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Is that gone live? Swirling for me live. Hello? Yeah, we are live. Hey, cool. So if you guys can see us, um, obviously, hello. Uh There's a couple of things, there's a poll uh on the right, there's a chat function on this. Um, and whilst we're waiting for people to turn out, we've got sort of five minutes or so before, um we're sort of scheduled to start, so there's a section on pole. Um, and there's just a couple of things to, to go through, you know, where you're coming from. Um, just some vague things about, you know, how interested you are in a surgical career and things like that and um why you might be interested and how interested and say nt are you and things like that. Um Also if it's possible if you can guys just to drop where you're either currently working or studying in the, in the chat for us, so we can get an idea of where people are and what they're up to. But yeah, we'll just give it a few more minutes and then we'll just, er, mix up Ross you for a second in Jefferson and just to note, I think actually there is a, one of the, the questions is a, as a post session. How interested in ent are you? Um So just be aware that one of them is a one to answer after we've listened to Harry convince us all that ent is the way forward. So just be aware, I, I think we should uh remove the postop question. So if you can have that, then we do that. Yeah, stop you. Yeah. Yeah, next one. Yes, I think we have about 10 people. Yeah, we'll just give it a couple more minutes, I think. Um, for you guys just joining, there's, um, there's a poll in the chat, uh, where just go through a couple of questions about where you, where you coming from, uh, what you, you guys are up to, um, and if you could post in a message in the chat where you study your work at the minute, that'll be helpful. Um, just to get an idea of where people are at really. And there's no, there's no sort of text question feedback. So just, just nice to get things sort of moving in the chat and actually at any point in all of this, if you've got any questions, you can just obviously just throw them in the chat. We get to them, we'll get Harry to have a chat through them at any point. So just wait a couple more minutes and, er, and get going right. How are we doing Jefferson? Should you want to make a stop, go, start going through the guff at the start. And then obviously people might filter in a little bit more. And uh yeah, or more. By, by the time Harry starts getting to the good stuff, I suppose. Yeah. Yeah. Sounds, sounds good. Sounds good. All right. OK. So welcome everybody. Welcome to the first of many teaching sessions. Uh This is a collaborative initiative between the West Midlands Foundation trainees Surgical Society and the Surgical Society of International Doctors all conducted under the ages of the Royal College of Surgeons of Edinburgh. Welcome. So my name is Jefferson. I'm an so at the Royal Shrewsbury Hospital and here with me today is Fraser Morgan. He's also an s show at the Royal Shrewsbury Hospital. We are organizing the surgical specialty sessions for you guys and welcome. So Fraser will tell you guys a little more about why we have organized the session and the sessions in the future and he'll give you a little introduction about everything. Sure. So this all basically came about through as I'm sure there's a lot of questions that go around. When you look to apply for things like surgery. We had the same thing myself and Jefferson when obviously going through all the same sort of process. And I think the best ways and tips and tricks and best ways to sort of go around this application process entering the core training and then into ST three and what things some people have done and obviously people who are in core training, things that they wanted to should have said or should have done earlier in, in their portfolios or things that they wish they'd added. So we thought we'd put together a bit of a teaching session when we speak to these people about, you know, their experiences, how they got on, you know, clinical insights to things that they would see uh on an on call from their speciality and actual things that are good for your clinical learning, but also things that might help you with um portfolio work and stuff as well. Um So, yeah, so we're going to get an idea of where they're at, where they come from. Um any useful tips and tricks on the way and anything perhaps they may have done differently or any advice they give to someone going through it. Now, um generally about the sessions as a whole, we're gonna look to do something similar to this every 2 to 3 weeks, you know, generally on Mondays, uh other surgical specialties, general surgery, we'll look to do some colorectal vascular urology ones. But there's any other things that people would like to hear from specifically. Um We can look to arrange that as well. You know, we've had discussions with people, um max facial and orthopedics and, and, you know, like I say, vascular and urology that are keen to do talks. So we've got plenty lined up to, to do it. So, any, any, if you know anyone specifically who, who would want to hear of those sort of things and obviously pass them our away and, um, obviously we'll send some, some more info about out that, about that out when, uh, when it's a bit closer to the time. Um, so today we've got Harry who is, um, just mix up to an ST three, um, in Ent, he's currently a, uh, finishing his course training in Shrewsbury. Um, and yeah, I'll let him, let him introduce himself and, and go from there. No. All right, thanks. Thanks Fraser. Hi, everyone. I'm just gonna put the slides on so hopefully you can all see that. Er, first I, so yeah, just to sort of introduce myself. So, yeah, my name, my name's Harry. I'm one of the core trainees at, er, Roy Shrewsbury and, er, just to give you guys a bit of a background about where I've come from. So you understand who, who might be talking to you? I did six years at the University of Liverpool. Then I did F one F two straight after that on the isle of man. And then, er, got into a core training job in the West Midlands. So I'm in my second year of core training and this is sort of the plan that surgery follows. I'm sure a lot of you will know but we'll talk further about it and we're at the stage of the year where you find out if through your core training, you apply for your ST three application and you find out if you're successful. So luckily enough, I've got a number in the Tees Valley Deanery. Um, so, um, I just, you know, thought that it was, it's nice to be invited to give these talks because sometimes at the beginning of when I started CT one or even before that, when I was applying for core training, you don't really have a sense of what it's like. And F one F two is quite defined, you know, your roles quite well. But then you step into this sho territory and especially with training, it's quite tricky uh to, to navigate around that. So I just thought maybe, maybe some, some insights would be, would be good. And if you have any questions going ahead in this talk, just write them down in the chat and afterwards, hopefully I'll, I'll be able to go through those questions and, and answer most of them. And uh so we'll see. So just to start off. Um So I chose Ent, but uh for, for, there's obviously a variety of reasons you, you might be interested in any different surgical uh specialty. But uh for me, uh after I've realized, you know, surgery is what I was uh achieving to do, I thought that Ent was the best. And for these for these uh following reasons. And, you know, one of them is it's incredibly varied and it's very exciting specialty. There's a lot of planning and subs specialization involved in ENT. And it's quite interesting, it's like you go into ENT and then you realize, oh, there's loads of different areas to go into. So it's so there's parts of it that probably cater for everyone's interests and then, you know, looking at what we do and how ent surgeons operate and how technology has allowed a lot of procedures that help patients a lot and require a good amount of skill that you learn. And it seems very interesting. I mean, not to mention also, the work life balance is quite good in terms of surgery for ent surgeons and, and you work a lot with a lot of other specialties. Um, so you get, you get an idea about how other specialties plan things and it's quite interesting, for instance, like max vax plastics and that's probably in theater outside of theater, there's all sorts of MDT S speech and language therapists and other other healthcare professionals that, that create quite a diverse and interesting environment. Um, and, er, and so I thought I'd just give an idea about what sort of stuff, the ent conditions you'll sort of deal with, er, during your core training years, er, if, if you do apply and do an en job and I sort of end up splitting them into emergency stuff and clinic stuff because as a core trainee, you deal with a lot of emergency stuff and you get familiar with how the emergency side of the take for NT is handled. So, very common things you come across tonsillitis, ear infections, nose bleeds foreign bodies and then you get sort of in your emergency setting further down. Some more interesting cases that are, you have to be dealt with there and now, and they're sort of, you know, periorbital cellulitis is dealing with stridor. Mastoiditis are parts of which if you're doing an nt core training job, you develop, you get comfortable with how you're managing that, how to manage that. And then on the other side of things, you sort of have clinics or cases where if you are attending clinics, you see the typical ent presenting complaints, hearing loss, the vertigo, the tinnitus, and you can still deal with also infections in a chronic sense and there's a big burden of cancer in Ent. So there's cases that are split very nicely between, I think emergency and clinic where you can get involved at different levels. Um, obviously you can split it by um the part ent that you're dealing with. Um But so I thought I'd talk a bit about what, what you'd actually do in a, in the day as a core trainee. So, um traditionally you start off on a normal working day, you get in, you do your ward round and that's usually at 8 a.m. and you have a team, you usually have one F one and you have some other Sh OS and often they're also GP trainees because they do blocks of, er, NT training. So often you might be the only core training in a, a core trainee in a department and you'll have other SS F two S GP trainees as well. And it's quite a good, good set up in terms of responsibilities for a core trainee because you almost have to lead a team in order to get the emergency work and the ward work done. So you're sort of the person underneath the registrar who can provide help because your interest is in ENT and, er, you might be working with F two S who are on the same rotor as you, but can, you can guide them and sort of be a bit of a team leader in that sense, which is nice. And then you have a registrar who's there to support and a consultant who comes on the ward rounds with you. And then after that, you know, if there's not much to do in terms of the ward jobs because typically inpatient ent isn't too labor intensive. Um, and the F one can, can sort out a lot of it, then, then you have, um, you know, you have theaters that you want to go to that, that seems like the obvious one. If you're a core surgical trainee you want to go to theaters and this is where, um, most people try and spend their time getting into operations and learning, er, core, core surgical skills. Um, the other one is clinics and, er, it's, it's, it's actually really important to attend these in your core training because, um, it's a part of, er, you don't really get to see clinics too much. Typically you're spending a lot of time in your, during, on calls and doing nights that when you're having normal working days you're trying to fit in theater a lot of the time. But actually, clinics are so important and that's because a lot of the stuff tested at the ST three application, which I'll talk about a bit later comes from knowing, you know, how cases are dealt with in the clinics. So only towards actually approaching ST three when the interview is coming up, did you know a lot of people above me just say, you know, you need to be attending clinics because most of the cases they're going to ask in this, in the interview are going to be coming from clinic based scenarios and they're going away from emergency based scenarios. So it was actually really important to attend clinics. Um, and then your other, you know, if, if you've sort of ticked off both of those for the day, then you can spend time in doing your portfolio research, teaching anything else that's going to help during your working day and sort of the takeaway there in just describing the day of a core trainee is that like you're not always expected to be there on the sort of on the wards helping out. And it's sort of you have an independence in managing your own time during the day. And that's quite important because typically coming straight from F two to core trainee and, you know, you're always on the wards, you, you have a bit more of a defined role as an F two. And then suddenly as a core trainee, it's about, you know, managing your own time. And this is, you know, a very rough split of it, but there's sort of a lot more um subsections of each thing that you can get on to. Um And I just thought I'd mention about the on call. So it typically with ENT, it's the same structure as a normal day, you'll still go on the ward round and it will happen, it finishes usually very early, like 9 30 to 10, doesn't really take too much longer than that. And then uh you, you have a, a bleep or a phone or, or whatever that hospital provides that you're under that you take referrals from. And uh this, this, in, in, in terms of um this part of being on ent is, differs from other surgical specialties where a lot of the time say the registrar is taking referrals and you're sort of doing going around seeing the patients. Whereas as an entsho you're the one to take the referrals and it's really good experience. It's pretty nerve wracking to begin with. And a lot of the time, you know, because NT isn't so well taught at medical school and it might be the first ent job you've ever done quickly. You, you learn to, you know, triage all these different presenting complaints and you, you're dealing with GPS and you're dealing with A&E doctors and, er, anyone else in the hospital that might have an ent problem, a patient with an ent problem. And, uh, you learn to, to, to manage that quite well and you have support, it's completely supported, you know, your, your registrar is always there to, you know, to discuss referrals and stuff. Um, um, but that, that, that, that's the only difference and obviously the day a bit longer. So, so technically, you know, if you are quite comfortable with taking referrals and seeing patients quite quickly, you can also on your, on call days, get opportunities to do, to do things that might, might, that, that aren't fully service provision. Like you might be able to get to go to a case and just say, you know, like, can I, can, I just do maybe half this tonsillectomy, uh, and the reg might, might be absolutely fine with that and it usually is, um, and then the other part of sort of being a core trainee on en or sh is the emergency clinic. And this is another aspect of ent that it, it, it's really, it's good because you're as an sho essentially running your own clinics. And these are, these are patients who are seen on the take or discussed on the take and instead of needing emergency care there and then they're told to come to an emergency clinic and that these get booked in throughout the week. So for the next two weeks, you might see all the patients coming into the ent clinic and it's got a very strict referral criteria because the clinic is sh led in nature usually, and it's supervised by the registrars on call or who are attached to that emergency clinic on that day. And, and by, by doing these clinics again, when you start, you're thinking, you know, this is pretty nerve wracking. Uh but you develop such good er ent procedural skills, getting to grips with all the skills that are going to help you on your own calls and actually help you in theater, for instance, using the microscope, you know, the microscope is something that you never slick at to begin with. But after doing a few pretty intensive ent clinics where everyone's coming in, needing micros suctioning of the ear. Suddenly you're quite developing skills with a microscope and then those skills translate into putting a Gramme in theater when you do have the opportunity. And so it's a lot of translational skills and as in sho doing core training provides a platform to get those skills in clinic scenarios, in on call scenarios. And they, they get you very technically hands on. And that's something that's quite different from the other core surgical training jobs I've done. So I've done a vascular job and a general surgery job and there aren't too many day to day like ward or, or a clinic based practical skills that you actually end up doing in those specialties that I found. Um, compared to Ent, so it's quite good, even if you're not completely going to theater, you're still doing a lot of, er, practical, still doing a lot of practical things. And just, just to highlight this here, here's a slide with sort of all the, you know, not all of them but, uh, an examples of, of just what you'd get comfortable with doing, doing ent core training. And so top left, you've got Pinner hematoma. So you'd be fully expected when these come in on your own call to be able to make an incision down, drain the hematoma and, and put, put some sutures in to close that dead space and then be able to review them in the rat clinic. And it sounds a bit daunting but this is stuff that whi you've seen it a few times. It's, uh, it's, you know, very straightforward and once you've got that skill and you can do it, it's actually very satisfying. It's very, it's very, uh, you know, nice thing to be able to do just below that. You have a, a very common thing that you get a common presenting complaint in the NT clinic patients with nasal fractures and they're seen sort of within 7 to 10 days after their injury and they come to your clinic, you will, you are expected to develop skills to know how to reduce these under, under local anesthetic. And once you're shown once or twice, most people, I mean, I'm, I'm more than happy to, to have let anyone have a go if they've seen it and they're comfortable and they're kind of confident doing it. And again, it's quite satisfying to, to get to a stage where you can offer that to someone. Um, here in the middle is the, the classic peritonsillar abscess. So being able to drain those, you should, should get quite familiar um with, with that. There's, there's plenty of those that come in during on calls and then uh neck abscess, top, right incision and drainage and doing any core surgical job. You're pretty much gonna be quite uh confident with doing, doing abscesses. I mean, they, they, they come under a pretty much every specialty within an area and uh doing incision and drainages on in sort of neck abscesses is completely within the remit. And then you'll learn about, you know, packing the nose n epistaxis ladder sort of thing. And that's a lot of practical skills that you're going to develop a, as an sho um that are, are, are all translational into the operations that ent surgeons do. Um So it, it is quite a, a stage thing that I see in my head. I didn't know this to begin with. You know, it's all kind of coming at you at once, but just actually thinking about what you're doing each day. There, there's, there's, there's sort of a method in how you can acquire skills and you know, become comfortable with ent um so just to get on to how to get into training and probably most people might, might know this, but just in case there's anyone that, that that doesn't, then the process is, is that after your foundation training or typically if you're a UK graduate after your foundation training, you, you want to apply for core surgical training. And uh I, I haven't included all the the different criterias for everything, but they're very easily accessible by just typing in core surgical training, self assessment into Google. And you'll, you'll come across a portfolio and all these processes are similar in the sense that it requires a portfolio and it's got on an interview and um you have to meet a certain score in your portfolio in order to get an interview I think what they have done in recent years though is include also an MS R A exam. So I think you need to benchmark for that and then your portfolio gets taken into account and then you have an interview so they've just added an extra extra hurdle, which I don't know. I mean, people have different opinions on. Um, but, er, so my, my first, er, bit of advice to get in would be, you know, to really look at this core surgical trading self assessment and look at every single category, it's probably been told to many of you from time to time again, but look at those categories and see what you can do to maximize your points and most of the time in your hospital or wherever you work. You know, if you have someone who's in core surgical training, then they can provide tons of advice about, you know, just in each area. There are ways ways of just trying to, you know, without putting in all the effort because it's like spinning plates, you know, you can, you can't spin them all. You have to spend time efficiently in order to get the max amount of points. And there are people around that would definitely be helpful. I mean, I know people who ask me sometimes and I ask a lot of seniors or a lot of people above me, you know, just what did you do to get these points kind of thing? And then you build an idea. So that would be the first thing and you want to get into core training. And if you're interested in ENT, then it pretty much has to be ent themed in the sense that you need to do at least six months of ent training within that within the two year block. And ideally, you'd like to have some other specialties alongside that are allied specialties because they help at the ST three application, I'll talk more about that in a bit. But as soon as you get your ent core training job, that's, that's step one. And uh and then step two is sort of what I've just done now, which is the ST three application. Um And so over your two years of core training, you're pretty much looking at this self assessment guidance guidelines for candidates. You're looking at that and you're just hoping it doesn't change because it might change a little bit, but you're looking at it and you look in each category and you're thinking to yourself, look, how do I get the most minor points. And by this stage, because you've already done a lot for core training, the interview, the application. Um because you've already done a lot. So a lot of it can be a bit translational into ST three. Often it's slightly more diluted in terms of points and you might need a few more numbers in terms of audits and things, but that's not normally an issue. Audits are usually pretty achievable and attainable in, in core training. Um, publications are one that people struggle with, but you do not need publications to get a number. It's, you know, they're helpful in terms of getting a few more points. But I had no publications pretty much. I had about two named publications. No, first ones were accepted and, you know, I still got in so it's not an absolute requirement. But, you know, the part of core training that you're really trying to fill that, I felt like I was really trying to fill was the operative experience. So they have all these index procedures for the NT self assessment guidelines. And you know, it's numbers of four tonsillectomies and they have to be supervised or performed and getting those numbers and balancing that with the service provision. And just sometimes how busy the job can be on the on call is tricky and that's where I felt like a lot of time was devoted. Um I did try and get publications here and there but, you know, if you get them great, if you don't, it's not the end of the world, like most of your time should be just getting the core points. Obviously, throughout the two years of core training, you're expected to have passed the Mr CS Ent. And that is um consisting of the Mr CS part A and then it's a separate OSI. So it's not part B and um in, you know, in, in my experience, I think it's, it's a slightly easier exam than, than part B, part B, you have to learn a lot of top topical knowledge about the whole body. Mr R CS Ent at the moment, the OSI is very, very achievable. And in, in my, in, in, in my opinion, it's a slightly easier exam. So that's a pro for wanting to do an ENT. Um, finally I just thought about the thought I'd talk about the SD three interview and for a lot of you it's probably like a lot, er, like, um, a few years down the line that you're thinking about these things. But if you really think about wanting to become a surgeon and getting into higher surgical training, then this is pretty much the only part that, that, that, that really does count because everything you're doing up until the SD three interview is to try and get, try and maximize your chance to get a job and then once you get a job, then it's a bit more set in stone that you're gonna go through a registrar years. So it's, it's, for me, I viewed it as like, ok, this is like the biggest hurdle. It's the combination of all your hard work and everything that you're doing should be trying to get to the point where you can give a very good account of yourself in the interview. And a lot of the time you feel like the work you're doing as a core training might not be helping you in, in, in, in very practical or or tangible ways such as I haven't got any portfolio points for the, for the amount of like clinics I've sat in or anything like that. No one, no one is really looking at that, but it really does help all of that, like behind the scene, stuff that you, you do towards a specialty, helps in sort of your interview because you see parts of the specialty that you're very comfortable with. And a lot of the time if there's like a curve ball in the interview, you'll draw up, like you naturally will draw upon those experiences that you've had to get yourself out of situations. And that's what I felt. And how it works is, you know, 33 stations, Clinical Communication Management and you have 10 minutes each and I took about 2 to 3 months of prep time revising with another person, another applicant basically. And we go back and forth and how, how, how I found the, the knowledge sticking, the knowledge would stick if I could relate it to any clinical experience I had. And it was far easier, even if you, you've, you've tendered loads of clinics and one of those clinics, er, you saw at certain, you know, case on that and then when you revising that it just sticks so much quicker and you, you can kind of see how the, see it unfold in a clinical setting rather than just try and bring it up in terms of basically just try and get your way out of it. Um, um, so yeah, I, I guess, er, you know what, I didn't do a, a takeaway slide but I'll just talk about the takeaway point. So, I mean, for, for me, if you're, if you're interested in ent surgery and, er, and for, for, for whatever reasons and you're, you're thinking of applying for an ent co themed core training job. II, I think that it's a, it's a great specialty to develop like so many different skills, practical skills as an shh, you set yourself up to enter a profession where you can again, choose from a lot of different areas to subspecialized or learn more about. And it's a very good balance in terms of how I view how work life should be, especially as you increase a consultant sort of years that you, you tend to have a much better work life balance. I've in, in my, in my opinion, in my experience. Um, so I've talked for a while if you have any sort of questions about anything I've said and it can be about any part of the application or like, you know, anything that you're, you're unsure about then, then please let me know. Hi, Harry. Thank you very much for uh, for that brief session. Uh, I think I'm considering a career in ent surgery now. Ok. Yeah, that was brilliant. That was really good. Thank you, Harry. Yeah. Um, I've got a couple of questions. Actually, it's quite interesting to see what your journey's been. I think from obviously med school straight through because I hope you don't mind me saying this. But oftentimes when I'm obviously looking at, um you know, Deaneries Post for F one isle of man is perhaps less competitive. Um But you've obviously gone from there to Thames Valley ENC, which is, you know, pretty, pretty bloody competitive. So through that process, um at what point did you decide? Oh, I'm gonna, you know, I'm gonna go for this. So I'm gonna start putting things into my portfolio and stepping things on a little bit and trying to, trying to progress. That was it, was it sort of, you know, mid that time and F one F two or, you know, was it, was it slightly later, what was your sort of process like that? Yeah. No, no, that's a good, it's a good question. So e even before, um F one F two towards the end of med school, I was, you know, thinking about surgery, thinking like, yeah, I, I didn't do much work or at all over med school to, to get into surgery. Although you're often told that by various people, you know, you need to be getting these publications XYZ I didn't do anything only within sort of the first like 33 months of F one. Um I was put on the isle of man, I not through choice or anything um, but, but I was out there and, er, it's, it's almost as simple as looking at that portfolio or the CST application I knew it was going to be in like a year's time because actually when you start f one then you only really have a year before you start applying. So I looked at that and thought, you know, how much of this is achievable and, er, in a place like the isle of man, it was actually very achievable. You can make yourself look very good on paper. Um because it's quite a small place and the service provision isn't so, so high. So you have time to sit your exams. I try to get the Mr CS part A out of the way through, but this was through guidance from people above me said, you know, these things are possible, you sit your M CS part a really early and you can do it and kind of thing. So I had sort of a good, a good structure on the isle of man where a few people above me, a few F two S at the time were surgically keen. And er, I said, you know, I'm interested in surgery and they just almost create, laid this path forward where they were like, look at all these different things on the portfolio, try and tick them off, get part a done and then the rest almost takes care, takes care of itself because you've done you've gotten the ball rolling and, er, suddenly when you come to apply, you just submit it all, you end up with an interview and then next thing you know, you're looking at, you're looking at where you're going to be for, for core training. So, yeah, it's, er, it was about f one, I'd say that I, I actually started looking at how I can get the points kind of thing. I think almost there is kind of don't be afraid to sort of put yourself out there. I think quite a lot of people when they're asked by consultants or registrars and what do you want to do or what are you gonna do with your life and all this sort of stuff is they go, oh, I don't know. I'm not quite sure. But if you, you know, perhaps the message there is that if you say, you know, I want to, I want to be a surgeon or I want to do XYZ, then those opportunities will kind of open themselves up. People will say, oh, you know, that's, that's Harry. He want to be, he wants to be a surgeon and, and it will kind of start working itself towards that sort of end, I think, possibly to that end. Um Was there anything that you thought along this process? Obviously one, the, one of the key things that you hear quite often is people who do or don't do the Mr CS part one before applications, would you say there's anything that you did or wish you perhaps, didn't, didn't need to do that, that you did and you would possibly advise against doing that? Er, yeah, I mean, I mean, I guess one thing that you have to consider is that, you know, you're always applying to get into training, if you want to do it as quick as possible, then that's fine. But, um, you know, considering taking like a year out, um, is, is something that, you know, I wish I, you know, one of the questions I'm just reading in the chat if you were to go through this process again, is anything you do differently. You know, one thing I sometimes think about is, yeah, what if you take, take an F three year and, er, so sort of f one F two after I applied and I got, got a core training number. Er, I got a, a, just a, what was it ent theme, core training job, which I'm in currently the, the geographical location of that job. Like, it wasn't, it wasn't one that I was particularly, like, really, really keen on. I was looking at, you know, Stoke in Shrewsbury and I was thinking, you know, I don't know about either of those places. It's a bit of a geographical gamble and this is the thing. You're often, you're often pitching the geographical location with, with the job doing the job when you're thinking about doing surgical training and it's, it's very difficult to get it right. So one thing that I'd say is don't be afraid of, you know, if it's not the right location for you and you don't want to taking a year out, giving yourself like an even better chance of uh getting the portfolio done, getting more points on the portfolio and stuff, knowing, knowing that you've done the whole process as well, so the interview will come a bit easier to you when it comes around to that time and doing that. Like that's something that, you know, II I just, I just accepted it straight away. I was like, you know, I'll, I'll go and do core training. But, you know, and it's, it's worked out thankfully now because I'm looking at, you know, getting an ent job in, in 10 Valley, but a lot of my sort of mindset going through it was that like, what if you don't get a number, you've done core training in this place and then what you come back and, you know, you still have to end up in a, in a poor geographical location compared to you. So it's like, uh that, that mindset I think is the hardest to contend with in, in, in this whole process, choosing location of job. You had quite a lot of permutations and backup plans and what ifs and Yeah, exactly. Yeah. So I've got a question for you um in, in your journey so far. What was the most difficult part of it? The most difficult part of it is. It's a good question actually. Um, well, I, I think that, you know, it's, it's almost not even to do with surgery. The most difficult part of it is that, er, un, unless you're in a great location that you've, you've sort of chosen that one of the most difficult parts of surgical training and it pretty much conserved amongst all CST S that you meet is that it's just very difficult to balance other things in life against surgery for those two years because it's, those two years are very, very intense. They're on call heavy that it's a very steep learning curve in the sense that look, you're applied for SD three and you're not, you might not get all your opportunities during the, the, the time that you're there and you might have to stretch yourself beyond that to, to pick up all these points to enter an application or to be, be competitive. And the hardest thing that I found is, you know, juggling all those other things in life that you, you kind of are interested in as well. Um So, so I guess it's that balance that you maintain and well, I mean, you manage to manage to get that balance. I mean, obviously, you know, it's difficult as we all know, but you do, you think, you know, you don't come out of it with a, in a broken down sort of mess that, what was that experience? Yeah. Yeah. I mean, at times, at times you, you, you do, you do feel like, ok, all you're kind of here doing is all about the, the, the surgical training and, uh, you sometimes feel like, you know, there's, there's not much time for, like, you know, weekends where a lot of friends are planning things and stuff or like relationships and stuff, then it's, it's pretty tricky. Um, but on the whole, it's, it's kind of like this is when I go back to for that SD three thing, it's like a commitment to that to, to getting that number because once you have that number, you know, a lot, a lot of those things take care of itself in terms of the balances, work life balances because it's much, usually it's much friendlier rota for a registrar than it is for a core trainee. And, you know, there is still a massive learning curve to get to consultancy, but it's a learning curve that is very nurtured, in my opinion. Sometimes in core training, it's a bit of a, you know, you got to really go out there and just create the opportunity yourself rather than sort of have it, have it slightly more laid out to you that the first step, I suppose, probably quite difficult. Um, a couple of questions in the chat, if you can see that, how much weight did portfolios carry before your CST. How many points should we aim for to be in a comfortable place to get into training? I think they're referring to the core surgical training. Yeah. Yeah. So II, I actually don't know how much, how many points is out of now. I think when, when I applied it was out to like 72 I think was the, was the number and I probably had about 55 or so, maybe like 53 to 55 if I can remember correctly. I don't know if they doped a few points, but portfolio scoring system has changed a little now about the en portfolio scoring. Uh How much do you think candidates should aim to have for the ent one? So that was out of 100 and I got what? 71 points out of 100 and that, you know, when I was talking around that wasn't very competitive, there was a lot of people with much higher points than that. Um It's just that like when it comes down to the actual overall ranking that they get, it's consisting of er the portfolio and your interview and the interview is always weighted much higher than the portfolio. So um it's, it's, it's usually around like er 6 60 40 or even 70 30 in some cases that the interview is, is more weighted than the portfolio. So, you know, as long as you get an interview, you can see yourself in the final stages of being a competitive applicant because you're like, well, I've met the cut off. If I do a really good interview performance, then I'm very much likely to have secured a job and the portfolio, the extra portfolio points in that setting, just kind of help a bit more of geographical selection provided you do a good interview job. That that's sort of the difference is your family saying, did you get into core, core surgical training first time? And how challenging, first time did you get into it? Yeah. So I, I did, I did and actually, so when I, when I applied I had pretty, pretty decent in that stage, I had a pretty decent er, portfolio score. I thought, you know, it was like 55 out of 72. I thought, you know, that was pretty good. Um, and then when I got to the interview, I, you know, I thought I put in like quite a good interview. I, you know, this goes by in like a second kind of thing. But I remember being at that interview and thinking, you know, I had some cases that I thought I knew about essentially. And then when I got my rank for the core surgical training, it was really, really low. I was like, well, I'm probably not going to get a job this, this, this, this time and what I got offered was er, four years. So two years of, er, general surgical jobs and they were just basically all gen search. And I was like, well, I'm not going to do that because I was interested in ENT, I just take a year out and reapply kind of thing. And then, uh, like, luckily through an upgrade, they upgraded it to an ent themed job and I don't know why this job came open, but, uh, then, then I accepted it at that point because I was like, ok, at least it's ent themed and you're getting ent experience. So you could technically apply for your ST three at the end of it. And, uh, um, oh yeah, what, what, what I'd say is that like, it, it's just, you know, I thought at that point it was very subjective, like the, the interview, you know, I thought I did a good job and, you know, you kind of over be any medic because you've done so many exams gets to the point where you kind of develop a sense of how well or not you kind of done. But in these things, I, I just had no idea and then fast forward that to ST three. You know, I thought I didn't do such a good interview job subjectively. It was, it was quite good. So, er, y you know, like I, when you're, when you're asking about how challenging it is, it's, it's like one of those things where it's like easy when you're in, you, you don't find, you haven't found it like, challenging because you've already got it. But when you're looking at the process and you're looking at, trying to get the, the interview and the portfolio, it's a big challenge. But what I, what I'd say is if you just go through the process, you know, you, you'd be amazed at how, how, you know much, how far you'd get just, just through, just through applying or looking at it and applying because there's countless times where I could have just, you know, not gotten, you know, not gotten an upgrade or like not, not. Um Yeah, II, I was always like second guessing kind of how well you do or, or at every stage, but the number one thing is just apply, just apply and see how well you do and genuinely you'd be most of the time be surprised. I think obviously having a themed job will have helped the ST three pathway. Do, do you think generally if you were in a got given core training in Thames Valley versus core training? Say on the isle of man again, do you think that would have particularly affected your ability to progress through the training? Obviously, there's a lot of chat sometimes about how teaching opportunities come about in different places. Be at tertiary centers, be at DGHS. What's been your sort of experience of that as a core trainee? I suppose working in both a tertiary center and DHS. How that sort of helped with you. Yeah. Yeah. No. E exactly. So at Stoke, I did six months of ENT at Stoke and, er, you know, because it was so, so busy on the, on calls and it's a unit that just has so many referrals and such a high through there of cases, big massive catchment area. You know, I just, it was almost like, even though ger are saying, you know, you should come to theater and XYZ, you know, come to clinics because this will help your STD application. I felt genuinely like, you know, I don't know how, I don't know who's got the time to do this because the team is so busy seeing patients with the on call and, you know, if you'd left you, they'd be stuck, it'd be like no one to do it kind of thing. So even though, you know, I'm looking at theater lists and they're great lists, the teaching opportunities are fantastic. You know, there's lots of tonsils, lots of like grams cases that I, I couldn't get to. These. I was like, these are hard to get to because you're just gonna leave the service provisions like very bare kind of thing. That's how I thought when I came to Telford, um dgh kind of vibes funnily enough. We had the exact same team for Stoke and Telford in terms of numbers of trainees. So it was, it's like half the burden of that on call because it's Ad GH, it's much quieter and, er, and then most of the time the team can handle it, you don't need to be there. Bam, you can go to theaters. So I got lo loads more surgical experience in Ad GH, than a tertiary center purely because I was able to just go to theaters and, and you kind of know your consultants a bit a bit better because there's only a few of them compared to like eight or so, 8 to 10 in, in uh, in the tertiary centers. Um I think a balance is good though to, to see, see how it's done from a, from a both, both experi, both um both sides. It is good. Yeah. Yeah, I've always felt that DJ S have a tight knit community where you're always accountable to, to your seniors and to make sure you're doing things you're not lost in the crowd. Have you, have you felt that way? Working in the EN? Yeah. Every en I've worked in en team I've worked in has been like, just, just nice like this, it's been very, very friendly any time that someone is keen or interested in Ent and you're part of the entent team, I've, I've not met any registrar that wouldn't try and cultivate that, that sort of, er, want or pursue for, for Ent. So a lot of the time it's, it's actually like a, and especially in the NHS. Now you find that there's very little like encouragement sometimes day to day and you're just doing your job kind of thing. Um, but, er, in, in, in Ent, that's, that's kind of what, what, what also persuaded me to do it, you just feel like, ok, people are people, if, if you're interested, other people are also interested. And, er, and, yeah, I do like the fact that it is a bit of a, you know, it's a tight knit team, the ent team. So I like it. It's a good point. One more question there from a, um, course any application, does it make a difference if your has an en theme audits and teaching, which I think you probably went through a little bit. Yeah. Well, no, so I didn't actually touch on that. That's a good point. It, for core training applications, I don't think it makes a difference and that might have changed. But II, I don't think it would have to be honest because by that stage you, you, you, you're not really committed to a specialty, I think that there's only one exception that I'd say is if very early on, I think, you know, you want to do plastic surgery, then when it comes to ST three, I think a lot of points you'd have to look at the self assessment as well. But a lot of the points are given for plastic themed, whatever audits, research publications. Um, so, so that, that might be one of the only exceptions but in terms of ENT, uh, you know, you can have publications in anything as long as they're like pub head ID or part of like an index, a recognized index, then, then you're getting the points. So you never know though, these things can change year to year. So it's part of the stress of just having to deal with it. But like, I don't think any time soon I'm not ii, I wouldn't, I wouldn't imagine Ent are suddenly going to pull out. You need everything ent themed. Sure. Um So unless we've got anything else uh in the chat, which we have, I think it's probably probably enough for today. If, unless any, any other questions. Now I hold your piece. Do we have any other questions guys? So I think we'll start wrapping things up and we, if, if anything pops up, we can, we can obviously address it. Um So obviously thank you. Massive. Thank you to Harry for doing that today. Um um So I think we've got a feedback form that's been up there already. Um So if you could fill that out for ourselves and Harry, that'd be, that'd be fantastic. Yeah, I mean, I'll put the link on the chart as well and if you can scan the QR code, that'd be fine. I think you will receive an email as well from medal to fill in the feedback form to get your certificates. Uh You don't get any certificates, if you don't fill out the feedback form, sorry that the med all is set up, like we say this out, this is wanting to do a series of these sorts of events. So Harry thankfully is hopefully the first in the long line of other special registrars from their speciality. So if you've got any feedback of any further ones you would like to see specifically, um, then we can arrange for that guys can put in the chat about what the next session you'd like to be. Um in the sense, we've got trainees from different specialties, Ortho vascular urology, uh oral maxillofacial. And we've also got trainees who are interested to talk about the CST training portfolio and application, but depends on what you would, you guys would like to hear about in the next session. I mean, if, if you guys don't have a choice, we will just crack on with each session every three weeks or every two weeks. Oh, there's, there's a question there. Dietician says, can you switch to another surgical specialty after doing core training in a different themed surgical specialty, I suppose for you, then that would be if you did your ent job, could you therefore then switch to say? Yeah, so yeah, it's, it's not a commitment to do that specialty. It just means that if you're on a theme job. So when you're looking at the ST three portfolio, the self assessment like 20 or 20% of those points come from time spent in specialty after F one F two. So it comes from, um, you actually getting to do that job. So by ent themed job, it just means that you're gonna at least meet those points to apply for ENT if you see what I mean. So if I wanted to do, I don't know, plastics or if I want to do general surgery because I've got two other jobs of the sort of general surgery, one's vascular, one's upper gi I could apply for either of those. You know, I could have probably apply for that because I meet the time spent in specialty to apply for that. If I wanted to apply for like plastics or anything else outside of that, then I'd have to probably take a year out to, to get enough experience in that specialty to apply for ST three. So it's not a, you have to do it kind of thing. It's, it's more of a, you know, it, it gives you the best chance to, to, to get into your, your, your special. I hope I've answered your question. You. That makes sense. Um, so I think we'll start wrapping that up then, um, honestly, if you got any, any other things to, to say any other things you want us to speak about, then, um, then we'll, we'll, we'll get it done. But, um, yeah, it's, it's been quite, quite useful. Thanks for bearing with us. As well for um you know, it a bit of a dry run this, this first time. We've not really done anything like this before. So I appreciate you guys for taking the time to, to watch this and get involved as well. So, and I'm sure Harry has shared his email address. Please feel free to email Harry bother him. Yeah, because he's got his training number. He's got nothing to do. He'll answer your questions. Yeah. Yeah. Please send, send any questions or anything. Thanks. Thanks guys. Thanks Fraser. Thanks Jason. All right, thanks Harry. Thanks Fraser. I think we'll wrap up. Then we don't have any answers to that question I put up. So which means we'll just have another session in a different specialty or probably have a session on the core surgical training portfolio application and we'll take it from there. All right. Thanks guys. See you next time.