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Good. Good evening, everyone. My name is Jason. I'm one of the surgeons. Socks had a vascular surgery on today. We have a talk about different parts of the rescuer surgery about the trading pathways. About common case. Is the life of a vascular surgeon on bit about research opportunities as well? So we have some a consultant and a senior training with us today. Mr. DeBary Onda Ms is Hannah Travis. So we're looking forward to the talks, so I think we'll start now. Any sort of questions, please Put them into the Q and a box on. We will try to answer those questions at the end. Thank you. Wants to get first. You depressed? Thank you very much. I'm going to share my screen, right. Thanks very much, Chaisson. Inviting us. This is the second one hand, and I have done, uh I always enjoy this cause I see you are so happy to be involved in this. So I'm going to talk a little about from how I became a vascular surgeon and why you might want to become a vascular surgeon. You can't hear me. Probably. Please let me know. Um say just a brief history of vascular. So during the day, when consultant but consultants you were no trained vascular surgeon, you were a general surgeon. You did everything well, anything that came your way. You didn't ask your colleague to give you a hand. You just go on and did it. Whether you did it good about, that's another matter. We discussed it another time. However, people realized why he's on them like a vascular surgery. Say they became general surgeons. I have a little interesting vascular surgery. So they started taking the complex referrals because that's what they're interested. Waas However, about six years ago, rascals said it came in saying statically ality um so we separated from general surgery and now what we're trying to become is we know vascular surgeons anymore. We now try and have a fancy title called and a Vascular Surgeons. This this apparatus from the John Surgeons on the vascular surgeons. You don't do any endovascular work and also probably two separate us from Radiologist See now are called themselves is image guided surgeons. Vascular surgeons want to be radiologist, Radiologist want to be certain that this is how it's all evolving? Yeah, okay. Say have briefly have did I become a vascular surgeon? So I did my levels. Like all of you. How I be a whatever Whichever subject today, I went to turn cross in Westminster Medical School in 1991. Uh huh. As you can see, I grew my hair very long on started drinking lots now. So me, uh, and eventually in those days, we had a traditional medical school. So you did two years off basic work. So all I did was anatomy physiology by chemistry, Uh, on it's and pieces around it. I never actually saw a really life patient until 1993 when we started our clinical attachments on in those states. He did six weeks of medicine, six weeks of surgery on one of my first attachments was that Queen Mary Hospital, right, Hampton, which may may not still exist, And that was the first time I saw this procedure, which is a lower limb by part. So this is someone who's probably got a blockage of receive official from the last tree and they using the vein to do a bypass, something like this. And I was hooked, but that was it. So I decided I'm gonna do something to become a surgeon. I'd like to see a vascular surgeon. Yeah, there's no real pathway in those days. There was still vascular surgeons, but that'll train from dental surgery. But that's why I decided to do somehow the other most to qualify in 1996. On I take a house job in North seven District Hospital in basketball and nicely become great doctors mess. Fantastic. And one of the surgeons I met there was a general David Harvey. You also be nursing a red straw in trying cross hospital. And at that time, he older members gave me one piece of the voice was, If you want to be a surgeon, if you want to publish, we Harish Okay, I thought I remember for my six months of doing that job. Then I take on various jobs. So became a senior house officer in those days, which is the your foundation Year slash all surgical training these days of Princess Alexander Hospital away Not a very well renowned place. Apart from that Glen huddle comes from Harley on. Wasn't football, I think Jay Good. Even one isn't Big brother came from Harley. That's about it, but actually from a training purpose, there was so much pathology. Actually, I must do a lot of coughing. Feel looking for a job. They did one of these smaller district general hospitals where you're more likely to get operative experience than a big teaching hospital where there's a lot of people around. Uh, in those days, you could not become a see what they call a specialty training unless you've done a research job. So I got a recent job in vascular surgery of the World Free Hospital under the supervision of that moustachioed mind George Hamilton. But actually, he was right. We've fantastic surgeon. Really supported, Boss, I've got my exam. I did my thesis. I'm actually what he did was he paid me to go to various parts of the world, present my research so much to get America went to Australia. I went to Europe, published about 30 yards papers in major journals. Well, I was doing my research job, so basically, I applied for a training number on, got it straight away. First time last year. Ah, and then did a year of Jones surgeries. This is all trial changed that. So I think Honey is going to talk about the curriculum of bed more when those days he did Maybe general surgery with some vascular said you. So you have one child century. I'll call every Thursday on call every fourth weekend. Amazing job, Lots of operating. Then I did year two general vascular surgery. It was around at this time, but there was a ugly thing rearing its head in vascular surgery. And it was this thing, Um, aneurysms had always beam done open on some guy in Argentina. He decided that, but they was possibly another way developed and the vascular newest. Um, I realize a bad time, you know, my own. But if I was doing something with vascular surgery, I needed to get some training in the vascular surgery. Training in the UK was only that we met the radiologist. They would not train you in those days. So actually, I learned what Google Waas. I Googled, uh, research fellow on fellowships in Australia, and the first head I got was for a place in Sydney on my right to the professor there, I said, I'd like to come and work in Australia in about a few years time you get off really good. Just email me your CV every year and we'll be in touch. But a year of colorectal surgery after I moved Middlesex Opals Fantastic job year for vascular surgery. Colchester, Uh, wasn't that's productive with the sugar being? For whatever reason, they were very few cases that year. And then by that time, it's secure to 12 months. You've been west, the hospital, Sydney. So Australia, for whoever is controlling the they rotate from February to February. So I got a three month job University, College, London for three months. Dispute off to Australia. So I what degree day? Well, I did my first of the North stray. Yeah, my from the twins there in the first week, we did nothing except going to see all the sites. So gold off a taste. And I Do you realize how beautiful Australia is? It was an amazing place to get to, um like, Okay, so you'll know the opera house. You can see it. That's more for a house. One of the bridges I can never remember. And this was from where we left into city to the right. And obviously, if you get to Australia, you gotta feed some kangaroos. We did that. And I've learned by kangaroo is when they sleep they look like they're dead because we tried to wake. Want to keep them up? Um, we actually did thing. They were dead. And you'll know what this is. You don't eat one, so ah, let's me between total d and Tweedle down Jack in jail. So this is a new South Wales in the air. Uh, something called Lantus Valley. Um, it on birth when we went from racing, you can actually better these frogs to race. Let's see, my Children became gambling at such a young age. There's a great experience for them. And actually, the reason I went there this I went there to learn how to do And a vascular surgery. Actually, when I came back with endovascular skills but a lot of a pen operating clear realized Australians that bit surgeons and they have very concentrated training. Say you, actually, Australian training is a one in one on call their their own call virtually for two years in a row without a break to get the occasional holidays. So when I went there became a one in too or what have does happen is that it came out after a year. Two years worth of training in operative ways came back. The role free hospital on started little one year. Teaching hospital consultants. I went back to holiday data loss of operating in 12 months, and they looked at my Stephen Ortho. Well, actually, there's something missing in there, which is a dentist will bypass. So I did what they call out the program experience of moved King's College Hospital in London, which is about an hour and a half away from what I lived in North London again. Fantastic experience. Great consultants learned Loft got a local job in off the Norco Tropical another place. There is so much pathology there. You you get tired of operating. Johanna would appreciate that any time. And then I was appointed University Hospital Birmingham in a consultant 2011. So when you started a consultant in vascular surgery or any specialty, you need to have some five year plans on. My interest was in the diabetic, but and then do a vascular surgery. So we established the first proper diabetic foot clinic and water, and I think in the West Midlands. There is still no hospital. Provide the diabetic foot, walk around in a multi disciplinary basis and hold in the middle. Okay, I'm We managed to start doing our complex and a vascular surgery procedures. Very interesting teaching in training. So I pulled a lot of 30. AM 50 medical Stevens started doing consulting the world, which is teaching and training consultant on how to actually teach. Finally, I was the first frost, a surgeon to have a angioplasty, lest in the whole of the medicines of my own to call it. And that was on the basis of having been trained in Australia. Um, after about 67 years ago. Bit bored under that fed up the NHS. All right, well, I'll take a year out now. This we're vascular surgeon is important. You're invited for jobs, labor, the country safe. I'm looking for a job. There are always jumps in the Middle East on in Ah, the Asian countries. I think I went to this little in Singapore called untime from hospital. Very unusual. Design is you conceive in the every patient in this hospital has a window to himself, and it's designed so they can actually get pressure. Never seen a hospital design like this You have advantage with this hospital was surrounded by four shopping malls and there was, ah, link bridge to all the shopping balls. And that was important for lunch. Every day, every day I had a now and after lunch which you will never find in the NHS. Um also managed to go on, get mine Deep sea diving certificate done while I was there. Uh, a lot of interesting people and my friends and we did lots of eating and drinking. Say anyone's from think of for Malaysia You know how important you to be drinking out a menstrual, some amazing places. I mean, this is just one place in Singapore, a match to visit about six countries around Asia. But the main thing was, is the better in the middle was that was my friend distal bypassed one of the first ones done there. No one's keen on open surgery they all want to do and a vascular surgery. But there is a place for complex treatment surgery and what I found was the pathologist. Very difference. They fear in Singapore wage in countries. It's a lot of renal failure and diabetes front. That's great, but you don't get the variety off operating the idea in the UK So after you have sabbatical enjoyed myself, I came back to see where. Hey cream list with hospital Do you want? Does vascular surgeon doing a typical week? I tell you, on a Monday morning, I have my angioplasty less already. A couple of and a vascular procedures do diabetic football ground. I did. One diabetic foot clinic seems to be to vascular clinics a week. So country, because of the reorganization, did okay with the single hospital. My gait to be my main operating. That's their harbors hospital and the rest of the time idea. Lot of teaching training on they said a lot of consultant development or university hospital burning of given that up. After about six years, I've just taken on the roll off the training program director for vascular surgery for the West Middle, Um, been about the operative. One of things he realizes Consultant is actually very little operated because you're have a fixed list on a fixed number of cases, actually, were you're doing is you're training the next generation, so when you operate, you're trying to give with much operating to the training is a possible within the norm of patients safety. I'm just going to go through the common operation, which is crossing endarterectomy least now I'm going to go in a bit more detail of double aortic aneurysm repairs level and bypass. I'm not gonna talk about amputation, but there's a lot of amputations going around and then create gave the official listing on my interest. But there are people who create Fischelis for dialysis. What I did do is, ideally, pediatric asked the surgery and some interesting cancer work. Yeah, because believe it or not, everyone needs a basket. A surgeon if there's a major vessel around a tumor, so why do we do across it and our direct mean it's appropriate and doctor me. It's basically reducing firing off or scratches and across the dollar tree to reduce your risk of stroke. This might be people who had a strike for people who might have a higher chance of having a stroke, um, on back. So basically, typically you put the patient's sleep so you can do them awake. Make a copy in the neck. We do. You find the Journal of Veins like this came back to you on on atomical days on. Then you get rid of the brain. We went to the site and you find the internal common carotid artery the internal carotid artery, which is usually the bigger one because your brain needs more blood than the external carotid artery, which supplies your face. If you're a big talker in May, be reversed on This is a common carotid artery. There are a couple of nerves you have to preserve. We do need to do your math. Me, That's the glass ulna nerve. And that's the vagus nerves that this. But it's franchise being down to give you a horse voice, and the heart glossal will give you a deviated tongue. What you do is you climb the artery above and below the site of the pathology. You then put a shunt in. I'm not going to go games enough. Why we put you on 10. You've been literally scoop out the diseased bet on, clear it all up and put a patch on it on. Uh um, it's usually a 23 hour procedure. Patient comes in. Today goes in the next day, and there are complications were there, but actually as one of the operations that vascular surgeons really do like doing. And one today, the other one that lot of vascular said want to do is have Donnelly or two down your reserves that this is the double it patient vessel and we trained ruptured aneurisms. People will tend around eurozone's support, just boxed and it found. But we're really doing it. Stop it bursting or to reduce that praying off cloth. And how do we do that? Well, if you like the old fashioned way we use if you down the middle, as you can see as someone's drawn on it very kindly for us, you find the aneurysm, you clamp it above and below that elasticity is the same. But I feel like I'm above be psychopathology. Open it up to you about all the clock with the major vascular instruments and then use literally stitched. A graph on this is a straight graft. Almost night it achieved graft, but if he had two legs ah, it would be called a trousers graft. Now we do this through keyhole procedures. As you can see of the slide. Well, actually made a cup to get explain to the femoral artery. We don't even need to do the back now. Probably a two sent me to cut. You can do this percutaneously, but the principle is the same. You're putting a graft inside an aneurysm, but when you're relying on is it's tensile stress and barbed wire. Keep it in place, and therefore it's not ideal it. If you're a young patient, that's probably good for older patient. This is what he was designed to be done for. It's when work is. It's leave Topamax. No, and that's what it looks like. Stay. If you look at it, you can see the bar. Why that bath wise surrounded by cloth. So that's stopping the blood flowing outside into the aneurysm, Rupturing on. If you're very clever, which some of my colleagues are, you could do this. This is a stent from the descending for us to get your toe branches into your superior mesenteric renal arteries. Well, the way down this is the ultimate goal for aneurysm surgery if you're doing a keyhole and then Birmingham, especially at the University Hospital Birmingham. We have a particular expertise in this weekend off of this too old more off the UK Other things we do is mark of Spain's Frankenstein's important, because normally puts the vascular surgeons Children three private school. But also it's also important cause of leg ulcers. Ah, and there's ways of doing it so you could do but your frequency energy stain. Um, I'm sorry. The top was laser ready. Frequency five. You can inject microwave energy. We go local. It it doesn't matter. These are all minimally invasive options. There was hardly anyone offering open brain surgery. My thing will will happen is eventually Ah, this will disappear off. And this is how you do. Um, a laser. You literally puncture the brain like you do for any other bed, and you burn it from the inside. It's the so called walk in walk out procedure. That's what patients want great for the patients. But the worry is that because of minimally invasive techniques, open surgery for their school die after eventually. Other things that we do is this is the manager plasty. So when I was a houseman, if you sort disease like this around here, there's a large blockage. This would have been there for a bypass now. Instead, I put a wire down my a loon. There on agent goes I'm after four hours, as opposed to being five to some days in the hospital. You can also, there's something clever. You go around the ankle on. This is a patient I did actually did a bypass and then in a non table, injured plasty. So we bypassed above the ankle and then balloon bit around the plant in the middle on Toronto, and this is made foot. Nothing works on Mike. So, uh, give up. Um, So what's happening in vascular surgery? I would suggest that carotid endarterectomy is an annual and surgeries that kind of reducing a number. And the reason is because people stops making, say, When I was a medical student, 50% of us by actively and I think about 45% might passively, this rule leads to be in the same all. Now I asked this question. The last bunch of medical student teaching was 35. Them in a room. Not a single one owned up to being a smoker. Smoking's going down there. Four are some of our pathology is decreasing or has gone up. Is the number of people needing bypassed. That's because of the diabetes. Ah, a lot of people needing renal access for dialysis so more low minded plasty and diabetic foot, but also because of my side of the beginning. There are no such thing as general surgeons. Everyone, including General, said North Phoenix want a vascular surgeon around if they're doing any complicated work with vessels because they are no trained to deal with and has been particularly hard for vascular surgeons when I think trading her being affected. But we've actually seen for more interesting pathology in patients than we would never have. And again, we're now learning to deal with the new type of our till issues that we've never had it before. We've actually have turned down people for surgery or we went down looking at, and they're vascular options to treat complex people where we knew that a open operation was the method. But because of covert, we changed our practice. We're kind of getting back to some kind of normalcy until the third of the fourth wave arrives. So mold, I said. My basket a surgery. It's a hybrid specialty. You do interventional radiology work where you do. Why were you open surgery and you can become good? It's involving. The new curriculum has just come online. Uh, if you're interested in a job for life, you will have a job for life. If you want to travel the world, you will need a vascular surgery expertise. Uh huh. Probably the most evidence based specialty. I think out then a lot of surgery. There is hardly anything that we do that is no evidence based. And if you're looking for team working, this is really a multi disparate team. Working specialty. I I have to be a vast a surgeon again. A news. Be a vascular surgeon. Thanks very much. Trying would share my screen, Thank you very much. Okay, I'll share my screen. So I'm having I'm ST seven in the hospital setting in the West Melons and I'm going to talk to you about life is a vascular training. So my pathway through has been slightly different, Mr Stories, but training as it is now. So you do your foundation training that she's two years after medical school. You then have your course surgical training, which is two years. And then there has been a period where there's been something called I S T training and that's led through to run a three specialty were destroyed. Training that's just been m caused again. So we've gone back to uncoupled called surgical training, so you apply for your foundation jobs. You'll apply again, for course, surgical training on. Then you apply again for your specialty registrar training on that is a six year training program at full time. And you do want to years of general surgery and 4 to 5 years off faster surgery. And after that six years, you become a consultant, vast vascular and endovascular surgeon. And that's the official title nowadays. So why did I choose vascular surgery? So it's evil. Heard of the six piece of vascular surgery? Well, I have the full piece of plastic surgery, so it's the people, the procedures of pathology and the patients. So I've worked with some really inspirational people. Throughout my training, I had a vascular house. Vascular job is an F one. I had my we did a 12 week surgical patient placement in third year medical school. I was a tear in cross that was Imperial College and tearing Cross Hospital on My based foam was a vascular surgery firm, and then I did it as an F one. I then I did my core, said We're training where I had six months of vascular surgery and I When I first applied to restrict numbers, I was a It was the full vascular was separate, and so I had a general surgical number on in that I did another six months. Vascular then became separate. And so I reapplied to do rescuer surgery because by this point, I knew that's what I wanted to do. Sorry. If you can hear background noise, the Children of just come up for bath time. So if it's noisy, I'm sorry. So the procedures and Mr To our is binge really the operations. I love the fact that we do very fine delicate operations such as the carotid, endarterectomy, knees and just bypasses. But you also have your big open and aortic procedures on then the endovascular side as well. She has a big variety of procedures. It's not like also pedic. You become a hip specialist and you just do hip replacement off hip replacement. There is a variety everyday, and you can have your area of special interest, but you still do all the other operations as well. The pathology. I think it is such a wide, very pathology you never have to have. That counts a conversation. And I used to find that quite draining in my general surgical days and lots of our patients, except that they their lifestyle has led for them to have the conditions that they've got on dismay. As we said, it is the big one. So but you never have to have the cramps, the counter conversation. And I appreciate not having to have that conversation. Onda patients that quite a good bunch, really. You always on our ward rounds they they always make friends. The amputees will hang out together. There's a lot of bunter. They'll join in and they're taking the MC out of the consultants with this and and so for me, it's the four pieces I said So vascular registrar activities, I think, is if what you see is a medical student or a foundation doctor and even a Zocor trainee is not really reflective of what the job will be. When you're a consultant and I think a registrar level, you start to see what life will actually be like when you reach the cough, the end goal, the end of training. So we do a variety of things. We are writers change on a daily basis. We do clinics. We have our general clinics with arterial venous disease is you have specialist panics that you can go to. There's the on call with the emergencies trauma, less urgent or feral referrals you do your wardrobe's with your elective patients in your emergency patients on. Then you can attend the specialist walk around as well, lots of opportunities of the various procedures in theater and then also the interventional radiology training. So we get trained by based vascular surgeons and interventional radiologists on our right. There is a bit different from a one on one on call or one in to uncle or even one and four say these are just some of the rate is that I've worked recently so and I'm at your HB a moment, and we've got a lot of restaurants. We got 10 oh, 11, registrar. So we're on 11 1 in 11 cycle. The right above that was Russell's whole. That was the one in six and you can see on call every other weekend. And sometimes you're on for 24 hours at, and you HB a moment. It's 12 hour shift system on. I think that's an important consideration when you're choosing your career is actually you dysplasias consultant life, but actually as a registrar, what do your own calls gonna be like? Uhh be is a shift system. As I said, So it will even do long days or we do night. But we only only do them every 11 weeks, whereas Russell's whole was a a non resident on call so we could do our own calls from home. But you basically your uncle one in sex. So there's that they're considerations toe have one of thinking about your Korea, and then my data daytime table varies. This is just a snippet of our time table full what we do on various days so you can see that my column is this called in here. You can see this was last year's, so I was in. I are on the Monday Theater one, which is our open theatre on the Tuesday I was off on a Wednesday on Thursday, I was in hybrid, and I had Friday morning off, so you'll see that I have every Wednesday off on every Friday morning off. Then that's because I'm a lesson full time training. My colleagues obviously had the full full complement there, but this lesson full time training, has enabled me to you and see other things outside of medicine. So you've got your standard training pathway. But then there's a lot. The other things actually make your training longer so you can take time out for research. Lots of people choose an F three or a CT three year, or they may want to have a family. Or you may be gifted at sports, and I had a friend who took time out to training to compete, to be on the Olympic team on. You can do an academic program so you could. And if you've got a particular interest in research my Kadena, then you can become an academic training. And then in your specialty registrar training, you people have out of programs, so that's what is called It's out of program, and that could be for research, and some people take two years. Some people take three or some people take four years, you can have out of program for experience, which is just to go and gain experience elsewhere. We can have out program for trainings you to move to another Dean Areola unit to get experience of operations that you might not be able to get in your unit. I've got a friend at the moment who's she normally works up in Edinburgh. They do loads of open aortic surgery, but she's hardly done. Any bypass is so. She's starting a mini fellowship out of program for training in Leicester next week, which have a big lower limb bypass unit. And then you can have out of program for parental leave. That doesn't have to be maternity leave. It could be and shared parental leave. So I've got a male colleagues who a lesson full time as well because they've got a family. So training actually takes quite a lot longer than their specified sort of 10 years out of medical school. So my training pathway, if I was appointed and in October 2013 to the vascular training program on, so if I had followed the standard pathway, I should have cc TT In October 2000 and 19. However, she couldn't see. I've had three lots of maternity leave and I've been less than full time. But I've worked with the way through and I'm gradually reaching the end. I did my fr CS party in June on. I've got my part B in three weeks, so it might take longer to get there. But my end game is gonna be the same as all my colleagues. The new curriculum has just come into play. And so that's now rather than being a time based training program where you have to complete 72 months of full time equivalent training, which would have seen my CT t out to maybe 20 24th in his once you've obtained all your competencies on you've got all your exams on, you're ready to become a consultant, and your consultant trainers feel that you're ready to become a consultant. Then you can see CT. So I'm hoping to bring my CCT forward. It's a negotiation I have to have ongoing of Mr To worry, depending on how much operating he gives me to get my numbers. So my normal working way I didn't arisen normal working, but I tend to be in theater on a Monday clinic on a Tuesday morning, and then I tend to in the day day case missed in the afternoon on Wednesday. I, um I don't work on a Wednesday. I do the schoolroom. I might go to soft play or a trip to a farm, or I play trades with my son on, you know, do a variety of other things on. Then that time comes and I might get some portfolio work done. Or I might be able to write some of the paper that I'm doing for us, a submission of energy, the school run. And then it's ballet lessons and tea and bathroom bed, and then the Children go to bed. And then it's the audit where called the right presentation. And then Thursday I'm back in on and I our list. So there's lots of variety. Friday is my I have a morning off to do the school room on, and then the afternoon, I look into all the details and department meetings. This was my timetable up until about three weeks ago, when we rotate it again. It's not changed slightly, but there's lots of different things that are going on and really talks about this work life balance on died don't I don't think it's a balance because it's never in balance. So at the moment, work is taking a big part of my life and a lot of time because I've got my examined three weeks on. My husband is picking up the slack and putting the Children to bed as his our nanny and are after school club. Oh, everything else I have to utilize to enable me. So that worked in take priority. But then, on normal weeks, actually, my family take priority, and then I'm taking the pressure off, and that's why I've done 60% training less than full time. So it's about integrating the to to enable you to do whatever is outside of medicine that keeps you interested. That might be sport. It might be that you're caring for elderly relatives or or no L D relatives, young relatives. You may want a family. You may be doing sport. You might have a business outside of medicine, but there are ways to integrate the two. If you want to be, sometimes just have to think about outside the books So this is my integration of work in life. Before my operating less last Thursday, I was up to put face paint on on make up for the school monsters Ball that was happening on the last day of half term. So at suit 30 my alarm goes off in the morning on then it just depends on what that there is going to bring on what I'm doing on what my activities are. My advice for anybody who wants to have a family is that it's possible it's doable. It's hard work, but you have to juggle it'll on. So you need support, whether that's local family support or whether it's paid support on. We don't have family locally, so we have a money. We have a dog walker. We have a cleaner. We wouldn't be able to have a family. I'm do our jobs. My husband's A GP as well on breathe out these other agents. I worked for a female consultant and when I was an F H. O and she said, outsource everything you can so that the time that you have with your family is quality time and not the time when you're having to do the mean your everyday tasks, and so I try and do that as much as possible. I can't remember the last time I went to the supermarket. We do it all online with you just have to usual time wisely. So I'd say there's no right time to have a family, but a good time as such. But there are better times on Don't. Lots of people will say, Have your family any in your training and then you can concentrate for the rest of it or get through your training and then have your family. What works for one person won't work for everybody. I think you just have to work out what's right for you and your partner and your family in vascular surgery. You do. You have to think about the radiation protection on your exposure to you, and it's completely safe to do providing you have the adequate lead protection. But the radiologist wouldn't let me in the room when I was pregnant with my first with the second I was doing general surgeries. I don't have to worry with my third. I did do endovascular work until I couldn't wear the leads anymore cause my mom was too big on. There is a financial impact off both having family but also working less than full time. So just a little bit, um, less than full time training on minimum that you can do is 50%. It doesn't just have to be a Xarelto. You can do it as a foundation doctor or is a court. Really, you could be less than full time on. Most commonly, people do 60% or 80%. You have to have Diener E approval, and it could be that you're in a job share where two of you are working at 60% all that. You can be less than full time in a full time slot. And that's been the situation for myself. And I said, it doesn't have a financial impact on your on your salary because you're not working as many hours of sleep, and the rotors can be complicated to balance them. You're entitled to the less than full time percentage that you do off annually on back holidays on, but you should complete the same number of work based assessments at the percentage, so if you have to do if you have to do 10 work based assessments and you work at 60%. You don't have to do six in that time, period. So the other thing I was going to talk about is the really club. I don't know if any of you have hard of it or members off it. I'm currently president of the Ruler Club way reaction the views of trainees and vascular surgeon here. And we're a completely independent body will run by vascular trainees for vascular trainees on with the only representative always for vascular surgical training in Great Britain or Island. And we have medical student positions on our executive committee and we have Medical Student Foundation called and trainees as well on we have representation on lots of committees. So in the Vascular Society Council, we have a representative on that count on that committee, the vascular S A C, which is the specialty of advisory committees. They work with the Royal College and Joint Committee on Surgical Training. So I was heavily involved in the writing of the new curriculum. We also have representation on be Set, which is the end of US British site of investor therapists on acid, which is the association, surgeons in training. And we've also Representational James yesterday busted the left and progressed, and there's lots of opportunities to really lift both to get involved on from a committee perspective. But we offer lots of opportunities as well, so we always advertise courses, fellowships, scholarships, events that are going on. We haven't aspire. Junior Weapon are series. So if you sign up to the real publishes for free and go to the education section, there are lots of started your encoded, but it's ongoing. There are lots of recorded educational webinars specifically about vascular surgery and essentially surviving a vascular surgical house job. So we go through history examinations, common presentations and how to manage them. And every year we run A s, a competition for the for medical students interested. There's financial prizes for that. And also, if you enter the essay, competition you and receive free registration to the Vascular Society conference, which this year is in Manchester, the competition is still open. I think the deadline is midnight on the 31st, so if you were keen and wanted to enter it, there's three questions. But if you look on the really website, you'll find it all there. And we also run an introduction to vascular surgery calls, which is a hands on practical session. There are, And so some of those places will be we'll go to the winners of the S A competition on then some of the places you can just sign up for yourself if you're interested. But that will give you both and open an endovascular experience the membership is free of I said It's open to medical students Foundation called trainees and specialist registrars. And you can join at that website there. And we're on Twitter face, but on Instagram So we have our our a gm. Is that the Vascular society? Annual scientific meeting? Um, there are committee positions up for election and our medical student position is up for electricity. Eight er if if anybody is key that wants to stand We've had fantastic medical student representations previously. We have a really drinks reception, A said, and there's the instructions. Vascular surgery calls on the S a competition. So why do Why do you ask your surgery? I love it. I don't think you could do it if you didn't love it. And my working life it's integrated. So I have a work life balance, and I've made lots of friends go through my training but nationally have got friends all over the country. If I need to know something or, you know, got to refer a patient I don't like necessary have to go through a switchboard. I can just find a friend who's on call somewhere on. It's great that we've really suffered through clover, both from training, but we've really missed the face to face interaction. And the Aspire Program is on annual registrar training run by the Vascular Society on the whole year. Grape all the spect away the trainees from across the country get together. It's quite a small specialty, so you get to know everybody got very supportive colleagues. Onda seniors on a Z, Mister Tyler said. It's an evolving specialty. We're learning new things all the time. So any questions and thank you know, especially with the participants. Sorry, Jess. Um, I have a question, if that's okay. Hi, Big. Thanks so much for your talks. I thought your basement and lovely to have ah, consult anesthesia registry to us. Um, Mr the less than full time training I've just got back from a conference. Actually, one of the conferences on I was handed by the RCs. The train is Glisson on. One of the articles in there was on less than four times treating as a consultant. Can you continue that? Well, you continue post E. C. T post like successful drug medication where you continue your less than 400. Or could you continue lesson for work as a consultant? Or is it purely is the training I listen to talk so lesson Full time training is obviously as a trainee, you can work less less time as a consultant, but that's normally negotiated on a on a case by case basis. Most consultant jobs are based on an affection Activities, which is 10 pays on do. Some of that will be taken out by the uncle. So you do your own your own calls a account for between one or three p A Z, which then essentially means that you have a free day during the week. Um, and I think most most consultants correct me if I'm wrong, Mr to worry, but they they don't have clinical activities every day of the week. There, there is normally a day where they they don't have clinical commitments on. That's what traditionally, when consultants did their private practice or their private work. And it depends on the job plan. My my intention is probably not to stay less than full time as a consultant, but it will depend on where I get a job. Other consultants I know I've got sort of annualized contracts. So they do their clinical work and the clinical contact work in terms time and then have more of the holidays off. So once it is, it is possible. But you have to negotiate it on a on A case by case like this on the the actual training that you said the last time four time training Is that becoming more common? Would you say or is it? Has it always been no national becoming more being made more wells? Um, I think it's become much more cancer. When I I didn't know any lesson fulltime trainees when I started, um, I I got pregnant as an S t three and so I've been a lesson for, you know, relatively early on on. But I've been less than full time since and since I started. There are now farm or less in full time trainees than when I started. I think this six or seven of us in the region are Mr to worry for vascular surgery. Yeah, so I think is the coming on both male and female. Less than full time, I think shed parental leave is becoming, Ah, much more of a thing I haven't I don't know anybody has done in the West Midlands, but certainly colleagues up in Manchester. They've done Should I know people have done share parental leave and it's worked. Worked really well for them, right? I think. Yeah, I think it's much more, um, acceptable And a common place then now than it used to be. Go nice and stuff. Well, thank you both. I thought they were both excellent talks really appreciate it. And, yes, I had, you know, just a few questions as well. That's okay. Um, it's sort of a director of both of you as well. So there's been a lot of talk that you know why, you know, generally accepted that endovascular surgery is becoming more mainstream and becoming more common. In what ways is it becoming more used in part of vascular center. And how will change in the future. You go first time, Um, so I think it's just it's even a small options. So patients who aren't necessarily fit for major a lower lung bypass contains several hours, even with to experience surgeons on bumpy. People just aren't fit for that. But an endovascular approaches. A local anesthetic procedure can be done relatively quickly if it's ah S f A lesion on. So I think it's just given us more options of treatment there. You have to remember that just because you can do something doesn't mean you should do something. So it just it's just another weapon in our armory for how to manage best manage patients. So there are some patients who will definitely do better with the bypass. There are other patients who will definitely do better with and vascular approach on. It's It's striking that violence and assessing each patient on individual basis toe work out what the best treatment option is for them. And we may we can tailor procedure with the treatment to the patient Robin just having 11 option Also, you know our patients are growing older and older. We, uh, treating people in the eighties and nineties, which 20 years ago we want to even touched Say things are changing. Say we can offer things doesn't mean it's the best treatment just because it might be enough to get them out of the hospital on paying free. And some patients don't want to have the big open surgery they prefer to have. Ah, you know, it's the end of ask you is are Requip mint of keyhole and you give the patients the choice. We can make our recommendations, but for whatever reason, they may choose. They prefer tavern and vascular aortic aneurysm repair rather than open surgery. Thank you. Um, in terms of this is just for regarding work, experience, things like that. How do you sort of go about finding, you know, good vascular surgery work experience, you know, build that experience quite early on. So contrary to popular believe I think basket of sadness or actually quite for a quite friendly bunch on does lots of research opportunities and projects to get involved with, and certainly if you, if you come Teo, you ate, be were based it out of Harland's Hospital. But if you come to be it is that Hollande Hospital and you introduce yourself Teo, one of the vascular team. We can put you in touch with the right people for various research projects and things like that. But it's the same. You know, Russell's whole or a carpentry wherever you work. There will be projects as registrars. We have to do, um, or did or didn't work on greed. Be involved in meetings every year, often as a medical student. You know, even if it's just participating in the data collection to get your foot in the door to them, may move up sort of through the process. Then I think that's a good idea. You know, you're welcome to email me, and I can put you in touch depending on where your placements are. Um, but yeah, so I think, Introduce yourself to team. Go and find a vascular surgeons, wherever you're aware of, you're working off. See them? They're not every unit in the West Midlands, but if you can try and find them showing in it shown interest. And don't watch the vascular surgery if you can on D and that that's probably the best way to get involved. Like I said, the really club and does have opportunities on. There's often if you join your get the surveys and various bits and pieces come through that there's also Vern, which is the vascular on endovascular research network on they often have a collaborative projects which you can get involved with. This. Well, um, I can't remember the bones email address, but if you Google Verne vascular Research, you'll be able to find that. Thank you. Thank you. Um, I think that's about I think that's about it. For the questions on Do I think a lot of the other questions with a Q and A box have been answered A z Well, I was worried that so I think we've clarified the questions Well, so thank you very much for your time today. It's been very informative and definitely has helped me today as well to understand a little bit more about vascular surgery. So thank you very much for you. Today is very much. Thank you. Thank you. Thank you. Thank you. Um, yeah. So, in terms of just some information for the next session, I'm going to quickly sharing my screen. Um, regarding some future events. Small gift of that now. Night. Yeah. Yeah. Um, can you see my screen right now If it's everybody see my spring level? Um all right. Okay. S o in terms of just some future events that are happening, Uh, tomorrow at six o'clock, we have the next, um, sat surgical session on the rest of the door axe and the cardio thoracic surgery. Um, Andi as well is that we've got the basic surgical skills session of the three coming up on Sunday on seventh in November between 9. 30 and 12. That's what the clinical skills from the medical school, um, andare next event that's coming up with the future is on trees, usually the 2nd November at six. On it's about the So you want to be a general surgeon? So part of the So you want to be a surgeon series at six o'clock on soon? Um, in terms of some feedback, we've got the any memberships to join the surgical society. We've got the guild membership went on by its QR code A Z well, as the feedback from here, the QR code for the certificate as well on d I will also put the link for the feedback form of the Q and A section B, um, of the cough. This is, um, have been ours. And so thank you very much. So I leave that that, um, thank you very much again, but both of you for your time. Um, it was very useful. Talk on Very best of luck. Thank you very much.