involvement of the gastroenterologists. Although there are some places where surgeons do the ERCPs as well. Um, and then the other modality which we use a lot in general surgery is CT, um, it's just showing a small bowel obstruction. Um And in the time, one of events could well represents a gallstone honest, for example. So what do I do in a week as a general surgical reg? Um, in terms of a session, a session means a half day. So an elective theater time, we'd have to sessions at least one full day per week, usually at least one clinic, one s tech session which stands for same day emergency care. So they tend to be about once every couple of weeks that we'll be doing one of these and it tends to be patient's that are referred acutely, but don't necessarily need to be admitted for the problems. So when they need an urgent ultrasound scan or they maybe have an abscess but they're well with it, they can come to a clinic the following day to save the backlog of inpatient admission's um ward rounds. This depends on where you work as to how, how they run it. Many places you have a firm and an attachment, for example. So you'll be responsible for your consultants, patient's um whatever days you are in. However, where I work at the moment, we do it in full weeks of war, drowned. So one in every seven weeks, we'll be responsible for seeing all the patient's in either colorectal or upper gi depending which team you're on. Um And that is your priority for the week. And then after that, the other six weeks, you will be doing other things and you don't have to worry about the patient's sort of continuity, anything on the war cause that's dealt with by somebody else. Um And endoscopy, we aim for at least one session per week within the gi specialties, of course. Um It's not always possible and ideally it would be a training list as well, but again, not always um scheduled, but we do manage mostly at the moment. I managed to get one session per week. Um M D C as well as usually once weekly. Um anywhere between 60 minutes to 2.5 hours, depending on how many cases we've got. That's usually like I said, once a week for me, it's on Tuesday at the moment. Um And then Dina me teaching is one session which is usually once monthly, it's compulsory and you're relieved of any elective duties to attend that um sort of scheduled in your work rate and everything. And then finally there's the other bits so governance ipod audit, that kind of thing. And I just put an example of a full time kind of weak what you might be doing in the morning and afternoon of a five day week. So moving on to kind of typical operations that I get involved with. There's a colorectal trainee split them into the elective side, the smaller cases and then the schedule bigger cases. So kind of things that we do day to day basis. Um hernia repairs that maybe primary, maybe incisional recurrent. Um so groins, inguinal oils, umbilicals, all sorts of different types of hernias that come across and get referred to us E U A is a massive area. So examination and anesthetic, many of the patients that come to us, we don't actually know what we're going to be dealing with until we actually get them into theater. So often their consent forms are quite varied and cover a lot of different things. Um The reason most mostly for them having the US because we are unable to examine them in clinic, for example. And therefore it's quite often an interesting revelation to find out what is actually wrong with the patient and we offer the opportunity then of course to treat as well as diagnosed on, on the table. Um, and then prolapse surgery. So this demographic tends to be the elderly females with rectal prolapse is there's a number of different ways to repair prolapses, either perennial or intra abdominal. Um And again, that's another fairly common presentation and elective case. And then moving on to the scheduled surgeries, these tend to be the cancer sections or IBD surgery and either laproscopic or open depending on the consultant and depending on the patient to a degree as well. I've just put a couple of pictures of the different parts of the colon um that we're removing the various different operations. So, right hemicolectomies often for a sequel tumor, we're sending colon tumor and we join the, the I'll um to the transverse colon anterior reception is taking away the sigmoid and usually for performing anastomosis as well. Um I've done a peroneal reception is to remove the rectum and anal canal as well. So those patients would be left with a permanent stoma um in the payment, Colostomy and Colostomy Hartmann's reception. Um So you're removing the sigmoid mainly and you often enough with a rectal stump and then an end colostomy which can be reversed in the future. But the, the outcome from the heart means is that you certainly for a period of time, you have an end colostomy and then a subtotal colectomy can be used either acutely or electively, you're moving the whole column and you end up with a joint from the Islay um to the rectum or in some cases, if it's an acute case, it would often bring out an end of ileostomy, let everything settle down. And then you could always have either a patch reconstruction or an estimated at a later point once the patient's recovered. So what does the acute involve? Um There's three sort of main types of shifts that, that I cover the surgical assessment unit long day, which is 12.5 hours and it's essentially just admission's. So anybody coming through GP referrals, any referrals with a surgical problem. And it, we cover both adults and pedes. Most D G H S will take Children from about 56 upwards. And if they're younger than that, they tend to go to pediatric surgeon centrally. Um theater long day is probably the nicest of the shifts because you're essentially covering all the emergency operating. It's quite variable. Some days are absolutely round packed of the days. You're not doing too much, but again, another 12.5 hour shift there. Um And the nights you essentially the different main difference is you're covering everything because it tends to be a bit less activity over overall at nighttime. So you're covering the emissions, the theater and the war problems as well. The picture they put on this slide is really just to show the variety of kind of presentations that we can have in general surgery. We tend to be sort of the abdominal pain people. That's how it often feels from A and E and you often get presented with somebody with quite some nonspecific symptoms. And really it's our job to work out with a good history in a good examination and then the investigations that are raping to us to work out what's going on as you can see from all the different quadrants in areas. There's all sorts of things that that may be going on for this individual patient, some of which obviously more need, more urgent attention than others. So what did I do in my last few theater on calls? Just as a bit of an example. Um Top right, there is a coffee bean sign from a sigmoid volvulus. Um So I was down in a any with a rigid sigmoidoscopy, deflating the colon, um deflating the sigmoid. It was elderly gentleman with learning difficulties. So that's quite a typical demographic of the kind of patient that gets full of your sigmoid volvulus. Um And that was reduced. Um So he was comfortable and then he ended up having a flexible sigmoidoscopy in the next day to fully decompress the colon. Also done many laparoscopic appendicectomy. Um often training the junior because one of the operations that many CT trainees start to learn and become proficient at over the course of the CT one and see, see to um and it's quite a nice little operation but it can, it can be underestimated. It can take anywhere from sort of 20 minutes, three to a couple of hours depending on how severe it is. Um The necrotizing fasciitis going into saw the big guns of the excitement of the surgical world. We recently other patient who had a growing abscess but he was diabetic and had rapidly spread in turn the skin technocratic and that involved some coordination from plastics as well, plastics consultant. And we also had urology involved in that case as well. Um Also, there's a lot of eu a so perianal sepsis, most people don't think of the US is particularly exciting, but they can be some of the most difficult to manage, particularly you've got patient with Crohn's IBD abscesses and officially, that can end up being extremely complicated. Um And uh the main priority with these cases, as you can see the picture in the middle is to drain the sepsis. And then often we bring them back for MRI scans or for further eus once things have sort of settled down to try and treat the underlying pathology once they've recovered from the acute event and then a perforated to use. We did a laparotomy a month or two ago for a gentleman that was in our colic, he'd come in with perforation and would have had an experts, not his actual X ray, but a similar X ray to the one shown in the picture with a pneumoperitoneum. Um, he had a D one also. It's fairly small. So we managed it with a limited laparotomy and oversewn of the ulcer and a mental patch on the top and he did very well and went home, I think about day six or seven. And then the bottom right picture is a loop Colostomy and that's the white bit is the bridge that goes underneath the colostomy, support it to support the weight of it. Essentially when, when we first formed, then they come out about day five. And this was unfortunately a lady who had advanced malignancy and had a fistula between her bow and her vagina. So she was leaking fecal material and have very, very poor quality of life as a result. So that was actually quite life changing for her and her symptoms that were really, really making her life very difficult. We're much improved by having the diversion of the stool. Um Next one, I just track quickly about endoscopy. So I really enjoy endoscopy. It's really, really difficult to learn. It's one of the most difficult skills thing I've had to learn. Um, colonoscopy can be very frustrating, but it's also very interesting and it's nice to do something a bit different as well from your normal clinic or from normal theater lists. Um, the pictures on the left are all related from two colonoscopy. So there's a picture of a polyp being snared even a little wire snare. Um we sometimes diagnosed diverticular disease, which is very common. That's the top right picture. Unfortunately, sometimes we find cancers very typical picture of what cancer would look like in the colon. They're bottom left and then the bottom right is a retro flexion. So, right at the end of the procedure, excuse me, we retroflex a scope to look back on itself and often you can see hemorrhoid pedicles just like that. Some juicy hemorrhoids there. Um In comparison, the pictures on the right are from a A G D, so a gastroscopy with normal looking stomach at the top. Um And then sort of typical pathology that you may find in someone that's got reflux or abdominal pain, um epigastric pain, you've got peptic ulcer disease, some ulcers on the left and the letter A and then an example of a bleeding ulcer in the duodenum in, in the picture labeled be. And so I just wanted to mention a little bit of the pathway progression as well. So typically, over the past 10 years, most people would think this is how it works. This is how it has worked. You complete your foundation training, you'd apply for CT and then during your F to you, then start your core training. And during that time you take your mrcs, once you've passed part B of that, you can then apply for your S T training, which is usually towards the end of CT too. Um, and then you get your registrar post, which would then take you from ST three up to ST eight. Um, towards the end of ST seven or eight, you'd start to think about doing your Fr CS. And then once you've got that exam past, you have completed your training. And then many people go on, particularly in general surgery to do a fellowship of some kind that may be an IBD or robotic training or Laproscopic fellowship just to sort of further hone in their skills and prep them for the consultant posts. Um It's worth noting as well that I'm not going into the academic side. I know we've had some brilliant talks previously about the interview process itself and academic training. And that's obviously separate from what I'm talking about. I'm just covering the main route that most people go through the um CT training and then reapplying for ST. So, um that was the traditional route, but we actually have an updated pathway now and the training has been split in two phases, excuse me. Um So in 2021 the whole curriculum was overhauled and the whole training pathways overhauled. So you now have phase one, which is the core um surgical years, so called CT one and C T two. And if you complete those and get your sign off A R C P for CT to then you've completed phase one, you then go on to phase two, which is the first four years of your registrar training. And what this basically encompasses is a kind of a general overview of emergency surgery, elective gastrointestinal surgery. And then you have to do at least one of the subspecialties in the box on the right. And phase three is the last two years of your registrar training. So really where you're honing in on your sub specific subspecialty skills and making sure that you're ready to be that day one consultant that you should be when you get your certification at the bottom. And this is just taken from the curriculum itself just to give you an idea of the critical conditions of the acute conditions that we have to know about and we have to be able to manage on a general surgical take. So as the consultant on call, you'd be expected to manage any of these conditions. Um uh I understood that. And so how do we log are evidence of our training as we're going through? So, um the pictures on the left or from the, the log book, which hopefully many of you will, will have heard of will be using already. Um It used to look orange and gray and then in the last year, it's just had a bit of an overhaul and it now looks like the interface on the bottom, bottom left. Um So we look because just changed how it looks, it works exactly the same way, but it's just slightly laid out differently. Um, and in terms of your assessments and things that's all done through, I SCP unfortunately, you do have to pay for this, but it's how you log all your cbds, your taxes, your PBS, um, everything that you need to prove that you're getting the training, um, and completing the assessments that you need to, to progress to the next stage and then finally bottom, right, the jet system, that's how we log endoscopy. So anyone that's doing colonoscopies or gastroscopy is you use the jet system, you need an account for that to log those. Um So I just want to talk a little bit indicative numbers. So what this basically means is what you can be expected to have done by the time you reach your end of your training. Um So this is what indicate numbers for phase three, the end of phase three. So when you get to your C C T, you'd be expected to have done 100 laparotomy is um at least 80 appendicectomy knees and at least 20 segment will collect to be some emergency receptions of the bowel. If your colorectal such as myself, you'd be also need to be doing um 30 anterior receptions, uh at least 50 segmental colectomies. So planned elective cancer receptions, um and some fish and hemorrhoids as well or logged as opposed to an upper gi trainee who would need um anti reflux surgery, bypass surgery for a bee sting things out like instead and I wanted to mention research as well. So um general surgery was traditionally associated very heavily with research. And many of the consultants that we work with at the moment will have needed research to have done a period of research in order to actually get the registrar training number. But that is no longer the case. But excuse me, sorry. Um So uh the box on the right with a big red cross in it is um what we were when I first started my training, uh we were presented with the requirements for from this, from the top side of research. So um 2020 this document still stood and we needed three papers where we were first author or second author at least. Um and we needed three regional presentations at a minimum mind dealing national presentations in order to reach the end of your training and get signed off from that perspective. But that all changed in 2021 when the new curriculum came in. It's now much more non specific and there is actually having gone through the curriculum with a fine tooth. Um There is no specific numbers that you require, but you do need to show in one of the domains that you have an appreciation of the academic side of surgery and that you're able to critically appraise papers um so that you can actively um incorporate sort of new techniques and things into your own practice in terms of how to get research experience. Um collaborative opportunities are really the best way to do it as a junior. Um There are many different opportunities, many different studies going on all the time. And the reason I put the assets signed just there is that they have a good list of all the current um kind of collaborative programs sorry, collaborative studies that are going on at the moment, you can get involved in um when things like uh data collection or assisting in the analysis state and things like that. So it's definitely worth having a look at. The association of church is in training website for lots of general advice as well about training and surgery. Um And then finally, just at the bottom, so some people still choose to do out of program time, many people get their training number S T three. And then at some point between S T three and ST eight, they decide to take some time out to do either an MD or a phd, which is obviously the other way to um to acquire the skills you require from a research perspective. Um And then I wanted to mention the courses that are relevant. Um So some of these are compulsory, others are not, but you come into contact with sort of the jets and the endoscopy side a bit later on. Usually there's a basic skills in upper gi endoscopy and the basic skills on colonoscopy that you can do. Um A TLS is essential and part of your requirements to progressively reg training crisp I believe is still part of the core training requirements. You have to have passed that in order to become a range. Um And the B S S basic surgical skills really is aimed, I think at a more sort of F one F two level CT one just to try and improve your skills so that you're getting use out of your theater time and you're able to do, do some of the skills in theater. And then last slide um for this section, it's just about timeline and complete competition. So I just put the timeline on the left there from last year's application for C T training. And you can see that the applications opened on it's an oriole system, so it's an online system fully online. Um They opened the beginning of November closed a month later. Um So you have four weeks to put your application in um the interviews uh then started just off Christmas. Um the interview window closed. So there's two months of interviews and then at the end of that month, at the end of March. So only a few weeks after the window closed, they started offering the places for the jobs and then you had, I think it's 28 days in order to either confirm you offer or to hold it or to, to further think about what you're going to be doing what you've been offered. Um And the boxes on the right are the actual numbers of applicants from last year. The top one is for the court surgical training. Um There were over 2300 applications for 622 posts. So that was 3.7 applicants for every one job that was available. And it's similar ratio to be honest when you get to reg level, just less numbers, obviously. So you've got 530 odd applications for 100 and 53 posts. So again, 3.48 or 3.5 to 1 in terms of competition ratios. So that kind of concludes all the bits I wanted to say about general surgical training and curriculum. Um And I just wanted to talk a little bit about less than full time training because it's something I'm quite passionate about the reasons why you might want to less train us the full time, the aims of less than full time training. Um the application process, how opportunities have changed over the past couple of years and some considerations you may have if you wanted to apply. So in one slide, this is my reason for being less than full time. So it's childcare mainly um and a number of other personal reasons as well, really. So having family time traveling a balance of home life, being able to still engage in extra correctly, I took correct curricular activities, having flexibility for my own sessions as well. If I'm wanting to do extra things, work related and to be able to attend nursery in school events more easily when you've got at least one day off a week. Um and then just having admin time as we all know, we often end up doing um work on portfolios and things late into the night sometimes. Uh and having periods of time off work where you can actually do all that stuff is actually quite, quite nice. So this is an example of ROTA I work 60% and this is a 14 week rolling rotor where I currently work and the orange boxes are normal day. So eight or 5 30 is a standard day elective work. Um The red boxes are long day on call so that the essay you cover the admission's um the blue are the long theater days. Um And then the yellow of the night. So you can see roughly how it works. Um As you probably work out from the pattern Wednesday is my main on working day um as is Friday, but I have to do some Friday sort of to make the balance of the shifts correct with the weekend hours that we have to do. Um It's worth mentioning um that you don't have to split it like I do. So I do a certain percentage of each block. Um So I do two of the three long days or two of the four nights. Um, each time that pattern comes around, whereas some people choose just cause it's easier for them to do a full blocks at full four long days, but then do it less often. So next time it came around, they wouldn't do any of that, just do elective days or have some days off in that time period. You also have to agree your pattern with your department. So it's very variable to be between departments and how many trainees you have here are less than full time as to how they work it. But most departments are quite amenable to sorting out with you and working with you to make sure it works for you. Um And I also wanted to mention slot share ing. So um at 60% if there's two trainees in the same department that both 60% it's often easier just to share a slot. So for the on cause of the acute, you just do 50% each. Um and then you'd make up the extra time in elective um uh cover as well. So in terms of the aims of less than full time working from health education, England, the idea of it is to retain doctors who are unable to train full time for any reason um to promote career development and a good work life balance to ensure there's continued training on time equivalent basis. So people are still getting the same training which is over a long time. Um And to maintain a balance in arrangements with regards to educational needs and making sure that you're not missing out on educational events. Um So a bit about the application process. Um So it's 16 weeks, roughly how long it takes. It's an online application all through health education, England. Um And there's been traditionally two categories for uh for many years, which is category one and category too. And there's been a newer development over the past couple of years, which is category three, which I'll talk a little bit more about in a moment. Um And just to mention that once you have your approval, excuse me, once you have approval from health education, England and urinary uh for your lesson, full time working, you then have to talk with your local department about how you're going to make it work. And obviously transitioning to that pattern if you're already in a position already in that job at the time. Um So category one is the biggest battery for applications. It's usually for a primary care or responsibility for Children. So often people returning from maternity leave or paternity leave. Category two is slightly different. So it's a unique opportunity. So for example, representing your country at sport or religious commitment um that you have um then you can apply for it for that reason as well. And then category three is something that is essentially just personal choice, not many people know now that you don't have to have a good reason other than you want to be able to work less than full time for your personal well being. Um, it all started from a pilots through that was running 2020 was rolled out in a couple of specialties such as A and E initially and all they did was they got a full time trainees to work at 80% for a 3 to 6 month period just to see what effect it had on them and whether there was a benefit to them. Um And essentially it was overwhelmingly positive. Um And as of August last year, the full program has now run out so that you can now apply if you are any, any trainee who is in a postgraduate medical specialty will have an opportunity to apply lesson full time as of August the 20 August 2022. Um So you can train us in full time as just a personal choice to help meet your professional lifestyle needs. Your options for training are between 50 and 80. So it's 50 60 70 or 80% that you can choose to train at. Um It's not currently available for trainees who are out of program, doing other things. So it's only when you're actually in a training post at the time. Um And I just wanted to mention that foundation trainees are separate because that's run by foundation schools and the applications are in this, done in the same way as what I'm with the information I'm talking about here. Um So, yeah, and the, the associations at the bottom are just sort of depicting all the different um uh associational I'm councils and uh basically big names that are in support of this and I've backed it as a, as a program. So uh in terms of evaluation of category three, um this is what led to the rollout really after two years of it, they at the pilot study, they took some information back from the trainees that had been working in the pilot and they found that 100% of them said they had an increased sense of work life balance and overall well being had improved, that 93% of them were likely to remain in training. Um If they continued at 80% Melbourne full time. Um and the 80 60 86% of them were planning to continue onto consultancy at that time. On the flip side, just in the blue box, there, there is obviously a negative impact for some people. So about 30% of the wider trainees who were still full time and many of the educators and most employers actually said that the less than full time trainees did negatively impact the service provision in that it made some more voter difficulties, for example. So what should you consider if you're thinking about training lesson full time? It's not all positive. So you have to uh realize that there will be reduced income as a result. Um And to weigh up whether the time that you are gaining is going to be manageable with the out goings that you have unless anything is changing. Um teaching and training opportunities can be affected. So for example, if there's a regular teaching day on a day, that's from your nonworking day, you don't have a sort of, there's, there's no, there's no need for you to go to that particular day. It's not compulsory. If it's on a non working day, then they deny, cannot sort of force you into going to that particular training day. Many people do uh and work sort of childcare around it to make sure they don't miss out, but you can end up missing some teaching opportunities if you, if things always fall on a non working day, for example, um similarly with particular consultant list, there may be some very good traders, an apartment and if they are operating on days where you are not working um every week, and obviously, you may miss out on a breath and, and so the depth of training from some particular consultants, um motor difficulties, I've used the word difficulties because it's very variable. Um Some hr departments are very good with the communication and a very on the ball and want to help and get greater sorted. But I would probably say on the whole, there is at least one or two difficulties with every, every transition to a new job with Elektra sorting out less than full time writer. So there is a bit of admin side to it and you sort of get, helps to be clued up on what you're entitled to and, and the process as well. Um And there is a loss of some continuity. So some people find it's quite hard to deal with. For example, I work Monday, Tuesday, Thursday. So if I'm an award cover week, there may be quite a lot that's changed on Wednesday and it can be a bit difficult sometimes on Thursday when you come back and you know, various things have changed, our patient's have moved, you're not aware of it. But um I think that's just something you learn to deal with over time. Um And there's also something called a less than full time champion like each of the NHS Trust, which is a national initiative so that anybody working in a less than full time post, he has any questions or problems and they wanted to raise. There's somebody directly that they can go to, to help them resolve those issues. Um The final side is just to talk about some benefits of less than full time training. So I did a short survey last year looking um uh speaking to a number of different, less than full time trainees. Um He were both male and female. Um It's an important point that I meant to make earlier that a lot of people assume less than full time training is just for women. Um, and it certainly is not. I know a number of male, less than full time trainees now who have benefited greatly from dropping their hours to either 80% or 60%. Um, but yes, so some of these are the phrases that came out of the feedback that I got from this survey. One person said they're more focused when they're at work, they're not as tired anymore, uh more involved in school and managing sort of more time with Children. Um One person that actually helped them to continue working and to not give up work after an emotional mental health crisis. Um Some people said that it helps, particularly if you've got other half that work shifts or rotor patterns that clash is can be very helpful to have 11 of you working less than full time to try and accommodate that. And also people feel more socially balanced and sort of enjoying their work as well, more as a result because they feel sort of more refreshed and ready and something that I've always said, um is that the last one is something that I believe is that I'm a better doctor and a better parent as a result of my less than full time working. So in summary, um general surgery, I enjoy very much. It's very varied. There's a large skill set that you can acquire it for the time that you're training. Um It's very busy but it is very rewarding. Um And I'd encourage anybody that's got an interest in it um to proceed with the training because I once heard somebody say if you don't hate being in theater when you probably gonna be a surgeon, um because most people are really put off by it. But yeah, and I know a lot of people who have come into it a bit unsure and it ended up going on to really, really enjoy their training. Um And then separately, less and full time working is now much more accessible than it used to be through this category three introduction. Um and that it can really improve your work life balance and health overall if it's something that you're interested in. So, thank you for joining, sorry about the issues at the beginning. I'm more than happy to take any questions or if any wanted to email me. I'm sure people be able to share my email if you wanted to sort of personally contact me outside of the platform. Thank you so much Suzie for your presentation is really interesting. It's really good to see how excited you are about your work and how much variety you get surgery and also how less than full time training is a lot more accessible than I think people have a perception of it being in general surgery. Um If any, everyone would like to the feedback form um, to help us improve our sessions, I'll be able, we appreciate. Technology is a bit of an issue with this one. Um, about sessions you'd like to see in the future. We'd be really grateful. You'll get certificates after you've done the feedback form. And if you want to post any questions, we'll stay on the phone for a couple more minutes. Thank you so much. If everyone's done with questions, I'll stop for cast then thank you so much, everybody.