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It's called like a speed wheel going. Yeah, yeah, it's buffering. Oh, there it goes. Hi everyone. Um Thank you very much for joining. We'll just give it another five minutes to let more people join and then we'll start shortly. Um If that's ok. Ok. Shall we make a start? A mir? Yeah, cool. Um Hello everyone. So I'm Julia um and I'm joined with the mirror today. Um and we're just going to present a session on the clinical station. Um So what was this is just a session outline about what we're going to cover today? So we're going to cover a brief introduction of what we've already covered in this, apply to S FP series so far. Um We're going to provide an introduction to the clinical station. Um go through a two E examination, present two scenarios um and give you some top TIPSS about how to approach the clinical um station in the interview and then there'll be plenty of time at the end for um any questions and answers that you may have. Um ok. Um So who are we basically, we're a free national initiative to support applicants um applying to the specialized foundation program. Um All of us are current S FP doctors um across the UK in various different tracks. Um And we'll just be providing informative webinars um as well as personalized um application support. Um So these are some of our upcoming events. Um So next week we've got the other half of the clinical station, so we'll be going through more scenarios there. Um And anything else that we've not covered today? Um So put that date in your diaries at 7 p.m. next week. Um ok, so, um just a bit more about ourselves. So I'm Julia. Um I'm currently on the research track in East Midlands. Um And I went to medical school in Glasgow and Hi, I'm Amira. I'm also in the research track in the Midlands. Um And I went to med school at Leeds Fabulous. Um So just a quick overview of what we've covered so far. Um So we've done a session sort of on the structure um of the interview. So you might get a clinical station. Um You'll get some places have an academic station. Um and most places for certainly for research. Um And I think all tracks will have a personal motivation sort of section um to the interview, often the interview consists of 2 to 3 clinical academic doctors. Um and it can take anywhere between 15 to 30 minutes. Um I know some of you have already had uh interview, um, notifications out already. Um and the key thing is that you book your slot early. Um So you get the time that you want. Um because I know certainly for us on placement, we never got any special time off um to have these interviews or anything or to prep for the interviews. Um So just book your slot early. Um so it can work with your timetable. Um Yeah, it's just another slide about um interview dates and making sure you book early. Ok. So we'll get on to the main focus of the session, which is the introduction to the clinical station. So basically, fundamentally, the rationale for the station is that they want you to be a clinically sound and safe fy one. And that's what the station is testing. Um The rationale behind it is obviously you have the research block or the leadership block or sort of dedicated a dedicated four month block out of program, which means that you will have less clinical experience during that time unless you have um to do on call or something with that. So, um it's good just to check what your clinical commitment will be during that four month block. Um And that's also useful to know when you've got your interview as well because if they are something about what do you see some of the challenges um during your block might be, you can say like time because you have to do on call in A&E or something whilst you've got your research block as well happening. Um Also, um just make sure it also just kind of screens to make sure that you have a good sort of baseline knowledge of um finals material and sort of like you're clinically sound. Um So demonstrate your knowledge um and make sure you're safe when you're approaching this, this um station and the scenarios that you may get given. Um So what to expect. So you might have one or more unwell patients um in a hospital of our setting. Um or it might just be a normal ward setting and they might have like an emergency buzzer scenario or you might get asked to see a patient um on the ward, the stations basically make testing your knowledge of at. So you're essentially just walking um the examiner through an at examination and it's testing your general sort of clinical knowledge. Um The station will be evolving so they'll start off with a little um clinical and yet at the start a couple of lines. Um um and then they'll ask you to assess the patient and then that's when you start your examination. Um some deaneries might have sort of distraction scenarios where you have an angry relative. Um Some deaneries might also give you some ethical um scenarios as well in there. So sort of like sees of care, um DNA CPR S things like that. Um And throughout it, they'll follow up um some of your answers with various questions throughout. Um And it can be anything from gen Med or gens that can come up. Um So how to approach the clinical s station. So basically, you need to think about your role. Um And fundamentally your role is gonna be as an fy one. So you need to have an understanding of what an fy one does in these scenarios. Um So it's no good. So you're gonna lead a crash team and you're gonna do XYZ cos in reality, that's what the, that's what um the more senior doctors do. Um So you kind of need to basically gather information, initiate basic treatment, alert someone more senior. Um And if you have multiple patients because they can give you scenarios where they have multiple patients and they're testing your prioritization skills as well. Um You need to prioritize on the basis of ABC. So airway breathing circulation. Um And anything else that might be happening. Um It's a good thing just to ask for things to be ready before you get there. So you, you might say, um I would ask the nurse to do a set of up to date um observations. If you say obs, I'm gonna emphasize this several times. Don't just say a set of obs, you need to actually specify like what observations you're asking for. So like I'd like a heart rate, I'd like a BP cuff put on, I'd like O2 sat et cetera, et cetera. And then just work through your a to in a systematic um structure. Um If you do have prioritization um involved in the scenario, it's useful to say, like make things obvious for the examiner as well. So it's like in your oy, you want to kind of make things very obvious. So it's quite good to have sort of statements like this patient is acutely unwell. So I'm going to do a systematic a to examination. Um I'm going to assess the airway and then assess the airway and then be like I found no issues. So now I'm gonna move on to breathing and then I'm going to assess breathing blah, blah. So make things obvious um because they probably are interviewing lots of you. Um and we all know about fatigue on online learning and things like that. So just make things obvious. Um if you ask for observations um or any sort of investigation, be prepared to interpret them. Um So you might get given like an E CG if you ask for an E CG um or like a blood gas um no common drug doses. So mainly just more the emergency drugs. So like the drugs that you were given anaphylaxis or in like a um a narrow complex tachycardia or something like that. Um reassess after every intervention, um escalate early treat as you go utilize all members of staff around you. So remember that as an F I one, you're not always, you're not just gonna be alone. Um seeing a patient there are gonna be like healthcare support workers on the ward. Um There'll be nurses. Um You've always got phones, emergency buzzers to get more help, et cetera. Um and just try to Sprinkle facts around um to demonstrate your sort of clinical academic. Um A so moving on to A to e so in terms of airway, so you want to go and assess the patient's airway. So if the patient can talk to you, then the airway is patent. Um look for signs of airway compromise. So um inspect um open the mouth, inspect for foreign bodies, listen for abnormal sounds, um state if you can hear a normal sounds, um What that, that might indicate what they might uh sorry, what they might indicate um in terms of intervention. If you have an airway problem, you're calling for immediate help from anesthetics. And if you can't get through to anesthetics, then um the crash team remember your basic airway maneuvers, so your head tilt, chin lift, um jaw thrust, um airway adjuncts and treat any specific cause as you go. So if it's anaphylaxis, remember your I am adrenaline moving on to breathing. So you would look less and feel you would obviously rev um review the respirate and O2 sats that you asked for do your sort of general inspection from the end of the bed, um assess tracheal position, chest expansion, um, tap and listen, in terms of investigations specifically for breathing, you're thinking about doing an ABG. Um, so in anyone acutely unwell, um if they don't have sort of a breathing problem and they're not on oxygen, you can get away with doing a VBG. But in anyone with sort of a respiratory problem or on oxygen or a new oxygen requirement or shortness of breath, you'd want to be thinking about doing an ABG realistically um and ordering a chest X ray interventions wise oxygen. Um So, and then treat the cause as well. So with asthma, you'd be giving like bronchodilators and steroids, et cetera, moving on to circulation. So, assessment wise, you're checking the heart rate, BP, fluid balance, um and CRT, you'd want to feel if the patient feels warm or cold, um feel their pulse, have a look for a JVP. So if it's raised, you're thinking about overload. Um If you can't see a raised JVP, then they might be sort of like um hypovolemic um auscultate as well. Um in terms of investigations, you want to gain access. Um So certain Cannulas too wide board if you're thinking about resuscitation, um but either way you want to get access, um at the same time, you want to take off some bloods. So always specify as well what bloods you want to take off. So you would specify like I'd want to do a full blood count. I'd want some using these LFT S, um C RP, et cetera. Um And if you've got an idea why, then you can kind of give a justification why as well at the same time. Um So if you think this patient might be bleeding, you'd want to say like, oh, I'd want to get a full blood count to look for. Um, look at the hemoglobin specifically. Um I'd also want to check like a clotting on them as well. Um And then you'd also want like like a group and save cross matching as well. Um In circulation, you might also think about catheterization. Um And in terms of intervention, you've always got fluids and fluid resuscitation and that includes blood as well like blood products. Um and again, treat the cause. So it could be something in terms of circulation, it could be something like sepsis. Um It could be acute, acute coronary syndrome, fluid overload pe hemorrhage and then moving on to disability, um assessing level of consciousness. Um So you wouldn't formally have to, I certainly don't think you would have to formally assess someone's level of consciousness in um one of in, in a clinical scenario in your S FP interview, I think, saying that you would assess their G CS is perfectly fine. Um And also you could always say like, um I would assess it via AVP as well. Um And then learn the causes of reduced consciousness as well cos that's um that could come up, um, always check people's review the drug chart in case there's any sort of medications which could be contributing to the clinical picture, um, temperature and don't always forget glucose. Um, so in terms of investigations, you'd want to do a blood glucose ketones. Um, if they've got reduced consciousness level or they've had a fall or something like that or anything, stressing a head injury, you'd want to do a CT head. Um, And then in terms of intervention, if they're hyperglycemic, correct that, um, make sure you're maintaining an airway if they've got a reduced level of consciousness. Um So you might have to reassess and go back and look at the airway, um and think about specific interventions. Um if it was like an overdose or DK A or seizures, which all could definitely come up moving on finally to exposure. So you want to do you want to fully expose the patient? Um You want to have a feel of their abdomen, um, have a feel of their calves in case they've got DVT, um and have a feel of their long bones. Um, always remember to kind of comment on if they've got any drains or catheters. Um, so the contents, um and how much is in them as well, um, and look out for sort of wounds, rashes, um, any sort of mottling and things like that. Um, in terms of investigations for exposure, the main thing you would want to be thinking about is doing cultures or swabs. Um So if you think they've got a UTI causing like sis something you'd want to do a culture of the urine, send it off your urine dip as well. Um In terms of interventions, control the bleeding and treat the infection. OK. So moving on to example scenarios. OK, guys. So, um so the first scenario that I've done is a prioritization task. Um So um I've just taken this, um I had a talk done at Leeds and um I thought it was really good sort of scenario. So, um I'll just give you like a few, maybe like a minute or two. Just to sort of like have a look through um these patients and then you can just jot down your order and if you want, you can put it in the chart. It might be, it might be good just for learning. Um I don't know if you guys can even speak on the mic here. I'm not sure. Um But we'll just try to make it a bit interactive. Um And then we'll talk through the explanation. So let's give you a minute to, and if you want to put your order in the chart, please feel free and we can talk about it and it's a safe space. So, don't worry, I think this is also very useful for when you're f one as well because certainly my first twilight, I had multiple patients that you basically have a device and all the jobs paying through being like you need to go see this patient using a nine, you need to see a patient using an eight like. And then I once had a patient come through a shivering which turned out to be um UIs and they were only using like a four. So I think this prioritization task is actually um very clinically relevant. OK? Um So if you guys have had enough time to sort of read through the scenarios, if you, you know, feel free to put your order in the chart. Um So in terms of like approaching this type of scenario, like as Julie says, it is very much like it does very much mirror clinical practice. Um Like, I've not had like a twilight on call yet, but like, I can imagine um and just sort of being in things like E au and sort of ed and stuff like that, like seeing sort of how they prioritize patients and things like that is, you know, it's quite eye opening. So I think one thing is to note that like, yeah, as Julie was saying, like some patients, I might not have been using very high, but actually their problem is probably like more of an issue than another person, that person that's using like an eight or a nine. So news is not the be all and end all, but it's a good sort of like um it's a good sort of indication of, you know, how sick a patient is. Um And it's just a good starting point. So the way in which you sort of prioritize and consider how to prioritize these patients is first and foremost, like thinking about, you know, how stable or unstable is the patient. Now, it's very difficult to sort of see that like just on paper um or just on like your, your device that you know, you're getting pinged through, but you can use certain parameters that are given to you. So you can use, for example, the new score, look at what they're actually scoring for. So are they scoring for the heart rate? Are they scoring for the BP? Um you know, looking at all the different observations and then also using your own clinical judgment about OK, like realistically like how worried am I? And that's when it, you know, you're all like fine your medics, like you've all got to this point because you are capable of being f one doctors like um so you have common sense as well. So, you know, that's what you're meant to show as well in your interview that you do have common sense that you um you know, will rationalize and actually like, think, you know, talk through your rationale with the examiner um or the interviewer. So always talk through your thought processes, don't like just sort of leave it to someone to like think about what you're actually saying. So always just sort of explain exac exactly what you're thinking. Um And again, like the easiest way to sort of categorize is through an A two E approach. So when I say that, I mean, that an A problem is always gonna supersede, well, pretty much, always gonna superseded A B problem. And A B problem is always going to be more important than AC problem, et cetera, et cetera. So like a patient with anaphylaxis, like they're gonna lose their airway very, very quickly. Um So they're more of a priority than the patient with, for example, an exacerbation of CO PD. Um So that's just how like it, that's a really a way important way of like categorizing. I remember like in my ay, I had a similar sort of prioritization task and I had to sort of explain my problem is more important than the B problem. And, you know, you got marks for that. So just being really simple and straightforward will get you points essentially. Um Also thinking about like the tasks that's been asked of you. So like, what's urgent, what's time dependent? What can wait? Um You know, can things wait, are things actually appropriate to be asked of you? Like if you're on a night? Um You know, can that things wait for, for the day team, for example, att O like, do you really need to be doing that on a night? No. Um And then sort of think before you actually speak as well in your interview. So like, um you know, just take your time, you have enough time if you need a bit more time, just let them know. Um It's better that you think take a bit, take a bit of time and actually just sort of say things coherently, um you know, and give your justification for those. Um And then sort of start off with like a step by step management. So start off with your basics for a to e like obviously explaining each step of your A to e reading through the notes in the drug chart trying to gain a bit of collateral history, maybe if you need to or history from the patient. Um and off and then, you know, speci say specifically what exactly you're going to do. Um So act like there's that examiner or the interviewer doesn't really know anything. Um And that's the best way to kind of systematically go through these types of scenarios. So I don't know if anyone wants to like put that order in, but if you just go to the next slide, OK. OK. OK. So yeah, chemo person first. Yeah. Yeah. Good. OK. So thank you. So, um so I know I just in a weird order, I'll just put the numbers. So the first patient that we, that is top priority is Claus Werner. 58 year old male has come in. He's got a background of chronic myeloid leukemia had chemo seven days ago and now he feels unwell. So, yeah. So he's using a 13. Um and he's tachycardic. He's hypotensive. He's hypoxic, he's tachypneic and he's pyrexic. So he's basically using for literally everything. Um And what's your kind of worry with this sort of patient? Would you say anyone got any ideas? Yeah. Yeah. Very good. Yeah. Neutropenic sepsis. Fantastic. So, well, not fantastic for the patient, but yes, good that you got the answer. So, yeah. So um clearly it's a high, high likelihood of neutropenic sepsis given his history and given and the fact that he's recently had chemo. OK, good. So the next priority is um Wilfred Jones, he's an 84 year old male. So he's an inpatient workup of a CS. He's been, you've been called to see him because he's got a new onset agitation and he's got breathlessness. Um So when you examine him or when you look at his news, so he's using an eight. So his heart rate is 118. So he's tachycardic. Um So his, his BP is OK. Um And his sats are 92% on 4 L. He's tachypneic, but he's not Pyrexic. So this is a bit of a weird one. You kinda need a bit more information. I have taken this as like a single prioritization task. But um the actual scenarios I've not gonna go into in a huge amount of detail. But what sort of things would you be worried about in, um, in this sort of patient? Yeah. Ok. Ok. One sudden onset of breathlessness in a patient who's got cardiac history, recent potential M I? Ok. So could be thinking it might be something like, um, pulmonary edema, um, flash pulmonary edema. Um, and that's a, um, medical emergency. So we'll talk a bit about like, sort of investigations and management, but that is like a big thing. So someone who's had like a recent Mr, so they're gonna have damage, aren't they to, um, that potentially their PPI muscles and things like that and they can easily go into pulmonary edema as well. Um, any sort of myocardial damage, um, can put you at risk of that. So that's why that's next on the list. And also given those parameters, you know, you are quite worried about. Um, so that increasing oxygen requirement, um, they respirate as well and t the tachycardic and given the fact that they've just had a myocardial event, um, you know, you kind of don't want to watch essentially. So that's why Wilford Jones is the second one on the list and then the third one is Yasmin Khan and 72 year old, 70 year old female. So you've been asked to review, she's got high potassium on today bloods. So, um, in terms of her sort of news, she's using a one. So not really anything too remarkable. Um, on her um scoring system but why, what are you worried about with the high potassium? How high is the high potassium? Yeah. Very good. Yeah, so arrhythmia. So and E CG changes very good. So, you know, always, you know, potassium is hyperkalemia or hypokalemia is one of the um forties um if you like for cardiac arrest. So, oh, so forties, 4h sorry. So it's really important to keep your eye on potassium. Um And yeah, 5.5. So yeah, it's above 5.5. That's hyperkalemia. Um So always important to look at that. Um And then the next one on the list is Robert Brown. So literally all you've got a handover is Melina. Um We will go and do a bit more into a bit more detail. But what are you worried about with someone who's come in with Melina? Yeah, that's right. Upper gi bleed. So, yeah, so yeah, we'll go through a bit of the explanation in a second. So yeah, so you can just see his parameters are ok. But um obviously he could, if he's having a bleed, he could become hypotensive. Um and he is a little bit tachy cardic country as well, so, you know, could go into shock. Uh And then Nicole is the parity more overdose. So she needs larking, she's needing a zero. So she's currently at present stable, which is why she's a little bit lower on the priority list. However, she will need um, a work up and she will need some treatment. So, um, she's still a bit more important than Agatha who's last so little Agatha, 92 year old female, she's an inpatient. She's got IV antibiotics going for a cap. Her cannula has fallen out so her news is a little bit higher actually than some of the other ones. But if you look at the task and you look at what she's in, you know, are you really overly worried about a cannula falling out? I mean, it depends if it's like a in recess then yeah, I might be a bit more worried but um, it's just, you know, it's a cannula, it could be, you have to think about other things in, in this sort of scenario as well. So moving on to the next slide, Julia, if that's all right. Right. So spoken a little bit about some of these, but, um, just in terms of like the patient. So I've just done like a brief summary of like what we would kind of just do in terms of the investigations and some of the management. Um, but as I say, this is not like completely exhaustive. So, um, in your interview, you're not gonna have like loads and loads of time, but it's just good to have like some idea of like what you would sort of initially start to do and talking through how you would manage those patients as well. Um So our first patient was class Werner's not put it in the right order, but it doesn't matter. So class Werner. So we're thinking neutropenic sepsis. So you wanna be doing a full A to e um in this patient and as Julie abusively like spoke about and you know, talking through each stuff, the A to e um you might not get time to do that in the interview but just saying, you know, I would just, and then we'll just move you on and then checking the drug chart on the notes is really key for this patient. So you are aware that he is, you know, he's a patient who's got some malignancy that they've had chemo. You need to know when they had a chemo, how many doses, how do they react to the last chemo et cetera? And so looking at that, that past history is really key um checking your ABG as well. Um So if they've got a new oxygen requirement, for example, um and, you know, looking to see if they've, you know, look at the lactate as well. So it's all, it's really important to look at, you know, the ABG, you can sometimes get away with E BG as you were saying, but I would generally just do an ABG um if, if they're hypoxic or they've got new oxygen requirement and then doing a chest X ray. So any kind of sepsis sort of work up, you know, you wanna get your chest X ray. Um And you wanna do your Buffalo approach. So your blood cultures, um urine output um and also fluids as well. Antibiotics, lactate and oxygen. So that's your kind of like standard sort of workup and then your bloods. So you're looking at obviously FBC S these clotting cultures and lactate. Um and then micro wise, you wanna be getting an MSU um culture, sputum culture and then also pair blood cultures and cultures from any lines. So, if this is a patient with chemo, have they got any lines in at the moment? Um And you know, could there be an infection going on there as well? So it's really important to do that. So that's like a comprehensive sort of workup with that patient. Um And then I think let's just have a look one second. So I'm just gonna talk through an order. So it's easier for you. OK. So the next patient was Wilfred. So we're thinking he's got pulmonary edema. So, again, with the pulmonary edema. So you do a two week. So have you guys had like pod man, I don't know if you're a pond. I don't know. Um So it's like positioning and then giving high flow oxygen um and then nitrates as well and then diuretics. So, um here, so you wanna obviously position them upright. Um Obviously having high for oxygen, 15 L of oxygen via a non rebreed mask. Um And then giving nitrates GTN or whatever um for IV as well and then also giving IV Furosemide. Um don't worry about like, if they've got like hypotension and pulmonary, that's just too beyond like what they would ask you. Um But it's important to like have that kind of initial management. Um in hand, obviously, you wanna be getting a chest X ray cause you, you wanna be looking at the classical signs of heart failure. Um uh And then also looking at your E CG as well. Um You know, this is a cardiac patient. Um Have they got any new changes on the E CG, et cetera, et cetera. And then with all of these patients, you escalate to a senior um you escalate ASAP like, but you mean like you, sometimes you're doing simulations and you think like, oh yeah, I can manage it. But in real life, I'm literally escalating like as soon as something, someone goes a little bit sick, I'm like, OK, escalate because even though I can like sort of do the management, someone needs to be aware of like what's going on. Um And you are not alone as an F one, so just bear that in mind. Um And then, so the next one is Yasmine. So she's got hyperkalemia. So her on her bloods, let's just say like her, her potassium is 5.8. So that is definitely hyperkalemia um at eight week, as I said before. Um and you wanna be giving her IV calcium gluconate. So it depends on the guidelines. Some people have different guidelines of different trust. So just always say I wanna refer to the guidelines before you do anything. Um But yeah, standard is IV calcium gluconate 10 mils to 10% and then you repeat it after 5 to 10 minutes. Um If you're not showing any improvement in the E CG for example as well, and then you wanna be giving 10 units of actrapid in 50 mils, 50% glucose also be giving Sal salbutol nebs. So why do we give calcium gluconate? Like what does that actually do? Does anyone? No, does it have any effect on the potassium at all? Ok. Yeah. Very good. So very good. And so yeah, it stabilizes the cardiac membrane. So it's not actually gonna do anything to the potassium. Ok. So with the actrapid and the Salbutol nebs, what does that actually do? Ok. Yeah. Yeah. So that's the thing that's gonna drive potassium into the cells. Um I know that's right. Um And so that's gonna help actually lower the levels if you like. Um you can also consider like potassium binders as well. Calcium resonium, things like that. Um bicarb if they're particularly a acidotic um if a patient is a renal patient or they need like renal replacement therapy. Um So it's really important to get a bit background about the patient. Um You know, were they on dialysis et cetera? Ok. So that's Yasmin. Um Obviously, if you've got any questions about these, just let, let me know um fine. OK. And then Robert, so this is the guy with the upper gi bleed, well suspected. So he's got this Melina. So you always need to get a comprehensive history about like, you know, the Melena. Um How long it's been going on for et cetera, et cetera, but tend to do acute management. You wanna do a three again um E CG get some blood. So PC sk these LFT S your clotting blood, urea, nitrogen and safe. So why would we get uh urea? What, what is it about urea? That's important. Any anywhere? Yeah. Fantastic. Yeah, that's a very good answer kinda. Um So yeah, it's like a protein meal. So essentially you're, you're gonna get uh basically a breakdown of like the red cells and things like that causing erased um Urea. Ok. So that's why it's really important to um check the urea and then you wanna do your Glasgow blotch Ford bleeding score. Um And then they need scoping. So you need O GD. Of course, you're gonna refer to gastro um and if someone's having um quite a big bleed, what, what are we thinking of doing? Any ideas? Yeah. Yeah. Very good. So activating the major hemorrhage protocol. Yeah, that's it. C cross matching. I thought to actually say cross match. But yeah. Oh I said group is over. Yeah, crossmatching. Um And the major hemorrhage protocol is really important. So um they will literally just keep giving you blood like until you tell them to stop, like they will literally keep giving you blood. Um So always important to like mention that if you know, if someone's having a bleed, that's just you can't control. Um let's say you've like tried a fluid resuscitation, it's still not worked. And a really important thing to mention is if you're not even sure if they're having a bleed or not. Um some pe some patients have actually been like, I think on my ward, like we didn't actually know what was going on, like, like why are there? So hypertensive, like we can't find any evidence of bleeding externally. We're not really sure what's going on. They actually were having like an internal bleed, but we obviously we weren't aware of that. So it's important to like, remember that if you've been given like two you 2 L of fluid and this their BP is still not rising. There's obviously something going on. Um maybe that they need blood or they might just need itu referral, which I would suspect is quite important at that point. Um So yeah, for all these patients, like, you know, be aware of like how you escalate. So you're escalating to your reg first. Um And then you may need to escalate, they all need to escalate between specialties. So you always escalate your own reg and then between specialties, if you on call is a little bit different, but still try to escalate to the med reg or surgical reg before um going to different specialties. And then thinking about like getting C ot involved like clinical um critical care outreach team, um They're really good because they can come and like assess the patient. If you think a patient's gonna fall off um very quickly, then, you know, it's good to just have them in the loop. Ok. So that's Robert and then Nicole Osborne. So um a lady with the para he more overdose. So, um you're gonna wanna get like a bit of a comprehensive psych history and a cat. Um Obviously do like your at E um BBg E CG bloods. Um And then with the bloods, you're gonna be getting a paracetamol level and salicy salicylic level. Um And then, so it depends on do, does anyone know about like sort of paracetamol overdose and like the timing and stuff like that? Does anyone if I told you that this patient took the tablets five hours ago? Um All in one go. This question actually came up in my finals about about about five. Yeah. Yeah. New one. Yeah, exactly. Yeah. So a staggered overdose is different to like, yeah, for example, four hours ago. So what you wanna do, I didn't actually put this graph on my slides but you wanna get like um do you know the normogram, the normogram where it like kind of goes like that. So it's a curve. So on the X axis, it is basically the time since they've taken like the tablets and then on the Y axis is basically the um plasma paracetamol um concentration. So you, you need their weight for this. Um and you'll basically need to know how many tablets they've taken. Um And basically you plot the concentration on the nomogram. Um So if you were to plot it at like say five hours, um and it's above the treatment line, uh the concentration, then obviously you treat them. Um and you start your N acetylcysteine. So there's this thing called a snap regime. So basically, you give like two bags of N acetylcysteine IV 1/2 hours, 1/10 hours, as I say before, like the guidelines do vary between trust and stuff. So just always refer to your guidelines. Uh your trust, you're not always expected to know like the exact doses and stuff like that, but just a good, good to know the initial sort of treatment that you'd use. Um with these patients. Of course, you're gonna need like serial VV GS. Um You'll need to be obviously doing your E CG as well. Um And to space is a really useful like tool to use. So like this basically has like it's like a database where it has like all the different types of like potential overdose overdose is in and then it just tells you like, how to sort of assess and manage um and treat those patients. Um So it's really useful when you're like on call as well. Um There was a patient with like a PHENobarbital overdose and I was like, what, what, what do I even? Um So yeah, always good to refer to that and mention that in your interview. Fine. And then finally, Agatha, so Agatha's cannula has fallen out. So the thing you want to think about is like, is it a necessary Cannula? So she does need antibiotics but maybe can they be given orally like or does she definitely need IV um when are her meds you? So if she's already had like her antibiotics in the afternoon, like kind of like wait a little bit longer. Um can anyone else as well do the cannula? So contrary to popular belief, um is not just doctors that do Cannulas like um and also sometimes nurses like they will like no disrespect to nurses, but sometimes they will like actually act like they don't do all, they will tell you that they can do Cannulas. Um So it's always good to just be like, oh, like do you actually do you do your Cannulas or like can you do a Cannula? So just, just sweet talk with the nurses a little bit. Um Is my tip cos actually you'd be surprised a lot of them can do it. Um fine. So that's I know it's quite like extensive and you probably won't get like that many patients in your interview. But it's a good like way to sort of think about how you're gonna approach like prioritization. Um and sort of the kind of common emergencies as well. Fine. So next slide, I think the only thing I would add to that is as well is like if you have given two stats, stat fluid boluses, um that's the point where you want to escalate if the BP is not coming up, especially you just have to be wary as well in patients with like C KD and heart failure that you don't overload. Um So if you are giving a stat, just remember to give half of that. So instead of giving 500 I give 250. Um but certainly if you're needing to give more than two boluses, that's what I would be escalating in terms of fluid management wise. Yeah. Yeah, definitely. Um Always good to, to be aware of heart failure and um obviously giving like your 250 mil boluses. Um But yeah. Right. So the next scenario is this is like a single patient of all scenario. So we've got a 20 year old male, um who's brought into the Ed by his friends with, he's got ABDO pain and lots of vomiting. So it's quite a vague scenario. Could really, really be anything. So first thing we wanna do is assess the airway. So, next slide. Next. Ok. So he's always patient and he's speaking full sentences. Um So, so what do we think of his breathing? Anything to a mark? Yeah, it's OK. I mean, he's a little tiny bit technique but he's other than that, his oxygen starts, they're on the lower end of normal. Um I think with oxygen and with acutely unwell patients, it's just always important to like, be aware that they can really easily deteriorate and become hypoxic. And um some sometimes like people just stick people on oxygen even if their oxygen shots are. Ok. So it really does like I II mean for me personally, if I've got this acutely unwell patient, I'm just gonna give him a bit of oxygen. It might, they might not need it for ages, but just whilst I'm doing my assessment, I'm just gonna give him a bit of oxygen. Obviously, you wanna overy a patient but for for about 1015 minutes, it's not really gonna do them any harm. Ok. Um And then obviously you wanna continue like your ABG and chest X ray, fine and then circulation. So what do you make of this? Ok. So can I put a bit of the um investigations in there as well? Thanks anyone. It hypertensive is high cardic could be sepsis. Yeah, very, very much could be sepsis. Yeah. Um yeah, so I'm worried now about this patient. So um more so than I was earlier. Um so that prolonged crap refill the tachycardic, the fact that the hypotensive. Um so I'm gonna get some IV access, gonna get some, get some bloods off the cannulae. Um And I'm also gonna get a VBG as well. So II know we said earlier that like, you know, ABG is important but yeah, VBG is really quick, easy. Um You can just do it whilst we're getting the cannulas in. Um So yeah, so someone suggested that has just suggested, could it be DK A? Um Well, let's have a look, shall we? Um ok. Um So yeah, so the PH on the ABG or the VBG um is 7.28. OK. Um And then you move on to D so you, you can add two GTs, it's fine, it's normal. Um You've checked the capillary blood glucose, it's come back as 20. You've checked the ketones, it's come back as five pupils are equal and reactive light and they're not pyrexic. So, yes, what we thinking now, I think you definitely could be definitely D ko um So, so does anyone know like the criteria for DK A or like aware of any sort of like parameters? Ok. So the general parameters, it does vary again a little bit between trusts because sometimes they notify me about ketones being raised, like to like one or something like that if it in a in certain patients. Um Generally, I'm not too worried about those patients because it could be like starvation ketosis and stuff like that. But, um, it does depend, um, where you go. But, yeah, raise blood, uh, blood glucose more than 1111 millimoles per liter or known or known diabetes. Um, if you've got ketones of more than three, or ketones more than two in the urine, more than two plus. And then if the venous ph is less than 7.3 or the venous bicarb is less than 15. Um So that's what you, when you're worried about DK A? Ok. All right. So the next, I don't know. Yeah. So you just do your full exposure. So check the abdomen, obviously, you check the long bones, um Nothing to her mark, check the urine as well. Um And then just do your VT prophylaxis. Um fine. So I just got this from the Rapid Ebook, the le Rapid Ebook, I think pretty much everyone can access this. Um And I'm not being biased but genuinely like, it's so good cos it has like all of the, like pretty much every emergency you can think of as an F one that you could come across. Um And it lays it out, like how to manage it and stuff like that, how to assess and manage. So check it out. Um Fine. So next one. So yeah, so we're thinking that this is DK now. Um So in terms of management, so the kind of three sort of hallmarks of the management. Um First of all, you wanna be getting in insulin at a fixed rate infusion. So naught 0.1 units per kg per hour. Um in patients who are known diabetics, you wanna continue their long acting insulin in all cases, ok. So stop the short short acting insulin but continue the long acting. Ok? Whilst we're giving you a fixed rate infusion if their BP is more than 90. Um again, I've taken this from the rapid Ebook. So it could vary between trusts. But generally speaking, if their BP is more than 90 then you wanna be giving them fluids, IV fluids in um the following regime. So you wanna be giving 1 L of normal saline over one hour, then over the next two hours, you want to be giving a liter of normal saline plus minus potassium. So you wanna be checking the potassium on a VBG um and then also um adding or not adding potassium depending. And then the next two hours you give me a liter plus minus potassium and then the next four hours giving a liter of normal saline. OK. So you need to continue this as needed to restore the circulating volume. Now, with DKA, people become really, really profoundly hypotensive and they do need aggressive fluid resuscitation. So, um if it's a young patient, you know, I'm not too worried about sort of fluid resuscitation. If they're a little bit elderly, maybe got a few more comorbidities, got conest cardic failure and stuff like that. Then obviously you are gonna, er, a little bit of caution, but generally speaking, you just need really aggressive fluids and insulin. Um, and then if the BP is less than 90 then you wanna give them a bolus of 500 mils. Um, again, heart failure, 250 mils of normal saline 10/10 to 15 minutes and then reassess them. Um, And then yeah, I spoke about potassium replacement before, but generally speaking, if they're very, very hypokalemic, like less than 3.5 then you wanna get a senior review 3.5 to 5.5 adding about 40 millimoles um of potassium um per liter. Um same chloride. And then if it's more than 5.5 don't need to add any more potassium. Um But you need to be checking the potassium, as I said before regularly um with serial VV GS. So you can't give potassium faster than 20 millimoles per hour. Um unless you're in like some sort of cardiac monitoring itu situation which you're probably not gonna be in. Um So just bear that in mind. And then as I said before, like hourly monitoring of vital signs, the blood glucose, the potassium, the bicarb and the ketones. And then I've just highlighted here like the targets for your treatment. So you want basically the blood glucose to four by more than three millimoles per liter per hour. Until it's less than 14. Um The K ketones need to fall by more than naught 0.5 mill per liter per hour until they're less than naught 0.6. And then the venous bicarb um needs to rise by more than three. milli millimoles per liter per hour um until it's more than 15. Um And then in terms of referrals. So as I said before, like you need to escalate to a senior like ASAP. Um and then, um I mean, depending on the situation, so your reg might escalate to C CT or you might have to um depending on your regs advice. Um And you also need to consider like itu referral as well. Um So obviously, with things like itu referral, the main reasons why you would sort of refer to itu is if they're failing to respond to medical management, um if they're requiring ventilator support. So if they're losing their airway, um um and also if you just can't really just maintain their SATS, you know, they might need further interventions um if they're needing BP support. So things like, you know, vasopressors and things like that, um You're gonna need that in itu and then looking at their blood glasses. So that's why it's important to always recheck their blood glasses because they could deteriorate and then if they do and if they become profoundly acidotic, then they're gonna need itu. Um So, yeah, and then in terms of like So afterwards. So, um, you, obviously if they're a new patient, a new diabetic, they're going to need like a diabetic team referral for sub insulin. They're gonna need outpatient follow up with the diabetic team. Obviously, if it's a normal, well, not normal but a, a diabetic that's known. Um, and we still need to kind of like reassess the insulin regime, um, just sort of giving you some more counseling about, um, sick day rules and things like that. So, um it's just important to always add that on to the end. Um But that's like quite, I mean, a lot of you will know about DK A, it's kind of a standard exam sort of scenario. Um But it, in this kind of story, I hope it kind of hammers home to you, like just sort of getting the basics done first. Um And then sort of adding to the end cos you can get a lot done just by doing that. So, yeah, spoken for literally ages. But um it's just saying like, oh, because quite often with these emergencies, you will have hospital protocols to refer to. So you can say refer to the DK A protocol um as well. And quite often they're sort of like just sheets lying around the W the ward or like there's posters in the ward with it on that you can always refer to as well. Um I know for DK as well, there's like a protocol that you can like print out, put in the notes and just tick as you go along about what you've done in hyperkalemia as well. Um So that's quite a nice way as well just to show what you've been doing that. Ok. So that was everything we kind of wanted to cover today. So these were our sort of top tips um um for the clinical scenario. So definitely revise sort of emergency clinical scenarios alongside your finals revision, start early. Um Don't leave it to the last minute. Um When you're actually in the interview pause, like you do have time, um don't be afraid of kind of pausing composing yourself like you do in ays um stick to your at E structure and remember to escalate to a senior early. So as Amir was saying about escalating along your ch sort of like um chain of escalation. So you're initially your sho that you're working with and then um if you can't get a hold of them, sort of your, your own registrar, um med or surgical reg and then to other specialities um utilize all members of your team. So remember you're not alone. So the sho the reg remember there's a hospital out out of hours team as well that can give you support and help. Um There's also in this hospital that we're both working at, there's an emergency support sort of um team that can do bloods, they can do um Cannulas and they can also do EC GS out of hours and they're there all at night. Um So it's quite useful if someone's needing like a vine level done at a specific time and you're running to see like a patient who's unwell or you're stuck with a patient who's unwell. Um, or you've got other sort of jobs to do and you're not gonna be able to do that bank level at that time. Just to remember, there are other people around that can support with that. Um And remember you are only an F one. So you're only expected to kind of assess the patient start basic management and make sure you get help um and make sure you let your seniors um make sure your seniors are aware if um you've got unwell patients and things like that at handover um or just generally make them aware. Um If you have multi patients prioritize your CCU sickest patient first and remember to justify your choice and be specific about any observations um that you want to do. Um there will be follow up questions. So I remember I got asked, I said I would do um do some use and these and then they asked me what specifically I was looking for on my use and knees. Um And in that case, it was actually a leading question towards saying, oh, I would check like a sodium and a potassium and then they went, so the potassium came back at this and it turned out the patient was hyperaemic. Um So these are some common scenarios that you can get. It's not an exhaustive list. Um going through the Oxford handbook. The emergency section is also really good um resource as well for common um emergencies and clinical scenarios that can come up and sort of treatment as well. Um But it's also really good finals revision. Um So in terms of surgical, um I put off on here because although it doesn't seem like an emergency, this actually came up as um one of my interview scenarios about off. Um And then it was an evolving scenario where the patient had come in to a surge ward. They had an off, you were asked to see them. Um I did an A to E asked for some obs and, and it turned out they had query sepsis. Um So I started sepsis six. And then it also turned out that they were hyperkalemic. Um And I got asked to kind of um interpret um an E CG and start management as well. Um And then these are some other sort of scenarios that can come up. Um These are some useful resources um that we thought of and sort of just general finals remission is also really good and this is what we've covered today. So we've covered a sort of going through a systematic a to e approach to all clinical scenarios, how to approach prioritization tasks. So if you've got multiple patients, remember sticking to like airway breathing circulation first. Um And then disability. Um We've gone through um some common emergency scenarios. Um And we've also provided a list of things that could come up. Um And remember to sort of gone through sort of justifying your answers in these clinical scenarios. So we've spoken a lot just now between us. Um So we're gonna open the floor to um all of you. So please fire away with any questions that you've got. Um you can either unmute yourselves and ask them or just put them in the chat. Um And it doesn't just have to be about clinical scenarios. It can be generally about the interview as well. Um If you've got any sort of questions, um in terms of interviews, I had an interview for Scotland and East Midlands. Um Amira. Yeah, I just, I just um applied to East Midlands. So, but yeah, if you've got any questions just generally more than happy to answer Julie, do you want to answer that? I don't, I don't have a clinical scenario. So um so I never got to see the screen. Um I just got read the scenario um to me and they basically just said, oh, you're an fo one on the General surgical ward. This patient's been admitted with A N A off and neck, a feur fracture. Um They're in pain, please go and assess them. It was as simple as that, nothing else. Um But I think maybe in other places you might get given um a little sort of like, like you do in the osk a couple of lines to read and then you get some thinking time and then they will ask you questions about it. Feel free just to ask any questions about fr one as well or the application process about what happens next after interview or anything like that as well. It doesn't just have to be about clinical. Yeah. So, so n is asking using breathing as example. Yeah. Would you check respirate oxygen starts chest X ray ABG, then wait for the interview to tell you what the patient is like or Yeah. So I would just say like um normally they normally they'll like sort of like like but in and look sort of tell you like, OK, they this, this and this, but they might be a bit mean and just be like, what do you want to assess some breathing or, and then wait for you. Um They will only tell you like what you ask as well. So like, so I think just take like take your time but, but I think, yeah, do ask the comprehensive list. Um That's a good question though. Cos I don't know Julie, what was it like for you? Did they kind of but in or did they just sort of wait for you to ask all the um So I said like, oh, I check a respirate and they'd be like the respirate is 22. Um, oh, I check oxygen sets, oxygen sets 92% on there. So they do just tell you straight away, like as soon as you ask for something. Yeah. Um, and then obviously depending on the results you would then decide what to do, um, and justify, always justify like why you would do something as well. Cos it might not necessarily be wrong. It's just like if you justify, then you're showing extra knowledge and um you're also giving a reason as to why you're performing that investigation because certainly in real life, when you're in F I one, when you're requesting scans or you're requesting, I think you do have to justify them. Yeah. Yeah. Even if you don't see why you're doing it, you have to, you have to sort of sell it. Um So yeah, so then Hamsa is asking for the academic part, is it just an abstract? Like how does that work for East Midlands? How much would you recommend? So we, we both have the same co we had East Midlands. So like they give you well, for us, they gave us like a paper and then I think we had like, I think one or one or I can't remember if it was it one or two days to prepare in one day. Yeah, we don't have very long. Um And then you basically just have to like, go through your, like kind of critical appraisal check that I don't know if you've been to our previous um um session, then you should be an expert and I'm joking. Um But like, it's always good to, to look at your critical, say, like things like um structure of like critical appraisal. Um and then looking at sort of like things that are bias and stuff like that. So going, we basically had like a day to do that. Um, and to be honest, that sounds actually quite nice cos I was just thinking about London apparently that they only have like, half an hour or something and then you kind of looking people or whatever. So, I think that's horrible. But, um, no, if you're going, don't worry about it. But, um, so, yeah, and you do have the paper in the thing, you can't really have many notes and you can have like a, a few notes but you have to hold it up to the camera. Yeah, basically. Yeah. Yeah, it's like a hostage situation. Ok. Um, so, yeah. Um, but it, it, it, to be honest, it's actually ok, like I got really grilled in mine. I really didn't think I would get. Oh, really? I really got, I didn't know I was like, what? And I mean, I think in terms of prep, like, sort of just, I would say look through some abstracts before, like, and try to, like, have a go at critically appraising those and sort of doing it like, verbally as well, like if you've got a colleague or, you know, someone who's also doing an interview, like, try and sort of practice with each other asking each other questions um about the abstract and things like that. I think that's really good. Um Getting us to like summarize um the information because you don't have very long in the interview as well. So they wanna see that, you know, your stuff. Um But you don't need, I've, I don't think you need like tons and tons and tons of prep like I think as long as you kind of use your brain and like common sense. Um and also looking at like things like diagrams, they ask about diagrams a lot and like graphs and stuff like that. Um So just sort of be aware of like the different types that you can get and it's very, very much like, say what you see. Um Yeah, so you want to that Julia, I was just thinking back because I remember when I read the instructions in the email, I was unsure whether they were going to ask me questions or I was meant to present it. Yeah. Yeah. And I remember thinking like, oh I, because I wrote out my notes as if I was presenting the paper being like the population. Is this? The intervention is this? And it actually they were asking us questions about the paper. Um Questions that they do ask are pretty broad at the start. So they ask quite a lot of open questions like, what would you say some of the strength of the paper are? What are some of the weaknesses? Do you think there's like a high risk of bias in this paper? Why justify what does this graph show um things like that? And then they ask you more specific questions related to the paper? Sometimes about stats, sometimes just about like hierarchy of evidence. Um Yeah, things like that. Um I would say um to me personally, I actually didn't have much um experience of critically appraising things and I was really scared about this. Um But what I did was basically, so there's a website called the Bottom Line which has like a it's, I think it's more intensive care but um they basically critically review like a lot of papers um and then write the critical review about it and then basically the critical appraisal, sorry about it. And then basically what I would do is like take the title of the paper, look up the original paper, try and critically appraise it myself and then um see how my critical appraisal fared against theirs basically and what points I missed out and things like that. And I found that quite helpful. Um But yeah, they ask you questions. That's really useful tip. Yeah, if you uh what was that called again? Julie. Is it the bottom line? Bottom line? Yeah, I mentioned it in like the one of the previous webinars that we did. Yeah. Yeah. No, I think definitely like seeing how other people, other academics actually critically appraise. Um Yeah, is a really useful tool. Um Cool. So please can you explain all the things you have to do for foundation like reflections? Oh my God guys, you really are, you're really giving me PT S not PT S like I'm getting the trauma right now. Um the E portfolio. How do you pass the year? So how do we even start with that? Like not like where, you know, you think medicine is over, you think all these things are over and they're not, they're really not over at the end of your F I one, you have to pass something called the A RCP. Um And um that is based on your E portfolio. Um So your E portfolio is basically it, some of it you'll have done during medical school. So they ask you for things like mini KS and CBD s which all fall fall under the title of supervised learning events. Um And essentially, yeah, that's what they are. You discuss a case with a senior. Um and then you can class it as a CBD. Um You do like um a senior watches, you examine a patient and that can count as a mini text. Um You also have a personal learning log where you have to achieve 60 hours of teaching and that's split into basically non core and core. So non core can be any sort of e-learning or any sort of informal learning or teaching that you've been to. So like, for example, hospital grand rounds, sort of like online events in the evening, run by Royal College or like um a research course or something like that can all count. And then your core teaching is basically your mandatory F I one teaching that you have to go to each week. Um And that's run by the hospital and it's basically there's a set curriculum that they align it to. Um and you have sessions on that every week and that's protected time. Um You also have to do things called dot S which also fall under supervised learning events um where it's basically more procedural skills. So at med school, you might have things called caps um logs where you have to kind of be seen to doing a um a cap glucose sort of like taking bloods or venipuncture or whatever or cannulation or a catheter. Um That's essentially what a dos is. Um at our stage, they've introduced these new things called learn and leader and DCT forms um for us. So learn is like any sort of learning encounter and reflection note and you only have to do one of them. You also have to do like a leader form where you've kind of shown leadership in the workplace. Um You only have to do one of them as well and then you also only have to do like one sort of DCT, which is called developing the clinical teacher where you've taken a sort of formal teaching session and received feedback from your peers about it. Um And a reg or like a more senior person has to sign that off as well. Um In terms of I should have said about in terms of mini cases and case based discussions, um you have to have a set number. So in our hospital, just at the moment, you have to have two mini texts and two case based discussions, each rotation um and a minimum of three dots. Um For each rotation, you also have to pass the P SA obviously by the end of F I one, you have to do things called TABS which are essentially multisource feedback. So you basically have to get 10 people to give you feedback from different sort of. Um It's basically like MDT feedback. So you need to have at least two consultants, give you feedback. Um At least one doctor who's more senior than F two, give you feedback. Uh two band five nurses or above two sort of allied health professionals, et cetera, et cetera. Um And you have to have one to pass a RCP, but some hospital trusts introduce various sort of rules. So our hospital trust requires you to have done two. Um, that's also similar to a PSG. So in a tab, you get to kind of choose who you send out your feedback to your feedback forms to and they just get an email and they'll fill it in with a PSG. That's something your educational supervisor sends out and it's essentially like a tab, but they choose the people and you'll need to, I think you do one of them. You might have to do two. I can't actually remember. Yeah. And then everyone has to do a quality improvement project at some point. So um engagement with audit um activities, essentially, you have to do a minimum of two reflections um per rotation. So they can be on anything basically about like how you manage a patient. Or um if something went wrong, like you prescribed something wrong, um you'd reflect on that um or just also just like your successes as an F I one as well. Um Make quite good reflections. Um And then there's other things like you have to do a PDP for each rotation. So you have to kind of do that before you meet with your educational supervisor and kind of say what you want to get out of that rotation, how you're going to achieve it and over what time frame. Um And then for each rotation, you have to have a meeting with your educational supervisor and your clinical um supervisor as well. And then at the end of the year your educational supervisor will sign you off. Um, you complete something called a form. I don't actually know what that is. I think it's something to do with absences or something like that. Um And then you also have to kind of map all these activities to the foundation curriculum as well as you go along. Um, and they kind of fall under the different sort of learning outcomes that the UK FP O want you to have achieved basically by the end of F one. Um And then there's other things like um you can do taste days and log a taster week as well on your portfolio and that can be kind of mapped to the um Ilo about career development. Um Yeah, I think, I think, I think that's all the portfolio stuff. Yeah, I, I've been learning stuff myself through this so great. It sounds awful. Yeah. Yeah. Yeah, you've got all that look forward to. So, um yeah, you think med school is over? You think all these like sign offs and things there? They're not, they're never over, they're never over. You never, you never have an affecting. So, um so OK, so the recordings I think should hopefully get them released, the recordings of the last two sessions. Is there a comprehension, ethical scenarios we may be presented with during our interviews. Um I think the main sort of things that we car up in your oy are good to look over a mirror. So like maybe DNA CPR ceilings of capacity, capacity. Um like, so these things like you think are like, do I just have to learn from us? You like, genuinely, they ha they happen like all the time um break, like you might not get a breaking bad news. You may, you may but it's unlikely it's less likely cos it's quite a, it's very deep. Um and it might be like sort of managing sort of complaints and things like that. That's, that's a good one. So, like, I think you've mentioned that you do like angry relatives. So, um and so hand how you handle those situations. Um But yeah, generally things like that g competence and um yeah, so the, the main thing is like recognizing like what are the ethical principles of like medicine? Um and like being a doctor and applying those to any scenario you get given. So you might not be 100 familiar with like those scenarios, but you'll be familiar, I hope with the ethical principles underlying medicine to be able uh enough to be able to be like, ok, well, you know, do no harm, um you know, benefits and things like that and autonomy and justice. So like, you know, being able to like pepper those into your answers and your justification is the main sort of like a they want to see that you are, you are ethical that you're just not just some you know, some random person that they've just randomly like decide to come into you. So, um as long as you're sensible, as long as you show your ethical um justification will be fine. Um Also sort of like the four pillars in it as well, I think is important to approaching an ethical stone. Cool. Does anyone have any more questions before we wrap things up? Am I, do you have anything to add? No, not really. I just think like, you know, you guys, I mean, sure you've sort of attended your previous sessions but if you haven't um might be worth looking over the recording. So I'll try and see, I think Alan should like upload those with like, um hopefully soon. Um But yeah, it's just about kind of like they're not, you know, they're not expecting anything more of you uh than what you already can do. Do you know what I mean? As in, as a, as an, as a poten like potential seem to be f one doctor like they just want to see that you are sensible that you are safe. Um And that you consider like the complexity of healthcare um as an doctor. So, um I wouldn't get too overwhelmed with like the nitty gritty of like at es and stuff like that in terms of like the specifics of management, I think just like just have you have the basics pinned down, that's the main thing. Um And to be honest, like a lot of these things that you should really know if you're revising for finals, like, you should really have. So it shouldn't be an extra sort of learning thing. Um, yeah. Well, there was one last question that came through just briefly. So, do you think after receiving it into the office we should use that week to intensively prep because it's been difficult to do long term prep with final year. Yeah, to be honest is the long and short of it. Like I remember. So my finals were in January. Um I had like a research project that was going on until like early November. Then I had my interview like mid November. So I was like resting so much because I was like, oh my God, when am I gonna revise the final slit? Genuinely? Like just take it one step at a time when you get your interview, like at the end of the day, like that interview is gonna be over sooner, more than you know, sooner, you know, do you know what I mean? So the time goes so fast, so quickly. Yeah. So I'd recommend just like just use that time. It's not gonna be a waste of your time, I think just, just spend that time intensity grabbing. You don't need that long to be honest with you. Um And like your finals are definitely a priority because at the end of the day, like if you don't pass medical school, then you don't have to, like, not trying to be. Well, like I didn't do any specific revision for it at all. I was like, basing it off my finals knowledge. Um I mostly did prep for like the sort of critical appraisal stuff because I just wasn't confident with it. Um The sort of personal motivation questions, reading like these questions again, like that was where most of my prep time went essentially. Um And also when like the paper did come out, obviously doing a really good critical appraisal of that paper and knowing it inside and out, um was helpful, but certainly before that, I was kind of just keeping things ticking over, like reading sort of a possible clinical scenario like a day. He kind of, um but it all fed into finals. Um but it is a busy time and like I would say, definitely, um look after yourself because it is a really stressful and emotional time, like applying to S FP. I don't think I realized like sort of the emotional burden it would take on me as well. Cos it's just a roller coaster of emotions, like you're anxious towards the interview, have the interview and if it doesn't go well, you're kind of like, oh no, it's the end of the world, but actually, it's not the end of the world. Like I just want to say like, although we did secure P post obviously, like it is not the end of the world. Like I know a lot of successful doctors that never did an academic track. Um And like if it doesn't go well, don't be too disappointed cos it, it's all useful experience and especially like for when you apply to I MT there will be some um doctors that haven't had an interview since the start of medical school. Um So when you do apply to I MT and you have to interview like these interviews will stand you in good stead. Um So, yeah, yeah, perfect. I think we're just about time. So I think we'll wrap up for now, but thank you all so much for attending. Um Our next event will be again on the sort of clinical station. Um and we'll probably cover more scenarios in that event um, next week. Um Please fill out our feedback form, um and you'll receive your certificate of attendance um and access to all the catch up content as well. Um But yeah, I think both of us would just like to thank you for coming tonight and good luck with um, your prep. Thank you guys.