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So You Want To Be A Plastic Surgeon?

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Summary

This medical professional on-demand teaching session provides an overview of what it takes to become a plastic surgeon and the realities of the job. It walks through what the courses look like in post-grad medical school, the importance of having experience, and the best way to approach people for a shadowing experience. The teaching session also covers how to get involved in a research project and maximize the impact of project work. Finally, the session reinforces that while medical school is competitive, it is important to remember that hard work will pay off. With this in-depth knowledge, medical professionals are sure to gain invaluable insight into the life of a plastic surgeon.

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Learning objectives

Learning Objectives:

  1. Understand the role, day-to-day life and requirements for becoming a plastic surgeon.
  2. Develop an understanding of how to properly approach potential mentors to gain experience.
  3. Recognize when a project is a ‘dead end’ and when it is worth dedicating time to.
  4. Understand how to build experience and hone technique through log-booking and other practical means.
  5. Develop an understanding of how to approach a competitive field with humility and respect.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

petted. Oh, my God. Um, on just But we come across on the media outlook of what we do is that we are incredibly glamorous on. We make a lot of money. So in the later part of things, I'm going to break down. What plastic surgeons actually do what your life will look like on how it's not actually anything similar to the American system from a pre clinical point of view. What is it that you're going to do? First of all, get some experience in plastic surgery. I work at the Queen Elizabeth Hospital. I also do some operating a new cross hospital for skin cancers on your If you're burning a medical student, you drop anemia. Be polite. Approach the department on. We can get placements in for a week or, if you want to come on days with the honorary contract on. Before you commit to a specialty, you should try out so you should come. You should see what theaters involved today's day lives involved what on calls in both, and until that point, you weren't really haven't understanding of what the specialty involved, especially in your pre clinical, important things about projects. Everybody all medical students ask about it on lots of medical students pre clinically. Ah, very keen to get involved in projects. There is a It's very easy to get involved in projects. You approach someone you ask them. Do they know anyone who's doing any research? Do you know anyone who's doing anything interesting on at that point? They will point you in the right direction. There is a danger with projects, and all of your medical students should know this. And I tell all my pat students same thing projects. Some projects are dead end projects and as a medical students very difficult for you to know. What is a dead end project? What is No, I don't let me start by explaining what a dead end project is. A dead end project is a local audit that basically you weren't published, you weren't present and you won't do anything with. It's not gonna give you points on the applications at any level on it's just a Nordic. It stays just in orbit from the dead end. One will take up a lot of your time, So then somebody might get you to order it on two years off skin cancers and you spend hours and hours and hours and you don't get a publication. You don't get a presentation out of it. And for me, that's no a productive use off your time. Okay, so what, you need to ask yourself first with regard to a project, whenever you're asking anybody, you're polite. You approach them and say, I'm interested in doing your project that is publishable. Those are the key words because you need projects that you can get papers from on. When you get papers, you get presentations. You get local presentations, national presentations and international presentation. So when I met this plastic surgeon in my left eye one year, he advised me this. He said, What you need to do is you need to get a project on. For every single project you do the work on, you need to have a regional presentation, which is super easy, a national presentation, which is kind of easy, and it just depends on what you how you present it, whether it's a poster or it's a presentation on, Do you need an international presentation now for me personally? In my later years of medical, I presented internationally and you guys, you might not know, but some. Sometimes you can get grandson on money from the actual medical school to go present projects and things like that abroad. So and sometimes those things that are abroad come to the U. K, which is even better. So, for example, some of the international meetings next year and the year after inland, for example, the hand surgery meeting and some of the other ones. You should keep an eye on all of these because the dates for their applications are super super early there, like seven months in advance. So you have to be prepared with that. The second aspect off medical school experience is experience. We high personally have loads of medical students that come, they come to theater, they come, they shadow somebody. They learn on day, see whether it's the kind of thing that they want to do again. Everything with a pinch of salt. And I'll give you a story that's really important that my brother is a and he had an extension, so we discussed this all the time. Now, when I was a medical student, I used to look at the FBI one's life on. It wasn't particularly good as a medical student. I was like, I'll do a better job than a well, I'll just be better. And then I became in If I one of my life waas okay, but it was exactly the same as what I saw. And then I looked at the Register life and I was like, For he works so hard. He's here a long time. He barely see his family. All of these kind of things. I'll just do a better job. When I became a Reg, it became very apparent that poor guy was doing the best that he could and that was the best that you could do. So don't think that you're going to do a better job when you're in the same situation as the person along. So if you look it for example, the Registrar of the S H O Z Day and it is a bad day on, do you do a whole week and you realize you know what? Actually, this isn't the stuff that I kind of enjoy. This isn't the interaction the injured. This is not got a good work. Life balance then actually have insight to be like. Maybe I should try some other different specialties. This is an important point because plastic surgery, once it's a commitment, is a very, very long commitment. It takes, like, 12 years on. It's got lots of heartbreaking it and lots of other bits to it. So I'll explain in the next talk about how to become a plastic surgeon, step by step, so we'll go through F Y one will go through a course surgical training, and then we will go through ST three applications a little bit. The last thing is, as you're going through your experience is you should have a lot on whether your log book is, um you can get a a log book, which is a website that registers you with a GMC number. But if you can't get that, just create your own log book with security setting. And all it is is any surgeon will tell you is the unit number for the patient, the date of birth in their age, the hospital you operated with on them and all of yours will be assist until you get to f what I want now. What's the benefit of that? Well, the benefit of that is, the more you do, the better you become. And like any specialty, whether it's carpentry or whether it's, um, plastic surgery, the more experience you have, the better surgeon you become now that whether that's practicing at home suture ing. Uh, while you're watching Netflix, which is what I used to do with an f Y one or anything else, experience is kink. So you put 100 you part 1000 suitors, and you put 100 suitors and you can tell the difference between the different medical students that come to theater on where it chose is when you ask somebody have you suited before And they say, You know, we have suited, um Andi, then that you let them loose and they do a great job, and it's very noticeable from our senior point of view. That's like, Yeah, when that person comes back, that's somebody worthwhile teacher. And that's just a practical aspect of life. It's not. I can't say in a different way. Um, okay, pressing next down, that's baseball. Okay, How to approach people, they say, is actually probably one of the best skills you're going to learn from this point of view. There are probably about two main ways to approach people. The first way is to approach somebody by email. That's the easiest way. What you have to understand is who you're emailing is incredibly busy. Okay, When they reply, they've taken the time to reply. So respect their time. That is the starting point. Okay, start your emails. Very practically with Hi, my name is so and so I am a burning medical student. I am in such and such year. I haven't interest in your specialty and I was hoping to shadow or come and work on most consultants on remember when they were medical students. Most of them are helpful. Most of them are approachable, but it's a matter of respect, especially when you're talking to a consultant. So I've known consultants for many years, and I still refuse to call them by their first name's. It's just there is a hierarchy in an order of respect, and surgical training is similar to an apprenticeship. Basically, you get men toward by very good people, and you slowly find who those people are, and you get better at, um, learning from specific people. The dangers to look uh, sorry. The second way to approach somebody is if you're on placement. Um, if you're on placement, you've been just asked somebody, which is what I did. And mine was a casual running with a plastic surgeon in I t U. So approach them. Introduce yourself. Be polite, be a little bit humble on. They will be here very helpful because that plastic surgeon took me to theatre on Monday. On Tuesday, I was off. I went to theatre on. I did. My first graph does. He introduced me to one of his mates. His mate was like, Oh, you have you ever done a skin graft? I was like, No, now you better start learning somewhere. So he taught me say on the thing about most of our surgical specialties is were incredibly, never do. You guys will understand this when you become registrars. So, um, the other day I was operating on a theater list with one of my best friends from medical school on. He was my anesthetist, Andi. He was the consultant. They're training's a little bit shorter on, but he looked at me and he goes when we were revising at four am in med school. Did you think would be running the trauma list acuity? I couldn't stop laughing because we had a very serious case on the table. But we still remember us at four AM panicking and looking at each other, being like, Have you read this chapter? You read that chapter what you're going to do next. So there is light at the end of the tunnel on. It does get better. The hard work is worthwhile. You will. The last point is kind of a philosophical point, because in medical school you will be trained to be a type A personality. Tell everyone the same thing it naturally is. It's a competitive environment on it teaches you it doesn't teach you appropriate life lessons. It turns you into a type a personality. Medical school tells you there is only one mountain in the universe, and all of you are fighting to get on top of that one mountain. The reality is, there's hundreds of mountains. There's lots of plastics posts. There is lots of surgical posts is competitive, But everything in life is competitive. You don't have to cut people up. You don't have to become an asshole to actually be good at what you do. In fact, what you have to do and I think is important is maintained. Civility. Be nice and try and not be as alpha type A. That doesn't mean you don't work hard. That just means you don't chop other people down. You can work this hard as you want and I encourage you to work hard. The last thing is at no point in your life where you know that this is like a peek or a great moment of your life While you're in medical school. It is a great moment of your life. Enjoy every aspect of it. Go out, Spend time with your friends. Have fun, Onda work hard, but enjoy it for what it is. Don't become that person that constantly looks at your next stage in your life. And you think, Oh my God, F Y one I will have some money and like will be better The F Y one. You look back on medical newish are wish I'd done there, so I wish I'd done that on regret is your biggest adversary because you're not enjoying the moment. So I think that's pretty much all you plead clinical. People need to do. And no, um, it's 6. 22. So, like what? 6. 30? Happy to Just not sure. 6. 30. Oh, actually, questions. Yeah, you don't take any questions. Now, Um, if people want to use the q and A function, if there's any questions for my will present them to him. Um what type of what? Your hand up. Yeah. Whatever works best for you guys. Exciting sound, burns or aesthetic surgery. Okay, great. Well, you pick both of my, uh, interesting areas. I'll talk about both of them later on me. Personally, I am going to be a bit burn surgeon on. I'm going to do hopefully touch wood burns adults as well as Pete. I love burns, but that doesn't mean you can't do aesthetics. To be perfectly honest, I start doing Botox and fillers about four years ago, so I have ah insight into the aesthetic aspect of it. But the aesthetic aspect of it, um, is how could I put this in a nice way? It's very political. If you've watched house of cards or anything like that. There is a lot of people who will spread a lot of rumors about a lot of things. And there's when money gets involved in stuff. Politics gets involved in stuff. So aesthetics, even a consultant level, is a bit competitive and can be a bit nasty and aggressive. So, actually, my personal feeling in terms of plastic surgery is if you can find a job that pays you an adequate amount that you're happy with on a simple day to day job. Um, then go for that. Um, my advice to you would be that the worst thing you can do in your life is to sacrifice, especially in certain stages of your life. Is sacrificed time for money because ultimately you're going to miss out on a lot of stuff on. If you're on any chest consultant and you do need aesthetics on Saturdays and Sundays were working like 67 days a week, and you're doing clinics and all of this kind of stuff. There's better ways to make money. You should all invest in stocks. That's what you should do now and then in 20 years when you're all loaded and stuff should just tell me harm. Oh, you know that speech you gave us off, man? so insightful. You made this all millionaires a little hard. Great. In fact, actually, you should arresting crypto, not stocks. But, you know, do whatever you want. It's not financial advice. You've got a couple of more in the actual Q and A function. Oh, yeah, I can see it. Yeah, Yeah. Okay. But anonymous. Uh, how do you know if a project is going to be a dead end? Okay, So couple of these e ways to find out is, uh, first of all, you use that thing that I said, Is this publishable? Second of all, when someone gives you a project, say, I'll do some research on it. This is a nice way off. It's being polite of the same time, being intelligent. Then you go to public. You find that what they've asked you to do. So if they've asked you to do a project on such and such go onto bubble type in, See when the last paper on that thing was published, see if there's hundreds of papers on it. If there are probably not the ideal thing. If the last paper and it was published, like, 45 years ago, then potentially you could get it published in any of the plastics journals or something like that. So you have to see where do you want to publish it? How many other people have published the same stuff? Is your number bigger than this? So, for example, if you're doing like a two year study on the only other papers have got, like, 20 patients. You're gonna have 200 patients. That's a winner, because that's a really high end number. Really good. The other thing is you can always message me. Uh, just asked me if this project is crap all good. And I'll just tell you next one not to move. If you could go back in time, what advice of tips? Would you give yourself The beginning of medical? Oh, that's easy. By Bitcoin, that is the one piece of advice I would 100% tell myself is, you know what? Take your student loan, put it into Bitcoin, and you could have retired about 10 years. Honestly, I really love what I do. Uh, I'll give you an honest insight later on about how the energy just is kind of falling apart a little bit on how my jobs changed, But I I love plastic surgery. I love what it's given me. I love the amount of time I've spent. I've traveled a lot with it on, but made a lot of good friends with it day to day basis. I'm quite happy, actually. Like, for example, today I've taken several skin cancers out of several people and in the morning skin cancer list. To be honest, I'm pretty content gonna watch about Netflix after this. Do a bit revision because, you know, I I still have exams coming up. So that's the other thing you should remember is for the rest of your life. You will have exams until you become a consultant and the exams, they're very hard. When we go through all the topics that plastics covers on, then I tell you that the examines all of them. Then you'll appreciate what is. How do you think we should make the most of mental during preclinical? Yes, so it's difficult, right? Preclinical years. You don't have a really connect with clinical. Yes, the clinical years are the great bits because, um, you are. There's a balance right in your clinical years. You are getting proper experience with patients, and you're feeling more and more like a doctor in your pre clinical years. You're reading a textbook and passing exactly, but in your pre clinical years, you have way more time to do way. More stuff like Go play squash, go hang out with friends, learn to time manage all of these kind of things are good. They're both valuable. Okay, Your pre clinical years make good notes so that you have the benefit in your clinical years of doing less work. Does that make sense? So if you're going to learn about them, I or anything like COPD or asthma or anything like that, if you make really good notes on them, you can use them for the next three years. Use a bit, use a bit of the Oxford Handbook and a couple of other things and just learn things properly. Don't last minute it with a mask the best way. Uh, did you interpret any point? If so, what was in? Oh, yeah, I didn't think I interrelated between 2nd and 3rd year. It was in pharmacology and your pharmacology. It waas an excellent year. Um, I thoroughly enjoyed it. I would recommend it. There's no rush to get to the end goal posts because your goal post will keep moving. Your goal post will be if I want. Your goal post will be CT one. Then you go. Place will be ST three applications and you'll never get to the point where you are. Um, so I would if you have the time. If you enjoy it, I would indicate, um, it's a great experience and it gives you points on your applications later on. It's not the be all and end all of the world if you don't gives you a good skill set. How to write papers on if you indicate and what my brother indicated, which was public health. You know, unholy. It's My brother went to China and then I went to visited him for like during Chinese New Year for two. It was amazing. Honestly, it was incredible. So, yeah, public health is the way forward. Ah, would integrating in tissue engineering and regenerator medicine be beneficial in plastics? Korea? Yes. Ah, so in particular burns. So, for example, if we are talking about burn surgery, we use artificial skin matrixes that are made off. Um, basically they're made off. How college in on their made off shark chondroitin. And so basically, it's a thing that we use on major burns to put on to. Their surface is okay now, Adelaide, which is an amazing unit in Australia, has created something called BTM on BTM is like integral, but a million times better. So when you put it onto patients skin, it gets revascularized and then you can actually get Capri for this. Amazing. I think tissue engineering original medicine is incredible. I think generally of medicine is the future. I think most people don't appreciate it. I think we will do a lot with potentially stem cells, but also, uh, pretty much plasma. So when you centuries plasma, they'll be stem cells in it. And it's suggestions on where to do an elective of plastic surgery. Yes, your elective is completely and utterly not important. Go traveling, go for a week anywhere. Okay, I did my elective at the Mayo Clinic, which is was America's best hospital. It still is. It's like super super loaded on. I spent six weeks, six weeks, 5 to 6 weeks at the Mayo Clinic, okay, and it was a beautiful experience on what was interesting about it. Waas They are so well funded. It's such an incredible service that even today, the NHS is probably about 2010 years behind, where the Mayo Waas seven years 10 years ago like we would go to a lecture theatre on the Daily Lama would be the guest speaker for the event. On it would be a legislator. That's the size of medical school. With everybody in the hospital. They're free lunch on a Q and A. Butter. I mean, America is on steroids. But why would say is your your experience during your elective doesn't define anything? You're elective is mainly to do with getting a bit of experience on traveling a little bit. Okay, so plastic surgery experience you can get in the UK there are outstanding surgeons in Birmingham. There are world class surgeons in Birmingham, so if you go somewhere else, you will get that experience. But it might be a little bit wasted. Like if you go to microsurgery in the mayor clinic. Well, you're not going to do my procedures for another five years. Six years? You're just going to get an experience in plastics. What makes you choose pharmacology for indication on what made you interplay so early at the end of your Okay. So the reason why interrelated so early was because I did not want to stop my clinical years. So I didn't want to stop the three clinical years on, do an interview, elation, go back to science, and then come. So I thought with the appropriate preclinical years I had for the first two, it would be a natural progression to enter kelated in pharmacology. Pharmacology at the time I loved I still like pharmacology. To be perfectly honest, I really enjoy it. Jamie Common was my supervisor. Still think you He works that right? Still a nice guy. Um, so, yeah, he was He was my supervisor. I had extra mentorship. I did farm near farm. It was It was brilliant experience. How did you get the experience to go into the main clinic? And how did you? Oh, very easy. So you know how I told you how to email people? That's how I got it. So email someone on. Do you just go to the mayor website? You find a whole list of emails things on do with the Mayo. And unless you have like us, Emily. So you won't do stuff. So you do an observer ship, so basically, you won't be operating, but you'll be in the theater watching them operate. You can do a research project with them. It's very nice they help you out with, like, accommodation. There's a massive hotel across the way from it, which is called the Kayla Grand McKayla. Grand has, like medical student rooms, which are basically cupboards. But it's amazing because you go there, you stay in this covered. You get access to the mayor, which is across the road. You go to a journal clubs on it, has a string on the ceiling. It's really nice, and it's really cheap. Actually, it's quite affordable, but yeah, email somebody in whatever department you want. Um, Andi, my on just say hi. My name is so and so I have a great interest in this. These are my I would love to do a fellowship in a year's time. Timing is advanced is the most important thing. Don't do a last minute thing. You need a year in advance to get people buttered up. What advice or tips do you have to gain experience from abroad. And how do you find opportunities? Very good. Okay, So I absolutely, absolutely love traveling at the end of the next talk, I'll talk to you about traveling and how to, um, maximize your study, leave your study budget on where to go abroad and when it's appropriate to go. But because I go abroad to do a good work. And I also go board for loads of conferences like lose. I've really used my training. Well, I mean that the car. Right. We're going. We're going straight into the next talk in it. Yeah, you we we Should we give it a couple of minutes to, like, a few minutes just to go and get a drink? Yeah. Just because I drink here. So I'm going to screen Share my thing is like, yeah, uh, the my desktop already. Let's go Two months about wind. Yeah, leg. Um on Then, uh, you can also that right. I will literally be back in two minutes and we'll go straight into the next talk and talk about everything else. Okay, on the next one would be particularly will just be a half a now, so you can get plenty of questions. Okay? Okay. I'm back. All right. Yep. That's good. Okay, so for the kind of quit vice, let's talk about plastic surgery. If you have ever watched Nip Tuck, it is absolutely nothing like it. So inept. A key is an incredible Siris. That clam arising plastic surgery. It's got two plastic surgeons they are from Miami on. Do they do a lot of inappropriate stuff? A lot of drugs on a lot of plastic surgery on it. Went on for five seasons on hand, on heart. It was the first experience. I had a plastic surgery. So when I first met the guy who, um, introduced me to pass it Oh, you're a plastic surgeon like Nip Tuck? Well, yeah, I guess so. So, yeah. Believe the hype. American TV series, American shows. Plastic surgeons are portrayed as, um, God's Yeah, they're portrayed is God's, um they are portrayed as life is perfect. There shed loads of money on d everything. But the reality is that you're in the UK system because you're in the UK system. You as a reference I one will be paid the same muscle left one's on as a plastics registrar. You will also be paid the same as every other plastics registrar. So whether you're a neurosurgery registrar, cardiothoracic surgeon, strong or anything else, your salary will be much the same on if you want to put go after money. Honestly, orthopedic surgeons make way more privately. So a knee replacement where you will never be looking to be needing or anything like that. Um, orthopedics is the way forward knees and hip replacements and aging population loads of profit work. Plastics, private work is a bit more, Um, let's say like a war zone. So let's talk about where you are, so you guys should all be in stage one. So your only medical school at the moment when you get to 50 year you have these situational judgment questions on. After that horrible experience, you will be allocated to where you're going to do, um, one half way to let me reassure you. Buy this. It does not matter where or what you do in your f Y one N f. Y, too. It is lovely if you get some surgical experience. Absolutely lovely. And for me, personally, I did, um, I I was very lucky I did my f y one. I did one medical job that was general medicine, elderly care and diabetes. On do rest of it, I had to surgical jobs. And then somehow, for F y two, I had loads of surgical jobs. The difference is that when my brother came to apply Member, there's a few years behind me. When he came to apply for that fly to my recommendation to him was pick a very easy F y, too, whereby you can get some clinical experience but also have time to write papers, because the thing that they don't tell you is that at this point, when you get to a specialty training, some of the points are allocated to stuff that you've done here. So if you've done order it every single year, that's what gets you points here. So what you actually want to do is be in a position where you have time. So my brother actually did, um, ophthalmology, and he did public health in F Y two on. I think he did orthopedics, so public health wasn't particularly challenging, but it got papers on it. Is that this point that it's important to get papers now. During medical school, you can get papers, you can have publications and you can have wood. It's these international presentations. All of them are important. What they are in is not important. And the world you need to learn is transferrable skills. If you've written a paper in something here when you come here, people at course surgical training will say, Oh, this person knows how to write the paper. If you've done order at this point here, that will also say, Oh, this person knows how to do in order Nobody really looks of what you've done when you come to specialty training when you're coming to ST three that your men to show you love a specialty. Now this ST three can be anything like it could be orthopedics. It could be ophthalmology. It could be a general surgery, but it's a this point that you have to show that you genuinely love a specialty and you want to do it for the rest of your life because they are investing in you for about 5 to 6 years. Okay, course surgical training wise. So this is my secret. And this is what I think you should all do. You should at this stage, when you're in fo I want not here, not in medical school. Okay, in medical school, get any order, get any publication, get anything right When you become an f y one, get a copy of the mark scheme for course surgical training. And it's very easy to do when you become an F Y one. You find the person who has just been appointed as a CT one and you ask you say, Look, what was the course surgical training interviews like, What did they ask you? What were they looking for? Okay, on by having that you have a two year plan, a practical to year plan that says I need more audits. I need more research papers. I need to do a bit more of this a bit more of that before you come to here. The mistake people make is they get to f Y two and then they decide. Oh, maybe I should look at the mark scheme and see what it is on. At that point, you just don't have the time anymore. Whether you want to publish something, publications take up to six months to a year to publish something. So for that reason, at this point up, the marks came for here. Okay, at this point, when you start here, get the marks came for here. Which is why I did, uh, now the way I did. It was a big old school, but now you could just ask people to get a copy of it. So the way I did it Oh, yeah, it's being recorded. So the way one of my friends did it was that they loved in till a website and registered for the interview. Just said they could see what the self marking scheme looks like. And then print screened every page of it on, then had a two year plan and ticked off everything on there wall that said, You need to have this many audits. Did I get it? Tick? You need to have this many publications. Did I get it? Tip. Does that make sense? So each stage, you just need to think and look a little bit further ahead. Not too far and plan for it. Does that make sense? So that's okay on this is a general, Uh, this is one of them that you can find that is quite straightforward. Um, it's like you get points for taste of sessions. You get points for attending a surgical course. You can get point, and this is like this is why it's worthwhile to show your interest in surgery as a whole. So the conference that these guys are setting up on the undergraduate one is excellent, cause you get there, you get an idea of how to suture. People like myself will be there to help you on. Do you come? You get to do some sutra and you get to do other stuff, or it's virtual like it was last year where we talk to you about the skills, what you need to do in the sessions on you put it in the important thing for every single one of you that needs to do this. Now it's have a CV, and I know it's really a pain in the ass, because I had to update mine for, like a year and a half, and it's really annoying, but update it regularly. These are habits that you should get into, but I myself may not have, but I would like for you guys to have it blown from my experiences. Have a CV updated. You go to their conference in January. You get your certificate, you scan it. You put into a pdf document and you save it on the USB stick and you save on your drop box on. Then you put it onto your CV. Don't lose out on anything you've attended. You do a taste of session. You go on, come visit us at the Burns unit. Come visit us the plastics list. You put it in the CV, just grow the CV Later on, you can call it and say, Oh, this is an interesting This is interesting. Um, and then this is just S t three applications for him, which I just told you about, which is basically very similar to this. But in ST three, application for plastic surgery, one of the key areas is you guys don't need to know this, but it's just to have an idea. They mark you on what operations you conduce. So when you get to see to you one which was back here when you get to see to one and c t. Two, you have two years to get a Siris of operations, and that's operations like burns, excisions being cancer and hand trauma. Those three areas and the high you scored, the better your portfolio markets. But the key thing is your portfolio is still no massive proportion off it. Actually, I think last I checked the interview was 70% of the marks Still, So on the day, if you content up in your fire, you will get a job on. What's interesting is the first time that I did my ST three interview. Um, so I did my CT three interview twice. So I did it once, didn't get a number, but got a lot. And then, uh, the year after I did it again. Um, what happened is I did the ST three interview the portfolio station and 80 something percent, um, on on my interview stations. It wasn't good. So then I blasted the interviews and the next time around with the same portfolio, just different consultants. They gave me, like 67% bombed my interview stations. I got like nineties, So I got the number in Birmingham. Um, realistically, with surgery, you can be moved around a lot, so it has a general indication. Not many people are as fortunate as I am to to stay where I wanted to stay. Basically, a lot of people move Diener Eater Diener. So it's just the nature of training in the UK. Let's talk about all the wonderful areas that plastic surgeons do when we talk about plastic surgery. A lot of people just immediately go to boot jobs on tummy tucks, and that's just because that's everything that's on the newspaper. But we are by far the most interesting specialty on the least repetitive. And there is just so much beautiful surgery that we do that nobody really appreciates us for. So we do major trauma. We do. Cleft. Would you hand surgery with your head and neck cancers? We do breast cancer work. We do skin cancer work on. We do reconstructive work and aesthetics. And now we'll go through some of them so you cannot see the glory picture, right? Not your head. If you get good luck. Okay, s so this Let's start with the first one. Hand to hand Trauma is amazing. It is delicate work. It is like a Rubik's cube on every single patient. Does nobody has the same problems. So some people rip off their finger. Some people fracture their fingers. Some people mangled their hands. Um, the one that's down here is a d gloving injury. So if you can see it, he's got his d i p j in there. Eso his distal phalanx in there. That's his joint. And he's had a complete d gloving off the entire finger as well as all of his vessels. So here, you're going to have to think off. Do we replant it? Do we consider amputation in this patient? What do they do for work? So there's a lot of things you got a straight a way. Think about Are they right? 100. Is this their dominant hand? What fingers are most important for us? Well, actually, your your thumbs, you're most important. Finger. Sorry. Yeah, the thumbs are most important. Digit. That is your index finger. But if you chop your index finger, you can always bypass it with your middle finger. Um and then your little on drink fingers are actually for grip strength, which is what they're really important for. You hear what you have to think is as a plastic surgeon you're gonna have to fix the bone. Step one, you're gonna have to fix the vessels with microsurgery. You're going to have to fix the tender. You're going to have to fix the nerves. There is a lot of things to fix. Now, on the right is a mangled hand. The manual hand is a This is probably about, I don't know, six hours, seven hours work. So you're gonna have to have X rays. So this patient comes into an E X rays. What do they do? What's their hand dominance? What structures have been damaged? Is it vascular levi A bowl? So you can press the tip of your finger and it goes white, and then it fills up, and that's called your cap refill. So you find out what they can do, then you think off. What have they ripped out on what needs fixing? So, first of all, like building work anywhere you picked fix the solid structure, spur. So on any amputation or any injury like this, you always fix the bony structure. So you have scaffolding toe work around the soft tissue. Um, Andi, it's incredible. Then you have the beauty off congenital on So this is I don't want surgery, but this can also happen in kids. So the first stage is at the Children's Hospital. They do a lot of hand trauma, but they also do a lot of congenital hand drama, which is kids that have been born with their digits fused, or kids who have been formed with Okay, I didn't put the other picture on. So kids who have been born with their digits fused kids who have been born with thumbs, missing kids who have been born with extra digits. There is just so much complex worth. And when you get down to the kids level at this level, your vessel is looking like, what, one or two millimeters to get the microscope in? You do microsurgery after you've explored it. Onda. When you have damage like this extensive damage like this, you can't just repair this. You're going to have to have caps. What do you How do you feel? Gaps. Well, you're gonna have to use graphs and graphs is when we take different areas of the body to work. So, for example, in this case, if you've got a bit missing on this finger looks a bit. Why? And then the artery the digital artery comes to here. It's absolutely mangled in the middle. And it continues going to hear At that point, we're gonna have to fix it. And what do you do if you look at your forearms now and pump your hand? You'll see all these beautiful veins. They're on those veins. You can actually harvest a vein and use it as a graft and use it as a tunnel. So you make a cut on top of the vein, pick the vein up, put it into the finger. Now you've got a connection. So these are all the beautiful stuff that we do I like. I really love my specialty. I love my skillset. It's very helpful. It's very useful. It's just it's just fun. And the red years are the best years because you get do everything. But all of this is also in an exam is Well, the next thing is, while we're on it in arms. This is a very, very, very close up of the break or places for pretty clinical people. You break your plexuses the nerve supply to your arm, Um, name Bring. It doesn't teach much and after me. Um but I went there, so I had to learn it all in if I want. But, um, this is your break, your plexus. Now you're thinking one earth, the plastic surgeons doing exploring someone's neck. But you have a lot of patients. You come in with traumas, you've ripped their neck or pulled their neck and have rich. These tiny nerves on these tiny nerves in the the neck are very close to important structures. Now, on the right hand side, you can see the gap that is born. So once you're exploring it, you can look. And then these gaps so confused nerve is pointless. So if it's got bruising or if it's damaged, I'll just turn to scar tissue on what you see on the left hand side. Here is this is a nerve graft. So you're sural nerve, which is near the back. Elec on surprise Sensation to me Last checked around your ankle you can basically cut straight down the back of your leg. Find this horrible nerve Pick it up on. What you actually do is you flick the nerve around on the reason why you flick the nerve around is because you can see my point of right. So if you have, if this is the sort of nerve that we're using as a graft, right. If it had branches coming out of here as the nerve regenerates, those branches will be lost. Downside sprouts, right? So if you flick it around, the theory behind it is that because it's backwards, it will only be one tunnel to the thing, and you don't lose any nerve fascicle. So let's break your plexus on break. Your plexus is phenomenal. I mean, you can have people who have spasticity. You can help them. You can have kids who can't move their hands and you can literally rewire their arms on. Remove a nerve that's working to somewhere that's not working on rewire them. So I did a fellowship in this. It's it's beautiful. Next cliff surgery for a period of time. I want to be a cleft surgeon. During my training, I didn't decide to do it because it was for me. It was the same operation over and over again, Uh, but it is an incredibly valuable, incredibly beautiful operation. You have kids who have deformities that once fixed they can talk, they can fit, they can go to school. It's life changing, and your impact on that child's life is for the next. I don't know, 90 years, 70 years. However long it is that they're going to be talking, however long is they can be feeding appropriately. So cleft surgery. At the Children's amazing work, we do a breast uncle plastic surgery. So in terms of breast surgery, we deal with deformities. We deal with cancer work so some of the surgeons are could do. The mastectomies on this is called the D. Every construction. Now it's based on the deep, inferior epigastric vessels that come up on supply your abdominal wall. They go through the rectus muscle on. What you can do is when someone's had a mastectomy. You can excise that to me, find the pedicle, pick up the pedicle on plummet, either into the internal mammary or thoracodorsal in their armpits, so you can pick which one you want to. If you're gonna go internal mammary, you have to cut out a rip, so you do some rib work and you cut out the room. Onda, you can get beautiful results on be life changing for women who've had breast cancer. Skin cancer work is incredible. It's not for everyone. It's delicate. The patients are lovely. It can be complex in a lot of cases and quite a lot the working under local anesthetic. It's very satisfying because you exercise things that could actually kill people. And if you leave them, they could metastasize. Not so much be CC's, but melanoma in squamous cells. True and again, it's complex work where you have to think about how you are going to reconstruct a defect for a patient on. At the same time, aesthetics is involved in every single aspect of these. It's involved in the breast work. It's involved in the lip work. It's involved in the skin cancer work. It's involved in everything and a lot of it. You learn you have to learn blood supplies, so we're jumping around a lot of the body at the moment or MRI. But the thing is, as a plastic surgeon, you have to know all of these because all the other specialties call you when they get in trouble. Plastic surgery was invented by Gillies in the middle of a World World War Two. I could be wrong. You might have been World War, but he basically created the specialty. Because you're the quarterback, you you should be able to help a lot of specialties. And in your day to day work, you can help the head and neck guys, the breast surgeons, the orthopedic guys. You help a lot of people, and you interact with a lot of other people, and it's because your work is appreciated. Well, sometimes appreciate it. So you understand about geometry. You understand about blood flow. You understand about how to make things aesthetically pleasing and produce the best results you do head and neck surgery. So Ent does a lot of head and neck surgery. They do the thyroids and stuff. But when you get SCC's or squamous cell carcinoma is or melanomas that metastasize, then neck dissections. Facial nerve palsy is another aspect of nerve that we do. Um, Andi Yeah, again, lower lip. So the problem is that with plastic surgery you, the only bit of anatomy that you don't really need to know is inside the abdomen, which is pretty easy. Guys, come on, there's colon or stomach. There's a lot, this kind of stuff Yeah, because you'll never go inside. That am brain on D. A bit of spinal cord, everything else, every other blood vessel, every other tender, every other compartment you should know. So if you want, actually, a good piece of advice for pre clinical guys is to really, really get hard on your anatomy like I mean, a basic. And it's not hard by the way I get, I get they give you that big folder to learn stuff and all that constant. But there's a guy called Ackland. Who is this really old dude who basically has a shed load of videos? His voice is incredibly boring, but if you can struggle through it and you watch each of them like three or four times, his voice is burnt in your head and his explanations are actually really good. So if you watch the hand one, which is like two hours 40 minutes about four times, you'd be really good at hand surgery like it's a lot of anatomical planes and dissections and things like that. So you get good at it. Lower limb trauma, so acute is roll center for defense medicine. So it means we get all the soldiers when I was junior from Afghanistan and Iraq. Um, although military patients. But we also get loads of trauma. We get cases like this where they had the glove ings where they've had damage, there might be vascular damage. We get lots of no entrance. And these cases we do with orthopedic. So orthopedics comes and fixes the bone. But you have to remember, if the metal work is exposed, this person is going to end up with an amputation. So all of these cases we do local flap so you can pick up gas, drop for an incision around the back of them, pick up gastro, bring it around and use it as a muscle flap. Or you could do the fancy hot stuff, which is free flaps. So on the right hand side is what is called a nail T flap and anterior lateral Zyflo. So you mark it up. It closes directly. It's called the fascia cutaneous flat to pick up the skin on the fascia above the muscle. On you find the pedicle, which is probably you keep excited. Dissecting it on it is about. I think it was the one that we did on, you know we did it. Precede little, but they're usually about three millimeters in size. So when you do have to do it, you have to find a vessel. You can put it to posterior tibial artery you put into side or directly onto it on DA these people. It's a limb salvaging operation, which means you save their leg so it's it's very satisfying, is very demanding. Microsurgery is hard, but you get better after you do courses. Stuff like that, areas that you don't think plastic surgeons go anywhere near because it's no cool paraneal reconstruction. We worked with general surgeons all the time. These are two flaps on the inside of the thigh Christie list with skin on reconstruction is there? There is, This is and it'll have a little perforated going to on you Kentucky. All this on the other option is a V ran flap. So if patients have for China wall defect or rectal defects or any defects like that, you can actually take the rectus muscle on the blood supply, pass it through the abdomen on reconstruct the rectum or vagina. You can even take both of them. But yeah, so we do a lot of cancer work. A lot of cancer. Reconstruction work we do a lot of sarcoma is what it looks like. By the way, um, you can take it for, um, defects. So, for example, pressure ulcers, anal cancers, a n, anything like that Post ap rick sections. Just take tension off. You put the skin in, they lay off of this. They don't put any pressure on it on after a period of time. It heals and stitches right in. Looks beautiful on my favorite area, which is burns. So with regard to burn surgery, there is pediatric bones and there is adult ones. It is not for everyone it is. You need to have a little bit of a strong stomach for it, but it is incredibly rewarding. On the right hand side is acute burn surgery. So when you get a big burn, you have, uh, you take them to theater, you resuscitate them. You work with the I t. You guys. It's complex on. For example, on Wednesdays, we haven't MDT to begin opportunity to come to the mg t three mg t has physiotherapist psychologist therapists. Um Oaties would sisters. It's a lot of people talking all in the best interest. So it's kind of it's it's Ah, it's a proper multi disciplinary approach Now. The benefit of burn surgery is that once you've done the surgery, you follow your patients up for several years. And actually, if they have any contractures short term, you can do secondarily reconstruct thumb. So this kid, um, I had burns, and it's all healed remarkably well. But after this, they've had score releases on grafting, and they've also had releases around their eyes. See how this goes in kids. It's more noticeable in adults. We do do secondary reconstructions, but when it's more difficult. So if a kid has a burn at a young age as their body grows, this needs releasing on, all of it needs releasing to get a secondary reconstructions. And honestly, working with kids is amazing. And then we excise the burns on D, and this is just an example of burns excision. So these are full thickness. Burns on is a little bit gruesome, but you basically just shave the burned area. You next engraft to reconstruct it, you can use, uh, dermal matrix. Sister reconstructed my experiences. Plastic surgery is I couldn't imagine doing anything else. I absolutely love it. One of the key aspect is the people you work with, and I work with amazing people. They are just awesome. The nursing staff the same. The thing you guys need to be aware of is that in the NHS, staffing is a big issue. And I think you will realize that as you keep coming into hospitals, loads the nurses are leaving on, doctors are having to do more and more stuff. So, for example, in the Burns ward, we are doing our own dressings more and more. And this wasn't the case when I was an S H o u just come in. Given opinion review, the patient on it's becoming more and more difficult with beds on day short staffing, lack of I to you beds and things like that. Would I do anything differently in hindsight? Not really. Ah, I'm quite happy. On a day to day basis, I have traveled a lot of places. Um, I was fortunate to do eight work. So this is me operating in Sierra Leone. We went for, um I think seven days and we operated for 6.5 days so soon as we arrive, there was loads of people in the clinic and the clinic. Hopefully we booked everyone in and we operated on loads of things like massive tumors, massive lipomas It was It was an incredible experience. Um, you can only do that if you've worked yourself hard in the first few years of your training. So I did this about 23 years ago on because I did a lot of cases. I'm quite comfortable with anatomy, and I've got a lot of experience so you can go there on day, not do anything. But how? How to say this. If you go is an STD three, you will go there and you won't operate. You won't really be doing anything different. When I went to a zesty five ST sticks because of the experience I had and all the things I did on the amazing mentals I have, um I was operating. I was doing burns excisions. I was checking up on my own POSTOP patients. It waas It was really, really satisfying is something I'd like to do for the rest of my life. And then this was when we went to Iraq. And that's my little brother, By the way, this one. No. Um so that's when we went to Iraq and in Iraq they asked us to do a camp on D. We did a camp for orphans on widows on. We saw loads of people gave medical opinions. I didn't operate, but I was offered a theater later on. But then covert hip. But then we saw each other. So about 350 people. So it was a very busy week, and it was very satisfying in terms, of course, is you can go on courses internationally. You can go on courses, um, presentations nationally, and the thing I've done is I've gone to a lot of stuff on. What I do is I use study leaf. So you have a study leave budget. That's a certain number of days in a year, right? Ah, do you have the budget on? The budget is like 500 lbs, so it will basically cover one of your tickets. It's not a great study budget, but at the same time, the leave is the key aspect of it. Because if you connect one week of study, leave and then connect a one week of annual leave. You find yourself while I actually did one week of annually one week of study, one week of annually, you would find yourself suddenly in Malaysia for a week with one of my other friends on, then in Singapore for a nerve surgery, cause I helped run this nerve surgery course with one of my mentors, Um on it was amazing because the person there was a load. So these are kind of air comes by the way they aren't attached to a human being. But you get to practice microsurgery, unnerve a pest, and then the course had there's an operation called, For example, there's an operation called a subset procedure, which is a nerve transfer procedure on at this course. Somsak was the person teaching with some side procedure. He just flew in just to do his two days on. He was amazing. So you get to a network, you get to meet these like incredible people. Honestly, role models will get you through your training because there will be a lot of people who, um may be perceived as assholes during your training that will really treat you badly. Treat you won't be nice, but what you will learn to do is see the ones that are wrong. Models See the ones that inspire you on, learn from them more on. Yeah, I do ask that. It's I do Botox do fillers. It's caused me a lot of headache. Um, because some people don't like it. Uh, very interesting, because rather than in some, this is some people Some people don't like you doing it despite beauticians on all these other people doing it. So it's a very kind of touchy subject, and he shouldn't be really, is you like, for example, any if any of my colleagues or any of the other I just want to do more than happy for them to teach them will show them or anything like that. But the thing is that I don't do as much as I used to do because I do more other things at the moment. But I still do family and friends. Um, on occasion, Um, Andi, It's a very touchy subject. He shouldn't be, but is incredibly touchy. So, um yeah, those are all the bits. It's like seven something 70. That's not bad. Any questions, then? I would just jump in for a second. Thank you so much more. That was absolutely amazing. Um, as always moments, one of our friends here but press before you guys all go. Obviously, if you've got any questions, please put them in the queue in a more will answer them in a second. But there is a link that I'm just gonna put in the chap on. If you go through on this link, it will give you feedback form, and then you'll be up to get your certificates through metal, so you might have to just create an account. But that's what we're doing. Order. So you want to be a certain talks on, uh, this year? So if you guys have got that there, um then Ah, yeah. If you stick around Mobile, answer a few questions and then once he's finished answering them, then I will show you kind of what our next events are in terms of. So you want to be a surgeon and I'll put a cure code up a swell So you guys can access that for getting kind of feedback and certificates is Well, um please go through and fill them in cause Absolutely brilliant for us, you know, help us improve the events or see what you guys want. What? We can change the next time. But that was absolutely fantastic. Thank you so much for my pleasure. Uh, someone I will reach some of the Q and A. You know much about post graduate masters in plastics. And how about if you're they are? This is indicating in medical school, um, in terms of point scoring, I'm not sure I'll be honest. One's A B, S, C and postgraduate Master's is a master's. It might be one point different. Well, I would say is the post graduate masters in plastics are expensive on. Do you pay for them? Um on, Do you pay for them at a time when you are learning or studying or getting into f Y one on, then you've got MRCs. I forgot that I'm on says that's something else you have to do. So you have to get registered with the War College of Surgeons burned. You have to do their exam. And so it's an expensive side track and a lot of extra work on. What you have to do is you have to balance. Is this extra work worth the points that I'm going to get? Or would one publication or two publications? So I'm going to do anyway? Be the same. Remember the interview. Your portfolio is not a huge portion off that interview. It gets you into the interview. It's your ticket into the club, but you have to perform interview. So that's what it is. Next. One Hydro to move you to send the length of the YouTube Ackland, a k l a N d. He's He's like I can act like a clamp. I'll type it for you, Ackland. Just Google it. It's free a. All his stuff. I think it's like from 20 years ago, but it's it is worth. I'm not sure if medical school has subscription to it or whether you can get it from the library. But back in the day when DVDs were thing, you could actually pick up the DVDs from there. Also, what organization or researcher industries you get a Volvo in to be more involved in research and publications, research in publications, they're not really organizations or research groups as such. What you want to do is you want to approach a department. So let's say you approach the birds department. Let's say you approach the plastics department. Let's say approach. You're doing a placement in wolves and you're doing it with the ent department approach whatever department you're in at the time on approach them. I warn you about something. Organizations, Onda, interest groups. Right when you get into a project where there's too many names on that paper you don't want to be part of, and this is something you might not understand When you look at the paper at the when you look at the line, this first author, the second author on their senior author at the end. Okay, As a medical student, you are happy with anywhere in that line. Okay, As you go higher up for interviews, you want to be second author or first author, and you can have joint first author, by the way as well. So you want to be in that bracket further on. Okay. At medical student level, you can be in any as long as any is not first author, second author, 25 names of everybody, including the janitor and then your name, and then, Senor, that name is used us like Like when you're going into a interview, someone's gonna be like, Which bit of this paper did you do off the 28 people that were on the paper? So, research groups, I will be very wary off unless you got approval on very, very important. When you take a project, before you start work on the project, get who is which named Ortho. This is really important because I get it in writing, send anemia and say, if you've had a social discussion, get an email and send it saying further to our discussion are I will be fourth Ortho. Okay, Does that make sense because it stops you from having advantage taken of you. It stops difficult situations. It stops problems later on. If the order of authorship is agreed early on on that order, authorship is associated with workload. So if your first off there you write the paper or you proof read the paper or you do you do the big stuff? Basically, does that make sense? Can you sign interact when they're hungry? One's not using your unit. Uh, I have no idea. Uh, you can go to YouTube type Ackland on upper limit after me. And basically, his video is completely free. I downloaded. No, I didn't. I never downloaded anything. Um, I got legal copy from the library. Obviously on. That's why I watch. But yeah, it is on YouTube. You just write Ackland anatomy. He is really boring. They're, like, really monotonous. So have a cup of coffee with you. And don't try and do this like a hero late at night, because, honestly, you afford to sleep to this man's beautiful voice. He's understanding of anatomy is amazing. Any questions? Okay. My pleasure. Anonymous attendee. That's brilliant. If anyone has any more questions, feel free to kind of stick around and ask them, um, if no, I think someone asked earlier. Move your email. Yeah, I'll put it into thinking. You know, if you couldn't control email, you might be inundated. But if you have any more questions and feel free to kind of email Dr. Murray Hill. Yeah, monster them every, um, he's always more than happy to help. Um, yeah, that was That was brilliant. Uh, what I'll do now is I'll stop the recording. Oh, no, no, no, no, I'm not. But you can find me on Instagram. What is my instagram? I changed it to Doctor. Um Oh, but it's like in a very weird way of saying, doctor.