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And we're back. We're live. Hello, everybody. Welcome, welcome to the sixth session of the F DS S surgical specialty sessions. My name's Jefferson and here with me today is Fraser and, and uh we are here to conduct the sixth session. Ok. So what are our sessions about? So the FTSS surgical specialty sessions is a collaborative teaching initiative that was started in May of this year. The purpose of these sessions is to give um trainees, junior doctors and medical students an idea about a surgical career in the UK. So in each of these sessions, we've brought on trainees from different surgical specialties. They've given us a brief talk about what a day in their life is like, what the training application for each surgical specialty is like and what to expect when they enter the training pathway. So uh this, this teaching session is conducted by the West Midlands Foundation trainees Surgical Society, the Surgical Society of the International Doctors and the Royal College of Surgeons of Edinburgh. So I'll hand over the podium to Fraser who will introduce the speaker for today. Hello, everybody. Um So today, by the honor of introducing MS Minas, who's a current ST three in general surgery. She got a PG dip in education, which, you know, is very important for these sorts of talks. And today she's talking to us about the surgical application process in the UK. So she's currently in ST three, moving on to ST four in G surge. So she's got quite a lot of experience moving to that core surgical pathway and also that specialist training pathway as well. So any questions throughout the talk, just pop them in the chat. Um Any technical problems that you come up with in the chat, um, pop in the chat as well and we'll try and fix things behind the scenes previously in these talks. You've had a couple of technical issues. Um So if anything goes wrong or you can't hear or you can't see the slides, just let us know and we'll, we'll, we're always looking at things so we'll see if we can do anything about it. So, without further ado I hand over to Mena and we'll just get on with the talk, right? Hello, everyone. Um Good a good evening actually. Um So, uh as Frasure and thank you Jefferson and Frasier for that. Um What I the me as I mentioned, uh sc three in general surgery, um I'm just going to run through. Well, I'll try and run through the um, ST three application process. Um We did mention that we'll give some advice on co surgical training as Well, so, um, I think everyone who's applied for post surgery would be aware of what the, um, self assessment score is and what the portfolio um needs are. Um, and I'm going to cover portfolio. Um, once I go through the ST three application pathway and then that should sort of translate into everything else that you guys need to do when you move on. So, um, I think without, uh, and once we've done that, I'll uh probably just um go through what a typical day um would be and I'm gonna make it sort, sort of like an average surgical trainees day and not sort of very specified to myself. Um because I commute back and forth a lot, which isn't gonna be very common um for the trainees. Um Right. So we're happy to go ahead. Right. So I think we'll start from the person specification. Now, it does seem fairly straightforward. Um So I'm not gonna go through the whole thing. It's a very um straightforward uh specification uh document. Um However, there's a few things that I want to mention, um because there, there are lots of international medical graduates who would be um listening in as well. Um Now when you apply for ST three, if you haven't done a co surgical um post recognize training, co surgical post before then, um it's a good idea to look at two main things. The first one's the person specification that is on Oriel. So this is a screenshot of the document from Oriel. And throughout the process I'll be using screenshots from either the he website or, or, um, or the official G CD website. Um, only because I, I don't think we should be if you ever attend to talk. And even when I did myself, um, I learned, um, I was told and then I didn't really listen to it and, and then I was sort of, um I learned to always everything that I heard in talk, I learned to Google it later on just to see if it was verified information. So for that purpose and to save you guys that hassle, I'm just going to use screenshots from those official sites. Um Right. So in the person specification, um there's two main things that you need to be aware of. So first of all, um previously, you needed to have mrcs by the time you apply for ST three, which normally starts in sort of between the um August to November kind of dates with the process process usually closing in either December or early January, um which is, is raed slightly by a few weeks over the past few years. So, um now you don't need to have that unless um it, it changes this year. So everything that I say is gonna, almost everything that I say is gonna be based on my experience for when I applied for S TT training in 2022. Um I applied in 2022 and then I got into T three training um starting October 2023. So, um you don't need to have mrcs by the time you apply, but you do need to have an mrcs by the time part A and part B is um completed by the time you start SST three training or, and I think that now the change that to by the time you get an offer, which is a little bit earlier than that, however, I would advise it, obviously do not leave it to the very last minute unless you know, whatever reasons you haven't been able to do a prior. Now, the second thing is again, um if you haven't had a recognized foundation training post or you haven't had a recognized co surgical training post, you need to get two main forms signed off um which are mentioned in the person's specification. Um But you've got to sort of look into it and read the whole thing properly. It's a very extensive document. You um basically the foundation, both of them, both of them are the alternative competencies form, competencies form. Um What are available on the G CS D website and the training website and you can download it from there. So that's the main thing. I think we'll move on to the next slide right now. This is again, this is another um screenshot from that person specification document. Um and a few things to mention here are that they men. Um If you look at the career progression, selection criteria and career progression, and then you look at the essential criteria um when this is the relevant competencies, that's basically what you've got signed off in your founding in your co surgical post or in the alternative competency form. Um Now, in desirable criteria, it does say 72 months experience less than 72 months experience um from my, from, from the information I gathered when I went through the whole process, um I, I didn't have that much experience because I didn't really train back home. But when you go through this process, you, I've seen people with um who got more than five years or six years or people who've trained um you know, um in India, Pakistan, Bangladesh abroad, basically, um those people will have, will have a higher, high number of months of experience than graduates from here or co surgical trainees from here. Um And that does play against you in the portfolio section, um which we'll move on which we will discuss later on. So, although they mentioned a desirable criteria, I wouldn't sort of necessarily um just go by that, just look at the, just speak to people um ask around and you'll get a brief idea about um what number of months is good. Obviously, it just becomes more challenging later on if you've got more experience. Um However, uh it doesn't mean that you can't get into training. Um, those are the two more important things. And then lastly, I just wanted to quickly mention obviously, this will matter to you once you're in training. But previously, people who hadn't interco surgical training post and then got into ST three training programs, they would end up with a Caesar CP. Um, instead of a CCT, this has now changed to CCT and I speak only for general surgery. Um, it probably applies to the other specialties as well, but I wouldn't know much about that. Um However, it is C CD if you've done ST three ge surgery training program, even if you want in a core surgical training course prior to that. Um So that's, I think those are the 23 point burden and points that I wanted to mention from the person's specification. Um Right. Uh We'll move on to the next one right now. This form is the alternative alternate competency form for people who are applying for ST three and haven't done a recognized co surgical training course beforehand. I think it's got a few points throughout it which um you need to look into carefully. Now, this document, it's got sections on pediatric surgery and it's got sections on vascular and it's got a few other bits and Bobs that you might find difficult to get signed off by a consultant. We'll discuss that in the next slide. Um However, be just be aware that this document as mentioned here. And point number, point number three, it has to be signed off by a consultant who you work with for more than three months. However, there are consultants who are happy to sign off, sign the form off for you even, even prior to the three month period if they're happy with you. Um but the guidance does say three months. And secondly, if for example, you worked with a certain consultant for, let's say six months or nine months or a year and they've ticked off all the sections that they've seen you perform in. But there are a few sections they haven't seen you perform in. What I would advise is that you want them not ask them to leave that section blank. And then you get another consultant who you've worked with as well, who's able to sign off these, these other sort of blocks and you'll understand more when we go through this. So if we go into the next line, right? So these are um if you look at point number 13, which was raised by a colleague a a few um a few weeks ago. So point number 13, the last one using a camera and surgical endoscopy. Now this is quite difficult because as co trainee, even as school trainees, you don't really get a lot of experience of holding the camera and endoscopy. Yes, in laparoscopy you do. But in endoscopy, unless you make the active effort of going and getting it done. Um, it doesn't sort of come naturally with most jobs. Um, so just be aware of this. Um, I just help if you speak to the Gastro lead, um, who is usually the lead for, um, Endoscopies and for upper G I Endoscopies in most, in most trusts and you can discuss this with them and if they're happy to let you come in, get a bit of experience, um, and then if they're happy to sign off, sign, sign you off for using, using the camera, then you can, uh, once that they're happy, then you can get your, any one of your registrars from your department to have a look, um, to have a look, uh, when you're sort of helping them out when they're doing either colonoscopies or ods. Um, now there's a few things to, to that. Um, so even as other surgical, even as a registrar, um, if you want to start doing endoscopies, the pathway that we normally follow and there's going to be variations between different trials. But the pathway that we normally follow is that we do other simulation course. There's lots of places in London and outside that do these simulation courses where you go and you get a little bit of experience with how to use what the, what the buttons on the endoscope are and all of those kind of things, um, and how to play around with it. And that's a good idea. To do, uh, once that's done and you speak to the gastro, uh, uh, the, the endoscopy lead, which is usually gastroenterologist. Um, and let them know that you've done this because that will just sort of in that will incline, um, you to, um, sort of get that experience with them and they might just want to say yes to that. Um, because they, they can be hesitant if you haven't had any experience prior to that and you've got no, they might be hesitant letting you sort of just come in and hold the endoscope. So that's a good idea as well. If you absolutely need to sign off. Now, I don't, I don't think people who in recognize school surgical training programs need this part signed off because they don't need to get this form signed off. But if you haven't done the recognized training program before applying three, then you do need this section sign and that's sort of one way to go around it. So you do the simulation, you speak to the gas, uh, to the lead, um, endoscopy lead. Um, and then you go in and help out, help you read out, um, or help your consultant out when they do these endoscopies. And that's that section signed off. Um, the other thing is point number 15 pediatrics. So, not all um, co surgery trainees are in pediatrics, but we still people who've not again done the tetanus training course and you need to get the signed off. If you haven't worked with the consultant in pediatrics, they're not going to be happy to sign this off. So, um what I would recommend is if you just go to your local pediatric unit, um, speak to the pediatric surgeon there, um and say you want, you want to come around with them on your own time, obviously, unless you sort of get a job in that department, but on your own time, um you ask them to let you observe and come around with you. And if you um obviously the timeframe that they would require would vary, but generally they're, they're fairly OK with signing this section off. And again, you can get the guidance says that you can get multiple consultants to sign off various sections of this form. So that way you get your endoscopy and you get your pediatric and all of that kind of stuff signed off as well. Um All the other sections, uh for example, the surgical skills, the critical care and all of the other documents, all of the other sections in this document, they're fairly straightforward and you would um your consultant or your would have seen you do that during your um surgical i job. So that's um pretty much it for the alternative competency form. Um Right. OK. So we'll come to the recruitment um timeline. So usually the now again, as I said, it does vary by a few weeks, but usually the applications, uh, the applications open in November, uh, late October or November. Um, I think it was December when I applied in 2022. But, and then last year, maybe was late November. Um, might be a little bit confused but usually it's November and December when they, um, open and then they close pretty much by the end of December. Um, the latest that I've ever seen it close would be this first week of January, but I wouldn't again leave it too long in start. And I would advise that you start preparing everything that you need before the application opens and then start filling out the application form. Um Sort of as soon as it opens really because you don't have to, you can just fill it out and then save it and then go back to it again and again and you will have to go back to it. Um because everything that you've worked for, most of us take the applicate most of, of the international graduates um are not very familiar with this process. Um And they might just feel that, you know, they just need to fill that form out and it's going to be straightforward. It isn't straightforward because you need to provide evidence for most of these things once the application deadline uh passes. So you just need to be aware that everything that you've put down there, you've got evidence to back it up. So, um yeah, so basically closes around December time and then you start um you get uh your interview uh timeframe is, is sort of March April we're looking at and there's a few weeks difference between the between general and vascular surgery. So previously gender and vascular surgery was one training program. They've now split it into two. the self assessment scoring and the portfolio is very, very similar for both with these training pathways. Um However, the interview format is a little bit different and there's a few weeks gap, usually a few weeks gap between the gender and vascular surgery interviews. Um and lots of people applying to both if they're open to doing both of these specialties. And then because it's a very similar pathway, it does help them. However, yeah, so December by December is when the applications will close, you'll probably have your interviews by March April for General and Vascular. And then the first wave of offers comes around in April, which is quite soon. And now these offers get recycled every 48 hours, which is the guidance in my experience, it gets recycled every two, at least twice a week. And um you can, the preferencing does open with each round of the recycle. So we were told initially that um the preferencing, we only, we can only preference once we preference the posts or the deans. Um once we've done the evidence. However, um when I applied um every two and every time the, um, so I didn't get in the first, I didn't get a placement in the first round and then every time the rounds would open every 48 hours, that is 2 to 3 times a week. Um, the preferencing would reopen as well and then you can make, then you can change the Deaner, remove the places that you want. Um, add some more places just depending on how you think. Um, it's gone for you. Um No, so there's two main things about the application itself about the rec um the response to the offer itself. So um when the first round, when you the first set of rounds, so which includes when it, which includes the time for when it's open and closed, um You can accept, which means that's the post you take and that's about it. Um And then you'll be removed from the recruitment um from that round of recruitment. Um If you accept or you can hold with upgrades, in which case, you will still be part of the recruitment process. And then if you've got, if you sort of someone leaves someone higher up in the ran from, you leaves the post, you can then automatically get that post if you've preferenced it higher to your current um to your current offer. So that's whole and accept. And the third reject is very straightforward if you've rejected it and that's about it. Um So that's for the first uh few set of rounds around, I think it was around May time and again, this varies by a few weeks, but it was around May time when that stopped. Um March A P when that stopped. And then the only offers you people were getting would be accept or reject and there was no hold with upgrades. So if you accepted it, that's it for you. If you rejected it, then you would just be removed from the process itself. So those are two things to be very mindful of. And I know lots of people who missed out on posts because of that. Um Yeah, so it mentions here, so this is from the 2022 period um that the on the on the third of May is when the whole deadline expired and then after the whole deadline, the whole deadline is basically the time. So prior to the whole deadline is when you accept and you can accept and hold and um upgrade that's prior to the whole deadline once that whole deadlines gone, anything that you've even if you've held an offer before that and you haven't accepted it. If the deadline passes, then that would automatically either change to a reject um or they would contact you to let you know that you've got to accept it for now. Um And then that's about it. Most of the trainees, I know we've all started in around October. Um But yeah, it can vary between August and October. The start date does vary between August and October, but for West Midland and for London, Dean Rees, it is October 1st 23 just gonna have a quick look at the chart messages to see. Ok. Um Right Fraser Jefferson, do you think it would be a good idea for me to just answer some of the questions now? Or should we just leave it, leave it to the end of questions? You go ahead and we can them all together. Yeah, I think so. Just keep the comments coming in the chat, anything that you want to be answered or anything you need to clarify and we can just pick through. I just have a quick question, a quick look at that. Ok. Right. OK. So, um I think the two main questions that have been asked here is that is the experience counted from the date of graduation and irrespective of whether we have worked in surgery or is it only the surgical experience that is counted for reduction? No. So, um we we'll discuss this in my when we go through the self assessment section. Um And I think you'll get your answer then. So I'm going to, I'm going to leave this to them. The other one is different crest form. No. So you need one crest form. Um You need one crest form and then there are sections within that crest form that if your results happy to sign off all sections. Wonderful. But if not, you ask them to leave that section blank, which they're not happy to sign off or which they've not observed you, um, you know, tell them to leave that blank and then you get someone else who's seen you perform in that section to sign off because they have to initial or they have to sort of along with the tick. They also have to initial, um, their, their names on there. So, whichever even if it's a different consultant, um they can sign it off. It's one form but you can get different people to sign it off. That's, that's the answer to that. Um overseas consultant. I um I think the problem with these is that these are these get long listed. So this is the process for long list and we long listing, we've not gone to the short listing section just yet. Um And most of the long listing is done by admin administration team members. So when they're looking at your request form and they see that it's signed by someone who doesn't have a GMC number because the consultants have to mention their GMC on there. And the admin person might just think, you know, this isn't valid and they might just not long list you and in that case, you'll get an email back from them that you're not eligible for long listing, which is why I strongly strongly suggest that you do it. You get only a consultant with um whose GM who's got a GMC number to sign these forms? Because, you know, it's, if you wait a year for the next round and if for this, if this is the reason why you haven't been able to apply, you are going to regret it. That's what I think. Ok. Right. So we'll move on to the uh right now, this is the scoring system for SG three applications. Um It's available on various websites. Oh no, no, the previous side. Yeah, thank you. Um So uh this uh two main things. First of all, the self assessment which we'll go through, it's got 10 questions. A total score of 34. The minimum you can get in it is um is two and then the second section which involves the interview. Um the interview itself has three parts, you have a clinical scenario. So basic clinical questions and how you would manage someone. Um Then you've got a management scenario um which is basically how you would if there's a problem how to deal with a difficult colleague, things like that. And then 3rd, 3rd is the portfolio section which is very much related to your self assessment because it's pretty much a portfolio which is leading on to the self assessment. Um Again, as you can see the maximum points within the interview lie within the portfolio section. So if you look at it a total score of 100 how to fetch, you've got 60 points just for the portfolio and the self assessment, which is pretty much sort of your CV. Um It makes you, it makes you think it makes you wonder how important these two sections are, which is why throughout sort of this talk, I am going to be focusing on mainly those two sections. Um So yeah, this is just a breakdown. So you have an idea, right? OK. Um we can go on to the next slide. Um So during COVID um self assessment scoring systems uh for a year during COVID, the self assessment scoring um wasn't being verified. However, since then, it has been verified, it was, it was verified during my process as well. Um And in um last year as well and when I say verification, what what that means is that in the self assessment questions, if you've said that you've done, let's say 20 appendectomies and you haven't uploaded um your log book, then that's not verified. So you will not get points for it. And secondly, who judges who verifies these scores that you get or who verifies whether or not what you've said is correct. It's a consultant, these are usually general surgery or vascular or um some sort of surgical specialty consultant. It's not the administration team, these consultants look at your um scores, they look at the scores that you've given yourself and they have the authority to either accept the score that you've given yourself in which case it's verified or they have it um or they will ask you for further verification, which in my experience doesn't always happen. Um They don't wait for you to send in further the documents. They just sort of, you know, give you a score that they think is based, they think is um is correct for you based on the evidence you've provided. Um And yeah, so those are the two things you can um you can appeal the score that you have in which case it will be um assessed by a second consultant who will then go through these with you. Um When I was in this process, um one of the questions I had given myself a higher score, um I'd given myself a score that I thought was fair enough. Um And then when I got my very fa score back, um they hadn't, they sort of downgraded me by 11 point. Um And I thought I've got nothing to lose. Um I believe in what I've done. So I'm just going to appeal that um I appealed, I appealed the decision and the second consultant, he thought that what I'd given myself was unfair. What the first consultant had given me was also unfair. So he downgraded me by another point. So just be very, and I, you know, if I thought, if I at that point I knew that there was, I was going to lose something by appealing. I wouldn't even have gone through, you know, gone down that route. So I would strongly recommend that you appeal only if you think that, you know, it's, it's a gross um grievance that uh that's been dealt to you. Uh Otherwise, um I think just something to be very, very mindful of that you have something to lose, um, if you appeal, but yes, you can appeal. Um, and uh again, during my time, I think it was 2 72 candidates. So you, you get ranked based on your self. So you have the self assessment and then you get ranked based on your self assessment score and the top 2 72 candidates. I think it was during my time that were, that were shortlisted for the interview and the cutoff self assessment score I think was around 14 or 13. That, that's again, I I had a higher score than that. So I'm not very sure. But um from what people have told me it was either between 13 and 16 and that sort of falls within the top 2 70 candidates for when I applied. Um And then last year, I think it was 2 88 candidates that were invited to the interview. Um but the call for the interview is based on self assessment scoring system, a verified self assessment scoring system, right? So we can move on to the next. Ok. Ok. Right. So we'll discuss portfolio as part of the self assessment in the other slides. Um I just thought to quickly go through the interview itself. Now you've got 10 minutes. So the way it works is that you called in, um you meet the team members, you meet, there was a panel of three people when I had my interview, I know people have had two consultants as well, but usually it's three consultants. Um They will start off by giving you, they start off by giving you uh a scenario which will, which will be sent to you before you meet them. So you sign into the interview um at the slot that you've um you've been given. Um you start off with the clinical scenario which is sent to you. You have um around eight, I think it's, you have around four minutes to read the clinical scenario. Um and you can use that time to sort of, you know, intercept what questions might come your way um or sort of get your head around it. Um Once those four minutes are up and they're very precise with the timing. Once that's up, you will then be taken into another room where um another virtual room where you will have three consultants or two consultants who will be doing the interview. And then during the let's say clinical scenario will be asking new questions such as um you know, you've got this patient come in with, you know, with an acute abdomen and they've got these are the mark this is, um, what their symptoms were. Um, they may not necessarily give you the, um, the investigations and all of that unless you say, uh, that that's what you want or that's the next step for you. So you would start off by saying this is how I will manage and they'll ask you, how do you manage this patient? And then you can sort of say that I'll start with my, this assessment or this and this, I'm not going to delve too much into the interview. Um questions. There's lots of um there's lots of information available online. Um And I'm not, I think, I think we're not really um allowed to um review the questions as well, but, but there's lots of information available online um regarding clinical scenarios. Um And then the second thing would be uh second station is management scenario which again, you, oh you have your four minutes to read the clinical scenario, then you go into your interview with the consultants, you have 10 minutes to do that as soon as 10 minutes. And even if you're in the middle of a sentence, they will cut you off and that's about it for you. Um Then you go immediately go into the next um virtual sort of room. You get your management scenario, which is how do you deal with the upset colleague, things like that? Um You have your four minutes to read that and then you are immediately taken into um the next 10 minute session, which is again with the consultants again, they'll ask you, how will you manage the situation? So you've got 10 minutes for that. Once those 10 minutes are up, you are immediately taken in into um you're immediately sort of, you don't move from one virtual room to another, but the same consultants will then say to you, ok, your 10 minutes for the manager scenario, um section of the interview are up, we'll now discuss your portfolio and then you they'll take around 10 minutes to um go through your portfolio and things like that. Um Yeah, so that's basically the interview and then we've discussed the mark scheme before. So 20 mark 20 points for the clinical scenario 20 for the management scenario. Um And then I think it was 20 something for the portfolio scenario. Uh Can we just go back a slide, please? Uh One more. Yeah, 26 for the portfolio. So clinical scenario 20 minute, 2020 points, which is 10 minutes of the interview management scenario, 20 points again, 10 minutes of the interview portfolio section 26 points, but 10 minutes for the interview, right? OK. We can move on. Thank you. OK. Um Right. So I think we've discussed this now. Um just briefly. Yeah, so the chemical analogs that you're given um aren't at, at an sho level, they're at an ST three level uh which, and these are very similar to how you would apply for non training, trust grade ST three posts as well. Um And as I mentioned, um if you want some investigations that haven't been provided to you in the scenario, you ask for them and you will be provided that information. Um again, management scenarios. So hospital situations with non clinical problems, challenging situations, things like that. Um Now we were told um in the guidance that we received uh during the application that our portfolios are not going to be available to the interviewers. So everything that you've got to um say to them is within that 10 minutes. Um For example, in my interview, I was asked, what are you most proud of? And it's questions usually along that kind of line. And when you practice for your interview, you need to be able to concise the best things about yourself in 10 minutes or within, I would actually say 2 to 3 minutes because you normally get around three questions for each section of the interview. Same thing applies for the portfolio section as well. So when you practice for the interviews, give yourself only two minutes or 2.5 minutes at the most to bring everything to bring the most pertinent parts of your portfolio um in a down in a way concise uh pattern which you can then sort of convey on to the interview interviewers. Um And that's uh it's very, it's a little bit misleading actually because I found it very hard to believe that they don't have access to our portfolio. Um But when they start asking me questions, I realize that that's, that's probably true because people who the consultants who assess our self assessment score are the ones who have access to our portfolio. Um That is the evidence that we've sent to them, but the ones who with the consultants, but these are not the same consultants who do our interview. So these are a different set of people who will judge us based on only how much we tell them about our CV or portfolio during the interview section. So again, that's something to be very, very mindful of I think because for example, let's say you start, you asked, what are you most proud of? And you start talking about some audit that you've done and you talk about it for like five or six minutes. Um You know, it does depend on the interviewer as well, but usually they won't cut you short. So you will have spent six minutes or seven minutes of your interview of your portfolio section on the interview talking just about an audit. And you may have a master's and you may have, let's say you may have an MD, you may have a really great research project that's published and Lance, you may have so much more. If you don't tell them, you don't get the points for it. So that's something to be mindful of Right. That's done. OK. We can move on. Um Yeah. OK. Uh Right. So we'll quickly run through the self assessment scoring section now. Um And uh we can go on next sec next uh next slide. Um So there are 10 questions, questions, 56 and seven, which we'll go through are divided by a number nn is the number of. Um so you can, it's very, very straightforward here and it is calculated slightly different differently for general and vascular surgery. But um I'd ignore the part end of July 2023 because for you guys, it's going to be end of, you know, end of um, July 2024. But basically, how many months have you spent in any job in medicine? Post foundation? That's the end. So for example, you are, you finish your foundation uh program or you got your foundation competency signed off in 2020 let's say, and then you've been working in all these other jobs, even if it includes a research job, if it's in medicine, that will still count. And then you apply for uh for the uh for the, for the, um for the ST three round in 2023 which means the time frame for you would be 2021 22 23 until July 2024. So that would make your N 3 to 4, which they would count as for. So I hope, I hope that's clear for you and this is really, really, really important and this is where people who are international graduates or who um who and have trained abroad. This is where they will lose their points because everything else um from question 56 and seven gets divided by N. So that's important. Um Now, when they say any job in medicine, post foundation, they do mean research because I know people who had clinical research jobs, which they took because they thought it would not count as experience. Um but it did count intensive care jobs. Um that do count previously, they did not. So all of these jobs um count and this last line that you read, this includes clinical and non clinical jobs in any speciality. This is a very, very important line because lots of people have lost points because of the addition of this line in the last few years. Um So that's pretty straightforward. You've given the number, you've been given the number of months and all of that. Um And then, for example, you think that you've just spent three years working, you get um give yourself a score of two, which is, which is um within your, within the 33 years, you think you've worked since you completed your foundation program. When you, when the consultant who's assessing your self assessment score, if he thinks that it's three that you should be given, that's what they will give you. And then that's what you can appeal or accept depending on what you think. Right. So that's, and which is a very, very important part of the self assessment scoring system. Um Right. So we'll go to the next slide. Um So again, this is just um this is very straightforward, how many months have you spent in general vascular surgery? All of that? So you can see here now, these are the total, these are the max points you can get. So, for example, someone, um, since, um, you know, by the time they apply for the CT program or since they've completed the co surgical program, if they've spent up to 30 months in a general surgery job, um, their maximum, they would get maximum points for this section, which is it. However, if they've spent 31 months, your, their score automatically falls to four. So that's where the, that's where that, that section comes into play where people think I work in surgery for too long. It's going to count against me. This is what this question number two is what that means. And, but this is, as I said, different to end, which is question number one, which we've discussed. Um, and then question number three is again, um, if you've got, there are a few specialities such as it, um, cars and all of that, which if you worked in for more than four months, you do get, uh, you can get maximum points if you worked in more than four months and two of these specialties, you get two points which I had because I'd done to and I've done, I, um, as part of, as part of my core surgery job. And I say I, because I was, I was one of the people who was really applied to it during the core surgery phase during the co surgery Essid phase. So that automatically did help me when I applied for my S3. Right? we can move on to the next section. Um, ok. So now if you're applying for general surgery, the main procedure that they're looking for to score you, uh, is appendectomies. Now, if you've done 95 appendectomies, for example, um, very unrealistic. If you're a core surgery training you're in, in the UK. But if you've done that, then you get maximum point of four. However, if you've done more than 100 which is, which is true for people who've done appendicectomy, who've trained abroad, their score automatically falls to one. So that's that. And then for vascular surgery, your, this scoring system is translated into appendicectomy, fela dissections, um, as well. So that's basically, so this is a very straightforward section, but it's the breakdown of the score. Um I can't really remember how many apps I had, but I didn't really get maximum points for this section because it, it was just too unrealistic. Um But yes, open appendectomies count laparoscopic ones count. Um It has to be the, the classification in log book has to be either performed or sts or stu which is trainer, scrubbed, trainer, un scrubbed, um, assisted doesn't count. So, um and yes, if people have done appendicectomy back home abroad, they can, um, get that verified, they can print out a consolidation report of the log book and get that signed off by a consultant that they work with in the UK. Um and that can count as well, but it does depend at the end of the day on the interview on the consultant who is assessing your self assessment score, but usually it does count. OK, we can move on to the next one, right? So question 56 and seven which are on this slide. These are these, these three questions are, these four questions are the ones where your n which is the number of years that you worked in medicine since foundation counts because everything that you have in every score that you have in five A B six or question six or question seven is divided by N and there's a maximum number of points that you can get. So let's say your N. So um this is again, very straightforward available on most websites available online for you to see. But five A is a score that you give yourself, you get a score of two. If you're a first author in a paper that's published in an index um per med index journal case reports abstracts do not count. Um Five p question five B is again, publication in a pub index journal. Case reports are do not count and, but this is if you are not a first author, but you are a listed author. Um If you've helped collect data for things that go with um like a mass data collection for these large um research projects, you will still get one, whatever your score is for question five. If you, let's say you've got a total score of four, you've got four papers that have been published as non first author. And you've got your N is um two that two years since that you've been working in medicines since foundation. So your score of four for question number five will get divided by N which is two for you. So your total score would be, would be two for this section. Similarly, six is publications um and seven is quality improvement projects or audits that you've done. All of this is divided by. And now what I would suggest is people who out of all of these questions, people um obviously spend the most time on question number five, which is research projects. However, question number six and seven is something that you can do really quickly in a very, in a relatively short time frame and you can maximize your points in this section. But if you have, let's say five, question number six, you've got five. you've got um 10 presentations. And your n since graduation, your N is um two, your maximum score, you've got 10 presentations. Your N is two, your maximum score would be five. Does that mean you'll be given a five for section six? No, you'll be given a maximum of two because that's the maximum that you have for this section for the audit section. A maximum that you can receive for. This is a four. And as you can see, you know, research, if someone spend lots of time in research and they have lots of obligations, they can get quite a few points because the maximum score that anyone can get for reflection five is eight. Um OK, that's uh we can move on. Um So these are things that I had in my portfolio. So question number three rotations, I had a rotation I to and Ortho. So I got two for that. Then um appendicectomy, we've already discussed that. Um I can't remember what my score was, but it wasn't the maximum one. I just got a log book, consolidated, log sheet printed and signed off by a single consultant and that was fine um publication. So I, I think my points were two for this section because I had done a clinical research over six months during the, when I was applying for ST three. And um I had a few other, I had my thesis as well that I um had done a paper on, but I hadn't been accepted by the time I, when I was applying for ST three. So I didn't, um, I couldn't sort of count it. Um, and then a presentations, um, I think I got the maximum points. I think I got almost the maximum points for this section because I had lots of, um, presentations. Um, another thing is when you have something, let's say you've done an audit in a, in your hospital, you present it at your local meeting. So you get points for audit. Then what I did and what I would suggest, you know, if you're short, short of time is you just basically go on to Google and go and search for conferences, um course um conferences, meetings, um surgical ones, medical ones, anything just search for. It doesn't matter how good it is, how bad it is. Just search for it and submit your audit that you've done to it. Um There are a few uh conferences that will accept your research and if it's a national one or international one, then you get a presentation out of the same thing. So these are sort of quick pathways and quick tips to get maximum points from something as simple as an audit. Um And I did most of my presentations during, during, during my surgery time and that was during COVID. So everything was virtual, which helped me because I saved money and I didn't have to travel as much, right. So I can move on to the next one. I think we're running out of time. So it'll be a bit quick. Um Those are just some examples of what I had in terms of presentations. Um And then, um again, um audits as well as I've mentioned, um simple audits that you can do in basically any, any department. So wet prophylaxis, abscess pathways, um discharge summary. Did it have all the details? You just make like a like an Excel sheet and choose the fields that you want and then complete and then present it in your meeting and then very, very simple kind of stuff. Um Patients, people who work in neurosurgery and stuff um or in oncology um and are dealing with patients have steroids, then they can do an audit on whether these patients had a weaned down plan for steroids when they were discharged. These are very, very simple things. Um And lastly if you go to your audit department within the, within your hospital, ask them about what audit they need done because usually these have, they have like performers where they just need you to collect data and fill. So you've got like a questionnaire already in place, you just have to go through the data and collect it and put it down on there and then they will generally make the presentation for you as well, which then you can sort of edit. So that's again a very simple way of doing an audit. Um and that's an audit. But question seven includes quality improvement projects as well. So what I had done, um I think during foundation it was that I just went to my department. Um I think I don't remember who it was in the department, but basically people who are in charge of uh printing of the information on the patient leaflets, which in my current trust, we have, you know, information leaflets for patients who are coming in for a cholecystectomy and all of that kind of stuff. So you just speak to the ones who organize that, tell them you want to improve it because of latest research or whatever. Um read about the latest research, see if anything needs change and just suggest to them changes to them if that's done and then they'll be happy to, then you can either get a copy of that as of evidence and give yourself a point for the quality improvement project. Um or you can ask them to do a quick email, just any kind of proof that you've done that project and that will count as a quality improvement project. And it's fairly simpler to do than even an audit, which in itself is simple enough. So that's that. Um All right. So we'll go on to the last two questions. Uh Right. So high UK degrees if you have now people from, I think, I think it's India, not really sure because I'm, I'm not from India, but people who have done their, their training in India, they have like an MD. I do not think, you know, feel free to correct me if I'm wrong, but I do not think that counts because the guidance says that you need an MD or a high degree that's associated with a thesis or a dissertation. So, unless you have that as part of that MD, it will not count. Um, for me I had an em sy that I did from Queen Mary University of London um in Laparoscopic Skills and surgical sciences. Yeah. Uh So um I got, I got, I got a maximum score of one for this and then question nine is uh involvement in leadership or management. So, um again, it could be outside of medicine but it has to be since you graduated. So for, for example, for me, I was, I was an organizer of debates in my, in my, in my med school um organization organizer for, for like I was a girl sports representatives organizing all our annual gaming competitions, but that did not count. Um What did count was everything that I've done since I graduated. So, um if it's on a national or regional level, you get two points for it. If it's on a local or trust level, you still get one point for it. Um That, that's a, that's still an easy one point that you can get. So if you're like a ro coordinator in charge if you're in charge of running a journal club, those are all points you can get. And the last point is a teaching certification. So, um, if you have a PG cert, which is very simpler to do than a PG diploma, um, you get two points where, um, number one, number two most degrees, if you're a core trainee will fund you for a teach the trainer course, a teacher, a teacher course, um, or a train the trainer course. Um You do that and you get one point or you can be a voluntary tutor if you've done um a trust great post. Or if you, even if as a core surgery trainee, you speak to the um education lead of the undergraduates who organize for these undergraduates or medical students to come, uh come into your department for rotations. You can get the email address of the person who organizes these rotations from the medical student, um write to them or call them whichever ask them if you can be a tutor for these students. Usually they're quite happy. So I did that. Um I it, it does take a bit of chas to and back and forth and it's obviously you've got to do it on your hard times. It is quite hectic. But um that's how I approached it. So I spoke to the one of the medical students, I got the email for the, for the, for the person who organized that, for it. And then I became a regular tutor for these students. I think it was year two and three or year two and four. I can't remember. But, um, and then I used to do like a weekly session and they're quite flexible and you're obviously flexible. It does have to be in person. So I had to, I did that for, I think, three or six months. But then I had to stop because I moved out of London for my, um, for my uh three job. But when I do go back to London, I will restart that because obviously, you know, you know, people from before and everything. So it's much easier as compared to drink in a new place. But, um, yeah, that's how you get, um, and that, that, that letter from the department saying you're at Tuah will get you points as well. Um And I also, so that's fine. I think we can move on to the next one and that's pretty much it for this. Um So degrees, I had an indicated BSC, I had um an MS C. So that's done. And then leadership. So again, um, if you help run an international doctor's group, if you're, if you're a foreign graduate, um, or you run some sort of a Facebook group or something that will count. General Club will count even if you've made a group that and you're preparing for mrcs and you've organized a few things you can use an evidence of, you know, your telegram group or the evidence of your Facebook group, wherever you have that platform. So just a screenshot of that platform will count towards leadership as well and then charities as well. So, um for myself, I was part of, of a charity um and then helped run some of the Bath Surgical Society courses as well. Um And one of the MRCS meeting courses, a very, very sort of ground, ground roots level for the mrcs one. Um And I help from the journal. So, so basic stuff like this, you don't need all of it. You just need like a couple of things and I say a couple of things because even one will get you the points, but you just don't, you want to be careful and maybe do two instead of one. And then uh leadership courses. So you've got lots of, so all the mandatory training and interest involves equality and diversity, leadership and management. So that's something that you can just do online because it's fairly mandatory or it's free. And even as part of the b if you're part of um BM, they have these modules, you can do them and then you get those, you can try and get those points from there. Um And then I had a PG diploma in teaching. So I got uh maximum two points for that section as well. Um And I, so I, I did my, we can move on to the next one. But I basically did my, in regards to my portfolio, I did my um, MS C in my PG diploma as part of my, during my core surgery ual job because I didn't want to sort of spend extra years doing that. So that's about it. We've come to the end basically. Um This is just a screenshot of referencing um because it just helps you get your head around where you want to get your head around or where you want to move. Um, and what preferences you want to give when you apply for SG three. And it's good to know this because at the time, it seems very, very, it seems like a very minor decision. But, um, as I've learned from experience, it's, it's not as simple as you think it is and it does impact your life quite greatly. So, um, yeah, I mean West Midlands when I got to West, it was my fourth preference. But, and, you know, I had even listed Scotland and Northern Ireland, which are then later removed because I realized I don't want to go there. But, um, these are excellent inr but, you know, just it wasn't possible for me due to personal circumstances. Um, but I was very happy to get we Midlands and I'm, you know, it's been an excellent injury to train in. Um, but, uh, it does make you realize that if you've lived away from that dery for a long while and you've moved to a new place. Um It impacts you more than you think it would. So I would strongly suggest that once you sort all these other things out, have a look at the referencing options, take your time before you preference, discuss with your family, discuss with your partner. Um Make a very, very informed decision is what I would say. Um That's about it. So I think we're at the end, we'll take questions now. Thank you. Thank you, mena. That, that was a very elaborate session. Um We liked it. They went through each step of the application process, portfolio and everything, examples and details. Wonderful, fantastic. Yeah, definitely. It's very, thank you. I hope it's been helpful. I mean, I remember the struggle. So um and I personally due to various other reasons, I didn't want to apply and reapply and do all of that again and again. So I knew that the time I apply is going to be it for me, which thankfully I got into. But yeah, absolutely. Absolutely. I think it's quite a complex thing to look at, you know, just superficially. So any insight into that I think is greatly appreciated by a lot of people. And I suppose the key to the takeaways that I think I personally get from this is that you essentially want to get in there the first time and maximize everything that you possibly can because the more time you leave it the more and more work you kind of have to do to top up that portfolio and keep it, keep it moving otherwise your chances decrease and decrease as you do it. Exactly. And I think many of the nuances that has told us about, you know, how you can, you can just upgrade your selection or draw, know all the nuances that come with these, the application process that those really matter when, when you're in, in the process and getting to know that beforehand, I think makes a lot of difference. Absolutely. I just for my own sort of personal understanding of your journey. M I'm trying just elaborating for everyone about what your sort of pathway was from in medical school to basic training to CST or what was your process. So, um I grew up in Dubai, I went to, I did my OGC in Dubai and then I went to Pakistan for med school. Um I studied at Travel Medical College, which is a government college. Um And it's got a very, it's got a higher, higher merit system than the private medical colleges usually. Um So as soon as I graduated, I did um f one there which is internship, which we sort of need to do. Um But I did that and then as soon as I was, I gave my pla one and my is which we have to do during that one year. Um And then as soon as I finished, I came to the UK. Then I did my F two from London and I did my co surgery as such a job again from London. During that, those two years, I did my MS C in, from Queen Mary, which I've already mentioned um, around towards the end of my co surgery as such a job, I did a PG, I did a PG diploma diploma as well again, virtually. So off site. Um And then I took, and then I wanted to apply for a DS G three course. So, um during that time I took six months to do a clinical research or um also in and then I got, and then once I applied and I got a place, um I got my replacement, I stopped working for those few months. I wanted to chill and take a break. Um which I would not recommend because I think if you've been out of practice and you just suddenly go into ST three, no matter how good you were in the past. If you've had those months of not working, you are gonna not, you, you don't want to do that. Basically take a break, rejoin some sort of work at least a month before your ST three. That's what I would suggest. So, yeah, so that's what I did. Um And I'm not going to details of which hospital and which trust because I think that that's not everyone's different and each trust has its own sort of advantage and disadvantage. Sorry, go on, on, on. Um I suppose a lot of people here will be coming from abroad looking at the UK system. I think on, on our initial poll, there was a good 60% of the people watching are from outside of the UK and having that experience of being training in Pakistan and coming over to the UK. How do you find that change in culture and health care services between Pakistan and the NHS? So, um so two things to mention number one. So I didn't really, so I did my graduation, I graduate, I went to med school and then I did a year of internship during which was doing the UK exams. Um And so I didn't really sort of train back home. So people who have trained back home or abroad, their experience is going to be different to mine because they've seen it from a very close level from a training perspective. And I haven't because the training that I've done has been in the UK. So, but there is a culture difference because I think um I think ethics is something that's very focused upon in the UK. Um And then in, in clinical practice and then, but people, I think, you know, from what I've seen people who've trained back home and then they come here or if someone who's had four years of training in India or Pakistan, and then they come and they train for four years in the UK or sorry, someone who's trained for four years abroad as compared to someone who's trained for four years, only in the UK. From what I've seen, the one who's trained back home has had a much larger volume of exposure. So their technical skills are going to be much better than people who train in the UK. And that's my personal experience and I could be wrong, but that's what I've seen and that's what I've seen. Uh But as I said, I haven't trained so I can't really compare. And again. Um So that's one thing. Secondly, I think people that have that graduate abroad, they struggle with very, lots of things. So when I come here to the UK, you couldn't apply for co surgery because you wouldn't be long listed if you didn't have the right to work in the UK, which is very, very, very, very discriminate, discriminating, it's very discriminating because you can't, you, you just, no matter how good or excellent you are, you just can't apply to go surgery. That rule has been changed since a few years now. Um So things have been made easier. However, the people who are, you know, things like audits, quality improvement projects, um research, you know, this is not something that people who go to med school um in, in this like, you know, in, in, in third world countries, um or even developing countries this is not something that they get a lot of exposure to. Um, as compared to people who go to med school in the UK or Europe. So that's one thing. So they have to work extra hard. I mean, it's a given that if you're a foreign graduate, even if you UK, born and bred or you're born and bred in a place like U A or Dubai or whichever it doesn't matter. You are, you are going to have to work extra hard to get into things like surgery. So I would strongly recommend it. I mean, this applies to myself as well. If I like anything other than surgery, I would have gone into it because it's been, it's been a very tough path and it will be, it will still be tough. Maybe it does get a little bit easier once you're in training. But that process until you get into ST three training, it, it's a different, it's an arduous journey. So do it only if you really, really want to do it. Not because you, you know, you want to be called a surgeon or because your family wants it or whatever. So I think it shows from the entire talk there that I think from what you say about, it's all about maximizing the time that you're, every time you'd be looking to do something else that's adding to your portfolio and the next thing and the next thing and that sort of leads into a question that Abdul has asked on the chat. Um, he's mentioned about your, your MS C oh your, your PG dip in, in clinical education that you have. He's talking about when he should go for MC, should do doctor essential, need guidance regarding doing a degree in clinical education and an MS C in surgery. What your So, um when I looked into the program, the Queen Mary, um there was a Trauma Embassy that's really, really, um, that's really, really famous. Um, because it's really good. Um, but I knew I am not going to go into trauma in the long run. So I chose laparoscopic skills and surgical sciences. Um, because for me, it, there was a lot of hand on, there was, it was very hands on. I wanted something that was hands on. I wanted something that would teach me the basics of general surgery. Laparoscopic skills is very, very general surgery apart from a few other things as well. So that's why I chose it now. It depends on what you want to do if you want to, let's say, work for the who in the long run or you want to go to the Middle East. Um, you may, you don't have to do but you want to train in surgery, for example, you don't have to do an M sy in surgery. You can do an M sy in public health. Um, I know someone who's recently started a master's from the London School of Tropical Medicine. Um And, you know, it's got great demand and it's, it's very, very transferable skills that you learn in there. Um It translates into a lot of specialities. So what I would suggest is choose an M sy based on number one, you know, a topic that interests you because you have to do a thesis in it and thesis is not a joke, it's very, very hard. And so number one, that, number two, it doesn't have to be in the speciality. You want to train in, it can be something like public health epidemiology, um, education, if, depending on what you, where you want to end up in the long run. If you want to be a professor, you want to be a lecturer, things like that. Um, so that's the embassy. Um, choose number three, choose an MS E that is light on your pocket because if you're an international graduate, it will be heavy in your pocket because you'll have to pay international fees. Um, unless you've spent like a few certain number of years or I don't know what the criteria for that is, but usually it's international fees. So choose, it doesn't have to be the top university in Oxford. It could be any university that has a decent program. Ok. Uh, number four, if you don't want to waste time, well, not waste time. If you don't want to spend too much time on it then you can break your one year, em, ss down into two year virtual learning program. So, you have to go. I had to go, we had like a summer school for the two years, um, of my Embassy, which I attended if they gave me time off during my cos surgery, such a job. So, choose something not related. Let, let you don't want to choose a master's that's only offered, um, in person if you don't want to spend a one year out of training or out of uh, a full time job. So that's the thing, those are the things you look at. Um, and then similar things apply to a PGC. So just any university, any, um, any college abroad or in the UK, doesn't matter. I think the priority for you should be good program as then you learn something from it. So good. I, I say good, not excellent. Could, it could just be good? Um, and the second thing, uh, light in your pocket because, um, as an international graduate, um, or even if you're a UK graduate and you're a foundation doctor, you know, we're not, we're not billionaires, we don't earn in millions. We, you know, we have a skill base, skill, um, that we're all, you know. Oh, is that done? Ok. So, yeah, so, uh, that's what I would, those are the recommendations I have for you. Hi guys, if you take a quick minute to scan the QR code and put in your feedback. All the attend receive a certificate for attending this event. We still have a few more questions if that's ok. We let the attendees fill out the feedback in the meantime. Um So I took the liberty of answering a couple of questions if that's ok. There is one question about surgical experience and CSD application. Uh If you do a trust grade, uh F three non training job, will this count as an elective in surgery? And my answer was no, it would not, it would count as surgical experience. Um Yeah. And uh the other one was for I MGS who come from countries where foundation training is only one year. Will any surgical experience after the one year be counted towards CST or will it be counted as an F two? No, it will count as an F two. I mean, you, it will count as what you want to, you want to make it count as, but if you use it as part of your co surgery time or residual time, it will, that's what it will count us. But again, I would strongly recommend that you use it as an F two because you basically, you know, you don't want to lose the year that you have for free waste. So F two is what I would suggest and you can use it for an F two. That was essentially my, my answer as well. Now there's another question can I ask you if anything apart from upper G I lower G I urology, TN count words, gen surge experience, specifically ent vascular hepatobiliary transplant, neurosurgery, thoracic surgery, pe surgery will all of these count towards chance experience. So I think the question answers itself because you've said neurosurgery, thoracic surgery, pe surgery, these are surgery, surgical specialties. So they are going to count ent will count vascular will count hp will count transplant. All of these will count towards surgical general surgery experience. Ok. So uh but I'm uh am I right in assuming that urology, TNO ent these will not count towards gen surge, right? For ST three for ST three, it for ST three. No, it, it did count because I used my TN experience for the points that you get um for doing TNO or it or whatever during your cour such your your time. So, II, I mean, accounted for me and it gave me points. So it's a good thing, but I think it does count. That's my, that's what I, that's my experience. Now, what's the other thing you mentioned? Urology? Um urology? I mean, uh frankly speaking, it is a surgical sub subspecialty. So I think it would count, but I'm not sure because I didn't have to uh experience that. So I'm not sure. Ok. Uh Can I just briefly mention something else before we move on to the next question? So, on the 30th of September, uh the surgical Society of International Doctors is in association with the Royal College of Surgeons of England. Uh We're conducting a conference in London. This will be both an in person and virtual conference. It's a great opportunity to submit your abstracts, get a poster or an oral presentation, lots of prizes. And uh it's also free if you're from uh some middle or low income countries attending virtually. But if you're attending in person, obviously you have to pay for it. It's about 40 lbs, but it's a great opportunity to network with surgical trainees. Um with international medical graduates who've gone into the surgical training pathway, they'll all be there. You can talk to them get first hand experience of what it's like to train in the UK. So the question joie is a, a post grad first year medical student. Um What would you recommend they do to increase chances of getting into the program? Um Also just a general question slides available for download slides, everything is going to be recorded and put onto the med platform and also the R CS Edinburgh website. I think if it's alright with me, he maybe you can email the slides to people who want them. Most of them are screenshots from official sites. Anyway, so I'll send them across. Yeah. And also the the links for these various forms are actually up in the chat that Jefferson posted earlier. So the question, the question there was um what would you recommend for a first year medical student, chance of getting into the programs. Um That's a very broad question, isn't it? Um, I mean, what I would suggest is things like, which is the same thing I said to my sister who was a medical student until a couple of years ago. Um, quality improvement projects, audits. Um, those are easy things to do. I mean, I think things like leadership um teaching will help you if you're going to get into cos surgery, which you need to do before. Um ST three anyways, um those will, it will help for co surgery and that's something you can do in your, in your um in your med school for now, the format changes. So four years, four years ago, the leadership um leadership things like uh you know, have you been involved in uh activities abroad and things like that? And leadership um gave you more points than it does now for sc three application. So things are going to change. So keep, always keep looking. You've got, I mean, your, your first year medical student, you've got like 445345 more years to go. So um just keep looking at that platform at the Oriel website, see what's changed every year and then you'd have a better idea. But I think for now all these self assessment scoring questions, um this is what it is for now. So leadership quality improvement projects, teaching in degrees um all of this helps. OK. So uh a question from NAV Raj an MS degree from India with a thesis scores points question mark by definition. It should because you've done an MS which is a degree and you've done a thesis which is basically what the question is. So you, it should score points and if it doesn't, you can appeal the score cause you, that's the guidance. So yes. OK. Next one is from Atar. Um Hello from Sudan. Hello. Um He did um a foundation year one. He did my military year in a government hospital and then in a private hospital for year two. So the solo operation was very, very little appendixes. We did three appendixes. Um 10 feeding jejunostomy, one feeding gastrostomy, one open co cystectomy, three BNS and two A KS and all the other operations. I was assistant. Is this going to be a problem? So he's essentially saying, is it a problem if he's an assistant um in his surgical numbers versus if he was the leading surgeon for core surgical training applications, um even being an assistant counts for sc three applications being an assistant does not count. Um And if you're looking at the self assessment scoring system based on what it is now, then three appendicectomy aren't going to give you much point. So I would, if you, if you can, I would strongly suggest that you try and do lots more appendicectomy if you've got a choice between a laparotomy and an appendicectomy, the appendicectomy because that's what you need at this stage. Even as much as you might be attracted to the, he brought me choose the appendicectomy. It has to, it can't be assisted for ST three. It has to be with your trainer scrubbed trained and ST four ST three. But for CST it would. Ok. Abdul has asked, um, my question is regarding core surgical training. does the time since graduation also adversely affect our core surgical training application? Um So I think this is Abdul's question. Think she means you said is the experience counted from the date of graduation, whether or not he's worked in surgery or not or is the surgical experience counted as a deduction? So I think, um, I, to be honest, it's been a long time since, uh co you know, since post-surgery application. So I can't, I can't remember to be honest. Um I know that for ST three initially, it used to be ca time since graduation, which was your n but, um, that, that has now changed to, I think it's tried to, they tried to make it more inclusive for, for, especially for, for, for, I think for women who, you know, got to stay at home for whatever reasons. Um So now it's only the time that you've worked in medicine, um, since graduation that counts for ST three, but for cos surgery, I don't know. Um, it's been a while I don't know what the application is like now. So I think, I don't want to say something that might be incorrect. So, um, but we can look it up and we can, when we send all the slides, we can, um, add that on there. True. But from my, uh, understanding, I think anything apart from your F, one and F two year counts is such good experience for that 18 month bracket. That's my understanding of things. Yeah, I, I can't, I can't, to be honest, I can't remember and things have changed a lot in the last few years. So I can't, but I think, I mean, I don't see why it wouldn't like in regard does the time since graduation also, I mean, if you've been sat at home, not really working, then I think Jefferson, that might be his question that if you sat at home not really worked. Um So in that case, I don't know. But if you have worked then um I mean, it, it would count as because you work in medicine. Uh But uh I do, I can't answer that. Uh 100%. OK. Um There's another question about surgical experience for core surgical training, straightforward. So I answered that um and the question was essentially will urology, TN and neurosurgery experience count towards surgical experience for CST. The answer is yes. Any surgical experience will count. Um I has asked a question but now I can't do more because of the war, everything is in hold. Do you have any suggestions to do other things that can help other than attending a conference? Um, first of all, I'm sorry, you're in that situation. It's, it's very difficult at the moment. Uh, I can't imagine what you're going through. Um, so well done for trying and sorting things out, um, from, from a career perspective. Um, I think attending so things like, you know, again, all these other things that can give you points, I mean, if you've got some sort of a research project, you can be part of or you can do that's good um audit um teaching because all of these things will give you points in the self assessment score and they will give you points in your interview as well in the portfolio section. Um If you're, you know, you're, I think one should always try and make the most of the situation no matter how difficult it it might be. And obviously yours is, does seem very, very difficult. But if there's anything even voluntary activities that you can do during this war that's going, going on that. And then you mentioned that in your interview, I think if that's not going to impress the interviewers, I don't know what will. So I would strongly suggest that you try and do what you can not just because you won't apply in service in the UK, but because, you know, it's for humanity itself. But um, it would, you know, you do something like that and you mentioned it in your, in the interview in the portfolio section in your interview. I don't see why that would not help you because that's, that's a great thing to do. It's better than me. I mean, I think it's better than me helping out with a charity event in London. Like, I think what you would have would do would be more impressive. So that's what you can do. And then um self assessment wise, I mean, anything that you can help organize or if you can help organize fundraising activity or something, um or you can help gather resources, supplies for the war that will help as well. Um or things like teaching audits, all of that will, will help. I think teaching more likely because you can teach basic skill, surgical skills to, to medical medical students there. Um And that would help them and that would count as well. Um The next question I think uh we, we can get more information regarding what counts the surgical experience because I do have a one year career break. Um So websites, so the links that we will send out from the G CST oral websites will help. And then there are these other sites like Trainee portal Medi, which aren't the official sites, but they have lots of information as well that you can look and that will help answer your question. Um there's also something that I figured out yesterday. If you go to a and you look at the closed vacancies from the year ago or two years ago, the documents from that time that we used during the application process are still available to download. So you can see what happened last year. Download and see how many posts were there, where the posts were and everything. So that's something uh you guys can do. I can help you. No, that's brilliant. I think um just generally then I think we'll sort of bring things to a bit of a close there. I mean, to me, that's been actually an incredible talk really. I think, I think it's quite nice seeing all these questions coming in from a lot of, you know, very driven people from all over the globe. Actually, there's a lot of people from all over the place. So I think having that insight from in that way where you've just gone through everything to a very, very good detail and trying to pick apart something that's very complex and make it accessible for everyone I think is, you know, a very, very important and powerful thing to do. So. Thanks a lot for taking the time to go through that with us all today. It's been a very, very impressive talk. Thank you. Um So the last couple of things here, Jefferson mentioned that the, the, the conference is available there and the feedback forms if you can fill those in. That'd be brilliant for us. Um We are looking to have a few more of these talks and hopefully we'll get those links sent out to you in future as they as we organize the specific times and dates of those. So keep your eyes peeled for those. Um And yeah, if there's any any further questions, if that's all right with you, now he will put your email address out and people can give you, give you an email if that. All right. Uh Yeah, if they email you. Uh yeah, I think um if they contact you guys or the organizers, I think that um yeah, that sounds fine. So thank you. Thank you guys for attending from Sudan, from Pakistan, from India, from the UK, uh from Mexico and all over the world. I hope this session has been useful. We'll be conducting like Fraser said, sessions every 2 to 3 weeks. We'll have trainees from different specialties come around, give us a brief chat and you can ask them questions and please do attend the conference. It's a great place to network and know more people who are I MGS doing surgery in the UK. Mm I guess we'll sign off then. Thank you. Thank you. I appreciate. Bye bye bye. Thanks me doctor. Thank you. Bye bye.