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so thank you very much everybody for joining on this somewhat gloomy Saturday afternoon. My name's Chang. I am an X alumni from Sam's, uh, currently an F one studying at Milton Keen's hospital. And we decided, um, myself and a few of the F one doctors to come together and put this course through to you guys to give you our tips and tricks on how to prepare for the assessment and and cover some of the more difficult question topics, which might come up. So just a quick disclaimer before I begin. Uh, so we're a bunch of different doctors who have prepared this as a revision, aid or resource. We don't recommend that you use this as your sole source of revision. Always stick to the resources that your university or your hospital will provide for you. None of the patients are. The cases are based on real life scenarios, And if there are any similarities, uh, it's merely coincidental. Similar concentrations are Preparations may have been changed in the questions that we supply to you for other course, just to make the calculations bit more easier, but we will try to stick to real life clinical practice when possible and just a quick reminder to always consult your university or hospital for any exam related queries and support. And make sure you always use the B, N F and medicines complete for up to date and relevant information on any drugs and prescriptions. So today's, uh, topics we will be going through the generic structure of the course that we've put together for you guys will also be running through what the PS PSA exam actually is, and the types of questions that you get on it. Then we'll have a quick comparison between B N F versus medicine's complete what the differences are, if there are any and what I would personally recommend. Then we have a really quick break in the middle, and we'll have a quick sponsor talk from the M. D U. And then we'll go through our pre course mark. I don't expect us to run over to long. Um, I would expect the session to last about 1.5 hours today, and we also have Christie and Lio. Who are the two, uh, imperial um, so academic officers. They'll be monitoring the chat throughout the day session if That's okay. And if there are any urgent messages, uh, please feel free to speak up and interrupt me throughout the talk. So let's go through the actual course structure that we prepared for today. So we're going to have weekly sessions at Saturdays at one o'clock. Each of the sessions should be lasting around one hour in length, except for today's and the last session. So it's 12 sessions in total. Um, next week will be going through the ins and outs of the prescription. Then we'll go through the different types of adverse drug reaction questions that you have. Then we'll be going through how to calculate, um um, drug calculations and all the mathematical ins and outs. Then we'll be running through a few themes, so we'll start off with palliative care. Then we'll go through Ki drug interactions, and this again overlaps with the adverse drug reactions. We'll be going through managing contraception and hormone replacement therapy, and then we'll have a session on managing diabetes. Well, then finish off with the last three sessions, including how to monitor drug management will be running through some shorter cases, and if there are any suggestions that you guys have feel free to always shout them out in the chat or during the end of course surveys. Then we'll be doing a quick run from data interpretation, and we'll finish the session with a post course mark. And if there are any other questions that you guys have highlighted throughout the course. So the actual PS PSA exam structure itself is split into eight different sections, and these are the types of questions that you'll get during the course. We'll be running for each of the question types one by one. But in total, there are 60 questions during the course during the exam. Sorry, and you'll have 100 and 20 minutes. That's two hours to run through them. The total marks available is 200. But please be aware that the questions have different Waiting's in terms of the marks, and we'll be going through that one by one. Usually, the PS PSA exam is held on a date that's decided by your university, I believe, and so different people have their exam on different dates, and that would also mean that you'll get different questions from somebody from a different university. So the first question and this is the most important question that you'll be covering or preparing for is the prescribing questions. And there's an entire blueprint, which I've added onto the notes of the slides, which will be handed out later, Um, which you can read through for all the way that the organizations have prepared the questions. But essentially, this question is assessing on your ability to choose the most appropriate prescription based on the question that is given and the way that they assess that is by asking you to write a safe and effective prescription. You'll have eight of these questions, and each question is actually worth 10 marks. You get a maximum of five marks for the actual medication that you choose, and you'll get a maximum of five marks for the dose, route and frequency that you prescribed. The medication ads. Because many conditions often have more than one treatment option, this is assessing your ability to navigate through the NFL medicines complete to choose the most correct or the most up to date and medically relevant management option. And as I said, most of your exam time will be spent on answering these questions. So just a quick run through. We won't actually solving this question, but this is what it would look like on the PS, a um, exam website. You'll get a case scenario, and then you'll be given a prescription request. So this one. We've got someone who's short of breath and has some edema. Chest X ray shows cardiomegaly, um, pulmonary edema. You need to write a prescription for one drug that is most appropriate to alleviate this breathlessness and edema. So there's your medications. When you type in your medication, there'll be a little drop down list and you'll be able to select the actual, um, specific medicine. And this question wants you to also write the dose and the route. The next most important question, I think that is covered in the PS PSA is the prescription review questions. So this is about you looking for a prescription list and identifying if there are any unsafe medications, unsafe doses or if there's any interactions between medications that you are expected to identify as an F one doctor. And it's also about identifying. So, as I said, the drug, the dose or the route that has been given, making sure that we're prescribing them at an appropriate and a safe manner. You'll have eight of these questions as well, and each question is split up into a question. A question be so. The question in total is where four marks. Which means that the prescription review you get up to 32 marks in total. So this is an example of a prescription review question. Um, so we got a 65 year old man who's come in. We have an infected distal phalanx. You can see that the question is split up into two subsections A A and B, this one says, like the one prescription that contains a serious dosing error. So you look through the list of medications and take one medication under columns. A question be It's like the three prescriptions that are most likely to be contributing to his hypochelemia. So many select three options here, so you can see this one. If it's out of four marks, question is probably going to be worth one mark. Question be would be worth remarks. Sometimes it can be divided by two and two marks, but you'll always have two questions to answer per prescription review. And there's a really nice way of solving these questions, which will go through when we look at the N F and the medicine is complete. So next we have the plan of management questions is fairly box standard. You get a clinical situation or scenario, and you need to determine which treatment is the most appropriate. You have eight of these questions, and these are multiple choice. These questions are worth two marks each, so let's just have a quick look through. So again you have the case presentation and you have a question. So in general, what I would advise is always read the question first, because as soon as you read the question, it gives you an idea of what sort of things you should be looking through when looking through the case presentation and the examination and investigation comments, Um, so this one is to do with the most appropriate management option says here that she requires treatment for breakthrough pain, and then we Sorry. Then we got a list of five options, so it's about using the best single answer for the planning management questions. Next, we have communicating information. So this is deciding on what sort of information you should be supplying to your patients and to have a healthcare professionals. So again it's fairly blocked. Standard. You only have six questions this time, so there's two less than the other ones, and each question is about two marks in total. These questions I often find a bit more trickier to answer because there's a bit more reading through and a bit more navigating through the TNF and medicines complete that you'll have to do again. We've got a short case presentation. You have your question here. What's the most important information option that should be provided to the patient and his wife? And if you look at the case presentation, okay, we can see that they've been started on sertraline, and we have five different options. What's important to highlight here is essentially, in most of these questions, all five answers are going to be relevant options, and ideally, you would be communicating all five of these to the patient. The question is specifically asking, however, for the most important information. So it's about using your clinical judgment, your experience, um, of situations that you've seen on the ward's. To select which of the five options would be the most appropriate or the most important to provide for the patient. We then have calculation skills questions. In my opinion, this this is where you'll have the easiest marks to pick up on as long as you make sure that you're doing it accurately. And as long as you make sure that you know of the different conversions and the different tips and tricks which will be going through on a different, uh, session, the most important thing I'd like to highlight this, um, question is that you will have a calculator which we've added here. This is the calculator that the PS a website provides from Imperial. I don't think they let us bring in our own calculators. And so we had to use the world on the website. Make sure you cross check with your university because sometimes it can be a bit different. But this calculator is a bit of a pain to use. You can either click on the buttons here, or sometimes you can type on your keyboard just to highlight. When I check this yesterday and during my PS PSA exam, you could only type the numbers, but you couldn't type for example, the plus minus times and divide and the equal sign wouldn't work either, so you could type the numbers. But then you have to go on the calculator and press the times or press the plus minus etcetera. So again, it's really important that you get familiar with this calculator because you will be time constrained when you go through the exam. And so it's important that you try and cut down, you know as much time as possible, so we'll run through the PS a website in a bit. That's something specifically for calculation skills. I highly recommend that you look through and get yourself familiar with. Next. We have the adverse drug reaction questions. There's quite a lot of text here, which you can read in your own time. But essentially the adverse drug reaction questions are split into four different types of sub questions, which will go through, but it's about identifying reactions to drugs, drugs that may react with each other and what sort of management you should give the patient if an adverse drug reaction does occur again, these are in an MCQ multiple choice style. You have eight of these questions during your full to our exam, and each question is worth two marks. So the four different types of adverse drug reaction questions you can get as specified here. So the type a question is identifying an adverse effect or a side effect for a specific drug. So the question well, specifically say that they started X medication, and you need to select from a list of five options what the most likely adverse effect is. Type B Questions are essentially the same thing, but in reverse. So you'll be given an adverse event in the case scenario, and you need to identify which medication, uh, is likely to have contributed or caused that specific event. Type C questions is kind of building up off from Type B. So then you'll have a list of medications, and you need to identify the key drug interactions which may have led to an adverse event. And this is something that will be going through a separate session specifically as well. And then last, but not least, is about identifying the right mode of treatment or the right medication to offer in the scenario of an adverse event so we won't go for examples of each of the four question types. But again, this is just one of the examples that's on the side. So we have a case here, and it says here he's advised to comment. Treatment with Propanolol question is, what's the adverse effect that is most likely to be caused by this treatment? So again, you don't really need to look through the entire case presentation. I would always recommend you give it a skin read. But if I saw this question in the exam, I would go to the question first. Okay, so they're asking me for the adverse event of a specific medication. What were they started? And they were started on propranolol. And then already, you can quickly cut down the amount of time to spend on these questions. Then I would skim read the case presentation. Okay, there's nothing that I'm too worried about, which may interact with the propranolol. Then you can hop over onto the NFL medicine complete and have a look at the adverse effects again. That's something we'll run through later on today and in each of the individual sessions. Then we have drug monitoring questions. This is about how in clinical practice, you would monitor the patient. What sort of investigations would you do? What sort of things would you look out for? To make sure that the patient is receiving the right and the most effective treatment that they could have. And you got eight of these questions again. MCQ style. And each question is worth two marks. This type of question I would highly recommend. Well, for all of the PSSA, I would highly recommend going through PS A question Banks. Um, personally, I used the geeky medics ps a question bank. I think they've gone into a great amount of detail for each of the questions. They have clear explanation from the majority of the questions, and they also provide further links. So, um, the personal preference I would have you recommend looking at the the medics, ps, PSA questions if you haven't already done so. But I'm sure that there are plenty of other question banks out there who provide high quality questions. Um, so, uh, the reason why I was saying that was the drug monitoring questions. Personally, I think it's about it's about answering as many of these types of questions as possible. So you know what sort of things that there are that you should, what sort of options there are in terms of drug monitoring, because it's not something that you can easily find on the N f or medicines complete or sometimes the answer won't be on this site. So it's a bit more about experience. And again, it's a bit more about knowing how to answer these questions and having practiced answering these questions. So what I mean by that? This question is actually quite a good example. So we've got an 86 year old woman. Uh, she's got some shortness of breath from pitting edema. So you're thinking along the lines of heart failure. Uh, in fact, it says so sorry. In the past medical history, she's true to be frozen wide, and the questions says, What's the most appropriate option to monitor for the beneficial effects of this prescription after two days of treatment? So you're looking for quite a quick, short term change or short term effect that would have happened after they were commenced on the furosemide. We've got five different options here. Sometimes the B n f for the medicines complete sites might give you a guide as to what sort of things you would monitor, but sometimes they won't. And so this is again about your clinical judgment about having answered these types of questions to understand what sort of things that they are looking out for for data interpretation. Essentially, you'll be given a case scenario and they'll give you some results of an investigation. And then you've got to decide what are you going to do with these results? So it could be blood tests. In fact, more often than not, it will probably be blood test. I'll give you, for example, if a patient is on levothyroxine and they've had their thyroid function test results come back. What are you going to do? Based on these results? That's a very common question. Gentamicin is also another common question that will come up, and it's about making appropriate changes to a prescription. If you need to do so, you only have six of these questions again in an MCQ format, and each question is worth two marks. So again, we've got quite a long case presentation here from this, um, specific question. So what I would do is go down to the question. What's the most appropriate decision option with regards to the morning dose of the insulin based on this data? So what data am I looking out for you and then look at the investigations part. Okay, so we've got an average capillary blood glucose of six prior to breakfast and then 18 prior to the evening meal. And then you can have a quick skin through just to see the past medical history, drug history examinations again. Nothing that's too concerning of me or nothing that would really be looking out for at this stage because I know what the question is asking. And I already know the most important part, which is the the B M measurements. And then you can make your decision option based on that. So those are the eight types of questions that come up on the PSA, and this is just a quick display of how you should dedicate your time and how you should divide how many minutes you spend on each question. So if you were doing it based on the fact that there's 100 and 20 minutes and there is, I think 60 questions if you were based dividing your time. Based on the number of questions there are, you'd only be allocated yourself 60 minutes to answer the eight prescribing questions when in reality, the marks that you get from the prescribing questions is 80 marks. So you should actually be spending we calculated as six minutes per prescribing question, because this is where you have the most marks on and you can see. Actually, over half of your PS a marks come from the first to question types that we talked about. So as long as you know how to write the correct prescription, and as long as you know how to review the medication lists already, you can bag yourself in an easy 50%. And then, from there on, there's not too much work on the rest of the six questions. So throughout this course we'll also be putting a bit more of an emphasis on the prescribing and prescription review stuff. But at the same time, we're not going to be negating all these other things because, you know, at the end of the day you need to get enough marks to hit that pass point. So this is just a display of the waiting on the amount of time that you should spend. And during the mark today, we'll also be dividing it so that you spend the right amount of time for each question. So in terms of B, N f and medicines complete, it's at the end of the day, it does come down to personal preference. It depends on what you're more familiar with. What you have been practicing whilst you go through the P s A marks. And whilst you go through the question banks that are out there online, the most important thing is to start using a website now and get familiar with the interface and the tools the B, N f and medicines complete essentially offer the same resources out there, but personally and imperial, the recommendations that we got from Imperial College was that they suggested using medicines complete over the N F. I found the interface to be a lot nicer and a bit more smoother when using medicines complete. And there's also a really nice interactions checker, uh, on medicines complete, which isn't quite the same on B N f. So let's just load up the two sides. The only thing with medicines complete is you'll need to log in, so make sure you create a log in account, I guess way in advance. I think you have to do it through the sugarless slash open Athens at Imperial. I think you could just type Imperial College London, and then you'll be able to sign in on your own account. Such I'm assuming that you guys can see the medicines complete and the TNF, um, sites that I'm sharing. If not someone just give me a shout, but I'll carry on otherwise. So I'm like I said, The same sort of things are available on both websites. You can look at the each individual drug both on the TNF and on medicines complete. You can also, uh, look at the different treatment summaries. And actually, I ended up spending more of my time looking at treatment summaries rather than rather than the individual drugs. So, for example, if there was a question on cellulitis and I wasn't too sure what the management was, then I can type it in, and more from not they will have specific guidelines. The important thing to be aware of is that there's a regular B N F and there's a B N f for Children. So let's assume that I had an adult who have cellulitis. I could click skin infections and I could look for a cellulitis. Here we go. There's a bit on treatment, but we're not too interested in this part. At the moment. We want to look at what the choice of antibacterial therapy would be. So you scroll down here. First choice anti bacterials. I can either give oral or IV fluid clock Sicilian. If they had a penicillin allergy, then I could give clarithromycin or oral erythromycin or doxycycline, and it gives you, you know, your alternative choices for severe infection, etcetera, etcetera. So it's important again to get used to either or of the websites and understand the layouts. Understand how they divide the subsections because this could save you time from scrolling through. So if I wanted to look at a dog bite, I could just like human and animal bites and then have a look through to the choice of antibacterial treatment section, and I think I'm assuming it's the same for the B N f in terms of the general structure. If you type of cellulitis, I'm sure they would have the same thing that pops up. But I'm just more comfortable with medicines. Simply is what I've learned to use. The reason why I choose medicines complete over B N F is because the interactions checker will let you essentially type in a list of, say, 5 to 6 medications. And it will automatically look at the interactions between all of these medications on B N F. To the best of my knowledge, up until last year, at least, you couldn't check five or six medications at the same time. You would have to check each of them individually. And I mean, it just sounds like a lot more work and a lot more hassle when you could just type up the entire list together. So if, for example, these questions here, we want to know what free medications are most likely to be contributing to his hypoglycemia. If you're using the N F, you essentially have to look at to individual drugs and check their interactions to see if there's a risk of hypoglycemia. Whereas on medicines complete, you can essentially type everything up at the same time, and I'll just quickly show you guys how to do it again. We'll be going through this more often in the course, Um, but it was atorvastatin. There was dalteparin, lactulose, oxycodone, paracetamol, ramipril, tacrolimus, blah, blah, blah. So then when you press enter, it will say there's no results. Then this is what I was talking about, getting to know how to navigate the website. When you look at the left hand side column here, there's a little interactions tab. When you press that it automatically search is all of these medications that I typed up and it's given us some of the key interactions you can see here. Delta Parent and Ramipril can cause hypoglycemia. Delta Parent and Tacrolimus can cause hypoglycemia. Ramipril and tacrolimus can cause hypoglycemia. So we have our answer there just like that. Whereas if we were to use the B N f, you would have to find, for example, Delta parent. And then we've got 100 and 26 interactions, which you can you can control left and you can find climate. Okay, so it says here that there's a risk of hypoglycemia, but the thing is, you've got to do this for each drug, each potential drug interaction And of course, you can use your knowledge to kind of cut out a few like paracetamol. I know I wouldn't really be. It wouldn't really cause hypoglycemia, but even then, it just saves time. And typing all these medications one by one on B N f just seems like a waste of time. But enough on that. That's something we can go for again in more detail later. Um, during the course. The other quick thing to highlight is the four practice papers on the PS, a website. You just need to log in or make an account if you're not done so already. And this, I would say more than anything, go through the questions but also become familiar with the site structure, because this is what you're going to be looking at on your exam day. Here's the calculator that I talked about so you can type in whatever and it gives you the answers. I mean, it's about standard. You also have access to medicines completely. NF medicines Complete the NFC or nice B N f a nice B n f for Children, but you'll have time before your exam to open up all these tabs and get your website or screen prepared at Imperial. Uh, they gave us plenty of time to set up the site, so what I did was I split the screen. I had the psh assessment on one page, and on the other half I had my medicines complete. I mean, on medicines complete. I had opened up multiple times already because I knew that I was probably going to be going back and forth at the different tools and resources available. You get a nice list of abbreviations here, but most of these you would probably know by finals. But again, if there's anything you're not familiar with, you can always look up here. And it also split it up into each of the question types on the mark assessments on the PSSA. They only provide you with 30 questions. That's half of the actual exam that you'll be taking, and you have an hour to answer these questions, whereas in the real exam you have two hours. So again, just run through these questions. The questions are really good, and they're actually some difficult questions, which I didn't know how to answer. So I had time to, um, look at the management for various conditions. Etcetera. Um, that's this website. I don't think there's much else I had to highlight. Um, for the PS A site. Oh, one last thing is and this is one of the things I found frustrating about the resources and help the Imperial was offering us when they were going through the mark exams, for example, they were really vague or bit rogue as to how you had to write your prescriptions for the prescribing questions. Because this is an exact replica of the actual site that you're going to be using. If you're unsure, open up this tap here and then you can practice writing your prescriptions even if it's not relevant. So, for example, if I wanted to look at the oral contraceptive, um, uh, I can't remember any of the names now, but you can see here if I type in FMLA straddle a list of prescriptions which are already typed in full for me. Whereas I think if I type the brand name like let's try the micro going on, okay, so if you tighten the brand name, it automatically corrects it to the the actual like official preparations that are available so you can essentially always cross cross reference with the PS. A site is what I'm essentially trying to say is when you can do that, the dose would be Oh, gosh, one tablet. There you go, in the room and the frequency. So they have dropped down lists for you to make it easier to prescribe. So I would highly recommend getting familiar with the PS assessment site. So that is the, um, the structure of the pas. So assessment gone through the TNF medicines complete will be going through these in more detail in the future sessions. My personal preference is medicines complete, but if you prefer B N f. I know a lot of my friends prefer the layout of TNF, but they just opened medicines complete as well. Just for the interactions checker. You can do that. So we're going to have a short break here because there's a pre course survey that we would like to hand out to you guys charging a couple of questions in the chart. Is it okay if I read it out to you? Oh, yes, please. Yeah, Absolutely. So first off, are you happy to share the slides on the middle after the session. Um, yeah. So the slides will be handed out, I think, to everybody who has registered and attended. Yeah. And also people that they should be able to access through the event page. Yeah, and the feedback for, um I think we'll upload it once. We've got enough responses on that. Next question is can you have the n f and embassy both opening windows on the test? Yeah, you can have everything open. So the way that I ended up doing it was on the left hand side. I had the PS PSA exam up on the right hand side. I opened up medicines complete, like, five times. One of them was on the drugs page. One of them was on the interactions checker. One of them was loading up the treatment guidelines or whatever it's called, and then I could go back and through. You can have as many times as you want open. They don't essentially restrict you in terms of that. Uh, okay. Thank you. What is usually the past mark for the PS. Psa? Uh, that's a good question. It's something I don't know. Off the top of my head essentially because each university or each test day will have a different range of questions. The PS a website, specifies clearly how they calculate the past Marc, but they don't provide a reference number off the top of my head. I want to say something around 70% but don't quote me on that. I'll have a look into it and get back to you. I can at least probably tell you what the past Marc was for the Imperial ps A date, uh, in 20 22. OK, great. When do we get given access to the PS a website? Um, when you get access to the PS a website again, this is a question that I will double check and will. I will I will send an email out or we'll run for it at the beginning of the next session. But I think I want to say imperial centers an email saying You can now register to create an account or you might just be able to create one automatically. I want to say Imperial actually send us an email saying that registration was open or access was available, so I'll double check that and I'll get back to you guys when I have a more specific answer. Perfect. And last question is, can you copy and paste from the PS a window into the other windows? I don't think you can. Um, can you copy and patient P s a window to the other one? I just closed the TSA site. Um, that's something I would say You can check when you get access to the PS a website. I'll have a go at the end of the course at the end of today's session. Rather, and I'll send out answers again to a lot of these questions. Um, off the top of my head. No, I don't think so. Okay, that's all the questions for now. Thank you. Amazing. Perfect. Um, Okay, So to those of you who don't have access to the Precose survey yet, I've got to put it into the chat now. So essentially, um, there's two sections to this survey. The first section is that we would like to do some research to see what the pitfalls are. Were preparing for the PSSA how confident students are and what sort of extra resources um, we can provide to those preparing for the assessment. If you don't want us to use your data for research, there's a little question at the very end of the service saying, I do not give consent for my data to be used just to double clarify all the data will be anonymized. And we only asked for some of your personal details just so we can generate a specific code to compare your pre course and your post course results. And then, once you filled in the first page of the Precose survey, that will lead you on to the second page, which will be the mock that we will be running through. So please make sure if you haven't already done so to click the link in the chat or scan the QR code and to the first page of the Precose survey, and then we'll go through the mock assessment together. And whilst people are filling in the pre course survey, if anyone has any other questions, feel free to shoot them in the chat. Otherwise, I just have a quick video to play from the M. D. U. Yeah, Hi, Chuck. Everything the audios play? Sorry, I think I'll have to re share chest screen. She's sorry. Okay, okay. Or okay. So that's a nice short video that the mg you have supplied us just want to give a big thanks once again to the MD you for sponsoring our course just got a little prompt to quickly read through while people are wrapping up with their pre course surveys. Um, getting on to the second page for the mark. Uh, also what? I read this And make sure you have either be an f or medicines complete loaded up so that you can actually answer the questions as we go through them. So there's a lot to think about when you start your journey to becoming a doctor. Indemnity needs to be considered early on as it's something that impacts your professional life long after you hang up your stethoscope. The M. D. U is committed to supporting members throughout their career, and it can be invaluable if some if things don't go to plan when you simply need advice. Were the UK market leader for medical defense and have an unmatched record of helping members overcome the challenges which could threaten their livelihood, you can call us in advance and speak to a medical legal expert. Our medical legal legal advisers are all doctors and have personal experience of the challenges you face. Whether your work is NHS indemnified or not, being an MD you member provides access to support for many types of medical legal issues, including complaints to the GMC attendance and inquests, disciplinary hearings and criminal investigations arising from your clinical practice. You can also access resources to support your professional development, such as seminars, the lung modules and wealth of advice on our website and the MG Um, build from foundations in your training years without support. Uh, that's the message that the mg you wanted for me to pass on to you guys specifically, I'd like to highlight. As medical students, you get free access, um, as a student. So why not? Secondly, especially since most of all of all of you will be on your clinical placements right now, even as students, I think you're you are required to have some sort of indemnity, and it's always better to cover yourself rather than regretting it later on. If something, God forbid does happen. And lastly, the MD also provide cover cover and insurance for your electives. And since, in fact, I'm I'm certain that most if not all of you guys will be preparing for your electives sometime within the next few weeks, you've got free access to the MD. You, um you know, why not? You're missing out on free support and free cover. Um, advice for your electives, but that's all we have to say for the M D. U. Okay.