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Maybe that should be life swirling for me. Maybe it's not, I'm not sure. Yeah. There we go. It's like now. Ok. Um, hello, everyone. We are. We'll start the talk in a minute. Um, we'll just wait for a few more people to turn up over the next sort of five minutes or so. Um, I just read polls that we've got in the chat. Um, and basically just a little bit of a, a background of as to, you know, where you're working, what, what you're doing in a minute and how interested you would be in say ophthalmology, um, before the talk and reasons for attendance, that sort of thing. So, have a look at those whilst we wait and then we, we'll start the talk in about five minutes or so. Hello, everybody. We'll be starting in about five minutes. Uh, please take a minute to answer the poll questions. See, there's a few more people filtering there. That's good. Um, we're just gonna wait a little bit longer, a couple of minutes to start. Um, and there's just a couple of questions that we can, um, get into on the polls on the, the messages um, on the, on the side. Um, if you can answer those whilst we wait, that would be great. Thank you. Ok. Right. Um, should make a start. Jefferson, Sammy, can you hear me? Yeah, I can hear you. I think Jefferson's having a little bit of wifi trouble. So if we, er, no, he's dropping in and out. Um, so what we'll do is we'll just make a little bit of a start, um, with talk recorded so people can come back and look at it later if they miss anything. Um, so what I'll do is I'll introduce, er, Sammy. Um, and then have a bit of a chat about what this, these talks are and then I'll just hand over hand over to Sammy. So welcome everyone. This is the third day in the life of surgery talks. These talks are organized in association with the foundation trainees, Surgical Society of the West Midlands, as well as the Royal College of Surgeons in Edinburgh, the Surgical Society of International Doctors and the Shrewsbury and Telford Hospitals. My name's Fraser Jefferson is also around somewhere but his wife, I keeps jumping in and out with Sh Os. Oh, there he is. There he is. He's back. Srey from Shrewsbury. Um, getting all the application process to surgery. Um, this, these whole talk processes came about, um, by talk, us talking to current trainees about their training, the idea of what their day to day life is. Um, in training in speciality, training as well, the application process and the journey they took to get there and we thought this would be quite a good idea to share with everyone else. Um And you put it out there so everyone else can learn from these discussions that we've been having. So the, the um the objective of these talks is to get an idea of people's specialities. Um give some clinical info about common presentations, um, how the speakers got to work. They were, um, anything useful they picked up along the way, anything possible they could have done differently. Um Generally we're looking to do these sort of sessions every 2 to 3 days. Um, different specialities. We've had one on jaw surgery. Um, and we've had one ent so far so you can look back, go back and have a look at those if you'd like and we'll do some further ones in the future. Um But as well you, any feedback on anything that you guys would like in the future, um, please, you know, let us know and we can maybe organize that as well. Um So yeah, just for the time being, if you can comment where you're currently working, studying what country hospital you're from. Um, and that'll be useful for us, give us an idea of what the scope is that we're looking at. Um And today we've got Sammy and he's an ST one and ophthalmology in the West Midlands currently working at Royal Shrewsbury Hospital. Um, so unless we've got, um, Jefferson jumping in and out, I'll hand over to Sammy. Is that all right, Sammy? Yeah, that's fine. So nice to meet everyone. Um, I'll just start off by sharing my slides and then we'll get started. So I, ok, can everyone see my screen? Um, assuming people can do unless someone lets me know. So, I'm Sammy. I'm one of the ophthalmology trainees in the West Midlands and currently I'm in uh Royal Shrewsbury and Telford Hospital NHS Trust. So, uh this presentation, I was asked to go through bit in the day in her life and by doing this, I hope I can answer some questions you may have as to why you might be why, why you might be interested in applying to ophthalmology? What is life like as a trainee? I can certainly give you some insights into um training life. Um It's, it will be different for consultants um just to be aware, but I can definitely give you some insights into how to my day to day life is going. Um And if for those of you who are on the fence of ophthalmology, maybe get a bit more insight into whether or not this would be a kind of specialty that you could do. And then in the second part of this presentation, um we'll go through the application process and this application process has kind of three parts to it. There's an exam, you have to sit before you apply, called the MS R A. You have to then submit a portfolio and then after that, you do an interview. So this is a timetable of a typical week um that you'll get in ophthalmology. Um You'll have a session in eye casualty, which is an urgent referrals clinic. So this, this would be uh you know, referrals from A&E for patients who need to be seen within a couple of days or opticians, GPS or self referrals or walk ins for any patients we may already have who's going through an acute problem. There's lots of procedures in ophthalmology. So we, we do sometimes a laser clinic or a minor ops clinic as well. Um Ophthalmology is generally known for laser eye surgery, but actually there's so many different types of lasers in ophthalmology, both at the front and the back of the eye to treat a wide variety of pathologies. Um You'll, you'll get a cataract theater once a week and um this is your bread and butter surgery. This is what, as a general ophthalmologist you'd be expected to be competent at, by the end of the training program, you'll get a mix of general and specialty clinics. So there's lots of different subspecialties within ophthalmology. Um your specialty clinic depending on uh where you are or your seniority or what kind of specialties you need to cover. There's uh cornea surgery, Vitra, retinal, oculoplastics, pediatrics, et cetera. And in your general clinic, this would be uh general ophthalmic presentations to our department. Uh You get an, the college gives you an RST A session, one session every week. Well, it can be one or two sessions depending on your job and your seniority. But this RST A stands for research, study, teaching or audit. So you can use this session. You don't have any clinical commitments and you're expected to do some uh extra work outside of um clinical work in this time. Um And a half day, at least usually a week, you get um protected teaching time in terms of on calls. Um Usually if you're in a, unless you're in a tertiary center, um you, you have non resident on calls, what that means is, you don't necessarily have to be on site. You can um you don't have to, but the problem is you because it's not on site, you don't get a, you don't get a zero day the next day. So if it is a very busy on call, um you've had a normal working day um already and then you'll work late into the night and then get called in the middle of the night a few times and still be expected to go into work the next day to do operating or clinical work. And in terms of weekends, generally, you may get one in 5 to 1 and nine weekends where you're on call. So this would entail er, eye casualty clinic in the morning and then non resident from the afternoon and the night. Um, and then the Sunday you'll do another eye casualty and then non residents into the Monday morning. So it's quite a regular, er, timetable. You kind of, you can predict your week and it's quite, um, you have a lot of routine and you're very protected as a trainee. Um, and, but it can, sometimes it can still be exhausting. Don't be fooled by the regularity of it, especially because you're on call at least once a week. And if you are, what if you do have a run of busy on calls? That's, um, you'll, you'll work, I've had days where I've worked 16 to 18 hours in a row. Um, if it has been, you've had a few, um, unwell patients in A&E, for example. So how busy are on calls? Some of you may know this, a comedian called Doctor Glo and Fleck on youtube and he's, er, he's made this short on, er, what it's like being an on call ophthalmologist from 5 to 8 p.m. So, if we just play that now we're lacking the sound there, Sammy. Yeah. So, um, what he's tried to illustrate there is the stereotype of the on call ophthalmologist not having any work really to do when they're on call. Um, and having a good night's sleep. Really? Is that really the case? Um, maybe for consultants? Yes. But definitely as a junior trainee. Um do expect to have some busy on calls because there are definitely some ophthalmology emergencies that definitely do need to be seen. The, the, the nice thing about ophthalmology is that it's most things can be managed by a trainee out of hours and most of the major things um can be seen by the consultant the next day. So it may, it may not necessarily be um as relaxing as you would, you might be expecting if you're a trainee. So you don't have to be on site, but because it's non resident, you won't get a zero day. You've already worked a full normal working day. Um You will get calls at the night in, in the night that you may need to answer. And if you need to cover multiple sites, just seeing a couple of inpatients in another site will um take a will take at least a couple of hours for you to sort out. Um So yeah, so generally as a junior on calls are definitely busy. Um But as I said, for consultants, it can certainly be chill. So some of the stuff I've seen on call recently, um You see a wide variety of pathology. I'm obviously not going to extensively cover everything in this presentation, but just as a general taste, this was a patient I saw in Birmingham with pan ophthalmia. So you'll see not only sight threatening conditions but life threatening conditions. So panophthalmitis is an infection of not only the intraocular structures, but also all the extraocular structures, the eyelids, muscles, orbital fat. Um So you'll get weird and wonderful things. Um I've diagnosed more, you know, cancers and tumors as an ophthalmology doctor than I ever did in my foundation program. Um You'll get lots of weird visual disturbances and visual field defects referred to you in the urgent eye clinic. Um I'm sure most of, you know, this is a bitemporal hemiopia, which is worse in the upper quadrants, which is typical of a pituitary adenoma. Um But also you've got to remember your general medicine, you've got to take a good history and be a good clinician and kind of pick up this is a very obvious left homonymous hemiopia, but you can get very subtle visual field defects. And so this again, you would want your, your primary differential might be an occipital stroke, for example. Uh this is optic disc swelling in the right fundus. Uh And in this case, it was caused by neurosyphilis actually, but you get lots of um this can be caused by anything from the most simple to the rarest of diseases in clinic. You get um ophthalmology is a very investigations based specialty. Um We have a lot of oct scans in clinic. Um It's a very high tech specialty. If you love your technology, we do a lot of imaging and tests in clinic and actually, we have so much imaging and we look at the images ourselves. We have almost complete ownership of our organ. Um We don't really rely on the radiologist at all for any intraocular imaging. So this is an O CT scan of someone's macula and here is some, it has cyst kind of a cystoid macular edema which can be caused by anything from uh diabetes to uveitis to um postoperative uh macular edema. And of course, we have uh surgeries. Um That was meant to be a, I don't know why it's age restricted, but that was meant to be a um youtube video on cataract surgery, which is our bread and butter. So, let's see if we can watch it on youtube. So, so I'm not, obviously, I'm not gonna show you the whole video, but this is a, a cataract um here because the, the lens is clouded and can you, I wouldn't underestimate cataract surgery. It's a very, has very simple and good outcomes, but it's actually quite complex to execute. So the lens is surrounded by a capsule and um you're supposed to here, the surgeon is creating a continuous curve, linear capsular ais. So an opening in front of the cataracts so he can um get access with his instruments. And then later, he'll use fake emulsification to divide up the cataract. And you need to be a bimanual surgeon. You need to be able to use both hands um as equ as equally well as each other and in order to control the ultrasound power, the surgeon is using his right foot and to control the focusing, the surgeon is also using his left foot. So you're engaging all parts, all four limbs for this kind of surgery. And it's a very delicate surgery. Um, if the posterior capsule is ruptured, that's a kind of irreversible complication. So you need to be very careful and this surgeon makes it look easy. But I can assure you it's it's not easy when you first start to learning it. So if we go back to my presentation, if you think you're a master suture and you're attention to detail is top notch. You can do major surgery at the front of the eye. So we do corneal transplants. This is something that can be done uh on a planned basis. For example, patients with keratoconus or on an emergent basis. For example, with patients with who have severe bacterial corneal ulcers that have perforated, we also operate in the angle of the eye. So this is a surgeon who's using a gonioscope to visualize the angle of the eye. So again, he's using his left hand to stabilize the eye and use the gonioscope to go into the anterior chamber and insert what's called an eye stent. And this is an uh a device used to lower the intraocular pressure of the eye in patients with glaucoma. And if you want, you can this again, uh for some reason, is age restricted. But this is uh you can operate, we have operations at the back of the eye as well. So this is a surgeon repairing a retinal detachment. So this is the kind of the view you'll have under the microscope. It's very beautiful, um very intricate surgery and retina surgeons. Um they get like their emergency fix. A lot of these cases are done under an emergency or urgent basis. And we also operate outside the eyes if you like um plastic surgery or you see yourself as quite an artistic surgeon. Um We can do so for this is an example of a blepharoplasty on this patient. Um So the loose skin of the upper eyelid has now been um retracted and has made this patient look quite a few years younger. And the nice thing about oculoplastic surgery is that patients will pay you a lot of money to do this kind of thing on them. Also, as I said, there's lots of ophthalmology is very high tech on call out of hours. I may be I might laser a tear that's been referred to me by the optician. There's a, you know, if you, if they have a horseshoe tear or a high risk break in their retina that might develop into a detachment, you can do laser, um you can do laser barrage around the tear using um the indirect ophthalmoscope or on a laser machine which uses the slit lamp. Um So that would be something you would do on call and it's quite cool. Actually, you in ophthalmology, you have a pathology, you do something to fix it and your patient is very happy with you. Um Lasers are also used in ophthalmology in glaucoma. We sometimes we we laser the trabecular meshwork to lower the intraocular pressure. We will laser the back of the eye in diabetics with panretinal photocoagulation to um reduce the hypoxic drive to develop anti vegf so very high tech um procedure based specialty. Um So now I'm going to move on to the second part of my presentation and I'm going to talk about the application process. Now, I've copied and pasted this from the um health Education England website. Ophthalmology is known to be a competitive specialty because there are few spots. So last year um or when I applied, I think it was just a couple of years ago. Um 700 people applied for 78 spots. Um but I wouldn't be put off by this because I hopefully, what I'm going to try and illustrate to you guys in this presentation is that a lot of it, no matter how late you decide to do ophthalmology, a lot of it is still in your hands. And most of these people because of the MS R A are probably not really preparing for ophthalmology per se. They're probably preparing for surgery or radiology since so many specialties use the MSRA exam. Now. So if you forget about the competition ratio. We can just break down the application process into three major components and we will um go uh in on in your journey of your application. You will first sit the MS R A exam in December, January time. You will submit your portfolio February and then you'll do an interview um in March time. And then hopefully you will get your ophthalmology ST one job. Now, if you look at the three different components, the MS, so it will all be added up together in the end to 100 points. The MS R A will contribute to 20 points overall and the interview will contribute to 30 points overall. So even if you think you are not quite a competitive candidate already, you've got 50 points to play with and trust me, there's so many things you can do to get the points on the portfolio. So the MS R A exam is an exam that's split up into two papers. It's a clinical problem solving paper which is a multiple choice test. Um And this essentially tests knowledge of medical school finals. There's nothing um weird and wonderful and it's used in many different specialties and a professional dilemmas paper which if you went to medical school in the UK, um it's exactly like the medical SJT. So my personal tips for the MS R A are review your finals notes from medical school because those are the notes that you would have used to revise from and when it comes to um going back and reviewing things that knowledge will come to you much faster than, you know, doing new research for this exam or new, doing a going through a new medical textbook. For example, um no matter how much you feel like you've forgotten, the more you go over something again and again, it will come back to you more quickly. So those of you who are closer to medical school may be at more of an advantage than those who have probably decided to do ophthalmology after 44 years after medical school. But don't worry about, I wouldn't worry too much about the knowledge of this exam because you have, whenever, when you're applying to ophthalmology, you would have already have done two years of at least medicine, surgery, psychiatry or GP. Um and the, the knowledge you have gained working as a doctor definitely will help this exam. So the second thing you need to do is simply go through question banks and just do as much as you can. Me personally, I use past medicine because in my medical school finals, I used past medicine and I found it to be useful and I did quite well in the MS R A. Um the other highly recommended one is MC Q Bank and there are others online, but I wouldn't get more than two, to be honest because then it becomes too much of a cost. Um in terms of money, they're all, it, it, it gets quite expensive. But um, I just use past medicine and I found it to have good, give you a broad knowledge um and good enough to do well in the MS R A and it's the, there's no secret. The formula is simple really. If the more time you spend on MS R A, the more points you get and 20 points makes a big difference because one point is a rank of like 10, 15 places in ophthalmology because of how tight, how many people apply and how tight it is to get the top 75 jobs. So just start preparing from October. No bother. Don't bother delaying it until November or December. Um, the more time you invest the more points you'll get. It's a simple formula for the professional dilemmas paper. Iw when I was in medical school and we used to prepare for the SS JT. People used to always say, ah, don't make sure you go to a course. Oh, no, sorry. Make sure you don't go to a course. Don't do any additional resources. Just, just um, practice the official papers. Um, and I didn't really believe them. So I kind of went on a course. I used the textbook and I did rubbish in the medical school. Sat. So when it came round to doing the MS RA, I was like, screw it. I'm just going to, I'm going to screw these courses, screw these textbooks. Um I'm not going to use any of these question banks. I'm just going to use the foundation program. SJT practice papers. Now, I know it says foundation program but promise me, it's literally the same people who make the professional dilemmas paper. And I literally saw questions, repeated word for word. So go through these two mock papers. That's all I did and do them twice if you can. And with this, with this test, it's more about developing an intuition rather than learning any kind of theory. So when you come to come round to revising for this professional dilemmas paper, just you go through these two papers and they have good explanations as well with regards to the portfolio. Um This is probably the biggest part of my presentation now, but it's worth 50 points and I promise you there's a lot of things you can get in the final one year to two years of applying um for ophthalmology. And what you must do is to go on this website. This is the seven deanie that host the recruitment for ophthalmology and download their evidence folder. This evidence folder is so transparent. It tells you literally what you need to do um to get the points to get in and it has nine scorable sections. The first one is qualifications worth four points prizes, five points, commitment, 12 points, a multis source feedback, four points, publication, six points and audit five points, presentations, six points, education and teaching five points and overall portfolio layout, three points. So I'll go through each section in turn and kind of give you the advice that um I would have given myself when applying for ophthalmology. So the first section is qualifications. So they give you a point if you've done a BS C or an MS E prior to getting into medicine. So if you've gone to a medical school, which gives you an interco degree, they don't count, they give you two points for an MD and they give you three points for a phd or ad fill. No, when you look at this section and you see, you're gonna get zero points. Don't worry, most people will get zero points with this. Either you have the points or you don't, I personally, I didn't have these points, so I wouldn't worry about this section. Um at all. If you have a phd or if you have an MS E, that's great. But if you don't move on and you've, you and go on to the next section and don't worry, the next section is prizes slash awards with proof. So if you are a medical student, if you happen to be a medical student listening to this, uh make sure you sit the Duke Elder examination because it's actually not too hard to get the top 10% and you can get two points for that and you get one point for being in the top 60%. So it's almost a guaranteed point. Anyway, if you get a first in an undergraduate degree, that's two points. If you get the Kombi Medal, which is, these two are just, if you have them, you have them. If you don't, don't worry with these, this kind of section, this is another section that most people won't get many points, but go through your, his, your folders and your previous archives and see, even if you've gone to. Um I don't know, like er you've done a teaching session for some society and they've given you an award, put it in because if it's, they may give you the point for it when the portfolio come to review your, when the portfolio, um people come to review your evidence. This is the most important section. And this section, if you're one or two years from applying to ophthalmology, this is where you can get most of your points and there are certain points here which you just should not sacrifice at all. So the refraction certificate is worth two points. Um I wouldn't bother with that because it's such a new kind of science that um I would just leave that for training. But what you can do is the part one examination, the part one examination is basic sciences with optics, um anatomy, physiology, pathology, et cetera. It is a hard exam. But if you do revise for it for a few months that three points is massive. And if you wanna max out in this section, you generally need to have the part one exam. If you don't, don't worry, I didn't have the part one exam. You can the next bit. It says non peer reviewed publications and case reports in ophthalmology. Um So you can submit anything to even an online journal. There's a, there's an online website called I news dot com or I news dot co dot UK where if you look at the articles on our website, it's all written basically by fy two doctors or F one doctors, writing articles um like reviewing an ophthalmology textbook, for example. Um And it's really easy to, to write something on that website. Um And they give you a point for it. I didn't have any points for this, to be honest. Um If you've done an ophthalmology elective or undergraduate project, you get um up to two points. So definitely, definitely, if you're still in medical school, try and get yourself an ophthalmology elective, it will show your commitment to the special team. If you're in the foundation program, you absolutely must not sacrifice on this point. You literally, you have one week, you're owed one week as a foundation doctor in the UK to do um you have study leave given for this to do a taste of the week in any department, do it in ophthalmology. Um Those five days are worth one point for contrast, if you have a whole ophthalmology F two job, that doesn't count for a point. So you absolutely must do a taste a week. Now, this attending C ophthalmology clinics and theater sessions outside of formal taste a week, um it's worth a point, but bear in mind it does not include your taste a week. So, in your off days or when you can try and find a nice consultant in your department and try and attend their clinics and theater sessions and get it signed off, create a performer and get them to sign it off and that will get you an extra point. It's easy and it's worth doing the next point. You can get the next point you can, can get something for is the I I simulator. So the I I is a surgical simulator which kind of you can simulate cataract surgery. And if you just sit, if you just literally, you sit down and you spend four hours on it, you get a point. The hard part of this is um getting a finding out where an I SI is in your region. So I know that if you're in the West Midlands, there is an I I in Wolverhampton. So you need to contact um someone from Wolverhampton uh to try and get you a log in um someone in the department there. I'm not sure who is there because I haven't worked there and there is one in the Birmingham and Midland Eye Center. So if um I might share my email at the end. Um So if anyone wants to, if you're in West Midlands and I will ask if you, if anyone wants to try and be put in touch with someone who knows how to get them an I I log in for the West Midlands. I will um forward your email onto the simulation lead for the West Midlands and what this is is it, it's not, it's not just sitting down for four hours on a machine and faffing about it's actually you have to do four hours of operating. So it does, it does take some time to be fair, but it's an easy point. So you absolutely must not um sacrifice this point. This is new uh where it says evidence of other ophthalmology simulation training one point max. Now, I have me personally, this is, I don't even know what other ophthalmology simulation there is. Um And I've even people have asked me about this. There is no kind unless you go to a course if you find a course that um is like an ophthalmology simulation. Uh Please let me know about it because I don't know what exists out there really apart from the eyesight. And then all you need to do is literally book some study leave and go to some meetings and they're worth points. So if you go to a national or international Ophthalmology meeting, like the Royal College of Ophthalmologist Congress that was just this year, but there will be one every April to May um uh other international Ophthalmology meetings may be Avo in America or Eu Retina, which is the European Retina Society. And you get a point for attending regional ophthalmology meetings and you get half a point per meeting. So literally just book study leave and go to the Midland Ophthalmological Society meeting and then go to the Oxford Oxford Ophth Ophthalmological Congress. Um And that will get you your point. Um And then there's other stuff that they say is discretionary, discretionary. That is one point max, which is very ambiguous. But um I would be careful with this because if you start adding too much evidence and irrelevant things to this section, they will mark you down on the final section which is, um, we'll get on to the next section in the portfolio is multis source feedback. Now, what you need to do is in your foundation program because this is only valid for 18 months of the interview dates. So you need to have it at least. So when I did it, I was in my F one program and I was, it was my first job and it just about lasted um until the interview date. So you've got to have one within 18 months. And if you have a formal online portfolio, um such as Horus, like I had for my foundation program, you can literally just download that and upload it onto um the portfolio and that will count or if you don't have a formal e portfolio, you can collect multis source feedback using words, documents or a form that you've created yourself, but you must get it signed by a your educational supervisor and they literally tell you what you get the points for. Um And they say to get the max point is you need satisfactory scores, which everyone will get with multiple superlative positive comments. So which is kind of silly really? Because it's not very um yeah, so you kind of want to basically slowly just like gently encourage the people, you're sending your MS F to to, you know, say, you know, just put in some nice flowery language. Um I don't really like this kind of stuff because it's kind of your playing. It's just so ambiguous. Some people will get three points, some people will get four points, but it's an easy three or four points. So this is um something not to stress about. Just encourage, gently, encourage your colleagues to write some comments and try and make them if they're to use positive language, just try and um flower it up a bit publications. Now, this is another section which you either you have or you don't have if you're one or two years applying for ophthalmology. I would not worry at all. I had zero points for this section. I'm proud of it. Um, I really, I couldn't care less for research but, um, some people have it. Some people don't, if you don't, don't try and invest your time in getting a publication be before applying to ophthalmology because the amount of time you'll invest into it and then for the return you'll get on it will be too much. You know, the, they're expecting you to get a point if you're up to fourth or so, obviously, you've got to do a lot of work to even get a point. Um So usually this is something if you've done a phd or for those MD candidates or if someone's done a good BS C, they'll usually maybe get a point on this section. But I got zero points on this section and actually speaking to a lot of ophthalmology trainees, many of them don't have any points on this section. So again, another section where, you know, I wouldn't worry about, you've got to think of it. There are certain things that are within your domain of control and there are certain things that are just not modifiable, just as, you know, like in cardiovascular disease, you have non modifiable risk factors such as family history, age, um ethnicity, gender, et cetera. But you, you don't talk to your patients about modifying those things, you talk to your patients about, you know, you should consider stopping smoking. You do what's within your power. So, um genuinely don't worry about this section. If you do not have the points, if you do, that's great. Now, this is a section which you really need to try and get the five points on. Um, they've made it harder to get the fifth point. Now, um they wanted it. So you need to do a quality improvement or an audit project. So in my next slide, I'll go through how to do an audit. But when you do your audit, you've got to init, you've got to be the, the lead for the audit. You've got to design it yourself and you've got to write it up yourself. Um And you've got to close the loop, it's got to be a complete closed loop audit. And once you've done that, you should get four points. Now, if you're lucky enough to publish it or you've imp implemented new guidelines super regionally, you'll get your fifth point, but I suspect the majority of people won't get this fifth point. So in terms of doing an audit, um just to go over it, I'm sure you guys know how to do an audit, but just to make it clear, just follow four steps. You need to identify standards. When you identify a standard, you want to audit you, what they will be expecting is your, either your, it's not some departmental guideline, it's not some regional guideline. They want a national guideline. So use one of the colleges guidelines or one of the um or nice guidelines definitely to pick a standard, for example, um my audit was on um routine uh sorry, visual like a visual screening tool for patients um being admitted to geriatric wards. So everyone in the UK according to the Royal College of Physicians should have as part of a falls risk assessment, a vision assessment as well. So your standard is according to the Royal College of Physicians, 100 per you want it specific and targeted. So 100% of patients should be having a visual assessment being admitted to a geriatric ward. Then the second part is OK. You start collecting the data, you get access to the patient's notes with paper or electronic and you see what's happening currently. Is it 100% or is it less? And this will form your first cycle. Once you've got the results, you can analyze it and compare it to the standard. You may find that only 40% of patients are getting that vision assessment. So what do you do? You implement changes, ideas to implement changes would include doing a teaching session to the staff on your wards such as health care assistants, physios, et cetera because everyone should be able to do a routine vision test or you can implement a guideline if you're doing a quick or you can create a leaflet or a poster, either way you implement some changes and then you collect data on the new practice and this is what's known as the second cycle. And only once you've done a second cycle, is it a closed loop audit? Because then you compare it to the standards and then if you want to implement changes re audit and then you complete that cycle. So you must, must do all of this plus design and implement it to yourself. Um And close the loop in order for you to get full marks in this section. The next section is presentations with presentations. There's kind of 34, I think presentations are something actually that's quite easy to get a year or two before applying to ophthalmology. A lot of, you'll be surprised a lot of er colleges or a lot of Congresses, a lot of these places, they do accept a lot of presentations and there's kind of three factors that you want to try and manipulate when doing a presentation. The first is, is it oral or poster? Obviously oral gets you more points. The second, is it local, regional, national or international? So obviously international will get you more points. And the third is your authorship. So, are you the 1st, 2nd or third author on the presentation? So if you can maximize those three things or have lots of presentations where, um you know, they are good presentations. For example, national presentations, where your second author by their oral presentation, you can get, if you have two or three presentations that you've done over the years, you, you should be able to get the six points in this section. There's a lot of er Congresses if in terms of ophthalmology examples, um there's the Midland Ophth Ophthalmology Society that's currently accepting abstracts and that should be an easy one to get something in. And um I think the Oxford I've heard the Oxford Ophthalmological Congress is also easy to get stuff in, but there's also lots of stuff because I was in my foundation program, I actually presented in the British Geriatric Society, um the British Gastroenterology Society and British Rheumatology Society. I think this, this next section is on education and teaching um with education and teaching people say you need to get. So the first thing is if you feel like you haven't done much teaching that what you should do right now is go on to um Oxford Ise Medical and book a teacher to teacher course that's worth at least one or two points. Um Well, here, OK, so they've clarified it's actually worth one point. So make sure you do that point because that is a point that so many people will have, you're only putting yourself at a disadvantage if you don't do this course. Um So just do a teach the teachers course. It's a two day course. It was quite fun actually. Um I did the Oxford Ise medical one and they're quite good. Um If you're in the foundation program, year two, the, the, the, the dean should fund it as well. Um, other things is they expect a variety of things. So, create an e-learning tool, ebook, examining undergraduates or having a higher education qualification. So, what I, me personally I didn't do any of this stuff but I still got five points because I just collected things that I had done over the years and things just sounded good. So, if I, when I did my foundation program in, um, in Cambridge, I actually I just volunteered to examined for Markovsky in er not even in at Brook Hospital, one of the nearby hospitals and they gave me a certificate saying I was a teaching examiner for Cambridge OSI. So it sounded good. So you got to try and unfortunately, with, with this part of the portfolio, try and sell yourself and when you present your evidence or your certificate, try and present it as nicely as possible and try and make it look as good as possible. Now, the final section is three points and what you need to. So how the, how you submit the portfolio in the end is you submit each section that I have talked about as a separate PDF. And what you have to do is so create, create a contents page and put the evidence in order, create page numbers, create a, make it presentable. Don't port put more than one evidence on each, each page and you go to ILOVE PDF dot com or another PDF website and you merge um you merge everything, so you have one PDF for each section. So you'll have the MS F section, the audit section, et cetera. And then you submit each of them um separately into the, onto the website and you should get three points. As long as you've created the contents page, the font is nice. Nothing looks you want to make things as well. Think from the perspective of the people going through the portfolios, they don't like to waste, they only have 20 minutes to go through the whole portfolio. So you don't want to put, they do marks if you put too much stuff in the portfolio, um They docu marks. If you put more than one piece of evidence on a page, they'll docu marks if things just generally don't look nice. I don't know why because, because ophthalmologist can be quite OCD sometimes. But with this, um I would go speak to an ophthalmology, a young ophthalmology trainee that you might know um or email me and just um get them to go through it with you to see how it looks or ask a consultant or something like that. So that's the portfolio. And I'm sorry, that's a lot of information. Uh But the next section is the interview. So once you've submitted your portfolio, you've done the MS R A, the final thing will be the interview which is in March and the past two years, I don't know what they'll do this year. But the because of COVID, the past two or three years, they've, it's been very easy. There's no complexity, there's no clinical knowledge that you need. It's literally an online 10 minute assessment on Microsoft teams and it's a communication scenario, a patient consultation. So you literally, you don't need to know that much, do that much preparation for it as compared to, for example, other training programs like CST where you may need to prepare a clinical scenario or a leadership station. For example, um the reason the college do it this way is because they say it's, you know, this is the communication is what discriminates candidates more. But I think it's so silly because you can have an off day and three minutes is reading the scenario and seven minutes is speaking to a patient. So if you have an off day, you're not going to do well in the interview. If you do well, um you'll get the full marks and I've seen people just speak naturally and they get the full marks. So make sure you write down this scenario because they do repeat scenarios. So ask other trainees that you might bump into what scenario they got. Um My, my scenario was the consultant asked me to cancel a cataract case because the patient's blood glucose was too high. So my advice is there's more than me to the surface. So if I was to go to this patient and say, oh, it's not just a case of me just canceling the case and being like, I'm really sorry for this, there's something else going on. They will get angry and you, and you have to find out why. So don't, don't be tunnel visioned just, you know, take a step back and when they start getting angry at you just, you know, ask them, you know, is there something bothering you, is there a reason why, um, this is particularly frustrating for you? I can I know it's not easy, you know, it's very difficult having your cataract surgery canceled today. But and and then they'll come and say, oh, you know, because you know, it's really difficult arranging transport. I took a day off work to drive my father here, blah, blah, blah. So then you can go. Ok. So how about we? And then what you should do is just offer solutions as doctors, we're problem solvers. And you will see these scenarios in real life if you and you definitely will have, especially if you've worked as a doctor for a couple of years before applying to ophthalmology. So you can say, you know, we can discuss with the bookings. Um and we can try and come to a date that suits you and we can try and arrange transport on that day, for example, so that shows that you understand the system. And also, for example, you can ex explain what a cataract is. Sometimes patients, they think you know, they, they're parent, their dad is going blind or something you can explain to me, you know, a cataract is something that can be removed at any time. Um It's a case of, you know, replacing a cloudy window. It's not something that's going to lead to blindness. So sometimes reassuring the patient is useful. So other tips and tricks is find a buddy in practice but don't stress too much, don't overstress because I've seen people's feedback and people who to sound too rehearsed, they get doctor marks, they won't score more than 21. So you must sound natural and I know the temptation is to practice, practice, practice. But honestly, if you sound natural and you, you're a confident but calm and empathetic doctor, they will give you full marks. And I've seen so many people just get 2021 cos they've practiced too much, go through scenarios. You know, if you're struggling to find another person who's also applying to ophthalmology, um I know people have used this website ST interview dot com. Um and they give you scenarios and another person to practice with a really good tip. I learned this from medical school is if you want to practice explaining common conditions, just look up the patient information leaflet for that condition because as doctors, we sometimes forget, um you know, sometimes the words we use that can be obvious to us is jargon. But it's actually really odd to the patient, like for example, cataract, you know, rather than saying, oh you have a cataract and um you know, it won't lead to bit. You can say, you know, a cataract is simply a clouding of the lens. You can use an analogy. For example, you can say, you know, for example, it's just like looking through a cloudy window. And what we'll do is we'll replace that window, but it's something that can be properly planned for at another time. And here's some good youtube videos. I'll share these links or um or Jefferson will share these links on the chat because this, these two youtube videos kind of go through how you would approach the scenario. It's via a guy called Aaron, he's a ophthalmology trainee in London and he made these videos for medical students. But I know for a fact he based these on the ophthalmology interview. Um really and how you approach that. So there are two, he goes through breaking bad news and then difficult history taking. So that's all you need. Really don't go through extensive resources and just go through find a buddy and practice scenarios and practice timing. Seven minutes. You want to begin and finish within the seven minutes, you want to sound, you want to start good and finish good. Because if you, if those two things are done well, you're guaranteed good marks. And when you round up, offer the patient ask of let the patient know that they, they can ask questions, offer a patient information leaflet, tell them that you'll be sending a letter to the GP. If it's a clinic consultation, you'll be sending a letter to the GP. Um if it's some condition that's causing them vision loss, um that is irreversible, refer them to the eye clinic liaison officer. Um And the eye clinic liaison officer can put them in touch with um you know, financial benefits, um low vision aids and support for people with low vision. So a good start and a good finish. Its be natural. You've already worked as a doctor, you will do fine in the interview. And then hopefully, once you finish that process, you become an ophthalmology doctor. Um Now I've kind of spoken from the perspective of a UK graduate, but if there's any international medical graduates, um because that's not a process I've gone through myself. Um I don't, wouldn't really know how to speak about it, but there's a good website that I'm aware of called the Savvy I MG and they have an ophthalmology guide. So if you're an I MG, this is a good website for you and that's my presentation done. So, if anyone has any questions, let me know. Thanks, Amy. That, that was an incredible presentation. It's very useful. I enjoyed it. We have a, we have a few questions in the chat. OK. Other questions in the chat. Uh All right. The first question is any career pathway advice to become a medical ophthalmologist. OK. So medical ophthalmology is uh another pathway actually, you can do internal medicine training. So you do fy one fy two just as usual, but you don't need to go straight into ophthalmology. You can do IMT one IMT two and then apply to medical ophthalmology, ST three. Now having said that you can still do the normal ophthalmology training program and just it's a nice specialty because it can you can then you can become it bed itself to all personalities. You can be the most surgical person in the world. You can be a retina surgeon during emergency or you can be, you can give up cataract surgery even and just do medical retina and uveitis and put your diagnostic on. So you can do medical ophthalmology with the regular training program. But there is uh ST three training program following the medicine. OK. That sounds very interesting. That was really good. Yeah, I I think from my perspective, actually it was quite interesting hearing um how um much sort of autonomy your timetable you have from an ST one initially, I suppose um how does that sort of develop as you progress through training? You have quite a lot of immediate access to things like clinics and and the are certain things that you start off with? Yeah. So ophthalmology is a good training program. Why? Because you are given clinics from day one. So you're literally, you sat in a clinic room and to sit in a clinic with a bit. It's not because you come from F one F two where you're doing ward rounds, you're in big teams, the consultant or the registrars doing the decision making. There's not much, you don't really have to know, do too much of the thinking as an F one or F two or, but when you go into ophthalmology, you're now sat in front of a clinic in a clinic in front of a patient with a pathology. And you have to have knowledge of that condition. You have to be able to communicate to that patient, what the treatment is, what the prognosis is. So it's really a baptism of fire, but it's good because like in IMT, you've got to get clinics signed off. But I know it's difficult just getting, getting to a clinic and you know, your life is clinics from, from day one, there's no ward round, which is amazing. None of that time wasting um doing the notes. It's, you're a doctor from day one. The doctor is taking your history exam, diagnosing in and then um but they do ease you into it. They don't just put the 10. Um There's a lot of noise coming from, I, I think Jessie and Mike might be a little bit loud. Um Yeah, so there's a, there's a, they do ease you into it. So for example, and they may just book you two patients. Um and the consultants are happy for you to discuss patients with them. So it's immediate, it's you and discussing with the consultant and then you manage and then the patient goes home. It's amazing really. And in theater, I don't go to theater and fight for cases with consultant, er, sorry, with other trainees or registrars. It's literally one on one supervision, me and the consultant. So you, you, it's really difficult in the beginning and very frustrating but come very good, very quickly. So you start to um in ST one ST two, you're working in the capacity of an ST three and other specialties because the training is just so good. And actually, consultants generally tend to be supportive in this specialty. If my theater or my specialty clinic list gets canceled, the consultant will go to management on my behalf and tell them to give me my clinic back or to give me my theater back. It's very, it's a very nice and good training program. It sounds incredibly supportive. Very, yeah, it's very supportive. There are very busy units. Um It's though and there are there can be elements of um service provision in urgent eye clinic. But no, you're basically you feel like a doctor in ophthalmology training. And yeah, I I can't remember the last time I did a discharge summary or a cannula. I think I had to do one cannula actually for the a panophthalmitis patient and that's it. The nurses do because it's clinic as well. The thing with the wards is nurses do shifts from seven till seven or eight till eight. So they leave when they leave. So if you ask them to do abbs or a urine dip or an ECG on a patient, there's no incentive for them to do it quickly. But when I'm in clinic and I need, you know, bloods, um, uh, color vision pupils or anything for a patient, they do it immediately. That's it. There's no questions asked and people are much more. It's a much nicer kind of life in that sense, but you are busy during the day, there's barely any time to, you know, grab a breather if you have a busy clinic and busy theater. Um because the busiest outpatient department in uh in NHS is ophthalmology. In fact, in the world, anywhere you go, the busiest outpatient department is ophthalmology. And the most commonly done procedure in the in NHS is cataract surgery, which as I said, it's not like it's not a simple surgery. It's a lot of, it's very cognitively demanding for an ST one, it'll take years to master cataract surgery. Um So, uh yeah, so it can be tiring during the day. And if you have a busy on call, it can be tiring. But generally because the work is rewarding, it won't bother you really. I think you detailed discussion about the portfolio and the process that you took into ST one training. At what point did you specifically think is the one for me? Because I suppose, you know, a lot of people will be joining the journey from a med school perspective that being the thing they want to get into, to study and other people be late on in, in life will think. Oh, you know, I want to switch to, to ophthalmology and how does that sort of process change? Um depending on where you're at in your journey. So if you're a medical student, um and you've decided to do ophthalmology, that's really good because you can start doing some things early on. So if you're in medical school, um I would do the first things I would focus on is because you've got the time publications, Duke Elder exam and from publications, you'll get presentations and other stuff and also some teaching bits. But you know, those kind of things that require a lot of work that you may be able to do in med school and do it in med school. When you're an F one. Now you're an F one and let's say you decide then that's fine. You may already have some stuff you may not, your timeline should be uh at the end of F one did the part one exam. You will, you're close to med school. So you would probably remember some of the pathology, anatomy, et cetera. There's some new topics like optics. But do it, then if you fail it, don't worry, I failed it. It's quite a hard exam to be honest. And F one, F two can be hard but you can reset it in F two. I, if I, because I sat in F two and failed it, I didn't really get the chance to try and get those points. But, um, do at the end of F one, do that and then, um, once you've done that, then focus on getting a taste a week. Um four hours on the eye side, get 10 clinics or theater sessions signed off. And then in, in, um, in December, you want to be revising for the MS R A and then after December will be the interview, but there's a lot of um points you can get in the, actually, you can only get in the foundation program really, which is like the audit and the f because they have time limits. If you do the, if you have an audit, that's five years old, it won't count as the audit. You have more time. You have three years. The MS F needs to be within 18 months. So quick, uh quick question about the audit. Does it have to be uh something surgically themed or ophthalmology themed? No, because uh that's, that's what uh it says for core surgical training. It's not the same for ophthalmology, ophthalmology. You can do any kind of audit. It's just what they're looking at is whether you have led, designed close the loop and used national guidelines as the, as the standard and for the final point presented it or published it. No, no, not presented because I, I presented mine and I didn't get the full marks, but you published it. If it's a audit or you caused a change in national or super regional guidelines, whatever that meant for a quick which um can be quite tough to get, to be honest. So definitely four points, you can't sacrifice four points on the audit. But if you get five, it's a bonus. Cool, Riley's asking. Um do online ophthalmology uh conferences count, sorry, do online ophthalmology. Uh I don't see why not. Well, it depends if it's an accredited conference that people will know because they, their portfolio, they'll just Google the conference and as, as, as long as it looks like a good national conference or a regional conference, it will, it should count. Um That's, you would think of it from the examiner's perspective. Um A lot of con con conferences went online over COVID. So even the royal um College of Ophthalmologists was I think virtual for one year. So um you could, you could do a virtual one as long as it look, it's an accredited national or regional um congress. Yeah, that makes sense in case of you basically trying to make things as clear as possible that I've done these things. Um and, and leave difficult, difficult to interpretation as possible. Yeah. Yeah. So exactly. So even when you make your contents page for each subsection, don't just put, you know, this is the evidence for this or evidence for that you want to, you want them to be able to mark it from the contents page. Like for my presentations, I didn't put um British Society for Hematology. Um COVID impact on, I can't remember what I did it on. I can't remember. But my rheumatology one was like, oh yeah, predictors in uh in Raynaud's, you know, biomarkers in Raynaud's phenomenon, I didn't write, they don't care what you did it in and in fact, it will bore the hell out of them. All you put is National Conference first or oral presentation and then they know from that. Oh, that's what oh Oral Point, National Point first all for point. So already they can mark me from my contents page. You want to present your contents page like that. Um And then once you've merged all your PDF si would make your contents page have a nice like plain background, like a light blue or something with a border, nice font. Don't put too much information on the contents. Literally, this, this, this page number, this is this page number. Um And then it's just easy to read. And then when you put the evidence like it's a certificate, paste it onto words, make it take up the whole page and then Yeah, and then eventually convert it to PDF and then you submit that. Perfect. Uh If I ask what, what's the MS R A cut off score for ophthalmology? Is there, is there something like that? Uh, it varies from year to year? Ok. Uh What, what was it at my year? It was 600 if I remember correctly it was 614. Um, and I don't know what, whether that's good or not because I know it varies from specialty to specialty. I don't really read too much into it, but um it was 614. I got 671 or something. I think 676 180. I can't remember. Um And that was above average for ophthalmology. So I got, but we got, if, even if you get above average because of the way they dish you even that back score itself will be converted into 20 points. So if you get above average, it's really hard to get like 15 or something, you'll get like 11 or 12 points. Only the outliers really get the 20 points in that section. But the, the points worth having because one point is the difference between 50 places um in ophthalmology. So um yeah, and the other thing with the MS R A is um it's, yeah, just to reiterate, it's finals knowledge. I know it's really annoying having to go home when you're, let's say the, your passion is neurosurgery or radiology or whatever and you have to go home and you have to read about pediatric dermatology or something silly. Um, I, I would go in it with the attitude that actually it makes you a good well rounded doctor. Um, if you, you know, the best ophthalmologists I've met are just, they were just good at what they did. They weren't good ophthalmologists. So when, when you see, when they were what they were like as a medical student or a foundation doctor, they were just a good foundation doctor and they were a good medical student. So being good at something is a habit is not something if you're the, if you have the attitude of, oh, I only care about ophthalmology or I only care about your neurosurgery and you neglect your psychiatry job or you neglect your general surgery job. Um It's not a, it's not a good attitude to have because you're not going to suddenly go into neurosurgery or ophthalmology and suddenly be a good doctor because being good itself is a habit in and of itself. And the general, being a good specialist requires you that you are a good generalist. You, you want to be the intelligent specialist um and not miss out on other kind of systemic diseases that may affect your patients really. So just go in with the right attitude and you do well in the MS ra I personally, I did I only used one question bank and I think I was, I did, I did all right in it because I was just when I was in F one and F two, generally, I would go home and I would read about the conditions I was seeing. So I kind of already had a good baseline level of knowledge, but generally people need to do two question banks completed to do, get a good mark. Brilliant. Um Thank you for all that Sami. It was a really wonderful talk. Actually, it's very interesting to see um an example of a a run through program. Um The the previous examples that we've had has been more surgical into, into something else, but it's quite nice to see that um a different perspective, especially focus on the MS R A as a, as a tool and how to focus on that. Um I got a couple of people asking for email addresses to any further questions after after the event. Is it, are you alright to share that with the people in the chat? I just put it in the chat. I may be fill out replies. I'm not the best, but I do, I do eventually reply. Perfect. And we've got a feedback form here um which uh you'll need to fill in to get a certificate for the for the event everyone watching. That's how me works unless you don't, unless do your feedback, they don't give you a certificate So, uh, please fill in your feedback. Do you have any, any more questions for Sammy? Uh, we'll, we can wait for another five minutes, maybe two minutes. Yeah, that's fine by me. Yeah, I think, um, like people are sort of slowly trickling away. Um, I, I'll go back through this chat and see if there's anything that we missed. Ok. Right. So, and you posted all the links to all the things we talked about? Yeah, I uh I posted everything in the chart. All the links that Sammy shared in his presentation. I posted a few extra links as well. Fantastic. Thank you. Thank you for that. Ok. Um Well, I think we probably wrap it up there unless anyone has anything and we'll ask now. So now our vol pa brilliant, I'm gonna say that's it. Um So anyone else who's, who's still on now, we're gonna have probably one of these sessions in the future on something else different. I know myself and Jain have been talking about future guest stars. We're gonna have maybe a vascular surgery next door, perhaps a general. So, yeah, keep an eye out for that. But again, thank you for taking this time to do that. It's brilliant. No worries. That's fun. Thank you. Thank you guys for organizing it. Pleasure much. Appreciate it. Right. I'm gonna turn this off now if I can. All right. Thanks guys. Thanks everybody for attending.