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OK, so I'm not gonna force you, but that's right. Mhm I'll be going now. Ok. Ok. Hello, good evening everyone. Thank you for attending part two of our S FP interview series yesterday, once he covered the clinical station specifically for lunch interview and today I'll be covering the academic station. So yeah, my name is Maria. I'm an F one doctor. I'm an academic foundation doctor under the Surgical Innovation Program at Imperial College London. Um I was very fortunate to have scored quite highly and also achieved my top choice and also my top order of rotations. So hopefully I can offer some sort of wisdom into this process. Ok. So before we start something, I would recommend that all of you do is make sure you have a look at the S FP handbook for the London interviews. They do actually have released the interview feedback form. So this is the exact score sheet that your interviews are going to be looking at. When they assess you in your interview, they released this last year in my interview year. And I think it's really, really invaluable and not make sure you don't go into your interview without having a look at this and also analyzing it personally today, I'll be focusing on the academic interview score sheet. So we'll be going through all of these five components and making sure that we go through um how to go through them. Yeah, someone's mentioned that it is blurry. Unfortunately, this was just how it was in the handbook. There was no way to optimize the image, but I will drop the link to the handbook later. OK. So the first question that you'll be asking in your interview is why do you want to do the S FP? So you'll have two minutes to answer this question. And essentially they're assessing you on two levels. Firstly, is your ability to demonstrate an understanding of yourself. So demonstrating your motivation, your interest, your career goals, just really showing off your abilities and your skills. And the second layer to answering this question is demonstrating your understanding of the SS FP and how this will support your long term career goals of an academic career. So you need to understand that you actually know what the A FP is, what it offers and how this supports and varies really well with your interests. Um Something I would say regarding speaking about yourself, a mistake that I made in my interview prep and a lot of my supervisors did say this when I was interviewing is don't be shy to speak about yourself. Um because if you don't bring it up, there's no way that they're going to know. And if you don't speak about yourself, nobody else is going to speak about you in your interview. So my top tips for answering this part um of the interview is be specific and show don't just tell and what I mean by this is don't just say I'm really passionate about research. I really enjoy research. I really like research, blah, blah, blah, blah, blah. I think any candidate can say that what's really important is to be specific and show your um show your skills. There is an opportunity to show off your skills, show off your wonderful experiences. Um So don't just say that you're interested in research, show that you're interested in research through your extensive experiences, um the knowledge that you have. And another thing, another thing that I did in the lead up um to my interview prep is I'd written down my answer. Exactly. I'd recited it. I would like regurgitate it in interview prep and someone gave me feedback if it sounded too rehearsed and it sounded really genuine. So what I would advise doing is instead of writing out exactly, just write a couple of bullet points that you know, you want to cover and then just speak organically. Um When they do ask you this question in your interview, someone ask is this question um 10 minutes of no. So you have about two minutes to answer this question in your interview. Ok. So you've answered the personal question. Now, we're going to move on to how to critically appraise an abstract. So I appreciate that this is a very, very broad topic and it's difficult to teach the entirety of critical appraisal in about 15, 20 minutes. But what I will be doing is I'll be touching on the basis. I'll be saying some tips and tricks that help me personally. And I'll also be having a couple of cheat sheets that you can screenshot or go over in your own time in the recording that can help you prepare for your interview and also how to critically appraise things. So I'm not going to have time to go through every single definition and everything that is mentioned on the slides. But my best advice is is if there are anything that you don't understand, you don't understand the terminology, I would go over it in your own time. Um And make sure that you learn them because all of these things could potentially come up in your interview. All right. So stage one of critically appraising an abstract is picking an abstract. So for the London interviews, the majority will be New England Journal of Medicine RCT S. Um But I also advise using other journals, high impact journals such as the B MJ, the Lancet and Jama. I wouldn't advise to purely, purely look at RCT S even though that's the majority of the interviews, I would also recommend specifically looking at cohort studies for other research such as case control, um meta analyses, systematic reviews and things like that. A couple of things I did towards the end of my interview prep right before my interview is actually critically appraising some poor quality research from lower impact journals. So this exercise was actually instrumentally useful in the sense that you can read an abstract and say this is poor quality research. But by systematically and critically appraising it, you can actually answer why is this poor quality research? Where are the faults in it? What would I have done differently if I were the scientists or the researchers conducting this research? So I wouldn't just recommend sticking to high impact journals. Just do a couple of low impact research papers. Um throw them in the mix. OK. So you've picked your abstract, you have your abstract and you've read it. And in the interview asks you, can you please summarize the abstract that you've just read? So something that I did when I was writing down on the piece of paper right before um my interview is I wrote down the summary sentence that I was going to say at the beginning of my critic appraisal. That's not for everyone. This is just an exercise I did as I appreciate that. This is your first interview since medical school. So probably in 56 years, you're a little bit nervous and for me personally, um yeah, and for me personally, just writing down the first sentence I was going to say really helped calm down my nerves and to really get into the swing of things. And then the PO framework which I'm sure most people have heard of. And you'll be quite familiar with, I'd say almost everyone I've done prep with use this framework for summarizing the research. So you summarize the population, the intervention used in the research, the control the outcome, key findings. And also I've mentioned putting into context in brackets. So I'll go over the P I aspect um the outcomes we'll discuss in the next slide. And also key findings. A point to remember is not to just regurgitate statistics straight from the abstract. They know you can read, there's no point in simply reading off from the abstract. What they want to see is your ability to interpret research, interpret statistics and understand the stats that you have read in the paper. So it's important not just just regurgitate it but to also understand and interpret the data. And I'm putting into context into brackets because you can either include this your po aspect of your presentation or you can include it in the external validity part, which I'll go over later. And this is also a really, really important part of putting into context because this is explicitly stated on the mark scheme of your ability to read an abstract and put it into a greater clinical context of why is this research important? Ok. So what does it mean to put research into context essentially? Just ask yourself why is this research important? What is the clinical disease burden for this disease? What is the treatment cost? Is the current treatment very, very expensive? And the proposed treatment is significantly less expensive? Can this offer a treatment that is applicable to both high and low income countries? And what is the target population? Is it a very niche target? Or is it actually a very wide target population such as antihypertensives or um antidiabetic management? And regarding outcomes, there are multiple different types of outcomes that you will encounter when interpreting abstracts. The two I'd like to focus on currently here um is surrogate outcomes. So it's essentially markers are substituted for a clinical outcome. And an example can be using ejection fraction as a marker for heart failure. Um And composite outcomes are a combination of different variables and we'll discuss composite outcomes later because they are mentioned in some of the mock interview abstracts that we will be discussing. OK. So you've summarized your abstract now, you need to actually get into the depth of critically appraising it. So first you look at the internal validity of the paper and internal validity is essentially looking at what extent does the study measure what it really is out to measure? Does it measure what it say it's gonna measure? And this is a framework that I use to particularly praise internal validity as you'll see with the candidates in the mock interviews. Everyone has different structures and frameworks. This is just one that personally worked for me. It may not work for you and it may not work for everyone. Um But this is just personally what I used. OK. So the first part of the critical appraisal, I personally, I looked at the study design. So what was the study design? Was it an RCT? Um These tend to be the highest level of evidence um on the pyramid, right, under meta analysis and systematic reviews. So this was the gold standard for establishing treatment and effect. Here. I've mentioned a number of different types of RC TSI would recommend just having a brief understanding of what they mean and understanding abstracts which may use these different study types. And then within these different types of RCT S, was it superiority and equivalence or noninferiority trial regarding other study designs? I would really recommend again, like I said, looking at some cohort studies, um we do have an example, an example, cohort study interview as well, some case control and a systematic review and meta analyses. The last two are far less likely to come up, but the top two are more likely to come up in your interviews. OK. So on study design, now we're going to assess the internal validity regarding the population. So what we're asking here essentially is is the sample assessed in this research? Is it reflective of the true population which we've drawn these conclusions from the research to. So things we'd look at is we look at the sample size and something you would say is I've noted that the sample size is X number of patients. I'd also like to review the rest of the paper to assess if they conducted a power calculation. Excuse me, you'd also want to look at the inclusion and exclusion criteria that they use for the population. And if they had quite an extensive exclusion criteria, it may result in a diagnostic purity bias, which essentially is where the sample population was not representative of the general population. Other things to consider are confounder. So what other confounder that weren't mentioned in the inclusion exclusion criteria that were not that we do need to consider? So common confounder could be age gender stage of morbidity or mortality of the disease. Um Smoking status is also a common confounder that may not always be mentioned in inclusion and exclusion criteria. OK. So now for the next part of assessing the internal validity, so I use this um little mnemonic Ramco don't, I don't even know what it means, but it just helped me remember. So first you look at how are participants randomized into the different arms of the trial or into the different arms of the um analysis? How are they allocated and then how do they measure? So how do they measure the outcome. Was there detection bias perhaps due to different ways of measuring the outcome, what was the follow up? So there's always something that you can mention regarding a follow up. For example, if the outcome that you're looking at is for example, cardiovascular disease, or you're looking at incidences of myocardial infarction for cardiovascular conditions. A follow up of about a year and a half to two years that is nowhere near enough. So generally, what you can always comment on is the follow up period in some trials. And did they use patient reported outcome measures? So this is something that I made sure that I did try to bring up. So if they, if they did use proms in the research, you can say it's an objective measure, it's self reported. Um it may not be as accurate. And then if they only had objective clinical outcomes that they use, they didn't use proms, you could even mention I would like to review or suggest that the research did actually use proms in their research as it would be good to assess the patient experience of this intervention. Then you want to look at blinding. Um a point to remember is for example, you may not always need blinding from um the observers. If you have a hard clinical endpoint such as death, that's an objective endpoint. Um But blinding generally eliminates performance and observer bias. So you'd want to look next at the outcomes. So was the trial registered with the outcomes registered a priori, which essentially means prior to conducting the trial and the research, they prepublish the outcomes that they will be assessing. So they can't adjust it according to the data. Um Yep. So the duration that they used to measure these outcomes and again, the endpoints that we mentioned, were they composite, were they surrogate, were they hard clinical endpoints? And then regarding participant selection, was there a risk of diagnostic purity bias or for example, Na's bias? So nas bias essentially is I'll give you an example. So it's in conditions which tend to have quite a rapid deterioration. So if you're doing a trial for pancreatic pancreatic cancer, the patients do unfortunately tend to deteriorate very quickly. So patients who are fit enough in the trial and they are able to live long enough to complete the trial. It does mean that they are genuinely healthier than the population that we are investigating. OK. And the final part of assessing internal validity is looking to assess if they did an intention to treat or per protocol analysis. So intention to treat is essentially this preserves randomization. So participants remained in their randomized groups throughout whether they stopped the trial or didn't continue with the intervention, they did remain in the analysis or per protocol where they only analyzed participants who completed the trial. So the benefit of per protocol is you can help, it helps you establish more of a cause and effect relationship and this is more beneficial in earlier stage trials. Whereas intention to treat is more realistic to how it will be as an intervention in the real clinical world. As not everyone is compliant to their medication, not everyone completes every course that you prescribe for every intervention that you give your patients. Other things that can be mentioned under the results and analysis section. When describing to validity, you'd also want to ask, you'd want to ask if they did a number needed to treat or a number needed to harm analysis. So an example of a number needed to treat would be so if it was 30 which means 30 patients will need to be treated with this intervention in order to see the desired outcome in one patient. Other things, if one of the outcomes is death, you'd want to assess if they did a survival analysis or cat plan might occurs, here are some key definitions. I would recommend understanding and going over in your own time. OK. So we've done PCO we've looked at internal validity. Now we're going to look at external validity. So these are the things that I looked at when describing external validity. So one you look at the clinical disease. So again, you can either put it into context after your po or you can pop it in here, but it's really important to make sure that you do discuss this. Um So you can do cost benefit analysis. Um What's the relevance, clinical importance um of the intervention that you're looking at and the next you would look at the population. So just a general sweeping rule, I know it kind of goes without saying, but you cannot generalize or apply your results to any participants mentioned in the exclusion criteria. Um You'd also want to think about implementation into lower socioeconomic countries and something to also remember is um potentially mentioning membership bias. So patients who do enroll in trials sometimes tend to be healthier than the general population um that you are looking at and then intervention, you'd want to look at practicality, resource burden, um number needed to treat, number needed to harm again as well. OK. And finally, ethics. Um This is a part that I did really neglect in my interview preparation. And then when I looked at the ma scheme, I was like, oh wow, there is a whole section in the ma scheme dedicated to understanding research ethics. So it's really important that you do have a good understanding um in your preparations. So as always, it literally brings me back to med school interview days. You need to link it back to the four pillars of medical ethics. Nothing has changed since we were like 16 17. It's really, really important to make sure that you mention these four pillars. So I kind of use mnemonic ce sf just worked for me, see for consent or autonomy. So a thing to remember is if you randomized participants and they were blinded, they were not able to consent into which group that they were randomized into. And this kind of does um impact patient uh participant autonomy, which is a point to mention equipoise. So clinical equipoise is, is essentially means that you have a state of genuine clinical uncertainty regarding which intervention is um superior or inferior. So for example, if you want to do an RCT, comparing DKA in diabetic patients and comparing insulin as an intervention compared to a placebo, this is hugely unethical as a very strong um clinical data suggest that the placebo will in fact be harmful to the patient and the insulin is the gold standard of management. So that's essentially um clinical equipoise. Like, do we have enough data to suggest that we actually don't know what is the right intervention for this and then you'd look at safety outcomes placebos. So this will link on to justice um the justice aspect of the four pillars of medical ethics. So back to equipoise, you'll be looking at justice and beneficence for safety outcomes. Um Yeah, so we'll be looking at non maleficent. So did they do an interim analysis throughout the trial to assess safety outcomes and whether or not the trial had to be halted midway. Um And f so you'll be looking at funding and registration. This is something that you should be mentioning in your critical appraisal without a doubt. So funding registration um with outcomes published a priori, you'd like to review the protocol as well to see if they changed. Um if they changed the outcomes throughout, did they have ethical approval? They always will have ethical approval, especially if it's published. And also you'd want to look at the funders. So for example, if you have astrazeneca or Eli Lilly as a funder of the research, the things you'd want to ask is I'd want to review and assess the influence that this pharmaceutical company had on the design of the study, data handling, data analysis and implementation of the trial. Compared to a funder such as cancer research, it is a far more impartial funding body that you would want to consider. OK. So for me, this was the hardest part of my interview prep. I didn't know where to start and I had no idea what it's supposed to look like. So here, this is just an example of me personally, again, just to reiterate this is what works for me. So this is what my plain piece of a four paper looked like in my interview. Um as I was preparing right before they were about to upload the abstract and you were about to appraise it. So this is the structure that I used. This is what it looked like. Again, it worked for me, it may not work for you. Um But it just gives you an idea as when I was in your stage this time last year, I had absolutely no idea what it should look like or where I should start and then just some top tips um for kind of approaching your interview prep and how to start and all of that. So top tip is practice, practice, practice. Um That's my best advice, practice with your peers. I would recommend having a minimum of two mock interviews with a successful applicant. And for me, that's when I kind of accidentally grew in my skills. And my understanding is when I had more senior assessment of my interview skills. Um So what it looked like for me practicing in the lead up to my interview, I personally, I spent about, I'd say 6 to 8 weeks preparing prior to the interview. This is just this timeline that me and my friends were going by. It worked for me. Um And it worked for us. Um I know multiple candidates who started prepping a couple of weeks before a month before. Um And they were all successful as well. So it just depends on you. Uh So we kind of started in eight weeks before we started doing prep probably about once a week. Um And then I'd say in about 2 to 3 weeks prior to our interviews, we started increasing it to about 2 to 3 times a week doing mock interviews. And then two weeks before my interview, what me and my friends did is every single day we critically appraised a paper. We set a timer for 10 minutes. We can do this together. Um We set a timer for 10 minutes. Um We'd all do an abstract. We'd all set an abstract each day. We'd pick a new abstract each day. And we'd spent literally just 10 minutes critically appraising a paper, writing it all down as you would be doing in the interview. And then we'd kind of send photos to each other and you'd be looking, oh, II haven't considered this point. Oh, actually, your point is really interesting. Um And that was, I think probably one of the most useful exercises that we did because it was time pressured. It forced you to solidify the structures that you'd spent um kind of identifying in your prior interview, prep. Um And it was just a really, really great exercise again, stick to your structures. I think that's really important. Again, it's a very nerve wracking interview. It's your first interview since medical school. So you might be a bit nervous, which is completely understandable as was I um but that's why it's important to have these structures that, you know, you can always fall back on um on the day. And three, if I haven't mentioned this enough use the Mark scheme, it's really important, it shows exactly what they're looking for. So, for example, if you're reaching the end of your academic interview and they haven't asked you about ethics because sometimes they may not, you have to bring it up yourself because you've read the Mark scheme, you'll know you're going to get a number of marks for mentioning it. Um So it's really important to do that and then just a few things that I wish I'd known. Um having gone to a couple of academic days, having started, like my academic training, I have realized a couple of things that I did wish I was told. So you don't need an S FP for a successful academic career. If an academic career, something you really, really want, not getting this S FP is not the end of the world. And that's something I can assure you of. Um I've met some professors and assistant professors who decided an ST five ST six that they want to do an academic career and they had probably about one publication at this point, didn't do an S FP or an A CF or anything like that. Um So it really isn't too late and it's really not the end of the world if you don't get it. And if you don't, unfortunately get the S FP, it's not a reflection of you as an academic. Again, it's a highly competitive process. And unfortunately, some things can just be due to luck of the day. Your interview is the abstract you have or just simply how you perform on the day third. And finally, I know I do sound like a bit of a bit of a parent mentioning this, but it is a really important point. Your finals do come first and the foundation of being a good clinical academic is being clinician first, especially at your stage of being an AF pa final year student or even an ACF So it's really important that you do have that solid clinical foundation to build upon your academic training. OK. Excellent. So, final thing before we move on to looking and actually discussing these mock interviews, um is this book here is excellent. I've given it a star. Um I promise it's not sponsored, but they probably should pay me given how many times I've recommended this book to people. Um It's a really, really excellent book. It really just goes through the basics of critical appraisal from A to Z. Um And I really think that it will cover everything that you need for this interview. So I would really, really recommend it. A lot of people recommended how to read a paper to me. Personally, I never read it. I just ran out of time. Um But it has become highly recommended to me. So um I don't know if I'd recommend it or not, but a lot of people said it's great. Ok, excellent. So um that is my part. I finally finished talking. Now we can move on to looking at some of the mock interviews. So while I get up the more interviews. If I could ask you guys to kindly please fill out this post course, post course questionnaire. Um Ultimately, we are academics. So we are hoping to publish this as it is a very novel approach of kind of having these prerecorded interviews that we play and then we discuss. So I'll give you guys a couple of minutes to fill this out while I get up the mock interviews. OK? And in the meantime, I'll answer a couple of questions that people have popped into the chat. Where can we get the Mark scheme? It's in the applicant handbook. I will just stop to chat. Now, bearing in mind this is specific to the London S FP. Um All the mock interviews we're about to watch will be um mock London S FP interviews. OK. So in terms of notes that you take during um no, you can't write anything on the paper before your interview. So they will tend to ask you. Oh, can you show me your desk? What do you have on your desk? Can you show me the paper forwards and backwards and show that you have nothing written on it? Um So it's only when they start the timer and they start uploading the abstract so you can start writing everything down clinical perspective. I think most of the S FP jobs have this S FP program. Um OK. Uh Thank you for the interview today. Um Just in terms of uh applying to S FP. I think I'm really keen on this program for a number of reasons. So first of all, just from the clinical perspective, I think most of the S FP jobs have really good mix of implications through medicine, surgery, often community jobs as well. I think that gives me a well rounded foundation training. Uh Personally, I'm interested in intensive care anesthetics and I think just rotations through some of the relevant specialties will give me good exposure, will give me important skills for treating the unwell patient in any sort of clinical setting. From the academic perspective, I've always wanted to pursue a career as an academic clinician. And I think through the um integrated academic training pathway and I think the S FP with its sort of protected time of four months, especially in the London Jobs. This is just really, really valuable because it helps me build up on research skills that I already have from medical school and gives me a chance to lead on a project to produce output and puts me in a great place to um access further opportunities in this academic training pathway. So I think there's just lots of reasons why the S FP I think is a really good fit for me and that's why I've decided to apply. OK, excellent. Thank you. So, um I understand that you've read the abstract that we sent you. Yes. Yeah. Yeah. OK. Can you please summarize the strength of the study. Yeah. Uh so to start with, this is a retrospective court study in the New England Journal of Medicine. And so, um I think one of the strengths would be that they've chosen a retrospective study design. And really that is the only feasible way to do this study because the um sort of prospective study design will have resulted in a really long follow up time which would be costly and difficult and there will be patients lost to follow up as well. Um The second struggle to study, I think is that it's a really large sample size and they've managed to get sort of over 7000 football players, um over 20,000 controls and it also increase the power of the study. Um The other strength I think would be that they've controlled for some key confounder. So things like age, sex and social deprivation and, you know, these are all things that are known to be associated with health outcomes in lots of populations. So I would say these are some of the key strengths of this study. Ok. Um And what about the weaknesses of the study? Um So I think that um sort of areas for improvement that I've noticed. So, um I spoke about compounders earlier on, but I do feel that um they've not controlled for some important factors as well. So things like ethnicity and also the fact that um we know that a greater proportion of of the football players are actually living past 70 as compared to the controls. So really, this means that life expectancy between the two groups are inherently different and we've not actually tried to control for that. And we know that increased age is a risk factor in and of itself for neurodegenerative disease. So I think that's something that needs to be considered as well. Um in terms of other weaknesses, I would say that they've chosen, um the, the outcome that they've chosen to look at would be mortality and they've chosen to look at death certificate and what's recorded on them. But um there would be definitely a proportion of participants that have never been diagnosed with neurodegenerative disease or even if they have, they may not be on any sort of prescription. So they are not going to turn up on their health record. Um So I think, you know, possibly more objective measures of mortality will be from neurodegenerative disease would possibly be things like imaging of the brain or even histopathological reporting of a post mortem brain. But I II understand that obviously, it is quite difficult to achieve for so many um participants. So, um I just like to point out that possibly there are better measures of the outcome and we're really underestimating the incidence of neurodegenerative disease. Ok. You also mentioned that ethnicity could be a confounding factor. Why would that be important in the study? Um So we know that there is um I think an inherently different incidence of neurodegenerative disease, let's say in a Western population or Caucasian population versus um other ethnic groups. Um And the fact that it's a co study, it means that we've not randomized participants to any particular group. So there could be systematic baseline differences um at the start of this study. So for example, um if, if we say that there is a greater incidence of neurodegenerative disease, let's say in a Caucasian population, I would expect maybe the football and the, the the group of footballers would likely be more Caucasian and given that they're Scottish. Um And there could inherently just be a high incidence of neurodegenerative disease to start with. Ok, excellent. Thank you. And finally, what are ethical considerations that you want to think about in a study like this? I think the first thing would be um just around the study design itself because um you know, if you look at the hierarchy of evidence, I think maybe, you know, a randomized controlled trial, it ideally sort of um offers a higher level of evidence. However, in this situation, I think it would not be ethical or even possible to perform a randomized controlled trial to randomize people to and inter professional or training or to randomize people to a particular group where they, where we know that they might be exposed to a higher risk of neurodegenerative disease. So, in that sense, um the only sort of really ethical study design that we can do will be a co study, which is what they've opted for in terms of other sort of pillars of medical ethics. I think we just need to read a full paper to find out if they've met them, things like whether there was informed consent for patients, whether patients had a chance to withdraw from the study at any point. Um and also whether there was any possible harm done to patients in the study? Ok, excellent interview from Helen. She's a very, very, very strong candidate. She's amazing. Um So we have one question leading on from this specific interview. So if they don't specifically ask an ethics focused question, how would you mention that you've analyzed ethics of the study? So I would recommend doing this towards the end of your critical appraisal. Sometimes I have heard of interviewers just leaving you to rattle off everything. So they may not specifically prompt you and ask you questions. So I'd recommend doing this after your internal external validity, you've done your funding um and your analysis kind of discuss that and then do ethics at the end. So being like regarding ethical considerations of the study, blah, blah, blah, um and then you could use the framework that we discussed earlier today. OK. Do you have any more questions um regarding this specific interview? OK, wonderful. So we move on to the next candidate. So what we're going to be doing is we're going to watch one more interview and then after that, we're going to pause and I'm going to answer some questions that were submitted in the Q and A yesterday and I want to answer some more. Hi, Jonathan. My name is Maria. Thank you for attending your London S FP interview. Before we start, we wanted to ask you why do you want to apply for the London S FP? Um Yeah, of course. So I guess my decision to sort of apply for the academic program was always driven by my desire to do research alongside my clinical work. Um This really started with my BSC project. Um So I did one of the Intercalated BSC S where I did a project based around access to novel therapeutics in cystic fibrosis. Um This is research I was able to present and publish and which has sort of influenced some areas of policy and perceptions in the disease. I think what that really showed me is that um well, in medicine, you can kind of make a difference, a big difference obviously with individual patients. Um And their clinical course research really gives you the tools to get at, at a, at a kind of macro level. Um And it can also be done in a translational nature which addresses issues which are really priorities to patients. So my project was done in collaboration from conception to execution with um patient stakeholders. And I think that was something which was really valuable to me. And therefore, I kind of want it to be quite a core part of my career moving forward. And so obviously, the S FP kind of is tailor made towards that. It has sort of the academic supervisor, it has the dedicated research time and gives me kind of the ability to do all of that alongside my clinical work in a sort of tailor made pathway um in a specialty that I'm interested in, in a very, a, in a very integrative way. Um So yeah, that, that was my main um my main driver. OK, thank you. And you've read the abstract. Do you have any questions for us at this stage? Um No, no, I don't. Hey, can you please a for sure. Yes. So this was a retrospective cohort study published in the New New England Journal of Medicine. Um with trying to answer the question of whether there's a higher of mortality due to neurodegenerative disease in professional. They say soccer players, well, I'll say football from here on out if that's OK. Um football players. And so this was a study. So I think this is first of all, a widely clinical clinically relevant study because football's a very widely played sport both in the UK, uh but also internationally in both high and low countries. Um And so obviously, any findings taken by policy can guide actual change in the real world. So this was a study which looked at compared professional Scottish football players with a control group. Um And they sort of tried to control for factors such as age and socio, socioeconomic status as well. And the outcomes they were looking at were death mortality from neurodegenerative disease, but also a secondary outcome of prescriptions for dementia medication. And they found a statistically significant increase in mortality. Um So the hazard ratio was 3.5. So basically over the 18 year period, they looked at um soccer player, prof professional football players were 3.5 times more likely to develop to die of neurodegenerative disease. Ok. Thank you. And what are some strengths of the study? Sure. Um So I think first of all, as I kind of previously touched on, I think it is a strongly clinically relevant question. So as they mentioned, there is already previous research looking at American football players and other contact sports, which has demonstrated an increase in mortality um from these sorts of conditions. And so I guess mechanistically, it it, it follows that it might be, it might carry over into football because off the top of my head, I guess I can imagine that sort of the the contact trauma of heading the ball, um can also can definitely would lead you to believe that could be a possibility. Um, football, I think is a much more widely played sport around the world than American football. And therefore it kind of provide some level, a high level of clinical relevance to populations in all sorts of countries. Um and health systems as well. I would say that. So this study used a retrospective cohort design. Um obviously along the sort of typical pyramid of evidence, it's not quite at the top. But I think for this study, I think it's a relevant choice because it's very, it would be very difficult to design the RCT around this. Um And there would be ethical considerations about that as well. Um And so I think it's appropriate in this respect. I think it's good for when you have an outcome such as neurodegenerative disease, which is relatively rare in the, in the wider population. Um So it kind of allows you to generate a decent sample size and look for an e decent effect as well. I would say that um mortality is the nice objective outcome and it seems as though the diseases that they defined as neurodegenerative were classified a priori. However, I think the issue with mortality and neurodegenerative diseases around the death certificate that can sometimes be a bit of ambiguity and it can be difficult to say whether someone definitively died of a neurodegenerative disease or with a neurodegenerative disease. Um So that's something I'd like to read up a bit more about within the full study. I think that it went, the study ran for, looked at about 18 years. Um I think that's appropriate, but I, I'd like to see something that looks a bit longer as well. Cos obviously these diseases can take quite a long time to develop and professional football players, generally speaking, will be quite young, although I guess it was a retrospective design. So I need to see the general age group that they looked at. Um, I think the fact that they tried to control for compounders such as I believe it was socioeconomic status. Um Also if I just have a look, sorry um age and, and things like that, I think were very good, I think especially in a retrospective cohort design, it's important to obviously try and um remove any sources of bias that are kind of intrinsic to your selection criteria. Um So I was happy to see that as well. Um In terms of the external validity, I think as previously mentioned, it's very strong but and potentially very wide benefits. And I think at any level sort of from profession, from adults to to Children who play the sport, it's important to know. Um and I think it'd be very relevant for, for players, but also for parents, for example of Children going into play this at school um to have that be fully informed and have that information. And I think that any interventions uh based around this would likely be very low cost and have very wide benefits will be speaking. OK. Are there any other limitation study? Mhm. So I think in terms of limitations or negatives, I think I've kind of touched upon the um, difficulty with ascertaining the causes of death. But I think as well, um, the study only looks at professional football players and obviously a professional football player, many aspects of their life would be very different to an amateur. But also the nature of the sport is different. It's played very differently at professional level and also it is, I guess much more intense people who train professionally will be, for example, having very high impact training, very intense training very frequently, they may have different modes of playing sport. And so I think ideally, I'd like to see another study looking at um are more having, which I guess is a bit more inclusive and looks at amateur players as well. Um I would also like to get an exact list of what they define as neurodegenerative diseases and to see if they use any internationally um recognized criteria or any guidelines essentially, or whether it was just the study designers who, who made that choice. Um they only also use a sample size collected from Scotland. I think I'd like to see ideally something taken from that's a bit more um applicable to sort of improve the external validity. So for example, an easy choice would be just to expand to the UK, but also looking internationally because football um is a sport that's played really in most countries around the world. Um whether that be in high income or lower middle income countries, I'd also like to see a power calculation if possible um, for the sample size because it's a retrospective study. So it's relatively easier to, I guess, collect a bit more data. So I want to see how they came to that. Um, the, the number that they chose and I'd like to see a bit more about how they tried to remove any source of selection bias from within their, from within their candidate choice as well. Thank you. And finally, are there any other ethical considerations? For sure. So I think with a retrospective cohort study, um and any retrospective study design, actually, there's kind of generally speaking less ethical, ethical problems that are raised as an RCT. So for example, clinical wise, because you're collecting retrospective data in a way things have already happened, you don't need to expose people to something new. Um And I think that's one of the strength of the retrospective design. However, that being said, um the authors do not, they would like to have a prospective analysis as well. And I think with that and things like the development of neurodegenerative disease, I think it's reasonable to ask for an interim analysis and to consider that in any future study designs. Um so that we can basically see if, if, if there is ethical to continue. But also, I guess there's issues around data governance as well. I'd like to see how they approach that and whether because obviously much more relevant nowadays, but um people, I guess have a right to their own data, it falls kind of on that principle of autonomy. And I want to make sure that I want to read about how they address that and make sure things were done appropriately. Ok. Well, thank you very much, Ashley. That's the end of your academic. Thank you. I'll hand you will ask the OK, excellent. So we've watched two really high quality mock interviews. We have one really great question from XU actually. So she's asking, would you talk about the internal external mobility of the studies under strength slash weaknesses questions depending on whether it was a strength or limitation of the abstract? Um Yeah, exactly. So the interviewer can vary. I've heard that sometimes they just say, can you please critically appraise this abstract? Then that's how you, that's when you go through the um format that we discussed and identifying each as you go along. Or sometimes you might say, can you identify strength? Can you identify limitation? Um One thing that I did for my interview is on my sheet of paper and some other people did this in inter for them as well. Um I had like a green highlighter so I would tick the strengths in the format that I described. So if they did ask me for strengths, I could look straight down and just read off each of the individual strengths. Um And then the ones that were, it would be one of the limitations that I would answer if they did say. Um what are the limitations? I don't know if Monti has anything else to add. So, uh firstly, thank you, Maria. I think I'm sure everyone found that extremely helpful. Um So specifically to that question, yeah, I think Maria covered it pretty well. Um It just depends on what's appropriate. Always try and remain versatile. It's really useful to have these structures in place. And I know from when I saw Maria do one of her mock interviews, she covered absolutely everything. She didn't really miss a single point, which is very impressive, but just do be aware that if you're being bombarded with questions um from the examiners or interviewers, then, you know, just be prepared to, to sort of mix things up a little bit because they might throw you off off your um sort of preplanned structure. That is a very good point um regarding the structure and just being a bit more flexible. So now we're going to answer a couple of questions, the Q and A are up until about eight o'clock um that have been previously submitted and then we'll resume um to continuing watching the pre interviews. So you're allowed to have an abstract with any annotation slash highlights you've made during the interview, but you're not allowed to have additional notes. Yes, that is correct, just like a normal exam, you're not allowed to take any external kind of notes or pieces of paper. Um For me, my interview was online. Um So you can't really physically highlight the abstract. Um But I know previously historically, when they did have um in person interviews, you would be highlighting and annotating the interviews, the interviews, the abstracts, I would say any question relating, I think in last on, in last webinar, we had a few questions about um like application procedure and things like that. I think I know Maria did. I certainly did. I would definitely recommend reading the um application guidance for the dries. You're applying to read it really carefully because all of the information should be in there. Um And if there's any information in there, that's not that you think you need, that you can't find, then I'd advise her emailing the whoever's provided it. Yeah, absolutely. OK. So first question is um OK, it's common pitfalls of candidates. So a couple of people ask, what are the common pitfalls of S FP candidates? Uh That's a tricky one to speak on common pitfalls. Um because I've not personally seen all, all s AP candidates, I'd say I can speak on my own pitfalls, I suppose, which probably were. Um maybe I think for me in the time pressure prior to the, the interviews that 10 minutes, you have to read everything. I think that was for probably the first one or two minutes was wasted just by sort of frantic, stressful, er, directionless thought. So, maybe I think what Maria described about, um, preparing, er, you know, practicing abstract appraisal, that's probably really useful because if you've done it multiple times before then when it comes to the day you won't waste any time or energy on thinking about how to do what you need to do. You'll just sort of get on and do it. So that would be my, the best answer I could give to that. I think, what, what do you reckon, Maria? Yeah, I think you covered it really well. Um, common pitfalls of candidates, I would say again, at least with me and my friends, I think we had the pitfall of seeing this as the end all and be all of your academic career and that put an immense amount of pressure on us. And I think if I really, I think I'm sure people told me, I think once you actually told me this, I just believed it in hindsight. Now, um, if this isn't the be all and end of your academic career and if I really, really believed that, I think I would have put less, much less pressure on myself and probably would have been much calmer on the day as well and helped you perform better. Yeah, absolutely true. Um, so how to compose yourself if you get very flustered in an interview setting? Oh, well, I've already, I've already touched on this one. take a deep breath. Have some tea. Yeah, that's fine. Yeah. Breathing. Don't forget to breathe. Um, compare yourself if you get flustered. Um, for me I feel like I'm most flustered at the very beginning of my interview. So that's why I know for myself, I just had to write out my sentence. So I didn't have to think at all for the first minute or so of my interview and then you kind of become more relaxed and can use into it. That helped me. Um Yeah, I have some tea and do some yoga. Yeah. And that's when also your structure comes back into play because you can, if you got a structure to sort of default to then if, if you feel completely lost or muddled, then you just always go back whether it's the A two E in the clinical or the sorry, I just keep bringing up the clinical, sorry guys can't let it go. Um But yeah, so always go back to your structure basically if you're completely lost, just think of Maria's structure, think of Maria and, and you'll be fine. Yeah. Um a question in the chat from Freddie Johnson. OK. Doesn't stink. Oh OK. I'm sorry, Freddie, I'm not too sure. So Freddie's asking he's applying for his interview. He doesn't know when the offers will be sent out. Do you remember roughly how long before the interview you got for? You it should be in the guidance. It's all in the guidance, Fred. Trust, the guidance, you should. Yeah, when in doubt or even if not in doubt, just always just read through every word of the guidance. It's, it's very important. I think everyone that does well in, in any job, not just s FP any interview process at any stage of your career, sort of being familiar with the deadlines and the procedures is always very highly correlated with performance, at least from, from what I've seen. Yes, absolutely. Um OK. So what are they looking for candidates experience wise? Um So, II suppose I can only really speak on behalf of the London Deanery because they do have a shortlisting for interviews. Um So again, look at the application guide, at least in my year, I believe. Um one year as well. So they were looking five points for prizes, you had five points for BSE phd or whatever. You had five point for oral and post presentations and then five points for presentations. So you, you were shortlisted um according to your score out of 20 the cut off varied year on year, but it was either 13 or 14 out of 20 was the cut off. So at least for London, that's the sort of experience they were looking at. Absolutely. I think in with regards to the London interview specifically, it's a bit different to some other units because the person who interviews you in London, it's a very depersonalized interview system. So, um essentially you just get as an applicant, you get put into a large pool of interviewees and you're kind of randomly assigned uh two interviewers on the day. Uh assuming it's not changed, that's how it has been, at least for the last few years. So the people interviewing, you won't necessarily ever see you again. There are other units where the person interviewing, you will also be your supervisor. So under those circumstances, it's a bit more important to demonstrate that you have interests, knowledge, skills that are going to be sort of conducive to the development of their department with the London interview. It's a lot more generic. It doesn't really matter what your specialty is, what, which area your experience is in. It's just about demonstrating proficiency and potential. Exactly. So I applied for the surgical program. I think I had a geriatrician and a gastroenterologist interviewing me pretty much like, um, ok, so what strategies were used by successful applicants to train for the interview? I think I touched upon this in my talk of what I was doing kind of eight weeks, one month and like a week or two before my interview. Um, and then I guess like Monty, what were you doing to help prep in your lead up? Um, I, same as Maria, I, it practice interviews, always helpful. Anyone that, you know, who's a successful candidate from the year before you reach out to them, do practice with them. Ideally, if you know, at the same unit of application, cos you want your practice interview to be as close to your actual interview as possible. Uh In addition to that, basically just cover the material that Maria's described. You know, you can't prepare for the exact abstract you're gonna get, but you can prepare for all of these considerations that you need to include and there are certain things you just need to learn. So, yeah, I think basically the content of these webinars is, is, is what we think is the best way to prepare. And in addition to that, just run as many practice interviews as you can. Yeah, exactly. Um, and then yeah, we've covered basic structures which a lot of people asked about good prep resources. Again, the book I recommended highly, highly recommend it. Um regarding other resources, I don't think I used much else other than practice. There's, there's no, I've never met him and I have no reason to plug this. Other than that, it is genuinely quite good. There's a book by a song called Anchor Caura. I think he's a plastic surgery training now. I'm not too sure, but he wrote a long time ago, a book called, I think it's a FP Secrets, maybe, er, it's on Amazon and it actually was quite helpful. Er, and other than that, it's just the same resources you used to revise for med school. Finals and, er, guidelines. Actually one thing I'd recommend reading for the academic interview is, er, consort guidelines. So, er, maybe Prisma guidelines. So they're essentially reporting guidelines for authors of um randomized controlled trials. They uh include everything that needs to be considered when reporting and also sort of when designing a trial, even though that's not actually what they're written for. Er, but you can also kind of use that as a structure for your appraisal, but Maria's basically already condensed it down to bullet points for you into slides. So you could just, um, cut, cut the corner and just use her notes cos they're pretty comprehensive. I do one more question. So, in the personal station, what would you recommend saying if you want to apply for a deanery where you're not from that you really want to apply to? Um, personally, I don't think that's an issue at all applying to a deanery that you haven't been to before. If anything that's a strength you want to explore in your city and your department. Um, and all of that. So I don't think that is a disadvantage in any way. Yeah, absolutely. It's, I think at this stage people are moving around loads, you know, when it gets to like registrar level, people tend to, to apply for, you know, substantiative of posts where they've trained. But around in med school foundation transition, people are moving all over the place if you're going somewhere new just be complementary. It's good to know a bit about the location. So you can sort of bring it up in the interview. There's a department you're interested in. They have a, you know, a good notable research department in an area you're interested in, you can bring it up. You can even mention names if you, if you have connections or you don't, you don't want to sound as though you're kind of name dropping because at the end of the day, it's you're the candidate and regardless of who, you know, it's about demonstrating your own efficiency. Uh But uh yeah, I would say just try and research if you feel like you don't know the the area or the department you're applying to, then then try to, to learn a bit more about it because they, it's good to see interest. Any interviewer or examiner will, will appreciate interest. Yeah, absolutely. Um I think specifically for non London interviews, something that really helped me is knowing the program, you want to apply for understanding their research, their outputs, their specific interests because it shows that you have done your research and you are aware of it. Um Yes. So I applied for that. I'm not from the interviews when fine. So we are at eight o'clock. Does anyone have any more questions we've covered uh the majority of the ones that were submitted previously and if there are no more questions, we'll continue watching the mock interviews Ok. Wonderful. Ok. So just loading it now while that good. Can we please guys, can you please kindly complete the feedback form? It's really important, Monty, and I haven't won the series before and we're quite keen on continuing it. So, and this is a relatively novel approach of having these prerecorded interviews. So we really, really value your feedback um as well. Thank you very much. Ok. Hi, Christy. Uh MS Mayer. Welcome to your London S FP interview. Before we start with the academic component, we want to ask why do you want to apply for the London S FP? So while on the NASA P, I've chosen to do your management and need um S FP. Um the reason is that I've done already quite a few basic science and clinical research um during my medical school years. And now I want to develop my management and leadership skills that will be in the valuable to leading an academic project or a clinical team as I progress through my career and as an aspiring um academic clinician, I think an extra four months during my foundation year would allow me to get some time to really focus on my academic interest. OK. Thank you. And have you read the abstract? Uh Do you have any questions for us? Um No, not at the moment. OK. Can you please summarize the obstruct? So this is a Multicenter randomized controlled trial published in New England Journal of Medicine. And the population that they're looking at are Chinese patients between 60 80 years old with hypertension. And the two arms of the controlled trial is um a target BP of 110 to 1 30 mol of mercury on one side and the other 1 30 to 1 50 minimal of mercury. And the outcome that they're looking at is a composite outcome um with including stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation or death from cardiovascular causes. And the results are has a ratio that looks at um the outcome over a period of um three years. And they showed that intensive treatment group, individuals are 26% less likely to encounter primary outcomes. But if you look at the breakdown of the results, there's only a reduced risk of stroke, acute coronary syndrome and acute decompensated heart failure. And the other primary factors did not show a significant difference as the 95% of confidence interval crossed one. And the results for safety and renal outcomes do not differ significantly between the two groups either. But they did point out that the intensive treatment group has high incidences of hypertension, um which can be something that we should be aware of. Ok, thank you. And can you please summarize the strength of the study? So the strength of the study is that um it answers a clinically relevant question on a very common condition and a common dilemma that many conditions face as sometimes it's hard to figure out whether this target BP is good for these patients. And what we should be aiming for with our um management and randomized controlled trial is the gold standard for comparing treatment. Although they didn't have a control group within this study, which is a good relating to its ethics. Um um it is a really effective and reliable way of assessing whether the treatment is good or not. And they have carried out randomization which avoids selection bias and imbalance in baseline characteristics. But I would like to see a breakdown of the baseline characteristics to see if it's significantly different, which can in turn affect the results. And they also showed a breakdown of the significance of the, of the individual components of the composite outcomes. So we can really see which are the outcomes that were affected uh improved or not um by the treatment. So we would be more aware of what outcomes that we've been looking for rather than just lumping all the outcomes together. And we, we don't know um what, what in what aspect that would really benefit patients in. And this study also has a large sample size. So it has a low chance of type two error. Um It's also a multisensor study together with a large sample size. There's a good generalized ability and external validity to Chinese population, but we'll need to see a power calculation to see whether this is efficient to avoid it, um, to completely avoid a type two error and it might not be applicable to other ethnicities as well. And they also have a long term follow up of three years, which is quite a considerable amount of time. But for example, um, longer follow up could be done. Um, although a drop out rate might be higher and it's also a registered trial. So it means that their protocol um cannot be changed halfway through the study. So, um it wouldn't run a risk of them trying to sort of fit a significant result according to what they have found. Ok, excellent. Thank you very much. And what about some limitations of this study? Um So from the abstract, it's not clear um how they selected or recruited the participants. Um for example, inclusion criteria or exclusion criteria and any comorbidities alongside hypertension, because many patients who have hypertension might have other cardiovascular condition as well. And it's not also clear whether the hypertension that um patients have are primary or secondary, which relates to the previous point about comorbidities. Um And whether they have controlled or adjusted their analysis with confounding variables, for example, smoking age or other vascular risk factors. And they didn't mention whether the patients or the um researchers were blinded to the treatment. Um And they didn't really mention what medications or what sort of protocol they're following in terms of which medications they're using to control the BP, which can affect sort of confound the outcomes. Because if certain patients are having certain medications compared to the others, it can affect the risk of other conditions just because of side effects of those medications as well. And I'd like to see if they analyze the results, um, according to intention to treat or per protocol, um, because of the long follow up, there might be high dropout rates or even because of the side effects of certain medications or just having a lower BP from the intensive treatment, um, that could affect sort of the interpretation of um, the results. Um And the, I would also like to see whether there's any significance of the high rate of hypertension. They said there is a higher rate of hypertension in intensive treatment group, but they didn't say whether it's statistically significant because hypertension can increase risk of falls, which can be a very adverse event in the elderly population. So, which can affect our clinical application of whether we would choose to give patients intensive treatment. Um, and they only looked at cardiovascular outcomes, um, rather than all cause of mortality, um, which, um, because the patients can, um pass away because of other reasons because of the medication or a sort of secondary effect of um, a lower BP or other things as well. Um And I think the conclusion is correct in some senses that the some cardiovascular events are lower. But then they sort of concluded saying that um all cardiovascular events rather than specifically mentioning the components of the composite outcome that were actually lowered by the intensive treatment. Thank you Christie. So, on the topic of composite outcomes, what do you understand of the definition of a primary composite outcome? And what are some advantages, maybe disadvantages of using it? So a composite outcome essentially is that you sort of take a few of the individual outcomes and put their data together to get a single sort of um adjusted mean outcome um to look at a broad range of outcomes without sort of it. There's a, there's a advantage that um for a for example, mm I'm not sure what's the main advantage of a competent outcome. It can probably make data seem more significant than it is just because some of the outcome um can be significant and that can pull the significance up when some of the um components within the composite outcome is weaker and doesn't have a statistical significance. And the disadvantage is basically, it can cover up some of the statistical um sort of weakness in some of the components. For example, if one is one of the component is not statistically significant and you don't tell your readers which of the components are significant then, but if your composite outcome, because of other sort of um more statistically significant outcomes are positive, then you can make your results seem um more significant and sort of make the results look nice as well. Yeah, you are absolutely correct. And yeah, one of the advantages is um it's particularly useful for outcomes with low incidence rates. So that's why it's particularly useful as well. And final question is, what sort of ethical considerations would we want to keep in mind when running a study like this? So when you're looking at ethics, there are four pillars of medical ethics. So, beneficient, nonmaleficent, um autonomy and justice. So in terms of beneficient, this study is looking at an important question and the results does um sort of benefit quite a large um population. Despite only being in the c done in the Chinese population, it can possibly apply to other Asian populations as well. Uh nonmaleficent, um they didn't use any control groups possibly because it's unethical to not treat um hypertensive patients just uh because of the um uh complications that you can have from that condition. So they only had two groups um presumably with the best treatment um at the time. And also um they did an interim analysis at one year as well just to look at um pro probably whether they should stop the study early um because of the significant benefit in one group compared to the other um as well. So um in terms of autonomy, um um and they would have obtained consent from patients, it's not completely clear whether they have um done so but there's one sort of consideration that needs to be um put um put into account. Um and the in terms of justice, they received academic funding from a, the um Chinese Academy of Medical Sciences and others. So um it's not clear what the other funding that they've got, but at least from the Chinese ACA Academy funding. Um it's not from a biased source of funding. So it's um it means they don't have as much incentive to um to introduce by subtly or have some other agenda in mind to affect the results. But if we can find out what other funding they get, this might be clearer as well. OK, excellent. Thank you very much Christy. OK. So that is the end of Christie's interview. Please drop in the chart if you have any questions before we move on to the next mock interview. I told you that. Ok. Hi Michel. Welcome to your London S FP interview. Thank you for coming. So before we start, just let me check that you've read the abstract and you're happy with the abstract. Yeah, I have. OK, excellent. Um Before we start, we want to ask you, why do you want to apply to this S FP program? Well, II think that London SSD uh provides a great, great opportunity for me to develop both my clinical and uh academic skills. And it would be a great platform to prepare me towards an integrated clinical academic career in general surgery, which is where my interest is. Uh I've sort of started my research interest when I intercalated in surgical innovation. And I was working on a 12 week uh independent project looking into validating new cancer detection technology. And that has given me a solid base with study design and data analysis skills. And I think the London program uh offers multiple surgery themes programs that would allow me to take these skills forward and develop them further uh as well as allowing me to take a good variety of clinical rotations. Uh And those things would then be great for me in terms of applying for academic clinical fellowships and potentially pursuing a funded phd in the future. Ok, excellent. And um can you please summarize the abstract that you read? Uh Sure. So the study that I was given uh was a five year outcomes. Uh follow up from a randomized clinical trial. Uh They was trying to answer a question uh whether medical therapy uh or surgical treatments for type two diabetes are better. Uh It's quite an important question as type two diabetes prevalence is increasing. Er, and er it results in many complications, both micro and microvascular. So the population of the for people with type two diabetes with BMI of between 27 and 43. Uh the intervention were either a roly G bypass or a sleeve gastrectomy with the comparator. These interventions with the intensive medical therapy compared with uh the comparator of just intensive medical therapy and the outcomes they were measuring uh was the proportion of people with HBA one C uh less than or equal to 6%. Uh They found according to the office that the surgical treatment was more effective in uh controlling or was more effective in uh achieving glycemic control with patients with type two diabetes. It was published in the England Journal of Medicine registered in a database and it was funded by African and some other funders as well. Ok, excellent. Thank you. Can you please summarize the strengths of this study? Sure. So I think one of the main strengths of this study is the fact that it's a randomized controlled trial, which is on top of the pyramid of evidence. And it's the appropriate choice of methodology to compare uh to different interventions or in this case to interventions and a comparator. It allows for reduction in, in uh selection bias through randomization. Uh I think the choice of the outcome being HBA1C is an objective outcome. Er and that reduces the chance uh of performance bias as a standardized way of measuring glycemic control in the long term. Uh Yeah. So I think those would be the 22 main strengths uh that I could think of. Ok, great. Thank you very much. And what about weaknesses of this study? Yes, I, so one of the things that stood out for me was the sample size of uh only 100 and 50. So I'd like to see in the full manuscripts, full power calculations. Uh There is potential, potentially, this study could be underpowered, especially for picking out differences between the subgroups. Uh The subgroups being only 50 participants each and then potentially less with uh the loss of follow up. Uh Another thing is that what I just mentioned, which is lost at follow up. So I would like to see even though they mentioned that 90% of people completed uh the five year follow up, I would like to see how that was distributed between the groups and whether uh one or more of the groups had more attrition that could lead to attrition bias. Uh And I think one of the things that stood to me as well was the fact that there was no mention of how uh adherence to the medical therapy was measured. Uh Again, this is something that could be mentioned in the main manuscript. But uh I would like to see whether the authors have made attempts to measure adherence to medical therapy. Uh And what the actual medical therapy protocol was uh as this could affect the performance in that group. OK. Thank you. And regarding this study, what sort of ethical considerations would arise from this research. So I think this study being registered, uh sort of gives me confidence that the authors have gone through appropriate approvals. However, I'd like to see uh that this study was approved by a research committee. Uh I think any randomized controlled trials uh raises questions in terms of uh sort of doing the best for your patients that you can and also for patient autonomy, uh patients being randomly allocated to groups. Uh And here, since the authors have concluded that there was a difference between groups, I would like to see whether there was an interim analysis preplanned. Uh That would then uh look and the fact whether one group is performing better than the other group. Uh Yeah, so those would be uh the main things standing out to me. OK. And do you think there'll be any other ethical considerations for one intervention being surgical and another intervention being medical? Um And the randomization of them? Yeah, I think that's a very important point as well. And obviously, uh you know, the acceptability of intervention to the patients and also the potential for even though they report that there was uh I think very few complications of the uh surgical intervention, those interventions are very different to each other. Uh So just ensuring that there was equipo and this was presented to the patients in uh sort of a manner that allowed them for the full choice. Uh I would like to see how many patients were approached for randomisation before they were actually randomized, how many people decided not to participate in the study as well? OK. And what do you think of kind of HBA1C being one of the main outcomes measured for this study. Are there any other potential outcomes that you'd suggest? Yeah. So whilst it's an objective outcome that allows for little performance by us, uh its clinical relevance, especially in the long term might not be that high as the clinically important thing in diabetes would be the complications. Uh So, for example, measuring things as rates of peripheral arterial disease, retinopathy, nephropathy. Uh And again, those can be measured objectively as well. Uh could be something that's more clinically relevant. Uh Having said that perhaps a 5 to 5 year timescale is might not be enough for those to develop in some of the population. So I'd imagine that's why, that's why uh the office I've chosen HBA one C. Uh But yeah, I think i it's it being the primary outcome uh might not be the most clinically relevant. OK. Hi. Welcome to your OK. Any questions about my cousin? If not, we'll move on to Sarah, who's our final interviewing? OK. Hi, Sarah. Welcome to your lab and an S FP interview. Before we start with the abstract. We want to ask you why do you want to apply referral S FP program here? Um So I really do like research, I've had quite a bit of exposure to research about medical school and I really think I want to take that further and I think the S FP is sort of this perfect balance and this perfect bridge between medical school and a further academic career, especially given the mix of research and clinical work that you're offered throughout the S FP. Um I mean, research, there is so much opportunity in London to work in sort of world leading institutes and working with experts in a team um to conduct research, which is just such a fantastic opportunity. Um I've had a look at some of the uh SF PS that I might be interested in. There was one in cellular pathology at UCL. Um I do know the campus over there and I think it would be a really great environment for me to work in. Um I've had experience before in wet labs at Yale University doing research and shadowing cytopathologist as well. And I really love that environment. I think that for example, this SP program would be fantastic for me. I think the other thing with um the S FP um is that it gives me such a great chance to develop myself as an educator as well, which is such a necessary skill to then go forward and become a clinical fellowship or to progress and then do a phd um through teaching other people. E excellent. Thank you very much. And have you read the abstract that we sent you? Uh Yes, I have. OK. And are you happy with, are you happy to proceed? Um Yeah, that's fine. Um So can you please summarize the abstract for us. Uh Sure. So this is a paper published in the New England Journal of Medicine in 2020. Um This was a randomized trial of using hydroxychloroquine as postexposure prophylaxis for people who had been exposed to uh COVID-19. Um The trial splits uh around 821 asymptomatic patients into a placebo group or a uh hydroxychloroquine group. Um And this was conducted across the United States and parts of Canada. This was a Multicenter study. Um The overall findings um whilst they classified participants into high risk exposure and moderate risk exposure, um did not show any difference between the risk of them developing COVID and moving forward. Um They did report, however, that side effects were more common in the group that received hydroxychloroquine than the group that received a placebo. Although these side effects were not serious. And overall, it appears that hydroxychloroquine plays no role in preventing post exposure. Um uh prophylaxis for COVID-19. OK. Thank you. And what are some strengths of the study that you identified? So, I think the big strength of this study is that they have a huge participant, cohort of over 800 participants. It's unclear whether or not these are all adults or whether they enrolled Children as well. Um Another big uh advantage of the study is that it is multicentre. So it does take into account or we can assume it takes into account um quite a wide variety of individuals um throughout a very large patient population conducted, as they say across the United States and also parts of Canada. Um this is also a randomized study that is also double blinded and it is also placebo controlled, which helps to reduce quite a number of biases that could potentially crop up in this study. However, it's unclear whether or not the patient populations across the placebo and the treatment group were matched to each other and whether or not they could um through matching and be appropriately compared. Um The other advantage of this study is um at least from the abstract, they do um uh have quite specific inclusion criteria. So individuals had to be um exposed to someone with um confirmed COVID-19 for more than 10 minutes and they must have had to have been less than six ft away from that that person. So that's quite stringent um inclusion criteria. In addition, they do also mention the exact dosing and course of hydroxychloroquine given to the treatment group um which makes the study very easily replicable um if needed. Um So I would say from my perspective, those are the big um uh advantages of this study. OK. Thank you. So you mentioned you'd want to match the two groups. What sort of variables did you want to match for? Um So I want, yeah, so knowing um what I know about COVID-19, how it affects individuals. Um and uh also the, the transmissibility of the virus and the strains and everything like that. Um I think, especially when, when looking at, at a disease like this, I think it would be worth taking into account variables like individuals who have um underlying lung disease to split them or at least match them with age as well. Um Yeah, I think underlying pathology and age are probably two of the most important things that I would match them for. Um um Yeah, and I think also, I mean, they did take into account um individuals with high risk exposure or a moderate risk exposure. And I think that would be also good to match across both groups. Ok, thank you. And the study is double blind. What do you understand about what that means? Ok. So that means that the the participants were blinded as to whether or not they received a placebo um or hydroxychloroquine. I think in this case, blinding participants is not necessarily um particularly important when you're testing the exposure of a respiratory um virus. Um they determined whether not someone had developed COVID following this based on either symptoms or laboratory controlled. Um sorry, laboratory confirmed COVID. That's not something that can really be affected by participant bias. I don't think they would necessarily faked having an upper respiratory tract infection if that makes sense. Um However, it being double blind means also the researchers were blinded as to who received the placebo and who received the treatment group. And I think that's important um in order for them to not necessarily shaf a group of people into having had COVID based on say minimal symptoms that may, they might have uh received, that would not necessarily fit the criteria of them being diagnosed with COVID based on symptoms. Um That's however, another thing that I would want to bring up um based on sort of criticism of this study, um whether or not patients were diagnosed with COVID um following their exposure to this known um individual was based on either laboratory confirmed COVID, which is a rather objective um criteria which is good. But then the other criteria was also that they developed symptoms, there are numerous upper respiratory tract and lower respiratory tract infections that can cause symptoms extremely similar to COVID-19. And if that wasn't then confirmed by um a laboratory test like a lateral flow test, um that could then mean that quite a few of the patients who were then classed as having gotten COVID post exposure could be inaccurate. Ok. Thank you. And are there any other limitations of the study that you have identified? Yeah. Um I think one of the other limitations is it's not very clear how exactly they selected the participants. Um It's unclear as to as to whether or not the participants volunteer to enter the study um if they were all chosen at the same time. Um And I think it relies quite heavily on participants reporting having been in contact with someone with confirmed COVID within four days and that they were together for 10 minutes without wearing a mask without wearing a face shield. These are all very specific criteria and you're relying on the participants being able to recall that information. Um And also recall it accurately. I think that's the other big limitation that I would give to this study. OK. And final question, what are some ethical considerations that you need to think about when running a study like this? Um So hydroxychloroquine, as far as I'm aware, is only used for or is one of the major drugs used for malaria, um which doesn't really have any relation to COVID in terms of its medical use and why exactly they would choose hydroxychloroquine is kind of unclear to me. Um I think with the ethics whenever you're, whenever they're considering giving someone a medication, um that needs to be taken into consideration, will there have any, will there be any side effects on the population that are testing this on? Um And why is there a need to test hydroxychloroquine specifically? I think that needs to be made clear. I think the other thing is um this study was funded. Um And it's unclear whether or not participants were offered monetary compensation for their time for being part of this study. If it was advertised that way, then it could be that participants might have put themselves in harm's way by coming into contact with someone with COVID in order to be able to participate in this study. Um given how little we know about COVID, but also how deadly it was in the first wave. That is definitely something that needs to be considered in terms of how ethical the study is. Excellent. Thank you. Ok, wonderful. That is the end of our mock interviews and the end of our um S FP series. Uh Thank you very much guys for attending our series. I'll just drop my email in the chat if you have any questions, any questions come up after this webinar series. Um An excellent. Thank you very much for attending.