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Good, lovely. I'll just introduce. Uh, hi. Um, hi, my name is, um, I'm on the, I'm, er, the present of the Left Orthopedic Society. Um, today's talks going to be done by Matthew, who's our fellow secretary. Um, so I, I'll, I'll leave it to Matthew to, um, to introduce himself and, um, brilliant, we'll take it from there. P can you just start the and just put it, let me know when to change? Sure. Hi guys, like PJ said, I'm Matthew, I'm one of the four medical student along with the PJ and I am the secretary for the or society for the 2023 to 2024 year. So today's session is just gonna be a breakdown of the course training, um, particularly the, the latest and most updated one for the 2024 application process. So the application process that is literally just passed. Um, the dead end was for the first of December. So here it is. Um, if you've got any questions, send us a, send us a message on here or give us a shout on our Instagram. Let's go for side, please. Yeah, next slide. All right. So this is just an overview of the timeline. So again, on the first of December, you would have pretty much added up all your points in the courses, training, um checklist and kind of submitted that. And in the next couple of days. So no later than the 20th of December, you've got a link to sit for the M SRA and that's a free exam and that's now used for GP training. And ASHE takes a lot of multiple different specialties. Um So essentially the main thing with that is know your medicine and it's based on the M SRA test score that you get selected for your interview. So even before your portfolio is broken down and checked, even before that, there's a kind of a bottleneck for the M SRA. I think one of the reasons they changed the exam from before was because there were so many applicants that they wanted to actually narrow down the applicants. So I think for 2018, there was 2600 applicants sitting the normal surgical exam and of those that were invited for an interview was half, like less than half. Um And I think it's, I think from the M SRA, it's the top 1200 applicants that get selected for course surgical training interview. And from that, I think there's like 600 places. So 25% of the overall people that sit the M SRA actually get into surgical training and half of those people that sit the M sra actually get invited for an interview. So the main takeaway message from this even before any of the surgical training portfolio checklist would be know your medicine um and try try as much as you can to do well in that test, essentially what it tests is all of your medical knowledge from specialty training. I mean, so it tests pediatrics, dermatology. GP so you know your overall medicine, not just surgery. Next, next low, please. So what are the domains for the 2024 course, surgical training, self assessment criteria. So it's split into four things. First one is commitment to specialty. Now, this doesn't just involve TNA. Although we are the TNA society to get into TNA, you have to, unless you're in Scotland, you have to go through URG training. Um So this is kind of a broad overview. Um although there are a few tenor elements specifically to it. Um First one is commitment to specialty. So that doesn't mean to surgery. Second one is quality improvement and clinical audit. Third is presentations and publications. Now this is a big chunk. You one and finally the fourth one, II think this is gonna be the determining for a lot of people that sets about a lot of people is gonna be teaching experience and training qualifications. Sorry, the S is a bit blurred and the side note that's a screenshot from the official NHS website. We'll come back to that right at the end. So what is commitment to specialty guys? Like I said, it's all surgical specialties. Now, this is split into a couple of domains. The first one is operative experience. What that means is logging surgeries. And essentially, you know, as a med student. Ideally in third year, if you're, if you're from Leicester, you go into surgeries and you observe now the normal thing would be, you know, you stand at one corner and you watch the surgeries. Um if you're an enthusiastic student or if the surgeon is particularly nice or, you know, if they're a AK guy or woman, they would probably let you in, they'll let you scrub in and watch the surgery. Now, what counts is the fact that you have scrubbed in. There's no points for observing, which is just standing in the room watching the surgery where you get a point is for assisting. And if you've scrubbed in that counts as assisting, that's the big thing. And essentially, if you get 40 cases logged with, um, the date of the op the patient number, um, the procedure that was being done and you get that approved by the consultant, then that's one log and there's e log books that you can log this at. And if you go onto the N SS website, they give you very detailed information of how to actually log it. And essentially, when you are submitting these cases, for example, all the TNA cases needs to be verified by one TNA consultant or the general surgery by one consultant. And you'll have to print that out and give it in as, er, evidence essentially. Um, now one of the, one of the very nice TIPSS that was told to me by Fy, one in Leicester was, um, when her boyfriend was applying for TNA TNA training essentially or for course surgical training, he got into TNA eventually. Um but when you apply for course surgical training, everyone has their minimum of 40 cases. So the key here is don't stop at 40 if you wanna show that you are enthusiastic about surgery. If you like surgery, actually go into surgery and really show you that this particular guy had over 100 cases and everyone else had like 6070 ok? Some had 80. But then there's someone with three times as much as the highest requirement, ok? They know this guy is committed to surgery and the specialty. So that's my advice for you. Obviously, every majority of the people, this is the easiest thing to score the whole marks in. So try not for the minimum and actually go in because you're enthusiastic about it and the points will flow and it will show in your interview after the checklist now, conferences. So if you've attended minimum of three surgical conferences that are endorsed by e either the Royal College of Surgeons or any, you know, acclaimed surgical society, you will get points for that and you only need three surgical conferences. That's maybe one in third year, one in fourth year, one in fifth year. That's not hard. Or even if your foundation is, you can do that. So on the right hand side, I've er mentioned a s surgical conference I went to in Imperial. It was the International Trauma Conference and that was brilliant. They had um a lot of professors, they had, they had Professor David Knot. Um If you know about him, he's a war doctor. He goes to very deprived war to countries and he set some surgeries there. He trains surgeons and even through Skype one time, he led a surgery by telling the surgeons exactly what to do through Skype. Even before robotic surgery was a thing, he was already kind of simulating that. And there was a surgeon there called Kevin Tsan. He's a neurosurgeon from London and he teaches at Imperial College, London. Um He talked about his experience of, you know, formula one flying him out to Dubai to be one of the doctors there to look after the drivers and to assess them to see if they were ok to go, go ahead and drive. Um So there's very speakers that come and don't just go again, like I mentioned before, don't just go for the minimum cases. Go to be inspired, go to actually learn something and get something out of it. A tip that was taught to me by 1/5 year. Actually, no, a surgeon was eventually we're gonna have to go to these ca these conferences anyway, to present to give oral presentations or poster presentations. So when you're a med student, it's a bit less expensive. So go to them have the minimum. But eventually if you are gonna work through your portfolio, you're gonna be there anyway. So try doing it when you're going to present, that will save you a bit of money if finance is an issue, which as a student is understandable. Now, the third category. So we had surgical cases. So surgical experience, we had conferences and now the third one is surgical experience. Now, this changed from 2023 to 2024. So if you've attended a minimum of a minimum of five days of surgical days a week, that is counted as three points. Now, before this used to be the same as your elective or undertaking a surgical placement in your foundation year. But in the 2024 category, there's a change and from my knowledge for attending a surgical ta week, specifically, you get one extra point, you get three points instead of the normal two points before in the 2023 for undertaking an elective or having a 12 week. So three month surgical placement and your foundation, you reach, you're bound to get that would have been three points. Now, they've reduced that to two and attending a surgical taste a week specifically. So if you have a special interest, for example, in head and neck surgery, ent surgery, you organize a minimum five day, um, takes to weaken that you get three points rather than the previous three points which are for the surgical elective or the minimum to a week, which is three month placement. And the best thing about the elective is you can travel, you can explore. A lot of people go to Cape Town, a lot of people go to Africa. A lot, a lot of people go to, you know, um to countries and they, they're able to assist in surgeries. Um The first video that I've shown to us a screenshot of a youtuber called that Medic. Now he's a ent, he was called surgical trainee. Now he's a specialist Ent Ent trainee in London. He's studied at King's College London and he has an amazing video of his elective in Cape Town in Khaya. And you can see him operating, you can see him jumping off cliffs traveling and he talks about his whole whole experience. So I'll check out that really, you know, if you want to be inspired or even look into it. And again, you can go with your friends surgical experience that's, you know, there's surgery there and then there's experience there, you can get out of it what you want and how to have a proper evidence for that. Again, that you can find it on the NHS website, but essentially the time you undertook it where you undertook it, consultant, a signature letter. Um That's what you need. Again, you can do it elective in England, in the country you're from. But if you're from England, going outside, you know, that's a plus point is a bonus. Next side, please. Ok. So the second category is quality improvement and clinical audit. Now, this is something you're gonna have to do in your foundation years, but doing it in your foundation years, you know, when you're applying at the start of F two, maybe that's not the best place to do it essentially to audit. If you know what an audit is, that's essentially you're analyzing, assess data and finding out flaws in either a system or some kind of practice, you're implementing a change after finding out what you need to change and then you're reassessing your data to see if what you, you've implemented has actually brought about something good. Um And I would recommend you start that as a med student, um, speak to a consultant and do an audit and essentially it's good to work in pairs. Ideally, it's very hard to do an audit. If you're, there's more than two people doing it like me and PJ right now, we're doing an audit. Um I'm not go, I'm going into the details of what it is, but essentially find someone who's enthusiastic about surgery, identify something which you think, OK, this is something that could be improved that needs to be worked on and find a floor and analyze it, collect data, analyze it, see, OK, or analyze data, find something that can be improved. Implement a change to make an improvement. Then in a couple of months time after you've made a change, reassess the data and if from whatever you've implemented. So from the change, if there has been a good outcome in clinical practice, that audit would be close looped. So you've done one assessment, you've found a problem, you've thought about, you've done a change, you've changed something, you've reassessed it and you found out, ok, there's some improvement that's a close looped audit. And if you've improved, if you are involved in a place you audit, that means you've ece essentially scored eight points. Um If you look on the left hand side, you can see 8.6 0.4 points. Now that depends on your contribution. So if you're involved in all aspects of that audit, you get the whole whack. But if you've minimum been a contributor in an audit, um, and that's brought about a change and it's a closely audit, but for example, you haven't been involved in all of the aspects, but you've contributed here and there and it's a close looped audit, it's brought about a change, then you can present that at a national or regional or local conference. If you've scored minimum four points in a close looped audit and you present it, then you can get extra points for that. So my recommendation would be find a partner, assess some data, find something you can change. And hopefully, you know, it brings about a change. If you score the whole point, try to get that out at a conference or some presentation regionally or nationally, there are specific guidelines to say what is a regional, what is a national, what is a local um platform? Yeah. Now the third thing is publications and presentations. Now this is what, you know, med students really want to get their heads stuck in and it goes without saying this is a lot of commitment. Um The text might be a bit small but if you've won a prize with delivering an oral presentation or a national at a national international level, um and your CF author, you get the whole whack, you get 10 points. Essentially a publication is something like you do research and the research is good enough. It's, it's high quality research and you know, it's good enough to be presented and published. And if it is good enough, it gets cited by PUBMED. And there's lots of consultants in Leicester that do research. In fact, there's a lot of publications that are happening, you know, across the country. But the main thing is is building a report with a consultant and actually finding out, ok, can I do research with you? But more importantly, um, you've got to understand the fact that doing research and trying to get publications, that's a long process. Um, that requires a lot of commitment as a med student. You know, I'm trying to do one right now. Um, it's hard work. So you need to get involved in it if, you know, you really think you've got the time to do it and you're gonna set apart a specific time to actually do it. Um, but at p, I don't know if you wanted to add anything about publications or presentations. Yeah, I think with, um, with publications it's about building rapport, um, with specific consultants or registrars. Um, like you, I know the top points here say you've got to be first offer. But in our stage, in our, in our, in our, in our medical school careers, it, it's very difficult to do first author off the bat. So it, it's all about doing it. Second author, co author. Um, which I know is on like two points here, but it's about setting yourself up now to kind of, um, know how to do a publication, how to write research. Um, and I think they all start with reading research first, um, which we don't do a lot of at medical school. So I think it's about, yeah, reading a few articles here and there every week and, um, and then you, you know, the style and getting yourself involved to consultants because at the end of the day. Some are more um receptive to getting you on board and some are not. So it's just about, yeah, do, do, do w working with, um working with who wants to work with you kind of thing? Great. And it's a really good point that you mentioned there that came to my mind. Um Essentially if you get your head in through the door and you do one and say you didn't get much out of it in terms of publications or presentations, you've still got the experience of how the cycle works, how to go about doing a new one. And the sooner you start, the better you get at it, which means the better you could be actually publishing. And I know even consultants they still go about doing research to publish. Because essentially at the end of the day, it brings about, you know, change to the healthcare, change to patient lives, um which is at the end of the day, that's what's most important. But again, to get into surgery, you know, if you want to be strategic about it, start early, know, you know how the process works, make mistakes, but eventually you'll be able to produce some good quality research and get it published safely. And for the point system, it does say it has to be, you know, public cited. So there's specific criteria, um there's guidelines that you can look up to see, you know, if it would actually score points and just on the note, um, I know med students are very keen to do case reports and editorials. Um, they do not get points. Um, so just be wary of that, it's good to do and I think the way to start off would be actually do a case report because then, you know, you know, the time it takes and you know how writing something actually is referencing and all of that, um, start off with a case report but then, you know, then work on to publication. Um, yeah, and this is just touching up on the evidence for what is an oral presentation. Um, what is a publication? Um, it's very specific at the end of the presentation, I've linked, you know, where you can exactly find this. Um, and the requirements that they particularly ask for, they're very, you know, picky about, er, what you need to count as evidence for whatever you're claiming to be because essentially you, you, yourself assess your course training portfolio and you count the points you've got and then you, you know, you select and you send it off and you do the test, you do the em sary and then you, if you're invited for the interview, you can't change anything, you can't change the points that you've, you have, you know, said you've got, and then when they assess you, if you've got less points than you say. Well, for example, say, you say you've got 50 points and you end up with less than half that. Um, that's ideally not where you wanna be. So having the evidence to back up the points, you say you've got, that's very important. Again, this is just touching on the evidence. Next slide. Now, like I said, this is what sets a lot of people apart, teaching experience. Um, now before, er, for surgery for course, surgical training, they used to count additional degrees, extra degrees um inters, but they kind of scrapped that and they added in teaching experience that teaching experience and teaching qualifications. Um they both come that essentially teaching. And the first one is where, you know, you've worked with local educators that could be a clinical education team and you've designed a teaching program across a regional or national level and you've given a series of face to face lectures um to teach medical students based on a gap you've identified in teaching. Um and there's a very specific criteria that you have to meet for this, for example, um to be at a regional level, you know, it has to include um maybe one or two deaneries. Um for example, there's a hospital in Leicester, there's a hospital in, er, or Northampton or, or Peterborough, if you do a teaching series across three or four of these hospitals that counts as a regional teaching series and you have to be a minimum of four of that and the main thing is it has to be aligned with the clinical education team, you have to sit down and talk to them. OK? From med students experience, you know, for example, in third year, um what are the things that med students from their feedback said could be improved in their 30th? Um And you find something that consistently med students have said, OK, in third year, for example, in our medical block, this was not something that we were taught. Well, you identified that and then you do a teaching series across that across one or two hospitals or three hospitals or one or two deaneries. Now that counts as a regional level to do a national level, obviously, that's very hard. Um I don't think you would need to do a national level, but at a regional level, one or two hospitals cover it. And the main thing is working with the clinical education team identifying a gap in the education, which isn't great and then implementing it and you do need to get this, you do need to get a letter of approval by the head of clinical education or a consultant that's overviewed it. And the evidence for this again is very, is very picky. Um You don't give a feedback, you don't give, you know, letters of all the feedback the students have given, you get all the feedback, you have a set analysis for that. So you analyze that data from the feedback the students have given and then you get the consultant to read over this, sign it or you get the clinical education team to reflect on the feedback they've given and sign it and approve it. And on the right hand side, if you look, if you look, you can see training qualifications. Now, if you see the images, it's surgery, guys, surgery is all about teaching. Um Believe it or not. I remember in my work experience before I came into med school. Um I was in second year of a level and I'm from Northampton. I remember going into a plastic surgery. So I was like, wow, oh my gosh, man, this is a plastic surgery I'm watching and essentially what it was, it was a five year old, four year old kid. It was just separating a little syndectomy. Um I was like, oh wow, it's plastic surgery. Um And essentially, I remember there was these two very old surgeons, plastic surgeons and halfway through the operation, I remember the older looking surgeon, you know, shouting and raising his voice at this less older looking surgeon who was clearly his junior and said, do what you do what you're meant to be doing, not what you think you're meant to be doing. And I remember thinking, wow, man, that's proper rude. Like how can you say that he's a colleague? Um Now in fourth year of med school, having been to multiple surgeries, having experienced the medical world. A little bit more. Um I understand the fact that, you know what he was giving him a bit of constructive criticism um in a bit of a mean way. But that's, that's what it is. I'm not, I'm not encouraging, you know, being mean to your colleagues. But for surgery, there's a big long road of teaching and showing you've got qualifications in teaching, showing you've done teaching through teaching experience and showing you've got qualifications in teaching that adds points. One of the reasons why they took away integrated degrees and additional degrees was because um there's a lot of applicants to England for course surgical training and across the platforms, it was very hard to find a equal uh equal criteria criteria to measure. OK, what counts as an integrated or additional degree? So they used the teaching as a set boundary. Um cos teaching, you know, if you've got a qualification in teaching or if you've taught and have experience in teaching that's transferable to pretty much everything. Teaching is a very consistent thing that can be assessed. So a master's qualification in particularly medical education or masters in teaching is what they're looking for. So say if you have a masters in, for example, sports medicine, that wouldn't cover points. It's particularly a qualification in teaching or clinical education. Now, a lot of deaneries I know in Leicester, um they do something called er CT FS. So what that stands for is clinical teaching fellows and they do something called, um, surgical teaching fellows. And what they do is they take a year out and they do APG cert three or, you know, they do, they take one or two years out and they do a diploma. And again, if you look, that gives you points. So essentially in terms of your checklist, a, a lot of people will have, you know, they'll have the minimum cases, they'll have their electives, they'll have their uh again, like I said, logbooks, publications audits. But I think what will separate you from getting the higher point is teaching experience, which is a bit more easier to do. But then the hardest thing is teaching qualifications, you know, going out maybe taking an extra year and actually getting a teaching qualification and come on. Um most of us who want to be surgery, we are very hands on, but you just want to get ahead, get on with it and do it. Um But taking a year out and learning how to teach or getting an education in medical educ or getting education in medical education. Um Ironic ironic as that sounds. Um that's quite a commitment and I think that is what's gonna separate a lot of people in terms of their core surgical training assessment points. Next slide, please. Yeah, so it points to be aware of um so recognized surgical specialties. These are plastics, neurosurgery, vascular ent cardiothoracic um urology, Maxx. Now, Max FAX is a very cool one. general surgery. Again, what we all about orthopedic surgery, pediatric sur surgery. And within pediatrics guys, there is pediatric orthopedic surgery, um, which is quite cool and conferences. They have to be accredited by one of the UK Royal colleges. So, the Royal College of Surgeons of England, the Royal College of Surgeons of Edinburgh, um, and, or they have to be approved by a national organization, for example, the British Orthopedic Association, the B OA or the British Orthopedic Medical Student Association, the BSA or, and it has to be accepted at a regional level. I think um they have to be recognized international or national organizations or specialties. Um, and for conferences, you know, they have to last more than six hours. Um er, and just be wary of webinars. I know after COVID, there's a lot of webinars happening but be very careful on the criteria that that year's course training portfolio, say in terms of do webinars count. Um And again, for a lot of your things, they will need a consultant's full name and their GMC number. So it's a very official document that, you know, so don't try to fake anything, don't log cases that you haven't done cos essentially the consultant signing that off will be signing that with, you know, his name and his GMC number. So it's very much looked into next slow, please. Yeah. Oh yeah, this is quite important. Um Just like getting into med school, you know, you wrote your personal statement, you had your references and all of that, you know, good stuff, all the things in your course of surgical training that all that points, you add up, all of that only counts since the moment you start in medical school. So anything before does not count. And there's a very specific thing where, for example, the first two domains were commitment to surgery and clinical audits or quality improvement projects. Um The evidence is used in those sections, they cannot be used to get points for later things like publications. Um Hence why a lot of people do multiple audits. So they do one audit, they get the full points for that and then they do a different audit and that gets published. So essentially you've published and got whole points with audits. Um but you can't use the same audit across if that makes sense. Um So the main important thing is actually read through the whole checklist and be very careful because it's very niche, you know, the criterias are very specific and make sure before you score yourself that you read through it and you're very firm in what you're scoring yourself. But I would say regardless of all of this, the main takeaway message would be for the M sra you have to be in the top. Um I would say 50 or 40% to be invited for a co surgical training interview. So technically a lot of, you know, med students or, you know, the typical Ortho bre stereotype is, you know, they know all their surgery but then they don't know anything about medicine, know your medicine because that is very much applicable. And I think the one good thing of implementing the M SRA it is the fact that it forces you to learn your medicine to get an interview in the first place to even look at your portfolio and I think that's all. Yeah. Oh, bang on Sam. I don't know if you wanted to add anything to that PJ. Um No, no, that was um really good and informative e even, even, even for myself. Um Yeah, I think there's a lot and II think the point to keep keep not is obviously that this is the, the, the thought of Matthew er kindly did today was about 2024. I know depending on whatever year we're in, this could be three or four years down the line. So it's always worthwhile to keep tabs with, keep doing for what the current guidance shows. However, um do do obviously see what changes and what, what more you might, there might be more or what might, there might be some be some less things. Um as time goes on, like the M SRA was um introduced quite um recently. So it's just about um yeah, just keep, keep tabs on it as the years go by and hopefully we'll do we'll, we'll do another talk on this, maybe, maybe next year and see what's changed. Um But no, thank thank you. Do you want to add anything else? Matthew? Um, like I said, so this was just a brief overview um in terms of breaking down, we might do, you know, 11 in the future, but breaking down the evidence or, you know, going into how to get the publications for TNA or even look at maybe how to do an audit. The audit me and PS are doing, you know, we might um you know, do a session where we actually talked through what we did and actually maybe, you know, just for fun for whoever is watching, you know, um to actually present that audit to you guys and tell you, OK, this is what it's about, this is how you do a audit. Yeah, so this, this is just a brief, very brief go through of the course of training portfolio. There's more detailed stuff coming here. Yeah. And I think our medical school, obviously when you go on to clinical placement, you, you, you can chat to, I don't know, call to train reg as consultants, but we don't really get too much exposure to this at medical school. So it's um so it's useful to attend sessions such as these and there's various other organizations that carry out very similar and it's always useful to um hear it from other people cos as it consolidates in your own mind and also um gives you that breadth of knowledge cos everyone, everyone's got a little bit to offer and you can pick and choose. Um Absolutely what information is relevant to yourself. Yeah. And uh yeah, feel free to, you know, follow us on our Instagram, um follow us on University Fleer TNA Society and uh give a follow to scrubs uh the main surgical society as well. Um, yeah, I think that's it from us. Yeah, lovely. Er, I'll just er, stop sharing the slides. Lovely, brilliant. What I'm gonna do is our talk. Um Thank you very much, er, Matthew, our next talk will be um hopefully in the New Year um and it's going to be run by one of our other fellow committee members um on er, common orthopedic conditions. Um and we'll also do a bit of a S SBA S AQ kind of um teaching series coming soon. So, so that, yeah, let your colleagues know and follow us on Instagram um where, where we usually update a lot of our um upcoming content. Um and we'll, we'll put this recording on metal. So if any of your friends or family wanted to, wanted to have a quick listen, um it'll be on our, our um orthopedic society page um on metal and you can look at it on demand as, as you please. Well, thank you very much for uh for attending this, this evening. Great. Thanks for watching guys take care. Bye bye.