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So we'll be starting now. Ok, good afternoon, good afternoon, everyone. Um Welcome to the CD symposium. Um Today will be having a discussion on CCT and C A pathways for urology in the United Kingdom. And um we uh we have speakers that would be taking us through this. There are people with um a wide range of experience um concerning these two topics. Um We have Mr Wa a urologist at the University College, London, King's College of Foundation Trust and MS Ijo Matsuo Urologist is our fellow at the Royal Christian Hospital. Um We'll be having them speak first and then we'll go for questions and answers after both of them are spoken. So the first thing I would do is for me to introduce the um first speaker that's Mr Audible. I can hear you. Thanks. Yeah, we can hear you loud and clear. Ok. Ok. So um Mr completed his medical degree at Saint George's Sge of London in 2007 and subsequently completed his surgical training in the West Midlands. He was awarded the membership with the Royal College of Surgeons of England in 2010, is completing a specialist training in urology in the East Midlands training program. He became a urological fellow of the Royal College of Surgeons of England. In 2017. In 2018, he completed a yearlong fellowship in and of the prostate and endourology at L and Non University Hospital where he developed these experts in performing a procedures. And in 2020 so 20 performed the first a procedure to be done at the King's College Hospital in London. Is this? He completes his master of philosophy in prostate cancer diagnosis from No Trent University. Mr S Clinical expertise in all areas of endourology, general oncology and neurological oncology. He is also a keen academic and has presented his work at several national international conferences. His research is well published with over 20 publications and pe review journals, seven of which is the first also as a Testament to his academic and thinker expertise. He was awarded the East Mid lunch training medal 2017 and the Iron MacCallum is charge price in 2018. Joining welcoming Mr Aio at the King's College of NHS Foundation Trust. Uh Thank you very much. I hope I'm coming through uh nice and clear. Uh Yeah, thanks to you and thanks to a as well for the uh introduction and the opportunity to speak to you all today. So I'll just start by sharing my screen and just let me know, can you see the slide? Yes, you can see these lights but um I can see you from my end. Ok. That's fine. As long as you can see the slides then. That, that, that's ok. Um, so, yeah, so, um, I've been given the task of basically talking about the CCT pathway. So what we'll do with this talk really is sort of start right at the beginning, which is applying for national training numbers. Um, and what is required, what hoops you need to jump through in order to get through, er, er, the national selection. Um, we'll talk a bit about the interview and the preparation needed for that and then once you are through to the other side, we'll talk a bit about um, what training offers and what training is like uh in the UK. So there are 18 training deaneries uh in the UK, obviously all up and down the country. One of the largest is the east of England Deanery. Er, and you can see they're in the middle of that. London has split up into London North and London South. So as you rotate through deaneries in a specialist training program, you will only visit units within that deanery. So if you're in London North, you will not have any placements in London South and vice versa. And that goes the same for, throughout the country, there is opportunity to transfer through different other, er, to, er, to other deaneries. If you have extenuating circumstances, you know, family, family, er, constraints and that sort of thing but it's, it's not really commonplace, er, er, to do that. Um, so when applying for national selection, as it says, it is a, a nationally run thing, um, these are some information from the 2023 entry for urology. Um, your core trainee years are, are the sho years, ct one ct two. Occasionally, some, er, doctors do act three year but usually phase one as we call it is CT one and two. And then, yeah, and towards uh well, really halfway through your C two. Yeah, you start then to apply for your ST three number people call it a number cos it's only a specific uh finite number of them available. There were 252 applicants er in 2023 round for 82 post which gives a competition ratio of about 3 to 1. So very doable. Um It was a little bit higher than the year before actually just under 4 to 1. Um but it is a very competitive process. So you really do need to hone in and um all the applicants are, they start early reading the books uh to give themselves the best chance. So this is the timeline. So if you are following the usual pathway in your CT two year come the er 14th of November, that's when the applications will open. So this is for 2025. So these dates are, are, are uh correct as of this presentation. So 14th of the of November things will start application deadline in December and then you'll have long listing, which will be based on your application to see who proceeds to short listing and interviews. And then after that, a series of offers are released and you have the opportunity to either accept the offer straight away or hold it and hope for a uh a more preferable option. And the reason being is all those deaneries that I had listed earlier, you have to rank them and you um in terms of your preference. Yeah, so there is essential eligibility criteria. Of course, number one, you have to be a doctor and you also have to have the MRC S by the time the offer is made. So if you're still waiting to do part B, that's ok. As long as by the time you know, April comes round, you've, you've completed MRC S part B, then there's no problem if you haven't, then unfortunately your offer will be withdrawn full GMC registration. So, and that can be done from abroad as well. You can still be registered with the GMC. So please do make sure you do that if you are coming from um overseas to come and um uh apply for national selection um successful A RCP. So this is as part of your phase one, your core training years, your CT one and CT two. Of course, you need to get that signed off. Uh And um, you need the appropriate visa, of course to be eligible to work in the UK. So when you do the application form, it's quite extensive application form. There's a total of C of er, 76 points available, of which the average cut off is around about 45 to 47. But it's been steadily edging up because the quality of the candidates is, is increasing year after year. So this round that's just gone, the cut off uh for shortlisting was a score of 50 we'll talk a bit shortly about how, what, what um what's required in order to, to, to get to hit those scores. Um The most important thing is that um you have to be completely integral and honest, there's no point trying to, to lie or to overinflate your achievements, just be straight down the line. Otherwise, if there is a, uh if it's, if it comes to light that you've thought to be um a bit um overzealous or not quite stating your true qualifications, then you will automatically be withdrawn. And more importantly, it will result in a GMC referral. So, so just put what you uh what qualifications that you have. Um So this is the application form. There's about 17 or 18 questions. We'll go through them, er, er, briefly now. So, you know, you don't get any points for getting a medical degree, er, the M BBS or the MD equivalent. If you've got a master's er, qualification, but you did not submit a thesis, for example, masters surgery, then you do not get any points and you don't get any points for a BSE or the automatical, a sorry, automatic master's degrees that you get from Oxford and Cambridge, there's no points given for that. However, if you've got a diploma in philosophy, phd MD, research thesis MC HMM S with a thesis, then you'll get six points for just having one of those uh below that is those who have um are currently doing one of those degrees but have yet to be awarded the degree. So you, so you only get two points for that. So if you have it completed and of course, it's much better, but they still acknowledge those who are still in the process. Um And then M se or equivalent without a thesis. Um You get uh you get three points for that question four since leaving medical school. So a lot of patients or a lot of patients, sorry, a lot of doctors who who have been doing um uh good work during medical school. It doesn't count really for this. This is all about once you've been a, a doctor from F one F two onwards. Um How many first author, peer reviewed publications? So the more the merrier maximum points available here is four. So if you haven't got a first author publication, you don't score anything for this round. And then the what's also in question five is first all the case report. So case reports often, um, can be a lot easier to generate, maybe a lot easier to come by. So you don't get as many points with that, but it's still worthwhile doing. So you can see that having two case reports here is the same as having one peer reviewed paper. And then you've got the non peer review, er, option at the bottom, you know, book chapters that you've been involved in BMA magazines, whatever you might have written, you'll at least get um, a point er, in this section. Now, audits and quality improvement projects again, since leaving medical school closed loop cycle. Really important. Yes, you've done an audit. But have you re audited and seen your change? So that's what I mean by closed loop to cycle quality improvement or, or uh uh er topic. So points available there and how many of the clo closed loop cyc calls er awarded in the, in the question above were urology based? Ok. So those who've had to do, who uh had the benefit of doing urology placement. So you get extra points there as well. Um Since leaving medical school, how many single cycle audits on separate topics? Again, points up for grabs here where you were the primary auditor that means you initiated, designed and completed the audit. How many of those have you completed? And at the bottom, how many single cycle cy cycle audits have you, er, er, urology based, have you been in? So, if you've got a single cycle non urology based project, you're probably not gonna get, uh, uh, any marks available for that. But where possible get stuck into some urology. And this is more for those who are maybe doing four months of general surgery, four months of orthopedics. I strongly recommend that you go into urology department and see what you can get involved with. Uh, now for presentations. Um, how many times have you given a first order, un moderated poster, national or international? Up to two points? Again, how many of the closed loop cycles awarded, er, were urology based? Um, since leaving medical school, how many single cycles of audits on separate topics? Were you the primary auditor? So again, um, lots of audit presentations here, er, to get stuck into. Now, the post graduate medical exam and teaching experience, have you been involved with? Teaching is really important? And it can, it can be as simple as, you know, organizing some urology based teaching for your F ones or F twos. Uh, every Friday make it regular, not sporadic is the best way. Um, II certainly did this during my, um, during my CT two and ST three lap years. Um, and, um, and the really important thing here is to get feedback. So just give feedback forms to your, uh, the, the doctors, the junior doctors or the resident doctors that you're teaching so that you can keep that in your father's proof of your, of your teaching and also proof of the quality of your teaching as well. Cos that often gets arts that can be arts at interviews, not just at registrar level, but also at consultant level and qualifications in medical education is a bonus. Um, not many people do have it but a lot of more and more doctors are doing, er, medical certificates um er in, in education as well, modular diplomas, MSC at the bottom as well. Gives you three points and then prizes, you know, have you been involved in medical teaching, training and delivery? Have you been awarded first place in any best presentation prize from regional or national meetings? Again? Really? Picking up marks. There's not many people who have those. So it all starts at the beginning and that starts with getting a project under your belt, getting it presented, getting it published, getting it um er er er presented at these uh national meetings and this is what allowed to be up in, er, give you the opportunity to win these um these prizes. OK. So, and then it comes on to your clinical acumen really. And um and there are some core procedures really that they want to focus on uh in the interview and it's essentially scrotal. So, you know, um epidermal cysts, hydrocele scrotal exploration, cystoscopy, original flexible circumcision and stent insertion. Those are the real four topics that you want to get honed in as an sho, to be able to do, uh, you know, supervised and we'll come on to what the definitions of level 12 and three are. But of course, the better you can, you are at it then the more points you'll get and I'll say the better what it means is that you can do it with a consultant site in the coffee room, er, sort of situation leadership roles. Um And look, you can even get Marksville president. Uh for example, um, opportunities will exist within your current department. You might want to take on managing the rota managing your current reg rotor, your sho rotor, things like that. But they're quite specific in that it needs to be done for six months or more. But any sort of leadership role you want to try and sort of hunt them out, sniff them out in your department because their points up for grabs on the, on the um application form for that. So now the interview, so as I mentioned, it's a competitive process. Um We've got about there'll be four stations, so we've gone away from a portfolio station. I think there used to be five or six stations and one of them was a portfolio station. But because of the robustness of that application form that we've just that we've just skimmed through, there's no longer any need to go into the station and reverberate, regurgitate all of that again. So now they're just four stations, communication, emergency, a skill station and then basically an outpatient clinic um setting. So here's an example of the communication station from er, this year actually. And I give acknowledgements to my um my current reg discharge as er, seeing for putting er, some of these slides together and, and the information. So classical stuff, the patient has ongoing left loin to groin pain, nausea, fever, poor urine output. In Stone clinic, the radiologist has reported uh passed stone which was treated conservatively from A&E and discharged from clinic. The medical student who was present with wants to review the images for learning and you find that there's actually a seven millimeter mid ureteric stone that was misreported and now the patient's heading into the car park. So how do you proceed? So this isn't really a classic. How do you manage acute obstructive kidney with a stone? This is all about candor, duty of candor. You have to be open and honest, you know, you're going to explain that. Yes, there's been a mistake made and I'll immediately go out into the car park and try and find a patient and try and bring them out back into the hospital in a safe environment, maybe in the presence of one of your nurses or your nurse specialists and go through the scans and explain to them what's happened and essentially put uh go through a duty of candor with the patient and talk about how you would like to remedy that. Um And of course, who you want to notify, how would you escalate, who, of course you will notify uh the consultant in charge of the patients care er, that this has happened and then what the next step might be, whether it's um, almost certainly being admitted uh uh uh urgently er for, for the most appropriate management and you know, this is gonna be, er, and there'll be an actor, you know, you're not gonna be speaking to AAA screen or a piece of paper, there will be an actor there, er going through this and there will be obviously quite distressed and it's all about how you can manage this cos you're gonna be quite stressed at the time. So practicing these sort of difficult conversations with patients is always, is, is always AAA recommended and um and other buzzword, things like pals, you know, if the patient was so unhappy and they wanted to make a complaint, then you'd know your normal complaints procedure for your hospital and how they can get in contact with the patient advice and liaison service. So for those who don't know, patient advice and liaison service will ps there's a route by which patients can um can express or, or communicate their grievances through the hospital and then they contact, they can contact the urology department directly or um escalate it to the clinical governor's need for the hospital um to see if anything needs to be taken further. So that's what the, one of the, er, an example of one of the communications, er stations, the other one that's quite common is, um, is a lost prostate biopsy specimen for a patient who's come for his results. So, er, just think about how you, you, you, you would communicate with that. Uh, the second is an emergency scenario. Um, so an example of this is classic Fournier's gangrene. Um 45 year old male background of type one, diabetes has had three days of scrotal pain and is tender recently shaved and should be told I had exactly the same history actually went on call about six weeks ago. Um small injury from which is healed and how do you proceed? And uh so those of you who haven't been on some sort of uh acute uh uh medical course or a crisp course or the care of the critically ill patient, then you should. But it's the usual stuff, your ABCD E um and uh resuscitating the patient and in line with uh a multi um disciplinary approach with your consultant, microbiologists and your a new consultant, anesthetists and your consultant on call. But the most important thing as long as you suspect Fournier's gangrene and know that this is a urological emergency, this isn't something that can wait until the morning, you'd want to uh get on with things immediately uh skill station. Ok. So they really want to talk about your technical acumen. Now. Um So uh this year, one of the questions was you uh inserting a, how you go about inserting a, a ureteric stent into a patient with a 10 millimeter distal V EJ stone might be quite impacted. What equipment would you need? What are your working components? So you cystoscope six, French Ureter access catheter 5050 contrast um er for your retrograde, if you can different types of guidewires. So when my registrars are in theater with me, we go through all the guidewires, you need to know the lengths, the diameter, the um the diameters of them. Um What's the difference between all of them? So if you don't, please do uh go through and know all the stents and uh guide wise that you use in your department and all the numbers associated with them who would need to be present. And how would you position the patient and ask for AC O? So clearly, they're talking about, you're going to need an X ray radiographer, you're going to need a cpod team, you're going a scrub nurse. Um And if you really want and if you wanted to have a consultant over your shoulder in the co in the or in the coffee room, then then, then say so. Um but just come across confidence so that the interviewer knows that you've done loads of these before and you're thinking about everything on very rare occasions. It's, it's really, it's um uh the, these can actually be lasered with a ureteroscope if you can't get through to just create a little access and then to pass a guidewire, not really to clear the stone but just to get us access. Um, er, which is an option as well, er, when the stones are very impacted. Um, and of course, if you fail, then you need to be thinking about your, your, um, your plan BS, you know, possibly to be nephrostomy or transfer elsewhere. But I think what you don't want to do is be struggling for too long. I think they'll say it's good to know, to know uh be aware of your limitations. And if you are struggling, particularly if it's just for a septic case and you do want to get your consultant in or aware sooner rather than later. Well, that's a classic skills station question. And then the clinical scenario, a 55 year old male presents with difficulty passing urine and reports, weak flow. Yeah. So your classical B ph, what questions would you ask him? What investigations, what management options? And this is all classical, um, er, call urology B ph stuff. Um, in terms of the questions, essentially, we're talking about the, the international Prostate Symptom score. So you should certainly know that I'd hope that if you are currently having the opportunity to do urology outpatient clinics, you will be asking every patient who presents with LUTS to complete one of those and go through those questions. Of course, you want to exclude any red flag symptoms, visible hematuria, um, full examination. Dre what investigations, you know, psa would they need a flexible cystoscopy? Would they need an ultrasound depending on what it seems to like? But you certainly want to do a flow rate, which is the, one of the hallmarks or the mainstays of, um, uh B PH management. And as we know, the management options are either conservative depending on their symptoms, severity, medical treatment with cancellation or Finasteride or surgical options. And as you know, now there is a wide caveat of surgical options for men with B PH. It's not just TU RP, we've got UFT ITIN resume aqua a hole, bipolar tu RP, monopolar TU RP in some units. Um uh So, um just to make sure you're aware of all of those, but that's a classical station that, that, that, that will certainly come out. So take home message, practice, practice, get into little interview groups, practice on Zoom or on teams with your colleagues um in our unit. Um Usually after the MDT, when it's coming up to interview time, the consultants will um grill the, yeah, those going for er interview and um and you really can't beat practice. Um So, so definitely um encourage yourselves to form some interview groups. Um read the up to date about guidance of medical clinical trials and studies are online and as mentioned, if you can attend any, any, uh, training courses that will always be beneficial. So, that's about the national training. Um, I don't know if there are any questions at this point or lamming or if there's anything in the chat box, otherwise I'll move swiftly on, almost swiftly on. Ok. So you passed the interview. Amazing. You're, you're excited. You're related, you're in the club now, the club to consultancy. So, it's an interesting thing. It's a great feeling that now your deanery is almost duty bound to train you to the level of a consultant, urologist, er, in the UK. But now the clock is ticking and er, the hard work really does, er, start now, I in the UK, it's a five year training program from ST three to ST seven, as mentioned earlier, you will be rotating through a single deanery and the aim of it is to train you to a level uh uh to the level of a day one consultant in core urology. It's not to train you to a robotic surgeon or AAA robotic cystectomy or a female recon surgeon. It's to train you to a core urologist. Ok. It's got three phases. I've touched upon phase one, which is the CT one and CT two. So you're now in the stage two going on to the stage three phase. So stage stage two is the ST three to ST five. And during this stage, you can sit the Fr CS part one and part two that does need to be endorsed by, I think, I think four urologists, 14 U consultant neurologists, if I'm not mistaken, uh to give you the green light to sit that and then the final phase is se six to se seven and then you get your certificate of completion of, er, of training. Uh, at the end of that, we're gonna come across a few abbreviations. Ok. That I'm sure a lot of you are already aware of, but we'll just run through these quickly cos they'll be coming up here and there. So AES is a designed educational supervisor. We all know what A RCP is. Um, W ba work based assessments, CBD S clinical based discussions, er, kick sips, which are capabilities in practice. And this is one of the newer, er, er, assessments which have been brought in now, er, good medical practice. National training number, health education England, who's responsible for the training of all the, um, er, er, er, medics in the, in the UK generic Professional Capabilities. Again, another new name that's been brought in more in the last year or two. Um, the multiple consultant report and we'll touch upon this a bit later, um, how we've gone from a situation of simply relying on one or two consultants to decide whether you progress after each year. It's, now it's now 3 to 4 and then we've got, um, clinical evaluation exercises which is a form of, of AAA assessment. Uh These are the supervision levels which we mentioned earlier in the application form. So level one is you're able to observe only. So for, for scrotal uh stent insert, insertion, er circumcision er cystoscopy, you really want to be at la uh level four, which is able and trusted to act at the level expected of a day one consultant for those sort of core procedures. Yeah. So the consultant of the coffee room and they just letting you get on with it. So if you're able to aim for level four, that's fantastic. Um Yep. So here's the assessment system um and it's portfolio based. So everybody should and it's all done via I EP the Inter National Intercollegiate Surgical Curriculum Program. So those of you who haven't registered with the ICP, please do even if you're not in training, um it just gets you used to using it, all the consultants are on it. So if you need any er er W ba S and Ks and, and things like that signed off, then um they can do that for you and it adds to your evidence. OK. When, when um coming to application um MSF S Multisource feedbacks, trainee self assessment. So you not only do your consultants need to do an assessment on you, you also get given the opportunity to, to critique your own uh progress as well. And of course, at the end, you've got this multiple, multiple consultant report, which then gene, which then gets fed to your educat approved educational, sorry, assigned educational supervisor and, and they then, um, present all this information to the ACP panel at the end of every year. So when you're, so when you've, er, let's say, for example, you've been, uh, you've got into the Yorkshire and Humber. So you start in Yorkshire, er, at, er, let's say you're in H, at Hull, for example, that means when you arrive, you'll be given a AES and a clinical supervisor as well. And the first thing you'll do is to have an objective setting, an objective setting meeting or a learning agreement and come up with what you want to achieve. And usually during the ST three to the ST five years, you really want to hone your core skills, you want to get the circumcisions tied. So you want to get your endoscopy and rigid tosc and cystoscopies and TBT S and T RPS, you really want to get those down and if you can do 50 to 100 of those in your first year or two, then you're doing very well. Um, halfway through that placement and depending on when you join, it might be a six month placement, but usually they're 12 month placements. So with a 12 month placement, of course, at six months you'll have a midpoint review with your, er, educational supervisor and you will have a review of your placement and then at the end of the placement. Of course, you'll have your final review to see how well you've done. And you can see now at the end of your uh sorry, halfway through there will also be a midpoint MCR. So all the consultants in your unit that you've been working with will be invited to submit uh feedback on your performance. So the learning agreement, this has been redesigned so that placement objectors are focused on helping trainees improve on specific areas assessed by the M MCR. Um Again, objectives are set at the midpoint review and then gone through again at the end to see if they have, if they have been met. So training time is indicative now. So it does allow, it does mean that trainees can progress at their own rate. And if you're doing really well, then technically you could progress faster. Um So we've, we've gone from a situation where it was numbers based. So it will say, well, you've gotta do 100 Q rps or you've gotta do at least at least 50 circumcisions. And if you don't do 50 circumcisions, then that means you're not qualified to do it, which is wrong. I mean, some people only need 10 or 15 cases in order to do it. So now it's all about levels have you can you get to level four, can you get to level, you know, level four or level five? And if so then great and if he took you 10 cases then fine if he takes you 80 cases, uh then, then, then fine. Ok. But um it's no longer are we sort of uh strictly on a AAA number of procedures based er, er, er cut off levels here. Now, the these are the critical uh conditions of the in depth procedures rather which I do focus on. I've already touched upon these urodynamics is up there as well. Truss or Tp, biopsy, lots of procedures. So that's, you know, as we mentioned, Uli Tu RP. Uh you've got two R BTA bit of um penis scrotal surgery there and ureteroscopy and laser tripsy. So for phase two se three to T five, you wanna be hitting at least level three for those and then the second half of your training, really, the expectation is that you should be doing all those other procedures pretty much semi independently. And um after each procedure, these are um all um you, you can ask your um clinical supervisor to submit or to complete uh clinical er, er, er KS and PBS and CBD s on them. So you, you still need to keep the logbook up to date now, just because we don't count the numbers, it doesn't mean that you shouldn't because, you know, we have to take everything with a pinch of salt and somebody tells me they've done four E RPS. Now, now a level five clearly that's not possible. So it, it, it does that it still acts as a bank of evidence. And your consultants will ask, you know, I will ask that, you know, how many have you done is what we always ask and it still rolls off our tongue rather than what level are you at. Because the number of times you've done something does is, does vary some degree of proportion of relationship to, to the level at which you can um execute it. They do keep your log book. OK. So here we have the GPC S multiple consultant report and this is what it looks like. So clinical supervisors would consider whether there are areas for development in any of these nine domains. Um So it might be a bit small but you can see professional values and behaviors and they'll either say appropriate uh for phase or area for development. So if it's appropriate for phase, they'll just move on. But if they click appropriate, sorry if they click area for development, then they'll have to write some comments er in the box in the middle. So we've got professional skills, professional knowledge capabilities and health promotion and illness prevention, leadership and teamwork, safety and quality improvement. So that's all about clinical governance. Are you involved in clinical governance? M and M meetings, audits, are you trying to improve? Uh uh have you demonstrated a um enthusiasm to any quality improvement projects in your department? Safeguarding vulnerable groups, education and training, research and scholarship and then the cis multiple consultant report, trainers will decide what supervision level to recommend for each of these and record this for each through the supervision level box. And uh it's interesting. So your consultants will give you uh their version and then you'll also do a self assessment and see where you are. And you've got outpatient clinics, emergency take ward rounds, operating lists and working in, in the team. So it's quite more, it's quite a generic and I quite like this actually because this is actually what counts this, this is 99% of, you know, your consultant working life here, these five points. So it's, it's, it makes sense for them to, to assess you on it during your training. And now this the RCP outcomes and you know, you don't want to be in a situation where you're, it's a daunting process. It should be an enlightening process where you go and you can see how you're doing, see what your consultants think of your progress. And you should have some idea. It shouldn't be a surprise really by the time you come to the RTP because you'd have had a midpoint view as well. Um But what you want really is the outcome one, which means you're achieving the progress and the development of competencies at the expected rate. Outcome two means not quite there. And in terms of specific competencies, so they need to give you additional training time and occasionally some trainees do get an extra six months added on to their CCT date in order for them to catch up and achieve this inadequate progress by the trainee. Similarly, additional training time required um release from program about training competences hoping that never happens to any of us or any of you. Um Outcome five incomplete evidence presented additional time may be required and that's a bit of a throwback to the days when you had to have 40 assessments done at the end of every year and the day before or two days before the A RCP. Most people just have 10 and then there's a big flow of activity um to try and get the, the, the remaining 30 done. And then the outcome six is right at the end of your CCT. This is the one that you want five years from the start where you've gained all the required competencies and you have been granted your certificate of completion of training. OK. So, so it's a systematic approach. It is they're, they're trying to leave little room for uh subjectivity. OK? Because there's been plenty of cases in the past where you just had a bad placement, you didn't get along with the consultant. And that was because of that. You had, you taken it with a bad brush and you just didn't progress that year, but now it's a multiple consultant feedback. So it's not just one, it's usually three or four consultants, uh clinical supervisor within your unit who are feeding back into the same pool, uh, in terms of your assessment. So, um, ii mean, as somebody who's gone through the training just to summarize, I know Orlan, er, gave her a lo synopsis in the beginning. Um, I actually did an ST three lap year first in the West Midlands. Um, they don't do laps anymore. That's a local approved, er, training post for registrar. Er, I did that in Redditch and Worcester, um, and then went on to do another five years of, um, ST three proper to SD seven, in Nottingham. And I thoroughly, I must say I thoroughly enjoyed my, my training and the reason I took my time you could, I could have opted not to count the lap year, but I wanted to count the lap year. I didn't, I didn't want to, um, rush my training, so I wanted to have the six years and I think that, that put me in good stead. So what my, my, um, my recommendation, my advice would be to make the most out of it. And we all, we're all here in this business of urology because we do love serving our patients and we, like, we love to operate and there's gonna be situations where you'll be given your rota and you may only have one session of operating a week but you notice that your urine, it has maybe four, you know, three or four operating theaters for urology, which have been used every day, go out there and get into those operating theaters. If you've got time off, if you um want to do some more scrotal expirations, even when you're not on call, you might have units where the registrar doesn't do nights. So I'm sure your consultant will be delighted if you wanted to come in and do the explorations. But that all adds to your ability. Um sorry to your experience and your confidence coming out. The other end from day one, actively ask about projects once you enter your department, OK. They could already have been started. Whether it's data mining, data acquisition that get involved, you always need to have some something um be involved with some uh some work. And as mentioned before, look for the leadership roles. And because all of those questions that were asked in the application about, you know, your research degree and leadership roles and things like that, they all get asked in your consultant interview as well. So, you know, the work isn't done once you get, once you get a training done, now you're working for er that consultant job uh at the end and again, always have a project on the go audit presentation, publication data is power. If you haven't got any information or if you're not working on a project, then you're gonna be at least two years away from publishing anything cos these things take time and never let A g, a bit of work go to, to waste. You'll be amazed what gets published on PUBMED. You'll be absolutely amazed like you can just go to PUBMED and type in random stuff and you'll be thinking, oh, my goodness. How on earth did this get, did, did this get published? So, don't think that whatever work you, you had, uh, well, it hasn't got the legs to get published. It will, you just have to find, find the right, uh, the right journal. Um Urology is great in the, in the fact that we've got, er, the British Urology, er, researchers and surgical training, the burse group, er, and the BSO as well. So if you can get any chance to get involved with those, um, er, those guys II would certainly recommend it. It's a great way to beef up your CV, to get lots of published, er, papers done. Um, I went to Vancouver to present for burst, er, the mimic study, which was about the spontaneous stone passage. It also got presented at AU A and they've had loads of, er, papers and things published out of it and that's simply just from, uh, collecting some data when I was at the Royal Derby Hospital. So do get involved with those, uh, with those, um, uh, uh, organizations and, um, everybody wants to be a pelvic oncologist or a lap surgeon to start off with. And, and as was I actually, um, wanted to do the open stuff. But the start of my training was when the robot was just coming in, a few units had just had it. So a lot of the consultants were on their learning curve. So the registrar didn't get the opportunity to get on the robot. But remember you're not being trained to be a robotic oncologist, you're being trained to be a day one call urologist. But if you do already know that this is definitely what, what you want to do, then you need to attack your training from SP three in that manner. So what you want to do is get all your level four competencies by the end of ST five, it's doable. So when you walk into your A RCP or ST six or ST seven, you can say actually look, I've got level four. So II wanna go to this unit so I can work with Mr X so that we can, I can get some robotic experience in. They haven't got a fellow, a robotic fellow and you know that that's a place to go. If you want to get some robotic experience or some andrology experience at Dudley or some recon experience somewhere else, you know, you can, you, you can um tailor your training, but if you go into se six se seven and you're still on level 2 to 3, then you won't be able to, you know, you can forget about it. You won't be given those sort of pick of the b for the opportunities to go here and there. Um those who almost certainly now you need, you, you will need a fellowship, some sort of fellowship. If you haven't been, you know, been able to, to fine tune your subspecialisation in, in the last couple of years, we were training and these are very sought after. They are, they're fr no, they're R CS approved fellowships, they're fellowships in Canada or Australia United States. So, and they're all very competitive. So if you are thinking about that, then there is information on the Royal College of Surgeons website, the ba website. Um but you want to start thinking about that almost two years or more before uh before that there is a cure of uh of um candidates lining up for those as well. So start thinking about that early. There's a take home message there. And um and the other thing, you know, 80% people say that 80% of um the trainees are want to be oncologists, but only 20% of the jobs are in oncology. So keep yourself flexible, keep yourself fluent, keep your, keep your, keep your mind open to other opportunities as well. And look, the bottom line is your training, your training program, your training years is a five year job interview. OK. The like the likelihood is that you will be appointed as a consultant in the Deanery in which you train and that usually happens 80 to 90% of the time. So get the know the consultants, let them get to know you find out which hospitals you like which hospital run. Well, who's got good camaraderie, where do the consultants support each other? You know, you know, the last thing you want to do is walk into a day one consultant in a toxic environment. I must say there are few and far between in urology, they're usually a good bunch, but you wanna get a feel for that during your training as you rotate from unit to unit and don't be, be put off if somebody says, oh, that's a bad unit. I mean, it's, I think it's important to know what a bad unit looks like and if it, you know, and the chances are, but actually it's actually not that bad. So, so keep your mind open and do and do, um just do take it all in as you're, as you're um touring the, the Deanery, er, year to year and remember who you start off as a, as a, when you start off at ST three, you're gonna be a completely different person come by ST seven. When I started S D3, I was single with no Children and by the end of SD seven, I was married with two Children and my priorities had slightly shifted. Um, and I moved away from oncology during my surgical training and wanted to do something more um endourology based and I'm very happy for it. But um, so just keep your mind open and see how you go. But for the most things you really want to do your best to try and enjoy it. Thank you very much. OK. Thank you so much. Um for the very elusive and um enlightened presentation. I actually thoroughly enjoyed this and I'm sure for us share the same view. Um So like I said, when we started, we'll be taking the questions um for both presenters in the end. So right about now, we'll be going over to the second presentation on the Caesar pathway that will be given by MS Ijeoma Chiua. So I'll just go through a brief about her profile. Um She got retired from University of my degree in 2007 with distinctions in anatomy, physiology, biochemic, and community medicine. She completed her residency in urology at the University College Hospital Ibadan where she was the former chief resident at the Department of Surgery UC H. She owes a fellowship of the West Africa College of Surgeons and Fellowship of the Medical College of Surgeons. Uh And she was the best Ging fellow, the Faculty of Surgery. At the time, she obtained a master's in Surgical Sciences from the University of where she finished with a phd grade. She has a postgraduate diploma in genomics. She was a urology fellow at the Hospital for NHS Foundation Trust and sequent back the fellow College of Surgeons of urology. She is currently a Caesar fellow at the Royal Hospital. Join me, welcoming M I Mazo as she takes us through the Caesar pathway. Thank you for that warm introduction. Um I shall share my slides. It's quite an honor to be here. I'm going to be talking about the Caesar pathway. Um Can you see my slides yet? Not yet? Ok. Yes, lovely. Right. So the name has changed, so it used to be called article 14 and then that changed to C A which is the certification of eligibility for specialist registration. And now from November of last year, I changed the portfolio pathway. Um and it's meant to be an alternate route by which people who have not gone into the national training program that Mr NW has talked about can still attain um consultancy posts within the UK. So we'll talk about how to achieve it and what to expect. Um Sometimes we have people who have also gone down the national training route, but for some reason, they did not complete it, they can still also apply for a Caesar route. People who come from foreign countries, they might have finished a training program there or have acquired significant expertise in urology. They can also apply for the portfolio pathway. So they are not in a GMC approved training posts, but they are eligible. Now, I'm going to start from the very beginning because as Mr Lari Wa has mentioned, I did not train in the UK and a lot of people will have similar backgrounds. So the question for some people is not even how do I start this portfolio or Caesar pathway, but rather how do I get into the system? And for international medical graduates, they are different avenues. The commonly known ones would include examination routes. They could come via the club or straight into a surgery with the MRC S. They are masters programs in surgery that by the end of completion would offer a GMC registration. There are some master's programs in surgery that are affiliated with universities but they are clinically related. So whilst the person is doing the master's program, they are also working in the NHS. And that way they have a GMC registration. They are gaining clinical acumen and they are working towards their goals clinically as well as in the medical real. Um coming to my mind right now is the edge hill university collaboration that is quite popular and it does offer such opportunities. Another mode of admission into the GMC for international medical graduates is the academy of um medical education or the Royal College of, of um educate of surgeons. They have medical training initiatives which will allow um those with clinical experience to come in without MRC S or the PL because they take into consideration what you've done in your country um or and compare it to the curriculum here that affords you two years of opportunity to train in the UK. And within those two years, you can work with specialists and then gain form report. And they might even recommend you to go on to have the Royal College of Surgeons Fellowships. And all of that. Lastly, we have the international med medical graduate sponsorship scheme which works in a similar way. So once the GMC registration is achieved, international medical graduates might come in in different job capacities, whether it's the SAS the specialty doctors, some might be local consultants, locally employed doctors, associate specialists, surgical house officers, the works or once you're in just remain focused, recognize what you want to achieve and work towards it. Remember to update yourself in terms of professional development, have your appraisals and after 3 to 5 years, your validations. Now as I said, I'm coming from the point of someone coming into the UK from somewhere else in the initial phase, it is quite a jolt. Um It takes time to find your feet and understand the system, which is why I'm really proud of the organizers who have the foresight to recognize that people need information and such for as this will provide that information coming into the country, having a mentor that can show one what is required is also important. It's also important to recognize that our systems are different. Knowledge is power or sometimes knowledge is not always enough, the textbooks are similar but the environment of practice is different. One might have trained more, for example, in open surgeries and realize you're coming to an environment that most things are minimally invasive. So there shall be deficits and skills. One might be coming into an environment where the mode of evaluation by the senior colleagues is different. For example, as Mr Quam was saying on arrival, don't waste time in getting on the IP portfolio register early start getting assessed for different procedures, don't leave it till the last minute. Another thing to recognize that there's a deficit in is the experience that you might have paid more attention to in your specific countries is different from what is acquired required here. He has gone through quite a lot of them and it is similar for the portfolio pathway. The reason why it was changed was that they wanted the portfolio pathway or the Cesar pathway to mimic the CCT pathway in its entirety. There will be challenges with that. They wanted to prove that it was equivalent. Um And the whole idea behind that was to say this person who has come from a different country has done a lot in their place and it is equivalent to what is done here. However, the issues that international medical graduates were facing was that there is a time limit of six years within which you can show that what you have done is equivalent and submit that for a lot of people coming from different countries. The six year limit has elapsed before they get on the Caesar pathway. So for example, if you have done pediatrics where you were before, it might have been over six years ago and then your current hospital where you're working does not have pediatrics and you're struggling to show the equivalence. So now with the portfolio pathway that has been scrapped, and it's just demonstrates that you have the adequate knowledge that a day one consultant should have, demonstrate that the skills are adequate and you have the experience and we'll take them one by one. So I'm not going to go into the old curriculum. I am aware that some people may have already applied for the portfolio pathway with the old curriculum, but that ended in July 31st. So henceforth, all that is being followed is the 2021 curriculum and I would advise that we um get conversant with it. I have found that a lot of places that people were getting caught out was international medical graduates were coming to the United Kingdom with Fr CS degrees. However, they were caught on wars by the fact that there is more than one Fr CS exam. The one that is recognized in the UK is that of the J ce not the J CF E. Nowadays, they are accepting the results of that, but you still have to write the second part, the vi a voucher. So they will accept the part one result of the International Fr CS. But you still have to write the vi a voucher here. So once you're enrolling, please make sure it's the JCI E platform that you are on. There are specific revision courses that are important as we prepare for the Fr CS. Um And I tend to find that because of the different mode of our exams, I'm speaking specifically for my training. Now. Um the way we do our vas is different, the rapid flow of analogies and the fact that you have to reference particular studies is different. And so we have to learn that when we come here. So it sometimes comes as a shock, but it once you know it early, then you start working towards it. And for the portfolio applications, once you have the Fr CS application, then they're happy that knowledge is covered. So you don't have to do much more than that if you want to demonstrate further knowledge with the European Board of Urology exams, the fe that is also fine, but the main one they require is the JC Fr CS. Um So for the application, as I mentioned, coming into the country, one needs to family arise oneself with the system. You have to be referred for the Fr CS. Previously, one could write the Fr CS without having an MRC S. But now that is not the case. So everybody must have an MRC S before they apply for the Fr CS. It's requires that you have a, have worked with the people referring you. It used to be strictly at least two years, but now once they are confident that you are capable of writing it and being safe, then they are happy to refer you. So now it's down to at least one year of UK, practice three referees are required as a minimum, one of whom should be the head of department, commonly termed the clinical director here or the medical director and they should be registered with the GMC. So common questions that people ask, can someone back home refer them if the person is up to date with the GMC? Yes, they can be a referee for the FR CS. Um When I started the first phase of the portfolio journey, I think one of the daunting things and I've discussed with other international um practitioners. One of the daunting things was the difference in statistics for those who were within training and those who were not considered trainees. And it was the statistics over the years had shown better performances with the non train with the trainees. But over time, this is getting better for the first part of the exam, which is the objectives, the multiple choice question, the gap is much less as you can see. But when it came to the viva, the gap became quite wide, 89% pass versus 37% pass. And that brings us back to the way we articulate our thoughts and our discussions all through the training years. They have, there are teaching sessions and they are viva practices. So coming into the country, it's important to start early to have a group and learn the mode of the virus here. So this is just to understand the nature of the exams and the parts involved in the FR CS exams. Um for the virus. I'm not going to repeat most of these, but it's important to because a lot of us are adult urologists. Um to find that one has a predominance of pediatric urology in one of the sessions that can throw people off their guard. But if you know it, then you work towards it. And I have to say these were the books that I found the most helpful as I prepared for the FRCS exams. So, um the other important thing is for things that one is not so conversant with the pediatric sessions, the female and functional urology or spinal cord injuries. There are courses and viva um sessions available for that. I have left some of them on the slides so that you can be aware of them. Um A lot of them are affordable and please take advantage of them. The other thing I have to say for those preparing for the viva is in addition to ensuring that you are up to date with recognized papers that are for or against what you're discussing. Also remember that they are standard consensus documents that give guidelines for whatever is being discussed. As I'm saying, as I keep emphasizing this might not be what one is used to in the countries. But we always know about the British Association of Urological Surgeons guidelines, the A UAE AU and Bao has consensus documents which one must be aware of before going for the exams. I have not updated this list but now there's an additional one on ketamine bladder. So just know these before going for the virus with the old curriculum, there used to be mandatory courses that were required for a portfolio application with this portfolio pathway. Those mandatory urology courses are not there, but we do have mandatory courses that apply to everybody and I shall mention those. So when putting in the portfolio application, remember to include evidence over the last six years. But as I as a lot of people might have experienced on coming into the country, they might not have got an NHS job. So there might be a lapse in the consecutive number of years that they've worked for with the portfolio pathway. The last two years are the most important. So just concentrate on those if you don't have up to six years of consecutive evidence to include. And the most important thing is for the last six months before submission, one must not have been out of practice. All degree qualifications from an overseas nation need to be authenticated. So we need to get a notary or a solicitor to do this. And the hard copies of the a authenticated documents need to be sent to the GMC with the application. In some cases, the awarding body needs to verify that indeed you receive probably a fellowship or a degree from them. I will specifically refer to myself. So I had fellowship of the West African College of Surgeons and that of the National College. And those awarding bodies needed to confirm that indeed, that was obtained and that was sent to the GMC directly. Also, you need to show that you're in good standing with your regulatory body in your country and they have to communicate directly with the GMC to confirm this. Some people req have documents that are not in English. So this has to have a two step authentication. So first, it has to be authenticated and it also has to be translated and the translated copy needs to be authenticated as well. And all of those need to be sent to the GMC as regards research, I shan't repeat what Mr Quam has emphasized on because most of it applies to the portfolio pathway as well if one has a postgraduate degree that involves research. So it has a dissertation that is a plus mandatory courses that demonstrate knowledge of research are those in red. So the research methodology, these are it has to be an NHS approved one and or even one with the Academy of Education, medical Education or and then the National Institute for Health and Research, good clinical practice that is mandatory, common ways to get other complications. As he mentioned, he mentioned the burst. That's a good way to collect some data. Have a collaborative um audit, sometimes like in COVID Stones, that was a complete cycle of an audit. And then there is published work from that. So if you're not on it, please google it and join and participate. Um The easiest thing to do is also be part of a journal club in your center. If you don't have one, you can always start one. Not only will that fill the leadership box for you starting that, it will fill the research and it will help you in terms of the Viber because you are used to discussing thought processes and discussing scientifically, then for those who are coming from overseas countries, one benefit that we actually have is that for the fellowships, we need to do dissertations and you have to go through the process of getting ethical approval and designing your protocols. So just make sure that you don't discard that and think you have to start afresh. That is a good thing as long as within the last six years. So in addition to those things, he's mentioned, this is the category of authorship that is required for the portfolio pathway. So as you are participating in studies, try to get your first authorship sorted. And then in terms of audits and presentations. Make sure you have at least two, either podium or poster presentations as first author. I get a lot of questions from people who come from um outside the UK about how to get involved in quality improvement projects and how to get involved in audits. And I will just bring your thought process back to what you were doing in a lot of the centers back home. A lot of people would have had um grand rounds where you ha you have a particular either a pathology or a quality improvement that you have worked on and you present it don't discard those. And it's similar to what is, what happens here. There might be a problem that needs to be addressed and you figure out a way to do it. I will speak practically. Um I saw in my center that there was an issue with patients having negative stone endoscopic surgeries and worked on a way to reduce that by altering the imaging surgery intervals. And that was a dual cycle, as he mentioned earlier. Um You have the Demming cycle. So you find a problem, you figure out you design a study then based on the results and the findings from that, you see if you can implement any resolutions that you, that have that, that the study is pointing to. So if there's something that you can improve on and the first cycle has shown you that is possible that this can be where we can improve, then you reinfuse that and re audit it and see if your changes have made any difference to the system. Don't think big a lot of things can be changed quite easily. Um And one mistake I find that people make when they get to the apartment is they don't ask questions, what needs to be done. What can I get involved in? Don't leave it till the last minute because there's usually so much going on, you just need to open your eyes in terms of education and training. We need to mandatorily do the training, the trainers course and a lot of hospitals offer this course. If you ask the education department, they might have links, especially with logic training. Um that makes it easier for you to get involved with. Um Another thing that we tend to forget is when trainees send us assessments, you need to include those in the portfolio pathways that's showing that you've been supervising people in the I SCP PA um platform. Remember to fill out an observation of teaching so that one of the consultants can assess you as you teach, get feedback from the trainees. Um Don't leave it to the last minute when nobody can remember what you you taught, get involved in teaching programs. A lot of hospitals have hospital wide teaching contact, the coordinators, tell them that you're interested. Let there be timetables that show your name fully for the portfolio pathway you need at least three of those to be able to submit. Um And then there's another practice that we're not really used to reflective writing. So I've included in the slides, a, a link to reflective writing. You can get it from the GMC um website as well, but include reflections on a lot of things. Those are quite important for the portfolio pathway. Once again, management and leadership Mr Nw has mentioned easy ways to actually get involved. The ROTA is one of the easiest ways. Um Bao has a working party for SAS. They keep calling for people to apply, apply, ask to be an audit lead. All you need is a six month period where you've demonstrated leadership. Even if there's nothing you can identify, sometimes it might just be in um being part of the infection governance. So sometimes they have meetings for ho health care associated infections. Being part of that is an easy way to get a leadership tick box, shadowing a manager, the clinical director might have meetings that he goes to the CD meetings, ask if you could shadow him for a period and then get evidence that you've done those mandatory courses that boost your portfolio application, UK health service management and leadership courses as well as consent related courses. Now, with the good clinical practice, there is a module for consent. So sometimes that might suffice but just to dot all I's and cross the T's, there are a lot of free NHS approved consent related courses that you can include when there's a complaint. Don't be saddened, discuss it with your supervisor and include how you dealt with the complaints in your portfolio. Also include reflections on this now important for the portfolio pathway because the portfolio pathway is not as charter as what Mr Enam described, many people might be working independently. So a lot of times they don't remember to document what they are doing or to seek for someone to supervise what they are doing so that they can get assessed, please don't make that mistake. Um Once all your evidence is put together, it needs to be verified. So for every institution that you have worked in and you're submitting evidence for that covers the last six years, there needs to be one verifier per institution and all those domains that I've mentioned evidence from those need to be included and one needs to now enter them saying what the institution is, what the document is, the years that it covers and you have to be very specific about how many pages are in that document. Now, one does not need verification for these things that I've listed here, but they need to be included in the application. The person who is nominated as a Verrier needs to be contactable by the GMC within 3 to 6 months of the submission. If they can't be contacted, then unfortunately, you will have to start again to look for a Verrier. Um They have to confirm that what you've submitted is what they have approved. So please discuss the evidence that you're submitting with the Verrier before you submit it and let them be aware of everything and they must have worked in close quarters with yourself during the period that you're referring to. In addition to the verifier, you need at least four referees. And as your so choosing referees, remember that they must still be in clinical practice or if they've retired, it hasn't exceeded three years. Now. As he's mentioned, the capabilities in practice are the high level learning outcomes that are relevant to surgery. And these are the five that he has already mentioned are relevant to CT. So the important thing I will tell you that took me off guard was as you are running clinics, keep your records, a lot of us might have independent operating lists, independent clinics, but you're focusing on service provision rather than the end goal. So keep your records as you go along. And important things that I did not pay attention to initially was for example, patient communication letters, there is a specific category for letters to colleagues, including the general practitioners. But there is a particular category for letters directly communicating to patients. I have to show evidence of that and it has to be in vocabulary that the patients can easily comprehend. Um then there needs to be evidence of multidisciplinary team working as well as discussing with colleagues about patients, all those need to be included. So aim to have at least 3 to 4 of each as you are building up a portfolio. Um The multiple consultants report on the I SCP does not apply to people that are going for the portfolio pathway. So it's very nice to do the MSF multisource feedback and keep that as well as do the M the multiple consultant report on the ISA P. But you cannot use it for the portfolio pathway. There is a separate one for the portfolio pathway and I've included the link there. Now, the difference is one has to have met with two or three consultants and have a discussion with them and they have to agree to prospectively assess you over the next six months. And when they agree to prospectively assess you, there should be a document that is signed and dated saying these two or three people will in six months, time as a minimum come back again and then do a multiple consultant report assessing your capabilities in practice under those five domains. And your aim is to be a level four of five, level four as Mr Nw has said, able and trusted to act at the level of a day one consultant, level five, acting beyond a day one consultant. But with the portfolio pathway, if that initial agreement was not made, then the document is null and void. And if it's submitted on the I SCP it is null and void as I've mentioned before. Don't be discouraged. Thinking of starting from scratch, you can have your work included from overseas. Just make sure that whoever you are asking to be a verifier has an institution based email that GMC would be happy to communicate with rather than a personal email. The similar standard of authenticity as Mr Wa says remains. So when you're thinking of management and leadership, whether you are the chief resident or you were in charge of organizing stuff, get all of those documented appropriately signed and stamped and you can include them um logbooks from home, don't discard them. You can enter them on the I on the E log book and include them as well um as well and then make sure that you also get from home, the description of what the residency training is like as stamped by the department, the burden of activity in your training center over a year period. So you can get um the patient burden in the clinics, theater burden include all of that, get all of those stamped and signed and use them for their portfolio application. Before a lot of international medical graduates might not get permanent jobs. You might have to leave and work in different hospitals and require different visas for that. Before you leave any institution. Please make it a point of duty to have the hr send you the departmental workload. Have a testimonial from the manager about your work ethics and have stamped and signed job descriptions, ros and of course, you already have your employment letter. This is just an example of one of the plans that I had got from one of the institutions before I left. And of course, the rota and I didn't include the workload, but they gave the departmental statistics. So that will be for experience category in terms of skill, the portfolio pathway just like the new curriculum has moved away from numbers. But because the portfolio pathway candidate is not always assigned an educational supervisor, a clinical supervisor, you need some guidance to be able to know what it is you need to have in your logbooks, which are going to be submitted because we are still going to submit the logbooks even though it's not number dependent. But at least this picture I've included and the numbers will give you a guide as to what you should work towards having in your logbook. And when submitting you submit in the E log book format, consolidated report and separate each submission by institution that you've worked in. Also when you're demonstrating skill and including procedure based assessments. Remember to upload your documents based on these categories. So subspecialties as well. So since a lot of us are adult urologists where we get caught out out, the DG HS might not have the district general hospitals might not have pediatric exposure. And since you're attached to a hospital based on the visa, you might not be able to move around. So how does one work around this? Because it has moved to being competence based. One can have case based discussions about these key points which are listed on the website. These are the key topics that you need to have. Level four case based discussions, clinical evaluation exercises on. And because a lot of centers still, even though they don't tend to pediatric urology, but they would still do a scrotal exploration for torsion. You need level four assess procedure based assessments for scrotal exploration, orchidopexy ligation of processes, vaginalis. The other possible thing to do is to discuss with the clinical director or if you have a clinical supervisor or educational supervisor about having a contract with another hospital that will permit you to go on your s pa time to work with these centers that have pediatric urology procedures or clinics. You will be able to then submit the contract and get a verifier from those centers. When you're submitting for the portfolio pathway. Now, they want at least 40 dedicated days or three months of pediatric exposure that can be difficult, but it is doable if you try. What we've just said, um the other opportunities is that a lot of centers are having what we have Caesar rotations. If you notice I was introduced as a Caesar fellow. So that allows you to move between hospitals, not having to bother about changing a visa between hospitals but getting the necessary requirements you need as you go along to be able to submit, keep records, please e everything might not be given as a performer. So I've just put what I designed for to show evidence of what I was doing. So this is showing wherever I go for pediatric postings or clinics. I put I log it in and I submit this. Uh every patient I see that has an andrology problem or um surgeries I do. For example, the, the top one is a tenectomy for an abortion that I did. You know, I log them in just to keep showing the evidence that you're keeping up to date. That's the most important thing they want to know that even if you've been practicing for ages, you're keeping up to date with the professional skills required. Um as you are filling in your work based assessments, remember that it's don't keep filling the same things. They are index procedures that must be filled and I've put them here, Mr Nw. Also mentioned them, aim for level four at least nine procedure based assessments with a minimum of three assessors. As you're entering it on GMC online, please be careful enter institution by institution. And I've added, I've shown how before I enter them, there is a list that is showing what CBD S you are providing and then you actually add the CB DSA list for the kus a list for the directly observed procedures. So be systematic about how you upload them. Um and the same way you upload them is how they should be referred to on the verifier form that the Verrier is going to sign. Please make no mistake in switching things up because those are little things that could cause a rejection. Now for the critical conditions, a lot of us see patients and don't remember to enter these on the I SCP. So I'm bringing it to your, just bringing it back to your attention for every acute scrotum. You see, you might not remember because these are things you've been doing for ages, but it's important that you get a level four assessment on that and those are the critical conditions. All you need is just one for each of them. Unlike the index procedures that you need nine from three different people, a special interest module has been introduced with a new curriculum. So as you're submitting for the portfolio pathway, choose one of these, it can be endourology which will be a flexible U RSS and you need a level four for that. But whatever it is, these are the required levels of assessments that you require and you just need four PBS in whatever special interest module you've chosen at the appropriate level prescribed and just by minimum of two assessors. So you have to declare a special interest module. I've tried to mention the peculiarities and the differences between the CCT. But the import you, even if you're not assigned an education or clinical supervisor, you can request one, initiate your um multisource feedback because you might not always get them to ask you to do one. So just initiate it, sometimes you might feel that you are being tuned towards service provision because you are quite competent and can run independent things, but don't lose track of what you need to tick your boxes. And you can always discuss with the managers and rotor coordinators so that you get things fitted in. If there are no teachings, start one. And remember going for those courses, I remember I mentioned many people might not be aware that hospitals have education budgets. So key into those and that will reduce your cost on the GMC online platform. Once you open the application, you have 24 months to be able to submit. After that, everything you have been uploading will be scrapped. So try to complete your entries within those months. It's a lot of work putting multiple assessments in one document, some of the documents might have 100 pages and I put them pain stickly together, but invest in a good PDF software software to do this. Make sure you redact all patients details as well as junior colleagues details. If you make a mistake and submit that don't be discouraged, it will be brought to your attention. It can be a cause of rejection But if you are resubmitting, painstakingly, make sure you don't do the same, reflect on it as well as include a data confidentiality course that you have done, try to restrict yourself within this and try not to duplicate any evidence. You can always refer to sections. For example, if you published an audit in the publication section, you can refer to the audit in the audit section. Don't upload it again. Don't be as slow as a tortoise and don't race at the last minute. Cos you're going to miss something, but just every day put something in, build up your portfolio and make it look good. These are the key points I've mentioned and then coming from a foreign country don't isolate yourself. People have done this before. You are not Christopher Columbus and discovering it an new. No, they've done it before. Don't be the example, learn from their mistakes and um get the tips along the way. So once it goes through the first pass, the specialist application team would go through the um what you've submitted. They will identify things that probably were errors or you didn't understand it from the specialty specific guidance provided. And they will give you advice and guidance on how to strengthen your application. So it won't be rejected and you can pass through, they will give you up to two months to do so. And if you can't finish, ask for more time and then resubmit, they will look through it again. Once they are happy that it is strong enough, they will forward it to the assessor. If it becomes an unsuccessful application, you can apply for a review if you feel it's, if you feel that what you've submitted is sufficient, but you just have to provide a commentary on that and then the specialist application team will look at it again. Now people get worried. Um a a lot of people and there have been publications saying the person who pull the portfolio route may not be equivalent to the CCT route. But that is not the idea. Um I think the objective demerit of the portfolio route is that it's restricted to the UK. So it doesn't apply to those who are in um who are outside the UK, in the in Switzerland and the E EA member states. So that's the restrict the objective restriction. Um The fact that there's no defined time frame is not like the other one that is five years, definitely you have to drive how far you go. But trust me the way that they have tried to make it more structured, who helps. So you just need to know your goals, start from day one and move on and it seems like a lot of work. But in the end, you achieve the goal which is to get a substantive consultant post as you go along just as Mr Nw said, don't get sidetracked by the glamour of probably robotics or something like that. Just make sure that wherever you go, you are relevant and you can make good contributions, you can carve your niche. Um All right. So once you get the Caesar, remember, it doesn't stop there. As he mentioned, start thinking ahead of what you're going to do next, where you're going to land, you will want to do some fellowships. You could also start with local consultant posts to get the feel of it, attend consultant courses, learning about job planning, business, case development and where you choose to work, think of the team spirit and the camaraderie there. Just as a farewell, this was at the last bows and it was such a beautiful slide that was projected by the bow, outgoing bows president. And it showed those who had CCT as well as those who had gone through the portfolio pathway in that year. Everybody's on the same page, everybody's a winner and it's high five to all of us. One of my mentors is there, Mr Rotimi David who helped, he finished from I A and he also helped um with my application. So I thank you all for listening. Um Free to answer questions. Thank you so much. Um Miss Ie Mazo for this very exhaustive and interesting discussion on the Caesar pathway. Um A lot has been said and I would say that um I really gained a lot from it and I'm sure others would also share the same opinion. Um So the floor is now open for questions. Um questions if you have questions we could ask and we could also put it in the chat box. Mhm Any question I have some questions. Um maybe I should just start with myself. Um So the questions for um mister um I would like you to throw some light about which conferences you found most useful um regional national International conferences. There are quite a lot of them, but which one did you find most useful in terms of your, by going through your training? And which ones you think are kind of quite relevant that would add a lot to one's portfolio as one goes ahead with training. Then the second question is um how much can one claim from one's study allowance? The educational budget, is it unlimited for trainees? Is or is there, is there, is there a cap to it? And um how can one explore the benefits of this and not um be short change as one goes through training? Because I feel it's important to be aware of all this such that one knows what is um available. And then the third question is um um what are your thoughts about doing a phd during training? Um Some people would say you take some time off, maybe three years. Some people say you can combine it, you know, all those kind of things. So what are your thoughts about that? And the questions I have for um MS um Chiua is um for the C A pathway. Most people when, when they get into the UK, um they don't really think about the Fr CS exam. So what do you advise? Is it work for a while? Do the Fr CS exam? Because I had some, I don't know if it is true. It is said that the starting point of the part is you even passing the Fr CS first. So what would you advise in that regard? Like should one focus more on getting the Fr CS out of the way first or just try to keep working? And then when you think you're ready, go for the Fr CS exam. And the second question is um based on your knowledge about the Caesar pathway, we hear about Caesar friendly hospitals or Cazar friendly centers. Are there, are there some you could actually maybe recommend or maybe some particular regions that you feel? Is that such that even those that are out of the country and would like to come into the country can actually look into applying or getting jobs in some of those centers? So those are my questions. Um So you just to take the questions together. There's a question for MS Chiu again from the chart book that what are the requirements for research for the disease that passed away? John Daniel, I may ask that question. So you can take those questions first and we'll see how it gets on. Thank you. So you can go first. Ok. Yeah, thanks for the questions. I'll ask the question about the budget first. So I think the budget is around about 500 to 600 lbs. Um and then everything else you more then you'll have to come out of your own pocket. But I do check um er with your or when you um when you, when you're drawing it can't get you too much, you know, I mean bounce is, that's a, that's our annual UK meeting is, you know, 304 105 100 lbs depending on how many days you want to go for. So it, it is very expensive but the budget will not allow you to, to go to everything all the time. What I would recommend you do is try and um align yourself with some, some of the industry. They're always happy to support educational grants. Um the drug company. So you might have some reps that come to your M BT meetings um talking about, you know, various drugs and things like that. They get their contact details and let them in advance. Usually if you send them an email from an NHS email, not a private Yahoo or anything like that saying that you're, you know, you're wanting some sort of offer of support for an educational grant, then they may be able to contribute something to that. Uh your attendants at a meeting even if it's just a, a hotel room, I'll then go on to question three, which is about the phd. So your phd is not necessary. Um, it all depends on what you want, um, in life. So even amongst us, urologists, we've got academics and non academics. So the academics tend to either already have a phd or highest, er, post graduate degrees or look to do that during their training, which is absolutely fine. They tend to align themselves more with research posts during their consultancy, er, years, er, rather than clinical posts. So, if you are more academically inclined then fine, but I wouldn't do it just for the sake of doing it thinking that it's gonna get you a better job. Um That's not necessarily, uh that's not necessarily the case. So that's not necessarily the case. I will ii will focus on training unless you are absolutely hell bent on a academia in, in urology. Uh And in terms of the conferences, I, um they're all, they're all very good. Uh But for different reasons I find. So for example, one of the first conferences I went to was the West Midlands Surgical Society. That was one of the first places where I ever presented anything. And it's a quite a nice small intimate meeting, but it gave me the first opportunity to be able to present some data at a low cost. I believe it was like 50 or 100 lbs to join. And it's a, you know, it's one tick box on your is EP portfolio, uh et cetera, et cetera. So they're actually quite nice and quite good. Um And then you've got Baus, I found Baus was very good for courses. Um So there were, there will be like a trauma, trauma, trauma, nephrectomy or renal trauma course or ATR P course or these sort of things where you can get some tick boxes on and build your portfolio. But I must say hands down the best conference is the E AU. Um And I found it particularly attractive because it's free for trainees. So if you are, for example, as a consultant, I think it costs 1000 lbs to go. So, hence, I've never been as a consultant, but as a registrar I went every year, I think I only missed one in six years and because it's absolutely free, all you need to do is pay €50 a year, at least it was back then. Uh €50 a year and then you get free entry to the conference and it's a fantastic conference. There's 20,000 urologists plus who attend the conference, loads of education, loads of courses as well. So the courses are, they're about 20 they're €25 something like that. So really cheap, you can book 34 or five courses, beef up your portfolio, beef up your ICP and um and really get a lot out of it. So really look out for them where you find that the location is not too far, maybe like Paris or Amsterdam and you're not having to travel to Greece or Turkey or something like that. They're usually very sort of commutable and accessible. Well, not commutable accessible. So you're not paying too much in flights and accommodation. And again, if you do, if there is a flight and accommodation layout, then do speak to the people in industry who might be able to support you with an educational grant er towards it. But if I had to pick one as a trainee, definitely eu thank you so much. Um So um MS Chua can go for our questions. So I think one of my slides was don't compartmentalize one of the key points at the bottom was don't com compartmentalize what you're doing. Don't restrict yourself saying I'm going to do the Fr CS and then I'm not going to do anything else. No, because the Fr CS is just an exam you will read for multiple choice questions and you will practice for the viva. But as you are going along, as our people will say, time waits for no one as you're going along, you are building up the other domains that are required, which is why I said immediately you come in, start with the I SCP and you're filling in the work based assessments as you go along, it is based on your work ethic and etiquette that the consultants will be able to confidently refer you for the Fr CS. So you can't just start waiting for the Fr CS from the get go, you need to be doing the other things as well. Um And now that you have to have the MRC S before you go for the Fr CS, there's a little bit more to do before you get to the Fr CS if you don't have it already. So don't just think of the Fr CS. It is the knowledge aspect but you still have to get experience and skills ticked. Then the second question, I'm just going to show the slide again. Um For Mister I, so the slide that was for research, if you can take a picture of that is the slide showing not yet mm fine, it's not coming out. But for research, what you need is publications that have been indexed for the portfolio pathway. You need either two publications as first author, one publication as for a author with a systemic review or meta analysis or one publication as first author and two collaborative papers. And you need two presentations as first author. So I'll say that again to publications as first author that can stand on its own for publications if you don't have, but you can have one publication as first author with two collaborative papers. You can have one publication as first author, maybe a literature review with a systemic review or meta analysis as first author. So that will take the index publications, other aspects of research that are required will be courses, research methodology course approved by the NHS the good Clinical Practice certificate. This is a free course and I've included the link on the slides. I don't know if you're getting the slides afterwards, but if you are, the link is included on the slides, um evidence of presentations are required for research. This could be podium or poster and then demonstration that you have been involved in the ethical approval process. And I mentioned earlier, if you have a degree that was got a postgraduate degree that had, that shows that you have research include that for those who did fellowships outside the country, dissertations will include that masters will include that if you have a phd that's included as well. I hope that has answered that the last question was which places are Caesar friendly? Um Having said that with what I outlined a lot of things you can achieve in different centers with good communication, what gets most of us is not knowing what we need from the get go. But if you know that these are the tick boxes that you require and this is what your center can offer. You. Then if you start early and start discussing with the managers and clinical directors and try to get the contracts from places around, then you will be able to tick all your boxes, some places have these caesar rotations where they allow you to move from hospital to hospital in the Northwest. Bolton is one of them. So they have a program that involves Preston Bolton, the Christie. So you can move between those and Royal Manchester. You can move between those. You will get andrology, pediatrics, female and functional core urology by just moving through those. So you will get all the things you need. Um Mr Khaled Hosni of Blackburn has started his and that will involve some more hospitals in the Northwest if you're going towards the south in Kingston. Um there are four hospitals around there that are working together to allow people to move under the cover of one visa between the hospitals. But like I mentioned, it is not always necessary. So even if you have are not in a location that affords that follow the specific special, specific guidance and communicate early your needs and hopefully you'll be able to use your SPS to also cover those things you need. Thank you very much for your um responses. Um M and MGI don't know if you have any other questions. I can't seem to find any in the chat box, ok. So um I would appreciate if all the attendees can kindly fill the feedback form. The link is on the chat box. Let's kindly fill up the feedback form. And um I would like to appreciate um Mr and Miss Jamu for taking out of their very busy schedule to give us this very enlightening presentations. I'm sure we've learned a lot and um we'll go back and as much as possible to do all we can to put all of these into practice. Um Also to appreciate the logs athlete um Mr Y for creating the platform for us to have this session. Um, a piece of information um by early October, most likely the first or second weekend, we'll be having a practical session on how to fill out the application form for ST three and also a session at that same event on the um tips for the interviews in terms of um what are the things we should expect from those that have recently um got in training numbers this year. So let's look out for the post time plan to attend. Um Thank everyone for attending this session and have a great day ahead. Thank you so much.