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It's going live, isn't it? Oh, we're live, live. Um, right. So we're going to get started in a couple of minutes. I'm just going to wait for some more people to trickle through. There's some polls in the chat. If you go on to the chat function on the right side of your screen polls top and we've just got a couple of things to click through, you know, where you're from? Um, how interested in our, in orthopedics are you and that sort of thing? So, just have a look at that for us. Um, and then we'll just get started with the talk in a second when everyone's, er, everyone's ready. Cheers guys. I'm answering the pause as well because I feel. Yeah. Yeah, absolutely. Got engagement to hear that. That's what we like to hear. Ok. I suppose I can click. Not a foundation trainee anymore. Can I never a foundation trainee else done? When was your, er, CP? Was it back in June? Uh, then that's just July. July is just, just free. He's doing it for fun. Ok. Brill. So anyone joining again? Um, we've just got a, we're waiting for a few more people to, to turn up, we're gonna start in a couple of minutes. Um, and we've got a, some polls that you can click through whilst you wait. So if you got the chat function on the right inside of your screen, there's a poll bit. Just a couple of questions as to, you know, where you're from and, and what you want to do. So we'll just get started in a couple of minutes. No, no foundation training so far. Fraser is a day late. So, yeah, sorry, change it. I could pretend. Ok. Well, I think it's six o'clock now. So if we wanted to start making a little bit of a start, I'm sure people will, will sort of trickle in, in the next sort of five minutes or so if we just start giving it a bit of a waffle and then we'll get, get to hear some time to get moving because I think um, we don't wanna waste too much of his time. Yeah. Sounds fair. Sounds fair. Alright Jefferson. Yeah. Yeah. Um, do you want to kick it off? Oh, all right then. Hi, everyone. Welcome to our fourth day in the life of Surgery talks. These are organized in association with the foundation trainees Society, Surgical Society of the West Midlands, the Royal College of Surgeons in Edinburgh, and the Surgical Society of International Doctors, um, and Shrewsbury and Telford Hospitals. My name's Fraser. We've got Jefferson here. We're both sho er, grade doctors from Shrewsbury and applying to surgery. Um These sort of series of talks came about by talking to current trainees about their training, getting an idea of what their days entail as well as well as sort of the application process and the journeys they took to get there. Um We thought then these discussions would be quite good to share with other people and spread that with that information about a little bit. So the, so the aim of these talks is to give an idea of about the specialities, you know, the clinical data that um these trainees get up to um how they got to where they are, anything useful, they pick up along the way or things they may have wanted to do differently. Um This is kind of one in a series of talks that we're doing. So we're looking to do sessions every couple of weeks on different surgical specialities, anything you want to hear about, particularly feedback to us and we'll have some, have some more talks. And like I said before, there's some polls on the right to click through. Um you know, just, just comment where you, where you're looking, where you're coming from, where you're currently working. And a bit of discussion, we've got, you know, if you want to ask anything at any point in the, in the chat, just drop into the chat function and we'll um we'll get to here to talk through, through the er, end of the talk. So today we've got Mr Tahir Klik who's a ST three in orthopedics. He's currently working in the Midlands in Birmingham of the street, part of the street, almost. Yeah. So here is a, for an ankle registrar working in North History. Robert Jones and Agnes Hunt the Star orthopedic hospital in the country. He's soon starting tomorrow as an ST three in the Birmingham orthopedic training program. It's, it's very famous in the country. Um, and, uh, he's here to tell us about a Dana's life. What the orthopedic training application is like some of the common cases that you would see as an orthopedic registrar and, and of course as, as an img how you can, uh, get into orthopedic training. So here the floor is yours. Uh, thank you very much guys. Uh, first of all, I'd just like to thank both of you. I'm extremely humbled by the fact that you guys chose me. There were so many others that I feel are a lot better. Uh, so, uh, what I'll do is, uh, without further ado I'll just start presenting. So hopefully we, we did try making this work before. So hopefully it starts working again. Interesting. Now, it's, it's so funny. Now, it's actually not showing me you should just now the bottom. Yeah, just click on that. I'll just, uh, share the entire screen to be honest. Let's let's just have the habit of it again. Everyone technical it's ok. There we go. If all those feels we share a screen, you want to try changing clients to see if it's working? Oh, yeah, thank you. Beautiful. Perfect, perfect. So uh hi everyone, my um uh and today just, just like I mentioned before, I'm extremely humbled by this opportunity. And hopefully, hopefully by the end of this, uh you guys would have read the objectives and hopefully by the end of this, I'm able to answer as many questions as possible. Um It took quite a while. Uh When I'll be going through the slides, you'll be able to see that my pathway wasn't straightforward and I'll actually tell you why that happened as well. But all I want to know is this is not to get you overwhelmed. Everyone's pathway is different and I will talk about this as well. Just try to get as much as possible. And then if still you want to talk to me on one on one, I think my email will be provided to you or I'll ask one of them to, I put my email at the end of this. Just give me uh uh an email more than happy to help. I'm extremely o CD with my emails. I think Jefferson will be able to vouch for that. I will answer, I I rarely pick up calls but emails, I'm always on it. So uh just Jefferson said I am one of the new SC three S that's starting in the Birmingham rotation, which is my first day is tomorrow. And currently I'm working in Oso Street as a foot and ankle registrar. I've been in O Street as a registrar for almost a year. Now, did six months of spines and currently just doing foot and ankle. Along with that, I'm a digital teaching fellow for the Ees Midlands as well. So this job has given me quite a lot of experience in making sure I help with curriculum building for not just the core surgical trainees, but also just manage the amount of departments. Um the teaching for departmental teachings that happen for every speciality, including anesthetics, medicine, of and gyne, everything that happens through a platform called the PG VA that's exclusively for West Midlands at the minute. So coming uh a little bit more about me uh to go even further. Uh I graduated in medicine from frontier medical uh dental college in ad in Pakistan. Uh This was back in 2013 did, which is f one year uh in uh Pakistan Institute of Medical Sciences, which is in the capital from 2013 to 2014. Didn't waste that much time. Uh So I think I finished in July booked my ticket did. Everything, came here in August 2014. Uh And between August 2014 to December 2014, I had finished both my pla exams. So as uh if, if you're not aware, these are exams that actually uh make, uh, so sorry to, uh, interfere. Um, I think your slides aren't visible. Uh, can everyone see the slides? Uh, can I quickly ask in the chat? Looks like to me they're dropping out and then dropping back in again when you change slide. So I think we kind of a disappeared now. Ok. Oh, no, because I changed slides. That's why. Mhm. Ok. Uh, I, I've just sent you my presentation. Do you want to upload it from your side? Do you want to just get on Jefferson? You can just next to it. It might be a little bit easier. Yeah, sorry about this. Everyone. As you could tell this is my first time doing this. It's all right. Technical mixes are to be expected. I think we will bear, bear with you to here. We'll forgive you this time. Don't worry. So, yeah, any just questions guys during the whole thing, just drop them in the chat and we'll um we'll get through them by just slight technical glitches. Appreciate your time. Thank you. Oh I can share my window now without sharing my screen. Would that help? Do you, do you wanna try to try and if it doesn't work, can you see it now? Yeah. So let me just go back one slide and Oh yeah, smoking it work. Yeah. So finally the window uh popped up. I wasn't recognizing it now. So going back did uh August or December basically did my problem plat two exams which uh registered you with the GMC. Uh These are exams that I think a lot of other people have written blogs about and now ongoing detail. Uh and then had a GMC registration in 2015 in January. Then the jobs are a bit too much in the UK. So, but I'll go through each of uh each one and I'll tell you what changed for uh uh for everything. Uh The first job I could find in the UK was in Leicester Infirmary. This was in a uh A E Truss grade F two level post. Uh A and this was from 2015, 2016. Uh What I quickly realized in my uh uh a job was that trainees, I wanted to be in training, I didn't care which training it was, I wanted to be in training. I saw uh trainees being uh having dedicated teaching time, dedicated uh education supervisors. So I put it to the task on my f two competency signed off extremely quickly, I think within two months. And then at that time, I actually wanted to do neurosurgery. Uh And that was probably the only reason I came to the United Kingdom. So I was able to get an so job in your surgeon King, King's College Hospital in London and where I stayed for about a good 18 months, sorry, 16 months because I know the cutoff for CST at that time or near surgery at that time was 18 months. So what I did was I did it 16 and then quickly changed my rotation to medicine because I didn't want to go over that 16 months. And that was in the Princess Royal University Hospital. This is an Norrington, which is actually a daughter or a sister hospital for Kings. After which uh at that time, you weren't able to apply for co surgical training directly. So what you had to do was, and I found this loophole that if you had a training number, it could be any training, you were employed by a ee and therefore you could apply for uh any surgical specialty or any specialty in the first round. So uh I was, I'd never done psychiatry before in my life and I was able to get a core psychiatry uh training post in Newcastle time. And that's where I spent about a year and a half in this year and a half, got my mrcs part A out of the way, got my basic surgical skills out of the way, even though I was working. And I was still, I passed my er CP for core psychiatric training. I still wanted, I still applied for core surgical training, gave my, gave the interview and was able to secure a number in the West Midlands. Um I I rotated between two hospitals, one was Stoke Royal Stoke University Hospital. Um And the second was Princes Royal Hospital in Telford um I, and at that time, neurosurgery changed its uh uh changed its eligibility criteria. So even though I wanted to do neurosurgery, when I came to the country, I was immediately, just because they changed it that year when I was applying for course course surgical training, they changed their eligibility criteria making it, making it impossible for me to apply. I actually got a rejection from neurosurgery in one saying that you are overqualified. So after which uh I was like fine, got co surgical training and this is where I had never done orthopedics before in my life. Uh wasn't very interested in orthopedics in my final year. Medicine as well. That's where they teach you the most. Uh because I was so tunnel vision for neurosurgery, all of my papers, all of my audits, all of my research was in neurosurgery and it didn't help. My father was one. So, and I'm Brown. So you would have guessed, yes. If I'm a near surgeon, you have to be one. I'm just joking. It wasn't like that. But then after that, when I got core surgical training, I got an orthopedic themed, which generally means that majority of your two years of core surgical training is in that specialty. I was extremely lucky. He was in the West Midlands. And so I did six months of general surgery in Roy Stoke University Hospital, which I absolutely loved. Um, almost almost got me converted. And then the rest of the 18 months was in orthopedics and this is where I was really thrown in the deep end. I was, first of all, it was a bit of a journey for me to go to the hospital because it took me 55 minutes to an hour in my first year. But then after that, on the way, I used to listen to so many podcasts, youtube audio, everything just to try to learn as much orthopedics as possible because who knew that bones could be fixed with a plate. I did it at that time. Uh But then after that, uh in 2021 when I finished core surgical training, I was going through my portfolio and I'll be talking about this as well for my sc three application, I didn't feel I was strong enough to compete. And I just thought to myself that I think I need to have more experience. Um So I was able to get a fellowship in Clinical Governance in the West Midlands. This was a very good opportunity because I was uh in the University Hospital of Birmingham Trust and I was designing and leading quality improvement projects which was trust wide. And I was able to do so in that one year, a lot of presentations, um uh audits quality improvement projects and really build my CV. But then along with that as well, this is an admin job. I, I wasn't on call. Uh at that time. It was COVID. I was sitting at home, I gained weight and I did and I learned so much about how administration of hospitals actually run. Uh And I was talking straight to the CMO who is the highest most medical officer of the hospital. And I really loved my time and I was able to get really good, really good mentorship from people from there. But then along with that, at that time, in 2021 I was given an opportunity to join ee uh for, for the West Midlands. And this is where my teaching and my medical education, uh the um enthusiasm really helped because I was not just helping the core surgical training, teaching sessions that were happening every month for the trainees, but also helping in building the curriculum. And I've uh and this opportunity, er, this gave me an opportunity to make two courses which were, which uh for the core surgical trainees, which has now been accepted by the Royal College of Surgeons in Edinburgh to be national uh courses. Uh But then after that, after my fellowship, I, I was able to get a job in Street, which is a renowned orthopedic center. And the best part about this is this is all elective. So everyone who, who does orthopedics uh or who's done orthopedics knows that there's two aspects. One is the trauma aspect that everyone always tells you, read all about trauma. But then when you go to elective it's completely different consultants are relaxed. Everything is a different environment and the books are bigger. If you can see behind me, all of these books are elective orthopedics. Um and these aren't even quarter of the books that you need to read. And then this year I was able to get a se three TNO job in the first preference because obviously I wanted to stay in the West Midlands. I was able to get in the prestigious Birmingham orthopedic uh uh training uh program. So going away from jobs now, I think the most important aspect that I get asked quite a lot. Uh was because I was so tunnel visioned in neurosurgery. I couldn't understand anything else. I didn't want to do anything else. Uh Of course, uh it was if it was a chronic subdural refer medics, that was that good uh in Ortho in near surgery. Uh that is a bit of a neurosurgical joke. So I always get asked why in orthopedics. But my answer is very simple. Why not? You get patients with limb threatening injuries, life-threatening injuries and most of them walk out and immediate satisfaction making patients life better patients come in horrible pain in their knee, horrible pain in their hip can do what they want. Fix them. Absolutely goes outside complimenting you the entire way. Don't bring cho uh uh and most of them bring chocolates. So that's also a plus as well. But then along with that, I just love working in an MDT because it's not just on you, it's not just, oh, I just do surgery and I'm out. No, you work with physiotherapists. You could work with occupational therapist and most importantly, the Holy grail, you work with Ortho Ortho geriatricians who help you making sure these patients are safe to go home, make sure their medications are fine. And they also help in reading those squiggly lines on papers. What are those called? Yes, ECG secgs. Definitely, they're, they know how to read ecgs. Do, uh, do you want an orthopedic register to read your ecgs? Absolutely not. I wouldn't. That's why you have Ortho geriatricians. Now, the next part is we have the best and the most coolest surgeries known to man. The operation of the century total hip replacement completely changes your life, completely changes patient's life. And it's, you have other amazing surgeries such as intermedin nails, you have plate fixations and I could go on and on, but I don't think anyone wants me to fan board over how amazing cool surgeries they are now. Coming back to the drawbacks. I think this is something that I have to talk about because I think I have to make this as, um, as in, even in the objectives of sales, tell the advantages and disadvantages. I'm horribly biased and I'm proud to be that way. There are no drawbacks at the specialty you go in, you meet amazing people. You make amazing connections with your colleagues. You work in a team I've never met. I've never been in another department which is so team focused than orthopedics. And I converted from neurosurgery without even thinking it would be because of how amazing orthopedics was in my course, uh surgical training. So there are none. And I'm sorry, I'm biased, but I'm proud to be now coming back to the confusion. So there's quite a lot of confusion of, ok, I want to do orthopedics. How can I do it in this country? And what can I do when I came to the United Kingdom? No one knew how to get into the surgical specialties. Um I still remember my first day in a, in A&E or first time I met, uh one of my uh lovely uh people from my country who I'd never known before. Uh I was very adamant. I was like, I want to do your surgery or any other surgical specialty. Nothing else. And I was told you'll be a lot happier if you do medicine and if you stop dreaming about it. So there's a lot of confusion with what other people tell you. And that's ok because they're trying to look out for you or they're trying to look out for you. It's fine. But I ne I, I'm a person who never takes no for an answer unless I have spoken to the right people spoken to the college, spoken to the uh everyone myself and I don't believe in hearsay. So hopefully, what, what I tell you this clears out some of the confusion. So the treatment complication is extremely simple. Everything is the er and it basically consists of three things. One is aura, one is a person specification and self scoring gu uh guidance. I should have talked about interviews, but I think an interview is such a broad topic and hopefully I'll be able to tell you just a little bit at the end. But I don't want to focus on the interview because I feel that is another kind of worms that I, that is not something to worry about at this minute. Now, talking about or I have never seen an easier website to navigate. And I think all you have to do is log in, make everything is free. You uh uh the second an application opens up, you apply for it. They tell you if you have shortlisted, they tell you about everything and because of how amazing the US system is now, they actually tell you if you're matched rather than go to a, a God at a number. But uh that's ok as well, but it's really straightforward but everything is on Oreo and I uh and I feel most of you wouldn't know this if you applied for foundation jobs or anything else. Now, the person specification is on this amazing website called Yorkshire and Hum uh Hum Dere. Uh And I can safely say this, the amount of views on this website, two thirds of them are mine because, uh, this and the next thing I'm going to talk to you about, which is a self assessment score and guidance is something I would, I wouldn't sleep without looking at it is such a good website where it tells you all the vacancies. It tells you all the tentative dates of the interviews of when you'll get to know. And so I, I would highly recommend you guys just to look at the website just to see how it is and just to familiar yourself with it. Now, the present specification is pretty straightforward. You have to do your Mr CS part A and part B without that. Uh before in the uh in the last few years, they always used to say, and even I think in this year when you apply for SC three, they always say you have to have completed your mrcs both parts before the offers or before your training job starts, piece of advice. Try to give it as soon as possible. MRCS is a black and white exam which you want to pass as soon as possible and then pay the college extortionate fees to just change your title from doctor to Mr. But I think it's one less thing to worry about. The last thing you want to do is go for interviews, having done your mrcs amazingly do uh do really well in the injuries and then waiting for your mrcas part B result to come. So that's, there's two things once you get an SC three and then Mr CS, my advice, get it done as soon as possible. Now, if you, if you've done your mrcs and you are not in a formal training program, there's something known as a Crus form. This can be available or this is available in Oro. And if you just do a Google search and this is basically all of the competencies you should be having before you apply for ST three. For example, everything that you go through as a core surgical trainee, the quest form, it's someone that you could sign off from a consultant or anything else. Uh One piece of advice for this one, I've seen a lot of people do this. Obviously, I've gone through training. So I don't know, you can get Crest form signed by anyone internationally as well as long as they have a GMC number. So that's something that a lot of friends did for foundation year and when they were applying for core training. So it is something you could do as well. And then the other way where I did it go through core surgical training, get your M CS that you automatically meet the person specification. Because the entire curriculum of the core surgical training is built to help you get a SC three or be eligible to apply for ST three vacancies. Now, the self scoring guidance is a or a portfolio checklist. This is something which has been the bane of my existence for about a good 2 to 3 years because there are a lot of formulas. There's a lot of things where you have to do your best to try to get as much as possible. Now, it has 12 to 13 questions depending upon the year this year. I think it was 11 or 12, but we'll go through each one and I'll tell you how I did to each uh each of them. Now, the first question is, I think the biggest drawback of anyone in my position as well because I graduated in 2013. And this says by the end of 2023 or by core training, how many months would you have spent in a total job in medicine? So over two years from primary foundation here. So what you have to do is this number is very important for three other questions. So what you have to do is you have to count the amount of years you've spent. So I think for me when I counted or something, it was around 65 this year or something. Oh, so that was my end number and that's automatically four. I want you guys to remember this because in the next few questions, you'll see how this gets affected and what you really have to do. And one of the reasons why I couldn't sleep at night because I wanted to get as much points as possible. Now, question two is pretty straightforward. It says how many Ortho, uh how many months have you spent in to orthopedics? The ideal uh would be between 10 and 42. As you can see, you get eight marks and because you've done core surgical training, uh, 18 months in orthopedics, I got eight in less. Uh And then after that question, number three is if you've done any other specialties, for example, ent neurosurgery plastics, uh, cardiothoracic emergency it, urology or a pediatric or general. If you've done, if you've spent four months in post or two or more in port, two more specialties you get the, the most because I've done, uh, general surgery and I've done your surgery and I've done emergency medicine. You could see that I, uh, I was able to get the highest mark in this. But then after that, the bread and butter of every ST three reservoir and sho how many DH Ss have you done? Or how many nails have you done? Uh, and this has to be an ses or stu it. If you have 12, please get more. Just please, it's DH S is, is something that you should be doing in your sleep and you should be going out of your way to hustle to try to get it. I had about 30. But that was probably because in my, uh, fellowships I was still doing, uh I was still doing locum, I was still doing things so I had all my numbers but I was easily able to get it. There should be no excuse for you not to have 12 or more. I will silently ju uh not silently, I will horribly judge you if you don't. Uh This is something that is the easiest four marks that you could get. Now if you remember the N number. Now, from question number one, this is where it starts affecting. Question number five is about your papers. All of your papers should be pu sighted and for evidence, they actually ask you for the pub me ID number. So I had a few papers uh that were in. So what you have to do is you have to just hustle to try to get as much public cited articles as well. And question we fine is how many first author do you have? Now? Question we fine. B or six is somewhat the same with the other and the formula is something that is, is a whole other kind of worms. They ask you how many other publications do you have uh which are public decided? So if you've helped out a friend, if you've helped out someone else, just do it. So what I used to do in court training was uh we had three people with us, uh the, the trio or the Musca, each one wrote a paper each one put, uh each one got help from the other person. So each one put each other's name. And by the end of it, all three of us had three sorry, all three of us had nine. So we were ea easily able to do it as you could tell as you could tell in math is not my forte. Now, question number seven is uh how many national and international presentations have you done? This is something that is, you can easily do. You have amazing workshops and you have amazing conferences by the Royal College of Surgeons of Edinburgh uh themselves. Just recently. They had the uh uh audit in Qy. It is incredible. Just send as much as possible. Uh The, it's national as well and internationally. Uh So I'm uh uh if you haven't uh if, if, if uh everyone's joint late, I'm from Pakistan. So one of my uh presentations was in Pakistan where I was working here and I went that counted as an international, but a friend of mine actually told me for them, they didn't count. So just be on the safe side. There's so many orthopedic journals, there's so many orthopedic conferences that you could do. But one other thing that's most important of all of these and question number eight as well. It does not have to be orthopedic related, any paper in any uh conference in any audit doesn't matter if it's orthopedic related or not. It does not matter as long as you have it done. Now, question number eight is basically how many audits or Q IP S have you done? And basically if you've done one audit, but you've done a re audit of it to close the loop that counts as two. Now the number, the first question, this is where it gets really confusing and horribly, horribly, they say horribly fair. I think it's unfair but it is what it is. What you have to do is the formula of this is so the maximum number you can get in question five and six together is eight. So if you have a denominator, just like in the first number of four, you would have to do four times the amount of papers that anyone else would have to do without that denominator. Uh In question number seven, a very quick example in question number seven, question number eight, the maximum marks you can get are two each. So two for question 72 for question eight, I had to do 10 presentations and 10 audits to get the maximum of two in each. So that's one of the reasons why I say the portfolio checklist is something that you should be literally seeing before you sleep because what you need to do is you need to have a realistic, a realistic goal of OK, this is where I'm uh this is where I'm lacking. This is what I have to do So that's what I did and I was, and I was able to get maximum scores in both seven and eight and obviously was not able to get the maximum score in five and six because I'm not writing 40 papers. Not even close. Now, going to the last few questions, it's pretty much standard nine is if you have done a master's, you get a number, uh, one, if you have done a PSE or MD, you've done a two, I don't know anyone who's done a PSD or MD and apply for ST three, but there are a few academic fellows that do nothing but respect won't suggest you do it. Uh But to your own question, number 10 is one statement that describes a leadership in management. So if you've, if you're a voter coordinator or if you've done the teaching sessions or teaching sessions will technically come under teaching experience. But if you've done a voter coordinator, because I think that's one of the most common things or if you're the pre me president, you give yourself a one because that's a local reason, leadership. Uh And then number two is if you've done a national or international. Uh So I for myself, because I've done hee West Midlands because that was West Midlands. I was technically able to get one in this and not two. Even though when I appealed and I said I actually help with. Uh so there's something called a core hub UK where all of the core surgical trainees of the United Kingdom come once a month uh for teaching, I help run that. So technically that comes under leadership but that it didn't fly because they said that's technically teaching. But that is something, it's very, it's very normal to appeal the results of your portfolio. So that's something you can do as well. Now, the last one I, I feel is the teaching experience. A teaching experience is something uh that I, I think I have a bit of more, bit of more knowledge and a bit more experience in. So if you have done little or none, it's very, it's very subjective in zero, you've done a regular engagement in formal teaching during the last two years. For example, if you, if you have junior doctors coming in, uh if you have junior doctors coming in or if you have medical students coming in the ward and you just teach them very simple like an ECG or if you teach them a chest x-ray and then actually get feedback from them, uh fill out the P platform form and put it on your portfolio that counts as regular engagement. That's what I did when I was in A E. But then after that, I've moved on to formal roles as my digital teaching fellow. And even before I, I've been the examiner for OY for MB BS in Newcastle University, I've been a mentor and a teacher uh uh for medical students and Kings. So there's quite a few, but I was able to get two because I've done a formal qualification in teaching. Uh because I've uh I, I had a certificate by then I think, or I had a diploma, I think I had a diploma but certificate or diploma gets you the same thing. Uh And that's where I was able to get it. Now before I go for the day in the life, I just want to tell you a little bit about the interview. So a lot of people uh from internationally and I or maybe it's just me or whoever uh has come and spoken to me. A lot of us feel that we need to do a lot more to get to the standard of the interviews or the portfolio. For example, you have to do audits quality improvement projects because I was lucky I had good bosses back home. They uh they made me do quite a lot but don't be disheartened. It doesn't matter. You can do a VT audit as long as that is a V audit that counts as two you're done. So don't be disheartened. Just look at the portfolio checklist, just look at what they are asking and try getting it done as soon as possible. I have never met a register who wouldn't help or an ST three register who wouldn't help or a core training after you give them tea or whatever register sho or core training, who don't tell you about this on how to do it. Uh to the point that after my interview when I went for my interview, interviews are three, there are three because it's still virtual. There are, there are three scenarios in it. One's portfolio, one's clinical and one's prioritization. So, prioritization, they give you a bunch of bunch of cases and you have to list them into the highest priority. And technically make the theater list. Portfolio is first and everything is marked out of 50. So the portfolio uh bef before you go to the interview, you go to the portfolio checklist, you tell them uh self assessment that by the way, these, these are my marks, you send them your documents, uh everything's online, they check it and then they mark you. And if you're eligible, then you go on. There's a very famous rumor that I've heard for the past four or five years ever since I wanted to do orthopedics that the cut off for portfolios um or self assessment to be goal for SC three is 9 21. Absolutely wrong this year. Uh One of my friends was able to get it in 16 last year. Another one had it done 17 the year before 15. So again, like what I said before as well, just unless you haven't asked the TNO Yorkshire and Humber website or whatever yourself, I wouldn't believe it. So, and that's what I did. Uh because uh the rumors I had, I sent them an email and they were nice enough to say there is no such cut off, but to be on the safer side, uh just try to get as much as possible. I won't give you a number today and I don't think you should be listening to any number, just try doing everything that you possibly can. Uh And then after you do that, you go to the interview, the portfolio station is pretty straightforward. I think any uh portfolio station is the same. Uh Tell me a little about yourself. Uh What would you do if uh someone calls you sin? Uh Someone tells you that they're uh re it and is hurling obscenities at you. Uh pretty much the same. Uh But I, I can safely say I was able to do quite well in my portfolio this time, I got a 47 out of 50 and there is no reason why any of you can do that as well. And clinical, I got 41 and the other one, I got 40 or 41 as well. Privatization. But I all I'm telling you is if you focus on your portfolio enough on the day, you'll be absolutely fine. Now, coming to the most interesting part of the talk day in the life now being a register is really hard work. You have nurses that really want your attention and what they want. Is, can you tell me what your consultants thinking because they can't approach consultants themselves. So a lot of the nurses will be coming to you will be ble you and saying, oh, by the way, this patient has been here for 48 hours. What's your plan? Boss, man. Patient just had surgery. Let them rest. No, never. So nurses come after you, then you'll have SHS coming at you and saying, I've just seen this patient don't know what to do. Uh Can you ask a consultant? What I should do? And then you, the last thing you wanna do is call the consultant because obviously consultants are uh either busy in their theaters or clinics and you, you don't wanna look, uh you don't wanna look uh someone who's going to a consultant every time, even though I'm extremely guilty for it. I'm famous for it in the hospital I'm currently in and I'm proud of it. I don't mind but it's very busy. So and also there'll be this one star yard medical student who comes to you and wants to write a paper and you're just telling them you're like, OK, so a lot of people coming at you, but this is a very simplified way, uh simplified day in the life of what uh you should expect as a registrar first off is clinics. Uh so clinics are technically fracture clinic, where is the trauma comes in? You just see how everything is um it could be for a consultant, it could be for everyone anyone. And depending on the hospital you're in the second one will be a trauma as it is. For example, if fracture clinic has been there uh has been done and you're seeing them for follow up, that's where it comes and then you have elective. I love this picture of the clinic because when was the last time you saw an orthopedic surgeon with a stethoscope, he was using to auscultate the chest and not using it as a hammer beats me. So clinics are pretty straightforward. You see patients as and when you uh either you can send them home, you could uh do anything else. Uh uh But one thing I forgot to mention here is uh I think more hospitals are doing virtual fracture clinics. Now, uh Teeler was really good because of the fact that I was able to establish a virtual fracture clinic there. Uh It's a very good way of whoever gets referred to fracture clinic, for example, from A&E who has a stubbed toe or stubbed finger and you don't want to see them because can you imagine someone being in face to face fracture clinic with a nail which isn't supposed to be looking the right way or something. So we created something known as virtual fracture clinics. They don't have to come in. We look at their x-rays in the morning, we look through their history. That's a is written, give them a call, see how they are and then take it from there. So that is something that you should be aware of as well. It's moving towards it. So that's a form of clinic that we do regularly as well. Um, for each of them, for clinics, theaters and anything else in a week. The curriculum, if you're a course, if you're orthopedic trainee, you should be having at least two sessions of theater time, three or two sessions of clinics. And that doesn't include fracture clinic that includes elective as well. So you have to balance it, but obviously that is a recommendation and not a standard. Another thing for you guys to really, uh, really figure out as well. Now then the best part of orthopedics theaters you're gonna have either trauma or elective. Um, and you get to wear these really, really cool astronaut suit as I, I like to call them. My nephew really loves them. Uh, because whenever I have to wear one, I have to send a picture after the procedure because he loves astronauts so much. Uh This is where the magic happens. This is where you change lives for the better and whoever can tell me in the chat what procedure has been done. You will get my respect, nothing else. I'm sorry, I'm broke. Uh, junior doctors are going on strike. Now, uncles, a lot of people don't like on calls, but I really love on calls. I think it's the most fun part of orthopedics. This is where you really can see the most interesting cases. You could do close reduction, you could do open reduction, internal fixation. For example, if there's someone who has a horrible injury, uh for example, a subtalar dislocation or anything else that you really have to correct inside, you take them to the, you do an open induction, internal fixation. And I think one of the most important aspects and, and one of the reasons why it's tested in the ST three interview is you have to learn how to make the list for the next day. You have to know what comes first one who comes first and then who comes last. And then most importantly, one of the best and satisfying close reductions you can do or you could try is someone with uh the picture that's shown with the banana arm. It's, it's just, I love it. I, and I it's not that even I want to do hands. It's just I, I just find them really satisfying to fix. Now, this is something that I horribly forgot. And when I was talking to Jefferson the other day, he mentioned, oh, don't you guys do Ward Draws? And I was like, oh my God, yes, yes, we do. And I'm not gonna lie. It's the most dreaded part of being a register. Uh And it is something which is missed quite a lot. I was in a unit where uh the posting war drawn would happen. Uh For example, if uh the patients from overnight admissions would be seen first thing in the morning by the consultant. But then other people who have just gone down the uh uh down the line, for example, after their, the consultant's take has been over or anything, they just gets missed. And this is where junior doctors sh OS F ones, they really struggle because you can't get, you can't get hold of registers. Uh They're busy, they're in theater, they're in clinics, they're doing something else. So, and they never pick up their phones. Oh God. Registers on their phones. That's where I think it, which is the worst thing. You can do it to a patient. For example, what if your uh uh relative was in the bed and no one was looking at her and a PDF F one is trying their best to get a register to come and check, but it doesn't happen. And that's one of the reasons why Ortho Geat wards are important as well, but Ortho Geriatrician does not see everyone. That's an important thing. They uh they have a quota to do. There's a called the Best Practice tariff. They have to see patients of uh neck of femur fractures within a certain amount of time or the trust doesn't get paid. Uh So that's another reason as well. And then I'm old enough to say this. More drones is something which is really important. And it was also the scariest uh in that time because if you can see from the picture, you can see clearly who the consultant is. He's the one with the expensive suit, the junior doctors or the registrar, are everyone behind them. And uh this is the time where and where the nurse was present, the the nurse in charge of the bay physical therapist with the anchor tattoo and the occupational therapist, everyone came together to see that patient. And it was a scary for registrars or junior doctors because this is the time when the consultant would ask, start asking you questions. And if you didn't know there are a lot of people uh who would just look at you and just be disappointed and it wouldn't just be the consultant, it would be everyone else. So you would have a horrible day. Uh There's a way, uh obviously there's a way around it, but I think one of the most important things I really wanna say in this presentation is this doesn't happen anymore, does it? And that is the change we need to bring and that is the change we need to try to do and to make it as safe as possible for the patients. Now. Going on, moving on. Let's go to the most fun part of the presentation where, which is interesting cases. So what I would really like to do is I would really, really like everyone to try to contribute as much as possible. So, what I'll do is I will if my, uh, starts working. Yeah, let's see. So, in the chat, if you don't mind, just telling me what you think is going on now is a 57 year old comes to the hospital after jumping on trampoline to show his Children, he can still do a back flip. He couldn't, he's not complaining of pain in his right ankle and is unable to weight bear. This is the x-ray. You see what is the first things first? What is the one thing you're really worried about this ankle? Is it normal or abnormal? Let's keep it that way. So if you don't mind just putting it in the chart D doesn't look ideal fraser. Uh top marks vascularity very, very good. Uh And I'm guessing you said that because of it's deformed, you're not wrong there abnormal. Uh come on ankle fracture dislocation. Now you're showing off now. Brilliant. Ok. So I love the fact everyone thinks this is abnormal, which it is, this is very, very good and the vascularity is important because of the fact that you can see on the lateral aspect there is uh it's, it's not looking right and also it's tenting of the skin. This is a surgical emergency. No, no matter what people say. Now coming to. So what do you wanna do for this? So you've checked vascularity, you've done everything that you have done in the bedside. What's the next thing you, you would want to get, it could be any sort of investigation. What would you like to do? Bleed the red? Oh, Jefferson. Oh, no, no, no, never, never bleed the reds before doing this. Ok. Good. So reduce first and then get x-ray. Interesting. So you've gone to reduce pain relief? Fine. So, x-ray and Ct Angio? Oh, kitten, you're going, you're going way too far. Ct Angio, the department doesn't like you and says Ct Angio is impossible to get. So initially, technically, so there's two schools of thought here. Uh And uh all was uh was I said the right thing, reduce first and get x-ray. But to be extremely honest, regardless, I wasn't thinking you to go that far. But as long as, yeah, as long as you get an x-ray, but the both guidelines actually suggest that if there is a subtalar dislocation and everything else, you need to reduce first and then get an x-ray because of the fact that it's tenting the skin, but let's not go there. So uh and stop showing off uh wi but you get an x-ray now, the x-ray looks like this. What do you wanna do? Do you want to goal for conservative management or do you wanna go for operative management operative? Fine, fine. Everyone's an orthopedic surgeon. So, yeah, yeah. Always, always the s the answer is always surgical. So brilliant. So this is what you've done. Now, you've actually put a beautiful lac screw in the lateral, uh, lateral malleolus. You have a sys screw in as well because you know why not? And then you put two, the screws on the median maliti are, uh, are questionable but you know what it fixed it? Wonderful. Wonderful. So, this is something that's really common. Ankle dislocations, uh, are really, really common and you need to know what you, uh, you need to know what to do. Uh, yes, you need to do investigations. You need to do bloods, you need to do an x-ray. But if you know how to reduce them, tell your re first, but then reduce them. Uh, but I would still say call another call, your reg because my experiences with ankle dislocations, you would be the most experienced in the room when you're doing them, uh, in A&E because you'll have a nurse, uh, you'll have an s who's taking care of the patient who probably has seen a few times. So you need someone there to tell you, ok, you're doing it right or wrong. Do the pro, uh, do the procedure, don't let your, uh, s do it but don't be the most experienced person in the room in my advice when you're in, uh, when you're, uh, when you're in sho, but when, when you're a register, unfortunately, uh, yeah, you, you have to do what you have to do, but fine. But if my sho had reduced this and then got an x-ray and it was reduced and then called me. I'd still be ok with it. I'd still be fine. As long as you've done as you, uh, as long as you know what you're doing, I'm happy. So, second patient, 87 year old coming in, uh, after falling while keyboarding coming, uh, of a left hip and is unable to weight, bear. What do we think is going on? Brilliant. Everyone knows. Everyone knows. Yeah. Yeah, it's enough. You're absolutely right. It is enough. Now, what do you think is going on with this one? Who's did someone say left? Not even before the x-ray? Oh, look, listen, you're killing me. Good. So what does everyone think is going on here on the x-ray? Oh, come on, man. Be is a vi enough legend? Ok. Fair enough. OK. So it's an intracapsular enough. Fair enough. And then after that, what do you do? Lots of shins and freezer? Very good. So you want to keep this piece in conservatively or non conservatively? Please be aware that this lady is an avid international skateboarder. Oh, Fabi her DH s interesting. Interesting. OK. Fair enough. Left hip. Happy. Non conservative. Fine. So everyone wants to go surgical uh OK. Operative. Fine be, huh? The DH S uh one of the reasons why it's an intracapsular, a candidate for th hr oh, you're kidding me. Let's not, let's not confuse everyone else but very good. Very good, very good. Uh, most of that as well. T hr brilliant, but we won't do THS for this age doesn't matter. Uh, and, uh, the activity as well. We don't care. We like doing Hemy. No, the DH S so this is what we did, we did a bipolar if it shows up. Yeah, we did a bipolar. Hemi. All this means is you haven't converted, you haven't done a full thr so you haven't done anything to the Aceta since the ball. And so I think I have it here. I, I did at one point don't know why I have this. So what you do is Ace tablet and that's your femur. I do apologize. I, I went to a course and I got this in a, in a bi uh in a hemi. What you're doing is you're just converting just uh the femur prepping it and putting a stem inside and you're not doing anything for the acetabulum for a total hip replacement. You fix the A uh you changed the acetabulum as well. Now, when it comes to, uh for me has seen um DH S very, very good. Uh I'm very glad you said that the only reason why you won't do a DH S is because the fact that the inter uh the way the blood, uh the blood supply goes to the femoral head has been cut because of the fracture configuration. So for you to put a DH S is you can do it, obviously you can, that's never going to be an issue. But the fact that the head would start going into avascular necrosis because of the fact that the blood supply is cut. So what you want to do is and also the most important thing with avascular necrosis, it hurts, it still hurts. So even after the patient, you've done a DH S the patient say my God, what have you done? It still hurts. So, what you do is you take it out, put a hem or a T hr I'm not gonna go into what comes for and the nice guidelines and stuff. I think a few people really know their stuff, which is very impressive. But what you wanna do is you wanna change that femoral head because of the fact that it will get necrose that way because the blood supply is gone. Ok? But yeah, now I think everyone has their pearls of wisdom. But uh this is something that I've come across a very long time ago and it is one of the mantras. I always do. If you seen my jobs, it wasn't straightforward. Uh I had to do course site training before I was able or eligible to get into course surgical training. And that taught me quite a lot. I was still able to do audits. I still did pass my A RCP. So I did my CPD si did my do, I did everything was required for me in psych to pass my A RCP to go into S TT uh ST two. But don't compare yourself to others. Now, you don't have that issue. You can apply straight to core surgical training and you can apply straight to SC three. But most importantly, it's not worth it to compare yourself to others. It's horrible. The fact that I had to do four times or five times more papers, more presentations, more audits, more everything. But that's ok. That's life. It's, it's the cars that you're dealt with. But what's up to you is you have to fail because if you don't fail, you're not even trying. So two pearls of wisdom don't compare yourself to others. You have no idea what the journey is all about. And second Denzel Washington, one of my favorite actors. If you don't fail, you're not even trying and it's ok to fail. It's just how you get up from failing is the most important thing. And the best pros of wisdom that I can give before I finish my talk is from our Lord Darth Wetter. You have to have faith in yourself. And there's so many people who've done it before you and so many people will be able to do it after you. So Darth Vader says, I find your lack of f disturbing and most importantly, and I feel this is just a core element of life. Don't put other people now, strong people they put them up, they lift them up just like third grade is doing right now. Always be there for other people because you have no idea how they'll be able to help out. If my friends in core training, uh, if we didn't help each other out the way we did, I don't think anyone, uh anyone uh uh of us would have been successful. So, have a good group of friends, have faith in yourself. Don't compare yourself to others and most importantly, don't be afraid to fail. If, if you fail, you can try it again next year. It's not like in America, you have to pay again to get at ST three to get into ST three or for applications apply again, Oreo is free. It's absolutely fine. Go back see where you've gone wrong. You, you'll always get feedback, always take criticism positively and go on for it. Uh Go uh go further. Now this is extremely hard for me because I've been talking for so long. I, I didn't think I was able to do that. But are there any other questions? Right. I that that was a fantastic top. Very inspirational. Loved every word of it. Yeah, it was fantastic. Thank you. Really good. Yeah, I don't know if you noticed, but I was, I was changing the slides there so I hope they did a reasonable job. Thank you. Yeah. Thank you. That was absolutely fine. Good. I think for me it's quite impressive to see all these different, um, ways that people have got into surgical training. Um, especially, you know, someone having gone through, you know, adversity and applications and having to come from abroad and apply to a system that you're not familiar with and then get used to that and then deal with rejections and figure out what's going on in your portfolio and build it to a certain standard. Um, I think we'll have quite a lot of people from quite a lot of different backgrounds at different stages of the training. Um looking to come in at probably different points. You know, people who are coming in after medical school, people who have done some foundation equivalent programs elsewhere and people who have perhaps done some surgical training in other countries. So I think a lot of the questions will be directed to do with portfolio stuff and how we can change across. So if you need some stuff coming through some questions, I just down from the beginning. Uh let's see. Ok. Uh as a medical student from a low-income country, what are the recommendations to get into residency? Uh Pedro Fernandez has asked. So boss, can I just be honest, I I don't think there's anything what you need to do is just like I said, portfolio, portfolio guidance, everything is online, everything is on. It's scary how much stuff is online. Just look at what they're asking for and just try to get it if it's for CST. CST has a very robust uh portfolio guidance. Now, just go on, on portfolio checklist, see how many marks you're getting and just apply. Literally just apply. I don't think there is anything that should be stopping you regardless of which country you're from. So as long as at the end of the day, no one's gonna ask you. Oh, do you have a British passport or not? They will still give you a visa if uh I know a few of uh uh my friends who are just joining us to three now they're, they're on visas and they were able to get uh uh surgical training. So that's, I don't think where you're from has anything to do with it. It's at the end of the day, if you're able to, it's a competitive process. All of this is competitive. So at the end of the day, as long as you're able to give a good fight to everyone say, do you know what I've done everything that I can. This is what I've done. This has come to my uh favor and that's it. Uh So big example is I think I was lucky my bosses were very good with audits and research, but I was still at a disadvantage because I did two papers that weren't public. So I recognized that very quickly and I was like, OK, this is something I have to fix and I fixed it. So it doesn't matter where you're from. As long as, you know, I used to say, I used to say this but I don't think this you can. It's possible. I knew every point of the entire portfolio checklist. I said, ok, if I do one more, I'll get this, I'll get this. So as long as you get, you're able to do that, it doesn't matter where you're from. Her has asked us how to get into CST with an orthopedic truck, please. So, CS C what you do is uh no, I think she means uh orthopedic teamed, CST. That's orthopedic them. Ok. So it's pretty simple. Uh A lot of people want to do general surgery in orthopedics. So it is a bit competitive trying to get it. So what you wanna do is you want to score as high as possible, you can in the CST interviews, interviews are pretty straightforward. It's always gonna be general, it's, it, it's, it's not gonna be themed towards anything. But then after that, after you're able to pass the interview, they actually tell you what your preferences are. So all of the jobs in the UK, there are about 500 CST to 700 or depending upon which year it is, you just rank what you want to do. So I was in Newcastle, I wanted to come back to uh to, to West Midlands because obviously I wanted to be as close as much, close to brown people as possible. So, what I did was, uh, I put that on the top so I wanted to do Ortho, actually, I didn't wanna do Ortho, I put plastics on the top. I put general surgery. I put, I put urology at the bottom and then I put orthopedic as my preference is, but I was able to get, uh, orthopedics. So I think just be competitive in the interview if you prepare well for the interview and now the dreaded MS R A or whatever that exam is, if you're able to do those really good, you'll be able to get any uh CST course that you can because everyone's gonna be applying for the same thing. If you s score better than other people, you'll be able, you'll be preferred to get that rather than anyone else. So that's the only way you can. So ka is asking about leadership um and teaching skills. Um So how do you build your portfolio towards leadership and teaching skills, maximum points a little bit of that. Um I think for me, the takeaways that I got, it's more towards the degree to which you're teaching. So am I right in saying that, you know, if you teach your local level degree then regional and international, international? No, no, definitely. So it's so for the leadership in leadership and management, they, they brought it down now. So leadership and management is sorry, I was getting a phone, a phone call. So if you get a, for the management, I think what we do is if it's local, for example, if you're a coordinator, if you're a president, if you've done something to bring about a change in a local or regional level, uh that's one and then national International. So a lot of people, what they do in medical school is they get into society such as the West Midlands FTSS, which is regional that gives you number one, if you go for the National, uh for example, there is the B MA or if there is the uh the British Orthopedic Training Association that becomes national. And if you brought a, a bit of a change there that comes to number two uh for teaching, I think uh before I did my uh did did my post postgraduate medic uh certification diplo medical education. I was still doing regular, I was still doing teaching sessions for uh medical students or pas or everyone. My piece of advice would be if you wanna do local, if you wanna get that number one, because number two is only if you do a degree which is there's so many universities to do it. My piece of advice for you to get the number one in teaching would be just tell your medical education department of your hospital and ask them, I am a sho these are my competencies. This is everything else. Uh Would you mind just making sure uh would you mind just if there are any sessions I can help out with, I'm more than happy and can I get feedback from it? So, as long as you're able to do that, that gives you number one point very easily. And that's what I did before. That's how I got to know the medical education departments of almost every, but that's an easy way to thank you, Jeff. You might take a lot of feedback on it. So just, yeah, uh just a second. Um It was, yeah. So uh Rana has asked, does electives done in Pakistan? Uh A ku give an edge in your application for CST. Absolutely. Absolutely not. Sorry. Uh I'm from Islamabad, so I know you fine. A KU it's huge uh in your application for CST. I don't think it counts because they don't ask for electives or do they? I, I don't know for the CST. Uh I think that there is no rotation in my God. That's incredible. Yeah. Then yeah, it will, it doesn't matter where you've done your electives because I've done electives in a, I've done, I, I haven't had the pleasure of doing it or the opportunity of doing an A ku, but I did it in London actually in Kings and in Queens for neurosurgery. I did it in basically um other neighboring cities, Holy Family Hospital and everything else. And to be extremely honest at that time, CS C didn't have that scenario of doing an elective but yes, it will count as long as you have the certificate that clearly says that you have done an elective from them. It doesn't matter where you do it from. Ok, perfect. Uh Next one is, is having your publication then curious, a red flag in your CV. Absolutely not. Uh, curious is by far the best website to use. And as long as it's public sighted, no one cares because at the end of the day, uh, they're not gonna say, oh, which journal was it? As long as it sighted? Uh, that's the only thing they'll care about. And what I would do is whenever you're submitting your evidence to, uh, CST or application or whatever, the Pump me, I did print off, uh, or just take a screenshot of your pubmed. Uh, I, uh, uh, uh, pubmed paper and just highlight PUBMED ID and that's it. I don't think, I, I actually don't think, I think Curious is a really good website and a really good journal to publish. And I am biased. I have two papers there, but still cool. All right. Uh, do we have to do all researches in surgery if we want to get a seat in surgical training? No, that's the best part. No, audits, presentations, publications, uh, have to be in surgery. They can be in anything. This is both for CST and ST three. I had audits in psychiatry, as mentioned, I had audits in medicine. I had audits in neurology. It, and if we got, uh, God, new specialty, uh, but had a few in surgery, they all counted. None of the research is matter. As long as it's public sighted. I think that's the only thing that you need to worry about. Rana. Oh, perfect. Well, it sounds like you're, you're the all round orthopedic surgeon. No. No, it's just, it's what I gave you. I could either cry about it or just do something about it. So, certainly gone through quite a loopholes. I jump through a lot of, I think so if I, I don't want to dishearten everyone, but there were six people that I met and we made a group in while we were studying for club that was the examination to get registered with the gym. C everyone wanted to do surgery. Everyone, all of them reverted. And, uh, two are now a consultants or about to be three are now GP consultants. And I'm the only insane one who's continued to do surgery. So, uh, it's, and to, to each their own, I'm not gonna lie. They did the right thing. They're earning so much. They probably have two houses by now. Uh, have something known as a house. I don't even know what that is. It's too posh for me. Uh, but I knew I couldn't do anything else. Uh, but it is what it is. Uh, either I could find loopholes or, and I burned all my shifts back home in Pakistan. That's what I told myself. I'm not going back to life until I came here for surgery. I'm not going back without it. So very inspiring. Now, before I move on to the next question, can I quickly point out to this conference that the Surgical Society of International Doctors is conducting? It's on the 30th of September 2023. It's, it's being done with the Royal College of Surgeons of England. Um We are accepting abstracts right now. If you scan the QR code, it will take you directly to the conference. It's, it'll happen in London. Um We have oral presentations, postal presentations, virtual posters as well. It's a great platform for you guys to display your work and uh yeah, attend as well. We'll have mostly I MGS attending the conference and have a good chance to interact with them. Everyone interested in a surgical career to be precise. All right. Um Next question, three conferences attending needed for full marks in CST. Uh are at conferences and symposium the same. Yes, there's no difference. There's actually no difference. It's just potato, potato, tomato, tomato. To be extremely honest, it, it really doesn't matter as long at the end, as long as you have evidence that you presented or you've attended. I think that's it symposium is, it seems grander. Uh It seems nicer because it's obviously I've gone to symposium back home in Pakistan and they're like five star hotels. Six star hotels. Food is awesome. Uh So, yeah, but it doesn't matter. It's the same thing. Ok, perfect. Uh, tips and tricks for a junior doctor. Having two years of experience, post house job in the home country and cleared mrcs wants to pursue neurosurgery career this year. I'm going to apply for neurosurgery. ST one and CST. How much is it possible to secure, uh ST one neurosurgery? So, uh it's been a while since I look at the uh neurosurgery uh eligibility. But the last time I remember it depend upon the year. So the maximum in a year that I was, uh I'd heard were 19 vacancies. So you have to know that they are almost 100 100 and 50 people applying for those 20 seats. So it is competitive. I won't lie to you, but it's not impossible. So it's pretty much the same thing if you, you still have to look at the eligibility criteria. So the eligibility criteria and last time when I wasn't eligible was if you've done 24 months after basically foundation year or before foundation, I don't know, you'll have to look on the website yourself. If that's the case you're not eligible, but it's surely isn't impossible. You've done your mrcs, which is I'm not going to lie. The only hurdle that's stopping you from going to ST three. So you can easily pursue a neo surgical career. Again, I will urge you to go online. Look at the nearest surgical portfolio checklist, see how much you're able to secure and then applications open in November. And hopefully, I hear from you in a year's time saying that you've gotten it. I'm pretty sure it's very easy to do. Uh, if you put your mind to it and I don't think anyone should be telling you otherwise. Uh, but if you've done most of it, if you've done mrcs, you have two years post house house job, just look at the other criteria and just apply. Yeah, so I've just put a link in the chat to um a competition ratio. So when you apply to um higher speciality training, there's these competition ratios of how many applications versus posts there are give you a ratio of how many people get that job. So that's in there and just have a, have a look through that you can look into it more specific detail about rounds and applications and things you sort of search for it. There's quite a lot of data out there actually. Ok. Someone said, thanks a lot Jefferson. Well, thank you for attending. Uh Jefferson is the legend, Jefferson and Frasier legends. They're the only people there to do it. Does it matter if we have auto number six in any research article? No. Does that count as coauthor? Yes. So it doesn't, it doesn't matter play the game play the system. They just said coauthor, they didn't say 678, you are still a coauthor regardless. It just if you go for the person's specification, it says first author coauthor, that's it. It doesn't matter. You can be number 11 as far as I care or as far as far as they care as long as your name's on it and a pub me C it, that counts. Perfect. Perfect. Thank you very much for this encouraging talk. This is very impressive. That's for you to hear amazing session. Thank you. Lots of, thank yous and amazing sessions. Uh Kindly guide us on how to build the portfolio for leadership and teaching skills. I think we've already addressed. Um What is an elect particularly at undergraduate level in Pakistan? Uh No, so, no, no, no. So um I'm sorry, I'm looking at the excuse me, comment as well. So an elective is basically an internship or if you come to the UK an observer ship that you do. Uh It's basically you go to the hospital and as the name suggests, you observe how everything is and it's a really good, it's a really good way of trying to know the system without actually working in the system. Uh And it's what I did was in uh fourth year. Yeah. Fourth year I came here, I did a, I did an elective in Kings and Queens Square in London in neurosurgery and then went back. It helped me with my NHS jobs, but not for CST. But now I hear that it, it, it gives you points in CST so you can, but it shouldn't, it shouldn't matter that much. It shouldn't matter if you, if you've already post, just like, I think your other chat and stuff, if you're already post post health job, I wouldn't worry about it, actually wouldn't worry about it. Ok. Any recommendations for ST three prep courses. So, there are a few and I'm horribly biased because, uh, I have, I think I've done all of them. So they, everyone goes for Ortho uh AC three Ortho. Uh and I would highly recommend that. That's a really good one. But it's a bit pricey. All of the SC three courses. And what I did, I went to four different ones. I went for Ortho interview, I for, for SC Three Ortho Ortho Boss and I went for another one that I'm forgetting. But I went online, I saw who had the most questions and I kept on doing them forever. But I think one of the most important thing is, is it's just the online questions, but they actually have their courses as well where it's mock exams and they go through it, uh, at all. I would recommend those uh, of and that's what I did. But I went a bit insane and my, even my wife was like, I think I've gone a bit crazy but it helped out at the end. So, because I wanted to make myself as uncomfortable in those mock exams as possible. So I was wearing a suit. I was in this room, I was everything, it was all exam situations. I was sweating, like, as if I was in, uh, the interview and I made myself uncomfortable in that situation because when I was given a, uh, a, a question in the interview that I wasn't prepared for, I, I took it as a regular day. I didn't take it, uh, and it helped me quite a lot. So that's what I would recommend. Gosh, that's pretty, wow, that's pretty, pretty good level of commitment to hear. It's quite impressive actually. Um How was your own questions, Jefferson? Um What are we up to uh difference between CT one and ST one and non training jobs? Um If it's not much difference, then why is it not recommended to join uh training directly coming to the NHS? OK. So that's actually a very good one. Because if you've done Observer ships in the past, so, you know how the system works. Uh And it's can I be honest if you're coming from Pakistan? It's not that different. Uh But Pakistan the way or the way it was done in the hospital, I was working in, it was 30 years. How can I say this nicely without being condescending? Uh The practice in box is 30 years, the way things are done is 30 years behind of what it is done here. Uh But obviously, there's so many other reasons for it. So I would recommend uh if you've done an observer ship brilliant. If you haven't just do six months, you don't need more than six months. It's, it's like you just need to know how the system works. And it's like any other job wards are the same in any speciality you go to except Amee. Amee. But Amy is weird. Uh But anywhere else, the words are the same as long as you know what the system is and how it works. You don't need to give yourself a year or two years. Nothing else. You can obviously apply for surgery. Obviously, I would highly recommend just even if you don't get an interview, get used to the process of it. And plus as mentioned before, it's free, so apply. But then you need to know how the system works. For example, one of the most important things I can say is if I was asked a very specific question in my interview and portfolio, and I can safely say the only reason I knew about it was because I was in training, they asked me extremely specific questions about training uh requirements, training, how to build other people curriculum. And the only way how I feel I would have known that was because I was in training. I think it's always, for example, one of the most best examples I can give is most of us drive on a regular basis if you're driving here or if you're driving at home in Pakistan or India or wherever you are, if you come to the United Kingdom, I would still recommend you to take driving lessons. May be 5 may be 10 just so that you're used to the roads under supervision. That's it, it, it is the same thing at the end of the day when you come here after you, uh, come back from your, uh, uh, from, uh, from your home country here. It's the same thing. Take a few lessons, see how you are on your feet or driving and then you'll be fine. Same applies to NHS because a crash course was given to me in A&E and I'm very glad I did that because Amy and my God, whoever works in Amy now, I have nothing but respect and I really wanna tell them what's wrong with you. But I would recommend I, uh, I would recommend that as a first job but just, just do it. So you get to know how the system is and then never look back. Ok. So, uh, this one already, Krishna is asking, um, she works Ortho jobs in India but they were affected by COVID. So no theaters or clinics for a year. Would that still count as Ortho experience three? Yes, it does. Because of the fact you still work in Ortho, it doesn't matter, even if you weren't doing anything, you had no patients. It still counts. Unfortunately. Uh and that's something you have to be very specific about because uh unfortunately, when you apply for AO consultants are looking at your application at the start. So if they just realize that you have more than 24 months experience or whatever the uh criteria is, you'll immediately get a rejection. That's what I got for neurosurgery. So you could have uh and you will not be allowed to appeal it. So I that unfortunately, that will cover. Yes. Uh Yeah, there's a question about the curious uh the red flag in your CV. I think we answered that curious. Yeah, it's fine. It's amazing, amazing, amazing website. I would highly recommend it if you give them extra money. They actually write the paper for you. You did not hear that from me? Have we, are we recording? Oh no, Mohammed is asking again about the training in teaching. What if you do an M MS C from Pakistan? Would it count in? Which subject would it be? You can't find much medical field in Pakistan. So medical education is something training and teaching. I think medical education. I think that's what you mean. It's very specific. It isn't. I think it's different in certain countries. So medical education as a whole to, to teach you about the curriculum building about uh teaching in general learning concepts, knowledge, attending concepts that is taught in medical education. And I don't think that's training in teaching. However, an MS C from anywhere counts because the, the masters I'm doing now is from Dundee. But at the end of the day, it's still an MS E so no one really says and as long as you have credits, so I think if you go to the portfolio checklist or anything, they'll actually suggest. How many credits have you done? As long as you've attained that level of credits for any type of masters accounts. So it doesn't matter where you do it and which subject would it be? I think medical education, it doesn't matter which one you're doing. So, uh I uh when I was going through certificate, di a diploma and currently doing the masters in my certificate, I was lucky enough to do one of the modules of the three that you're supposed to do in surgical, uh surgi surgical training. Uh And number two are very optional ones or very uh uh ones, optional ones that you can do. But I love simulation. So that's what I went for. I went for curriculum building as well because uh of the job I, I was doing and I'm doing and then my master's is actually in simulation in orthopedics. So, but at the end of the day, it doesn't matter. No one's actually the only thing they'll ask you in the portfolio interview is when you say, oh, by the way you've done, you're currently doing a master's in medical education. They can bring about their OK. And I think one of the questions for me was how important is teaching for you in, in, in surgery. So I was you're able to direct the the consultants asking the interviews to what you want and what your superpower is and my superpower is in medical education. So I was able to highlight that very efficiently, right? So Mohamed's asked again about the job work responsibilities difference between ct one ST one non training job. So I probably didn't ask that properly the first time. So he, he's asking for the difference between the job or work responsibilities between CT one or ST one and non training jobs. So as far as I'm aware, CT one and ST one are equivalent in non training jobs, you're all working to the degree of an sh show you a senior house officer. And it's just a case of whether you're in training or not in training. But to be extremely honest, the only difference that I can see in training and non training is once a week or once a month, you'll probably get teaching, which is dedicated and they can't do anything about and you have to go, you just have to go, uh to it or you'll be penalized for your A RCP, which is the yearly checkup that they do on you just to make sure you're in line uh non training jobs, you don't have that unless you work in a really good department which actually provides you teaching, uh, for it. Uh, but that's the only thing, responsibilities, job work. You're the same. You're as mentioned mostly in the wards. And what I did in my neurosurgical job. It was non training. I was still in theater. Uh, I did the ward out early in the morning. Uh, listening fast, did all the jobs went to theater. Nursing. Knew where I was. My feet was with me. If there was anything, if there was att or discharge that had to be done, it would be get, uh, it, it would, it would get do, uh, it would get done. But they would have to wait, uh, because I would be in theater but you have to be, you have to play in the system. You need those DH S numbers, but you also have to be in the ward without being in the ward. You won't. So most of the juniors that are with me, I tell them if you are helpful with the nurses, the nurses will be helpful with you if you do the jobs really quickly. The second they say, can you prescribe laxatives at two o'clock in the morning? Yes. Done. Uh, can I have, uh, fluids for a patient? Three o'clock in the morning? Done. If you drag your feet in helping the nurses, you can actually be very frank with them and say, can I go to theater? Would that be ok? Just go. They'll actually, I had one amazing nurse who helped the bleep for me, for the ward while I went to theater and she had my number. She had everything she would literally message me saying, by the way, this relative is here, I've told them you're in theater. When will you be done? I'd say I'll come in an hour, come in two hours and I'll see them. You have to play the system. You, you go in every job saying this is what I want to achieve in this job and you work around it. But as mentioned, patient safety is always first. Unfortunately, as a junior doctor, as a non reg, so as a your uh house officer, you have to be in the wards, you're the first point of contact. If anyone, if anything goes haywire, you should be the first one there. So as long as people know where you are, you can be anywhere in the hospital. Ok? Um A lot of questions I think we can charge him for the questions now. Good, good. She's asking to be asked about questions regarding your research papers in your interviews. So I think that's probably if you're the 10th author on a paper that you've not read because you've just done the references or something. Do you need to know about in an interview? To be extremely honest in se three interviews? Probably not because they have 10 minutes for each of the stations. So they don't really, it just depends upon how you take them there. Uh What I was able to do is because in the last I think year I was able to write two or three papers uh for qu improvement projects. Uh five presentations. I highlighted them when they asked me, oh, can you tell me a little bit about yourself? But then to be extremely honest, they didn't ask me anything. Uh because I, I focused, it's the way you do interviews and, and that's the thing I didn't want to go into because doing an interview is slightly different than anything else. It's another kind of worms. It's how you direct the consultants to your superpower. As mentioned, my superpower is medical education and that's where I've done the most work. That's where I am. I like to think I'm a little good at a little, not, not, not any, not better, but I wanted, I wanted them to know how much I've done. So I talked about it, but then I talked really about the medical education. So they started asking me questions about that but know your papers in and out. The last thing you wanna do is you've done an excellent paper on something and they ask you about, oh how many patients were there? And you're just waffling and saying, I think they were 2000. 0 no, no, no, sorry. I've added an extra zero. There were 200. The last thing you wanna do because you want to be as confident as possible because the interview is actually an interview of a consultant when you go applying for ST three registrars, one of my, uh one of my closest friends told me that and I didn't believe him when he told me, but it is all they're doing the consultants when they're interviewing you is they're figuring out will you be a good colleague later on after six years? And if you're able to show that, you know what I am hardworking, I've done so much, but I'm a nice guy as well and I know all my uh all my stuff, I've done my paper, I've done my uh medical education. I have done all of the requirements of the eligibility criteria for SC three. But you know what, I'm a nice person as well. I'll II I will take care of your trauma when you go for golf. So that's what you wanna do and not clearly that, but that you wanna show you're a good colleague and that's what the interview is all about. And the last thing they want is someone who is just making up papers because uh they, they take that really seriously and you can get disqualified for life for, for doing that. Um Right next one, Maada is asking any advice where in the UK, we best to work in T and O as a foundation year doctor anywhere. It does not matter. I actually think that uh I'm biased horribly because I've stayed in the West Midlands for about 4 to 5 years now. And four years. Five years. Oh, wonderful. Uh 4 to 5 years now. So I would say yes, come to West Midlands uh Telford where I did my CT two is the best hospital to be in uh New Cross where I'm going now is the best hospital to be in. But it is what you want to achieve of it. When you go on foundation to your doctor or, or wherever you just wanna make sure you have literally said this is what I want to achieve. And if you go to your meeting for your supervisor and tell them, by the way, this is my plan that I want to achieve this and then come up with solutions or uh ways of trying to achieve them. They'll actually think, you know what, this kid's actually really good. He's thought about it. He's taking it seriously and let's work for me because I don't have to do anything. You'll do everything for me. So that's what you wanna do. So I actually think I'm biased, I'll say West Midlands, but anywhere uh it doesn't really matter as long as you have the right goals in mind. I think that's the most important thing. OK. So RNA is another question. Um This is a bit of a deep question actually, I quite topical for the UK. Um What are your views regarding saturation and pay scales for doctors in the UK especially. Is it enough? Ok. I get this, uh, I get asked this question a lot and people hate me because of the answer. I think. Uh yes, you want to have enough money to, to live decently. You don't want an Aston Martin or you don't want a Ferrari at this minute. Uh Which because you won't be able to pay the road tax. But if you wanted to do, you have to really look at why you are in this field. Yes, you want to get enough money to just be ok. But if you really wanted to earn money, medicine is not the place to be. I think it is. It's not demoralizing. It's just the fact that the amount of work that you do, the amount of responsibility you have, you literally are changing people's lives for the better or worse, uh, in split decisions in split seconds and that's too much responsibility and pressure for someone. So you really have to want to be a doctor to go on pay scale wise. I think it's decent. You're still able to manage. Yes, it's not gonna be extravagant. Yes. You the car, the Nissan GTR that you really wanted, uh, you won't be able to get in your, uh, uh doc uh, in, as a doctor pay in the first year or two, but you work towards it. You, uh, it's, I think back home it's really fun because of the fact that you work in Pakistan, especially, you work from 8 to 2 if you're lucky, 9 to 2 and then you're off, you can do whatever you like. Uh, and a lot of my friends now are doing side hustles. Uh, so they tried doing crypto. Let's not go down that route. That's, that was a disaster. But I think at the end of the day you're still able, uh, I'm married. Uh, And uh I think we're, you are absolutely fine. Uh We both have cars. We both live in a uh in a flat that isn't falling down or not in a rough neighborhood or anything. It's in a decent neighborhood. And I think we're absolutely fine. I think everyone who comes from uh box and says, yes, you know what this is for the better, this is everything else. It's something getting used to. I'm really lucky. I have a very good partner. She's been with me throughout. She, she came, so we got married when I was in London. So from London, we went to Newcastle, Newcastle, went to here and we stayed here. Uh So she has always been supportive of my uh obsession. I, I think I will say of getting into ST three and I think as long as you have someone who is there and who is OK with the fact of not driving in Aston Martin or a Ferrari. I say that because that's her favorite car. That's why uh, and I, I think she can, she can hear me right now. So, as long as they're ok that, you know what, you'll get it after a few years, I think it's fine. I, I don't think it's that bad. Uh, I, I actually don't, I was there in the 2016, uh, things as well. Doctor strikes as well. And that was bad. I, I, it's ok now, so that was my two cents. But obviously this is my opinion. It's not the right one or the wrong one, it's how you take it. But if I wanted to do something in which I would get paid a lot better, I would work in stock, stock markets and those, those guys working in kind of warfare. Amazing. Um, ok. So Mohamed is asking a specific question about why is it not recommended to join a training program directly coming to the NHS? What would you think? I, I think, um, I think I've talked about this but the only reason why is the same way, I'll just give one example and hopefully that helps when, if you've been driving all your life back home in Pakistan, er, if like, for me, because I came from Pakistan and you come to the UK, you're still used to driving, it's not gonna be any different, but there's going to be certain things that are different. For example, in a roundabout, you're supposed to blow clockwise. You have to let the person on the right leave bucks stand there wasn't like that. You just went, uh, and you, you, you were like, uh, fine, whatever you heel stop from me. I have a bigger car or flashier car or anything. It's the same thing here. It's not that you don't know about the field. It's not that you don't know about a ward because as mentioned, wards are see everywhere but at the end of the day, it's just to keep you safe. It's for you. It's not for them. It's not for uh it and it's for the patients just getting used to the system. It'll be a really big difficult uh it'll be very difficult for you to be in training. So I would recommend and again, that's my recommendation, six months, you don't have to do more. Six months in a non training job, find the system, try getting a few audits here in those six months time and just apply. Don't stay long. That's what I would do. But that's, that's what I would recommend a couple of questions. Then I think um one from the chat and one from me, I think um Mohammed's asking is a position in running an online platform like me. Would that count? I think. Yes, it will because it's national, isn't it? And international, I think it counts. I mean, at the end of the day, it's somebody who looks at the feedback like you consultant and observes what you're doing. And of course, exactly. And most importantly, what you're trying to do is uh what you're trying to do in leadership is you're trying to manage the platform. So for Jefferson and Fraser, I think both of them know this, both of them will get international, international numbers for their leadership and management because what they've done is they've, they've made a platform where uh people like me, obviously smarter than me have come before they come here, share their experiences, do this and that counts, that counts as a very good leadership and management because you're managing me this program that you've done. And that counts. It's just how you play the system. I actually for leadership and management. What I did was as long as you had feedback and helped I play the guitar and I was told by a consultant for my CST applications, obviously, I didn't do it because I wasn't crazy. Uh But he actually mentioned that if you teach other people guitar and as long as you have feedback from them that comes as teaching because no one ever said it was medical teaching that you had to do as long as the circle was completed of you giving the teaching session having feedback. That's it. So I didn't do it because I already had so much others. But I, I just thought that was amazing. And that thinking of outside of the box isn't something that I was used to and that really helped me just playing the game and just figuring out what would work. So definitely fill in your teacher, your feedback form. So this center around my last, my last question from me, I think I quite a lot of people watching this talk will probably be img who are thinking about making a move over to the UK to engage in a teaching program, which I think is probably quite a big move, you know, moving to a different country, engaging in a new system, changing a whole way of life. And it's a move that you've done personally. What would you say to those people who are perhaps on the fence thinking about? Is this, is it worthwhile? Should I stay where I am? Should I go and look for pa passages green? And what, what would be your sort of advice is if someone is, wants to do it, they're sort of, you know, on the fence a little bit about about. So I get asked that question quite a lot from uh friends or, uh people just randomly who just met me in Pakistan or anyone else. I get asked that question quite a lot and I tell every single one of them, it's just, it's not easy, it's really not. You could look from the amount of jobs I've had and everything. It's very, it's very easy to lose your heart and just do something else uh or go to another specialty. But wherever you are. At the end of the day, I realized the best form of patient care is in the NHS. You learn new techniques, you uh you, they teach you good techniques. They are amazingly funded for some bits and most importantly, they're trying to make patients lives better. So, back home in Pakistan, what used to happen to me and again, this is just from me, uh everyone would have different experiences and everyone have different things. I wasn't when I was my doing my F one, all I was doing was just absolute carnage of donkey work. Just making sure the wards were done going to A&E just making sure the Clark was done. No one cared about what was happening, what wasn't or anything else. I always wanted to come to the UK. Uh I was first off, I've done electives and I was loving, I, I was in love with the NHS. But along with that as well, it was just, I wanted to learn new stuff. I wanted to learn new techniques. I wanted to be in a place which was, which wasn't dependent on the boss for teaching. So back home where I was doing my F one, your teaching and everything, depending upon your boss and research and everything else. If your boss was uh research oriented, you would do a lot of research. If your boss was education oriented, you would be taught amazingly. But then other departments you went, if your boss didn't feel like doing anything. You wouldn't, you wouldn't get anything. But in the UK, I think it's what you make of it. Everyone's really encouraging, everyone's really supportive. As long as you show promise that you are hardworking, you're there. And most importantly, surgery is still old fashioned. As long as your boss is happy and you make sure that your boss is aware that all the patients are ok and you're o you're there to help. They'll, they'll give you so many opportunities. It's not even funny. Most of the opportunities I've gotten isn't by, uh, and especially in course, surgical training wasn't something I did to go out of my way. For example, I came in late or anything else. I just played the system. I went to the right consultants. I was extremely lucky. People gave me opportunities and I took them, I didn't let anything go. Uh I didn't leave anything for granted. I made sure to give it 100 and 50%. Not even 100. And then it was all up to the consultant and I was able to, uh, and I was able to get quite a lot of stuff because it was a, it was an exchange that I don't think I felt from Pakistan or where I, or anywhere else that I've done whatever I gave I was given more opportunities. For example, there was a project someone gave me, I was able to do it very quickly and I literally was like, is there anything else? And just because of that, just in the last six months, I was able to do four or five Q IP S and two papers and two presentations. And as long as you have that mentality of trying to get it done, you want to be in a nurturing environment that actually realizes your talent and make sure that you, you're pushed to your capacity. Pakistan was amazing and I would love to go back, literally love to go back. But I think I did the right move by coming here because I wanted to, I actually wanted to learn uh from the source because everyone who was teaching there was UK grad at one point or not. So at the end of the day, it's everyone has their own story. But my, I think one of the best things I could do was move out and with the intention that I would learn as much as possible and I won't take it for granted. So sorry, I think I kept on going for a fantastic, that's a really a kind of inspiring kind of tale. To be honest. I think it's very impressive to hear all of that. You, you you've done to get into where you are. Um So any sort of career I think people get into eventually I think is you're going to find benefit from that story. So I think I'd like to say thank you to, to here for that big long talk that we've gone through and all the questions that was very, very useful, even myself to hear all that is fantastic. So I think what we'll do is if there's any more questions for, to hear, we'll drop his email into the chat. If you can put it in there, Jefferson or to hear if you've got it there, I, I'm sure you'll receive lots of emails now. No, you've been very inspiring to everybody today. I don't think, I don't think I've done anything, but I'm extremely humbled by the opportunity. And the fact that you guys approached me just makes me feel that I've done something which I don't think I have. No. Thank you so much. If, if I'm able to even help out just even a little bit, I'm more than happy. But yeah, just send me an email more than happy. I'm really O CD with my emails. Don't respond to messages, but I, I'm horribly O CD with my email. Just send me an email more than happy to answer anything to the best of my ability. But one piece of advice is just all the advice I can give is my opinion on what I've gone through. But that doesn't mean it's the right thing. Go to the source. I, I think every one of us, all, all three of us will say the same thing. Go to the source, go to your share helper website, go to the person's specification yourself, try to read as much as possible from yourself, try to gain the information and then make up your own uh decisions. Don't blindly trust anyone because it's it's ok to, but you have to know what is going on and people's understanding will be slightly different. So make up your own. So as long as I can leave you with that, another uh another advice, I think that would be the most important thing. Great. Thank you. Alright. No, thank you very much guys for having me. It really, really means a lot and horribly humbled, horribly humbled. Thank you very much. Thank you. All right. So let's wrap up then once again we've got this conference. It's a good opportunity. Please register and of course, fill in the feedback form to receive your certificate for attending this session. So we'll have another session more than another session. We, we have at least four or five sessions planned every couple of weeks. Uh We'll see you. Bye bye. Thank you, everyone. Cheers bye. Thank you. Thank you guys. Thanks.