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Lovely. Uh Hi, everyone. My name is Adina. I'm the specialty care webinar lead with mind the bef, I've got my uh colleague, Doctor Pa, he's the lead with Minder Bef. Um I'm really delighted to introduce Mister Jason who um joined us today to speak about the career in neurology. So he's going to discuss about the day to day life in neurology and touch briefly on the training pathway as well. So I'm gonna hand over to, ok, thank you, Adina. I'm just gonna share my screen. Um So just let me know that you can see it. Yeah, we can see it. Perfect. So, hi, everyone. I'm trace. I'm one of the Euro GSD three. I'm currently based in uh UCL H in London and on the side, I am a, an honorary clinical research fellows at King's College and College. Um So thank you for coming. I think you have made a very good impression already and choosing to tune into what urology could be as a career. Um Obviously, I'm very early on in this career. So I will only give you things that I know so far. Please don't take it as a full guide onto what urology could actually be because it could be things that haven't quite explored just yet. But I hope I can maybe just give you a bit pointers and a bit of a understanding into what your ology could be as a junior doctor, especially when or the resident doctor, uh when you are foundation doctors, you are called surgical trainee or you can as a special to registrar. So this is what the talk would be about a in the first part. So the second part I thought uh would be to maybe share a bit of my experience in research uh as a non academic training. Uh some if not, most of you might have done more than I do or be more established and, and I'm very happy for with that. Uh So this is just anecdotal experience that I have. Um Just to, I hope maybe encourage others that haven't done so to open your mind to research and find that helpful as part of your career, whatever you choose to do eventually. So let's get cracking. This is what we would like to go through today. I think I will start by telling you how I ended up doing urology and how I made that decision. And then tell you a bit more about my experience of my neurology and how that makes me feel uh full in which I can tell you what kind of urology uh enus really as a as a special or as a career as a consultant. And following which if you're still interested and still tuned in how you can become a urologist if you are a trainee in the UK, and then we go to the second part where we talk about research. So this is a very interactive session uh or like it to be, uh please feel free to share your questions on the chart. Um Adena has been given approval to stop me at any time. If not, if you think that you would like to ask me in the, in the end, that's absolutely fine. There's no boundary to this. If there's no answers to your questions, I will let you know just as such. So, apologies if I were to disappoint in advance. So to start with, I've gone through a pretty uh conventional pathway. I was, I was saying, so I went to Manchester Medical School for five years at the indicate I then graduated when COVID hit, which means that I graduated four months earlier, did an interim F one job. Uh I then applied down to South London or Cancer or Sussex area where I did my F one in ST thomas' and then I did my F two uh in invasive guys and Thomas and Base and T 12. Uh Following after I go, I went straight into surgical training in Northwest London. That's neurologically themed. We come to talk about this theme training in a bit but essentially what I did in CD, one was eight months of urology um to start with, followed by four months of colorectal surgery. Uh Before I then went on to do 12 months of P urology, Imperial College A and that and basically two months ago, and now I've started my specialty training in UCL H. So essentially through my training I have or through these um foundations and course surgical training, I have been applying for the next step, which is not very common nowadays anymore. Um which I guess I would like you to know because I haven't done uh trust grade jobs or uh clinical research fellows or taken years out to do you know, research uh in the form of master's and your phd just yet. So I can't comment too much on, on those. But if you have any questions, feel free to, to, to ask as well at any point. So this is my journey. So I started F one, it was COVID years. I then during my fa one done uh did MRC S part one in January and part B in July um because it was COVID and we have time on our hands and, and I guess I'm sharing this part with the M RCP to let you know that at the time, I haven't fully made up my mind that I want to do surgery. A and so actually in FY two, which is the earliest you could, I then the M RCP part one and part two. This is quite important, I think to share with you as part of my journey because I wasn't someone that went through medical school thinking that I was going to do surgery less. So even urology, I in fact went to medical school thinking that I would do actually clinical oncology because cancer was kind of the overall uh goal or overall condition that I was more interested in where my passion is really. Um And as far as you can see on the right, um for my research, I essentially started with a taste a week in clinical oncology guys, uh which has a bit of an overlap with global oncology, which started my research path, which I will share with you later on. I done essentially in C two when I am, when I was a course surgical training in neurology, I also joined prostate to do some of the research work from that point onwards. Um I guess this is important uh in the sense that II think one could be um could keep their mind open to a certain extent, especially in the foundation years to decide actually what you want to do. Because a lot of things you experience or you might have an impression on your medical skills could be quite different with what that job actually is like as a, as a as a doctor essentially. So keep an open mind and you might find yourself uh in a different path um of your, of your training. So go straight to the point. So why urology, I think this is the five active that we used to summarize urology. At least it is to me. And my decision to choose urology actually wasn't that aligned with this in the sense that it is not how I got motivated to choose urology uh as a career. In fact, with my main passion in cancer, uh I chose urology kinda early on in my F two when I have applied to both I MT and CST. And I was choosing between a urology, the job and uh I MT job that has oncology in it with the thought that I might take that on and progress through to clinical oncology. The main reason I chose urology at the end uh was that I believe as a surgeon, you have more control or independence in uh treating and curing cancers. After all, 50 to 65% of cancers are treated and cured by surgeons. And I believe that that independence would give you the freedom eventually if you want to practice in somewhere more deprived uh or to improve access to cancer care overall. So that essentially was the main motivation behind my decision to choose urology over clinical oncology and urology. Specifically, as a surgical specialties is strong in U surgical oncology. There are five different kinds of cancers, um kidneys, prostate bladder test. Um what's the last one I missed out and penile a so, you know, it's, it's, it's, it's quite interesting and it's, it's a very developed few. But now that I've experienced urology, I think that is more to it and I will go through each of these acts trying to convince you that there's some marriage to it. So it's fun. So, I don't know if you had any interactions, any experience in urology. But my general impression is urologists are found people who are friendly. Um Well, this I suppose is in the surgical realm where there are, I know stigmas around how the surgeons could be. Um And I do think that that's to a certain extent it's true. But urologist are definitely, I would think the least offend of them all. And you will find that actually, we are fun because we often come across very fun stories to share and that's from work in general and also the nature of things that we do. And lastly, probably a big cookie for, for the specialty, you know, big attraction is that we are known to have a good work life balance as surgeons. And I think this is probably on par with other, you know, maybe equally comparative surgical specialties like ent or plastics. And this is both in your training. So 5 to 10 years leading up to you being a consultant and you as a consultant, I would say, um just given the nature of work being quite elective, there are emergency work but mostly covered by juniors and uh the freedom for you to um purely focus on elective works as well quite early on as a consultant. So besides fun, our urologist also very progressive. So a bit of history for you, we are the first specialties that use laparoscopy. We are the first specialties that adopted robotics and we are now also the first specialty that is using Singapore robots. So I personally thought that, you know, as someone that wasn't really surgically minded, you know, it could be quite cool to be to be a robotic surgeon. After all, you are using uh the state of the art technology innovations to to advance care. And there are, there is a lot of da lot of benefit that could come out of it and that benefit goes on to patient care. You know, I think that that at the end of the day is, is a satisfying um uh thing to be doing or skilled to master and following which I don't know if most of you have this experience, but we are also very proud of, of possibility to make things smaller and smaller, especially when it comes to endoscopic procedures. So obviously, we are the specialties that use the most endoscopy um as, as surgeons because of the work that we do through, you know, um it's kind of transorally and there are new equipments coming out that are smaller that make things more and more less invasive and more possible uh with better lasers, better wires, better scopes, anything you can think of. And it's, it's really quite interesting uh when it goes through this journey, especially with the consultants as well. Um that would teach you how things have changed. And that sense of it being a progressive career is or progressive specialty is, is real and it's on the almost a day to day basis. And lastly, we are also progressive on the on the kind of social front, we do have the most number of female surgeons um in the surgical specialties as well as train ratio. I can only speak from the dry I based in and I know that in London, there are more female specialty registrars than male specialty registrars. And I'm not saying this as something to be proud of because it should by nature be equal. But unfortunately, the fact is that sur surgery is still more dominant in general, especially in leadership positions, but at least from urology point of view as a female trainee, you might feel more welcome uh and might feel more free and have, you know, more meritocratic as a states because we do have the highest representation of female uh both as consultants and trainees. Third, I think this is something that's quite important to me. I think if you choose a career, a career that provides you with challenges uh at every point of time. And I think if you are someone like me in that, in terms of your mindset, then maybe urology is for you. In fact, because as a specialty, it is challenging. If you haven't done urology before, you probably would think that urology is, you know, stents cat stones. But actually, it's a lot more than that. And if you think about it, you actually need to go through a lot of learning curve to be a very good urologist. So the first stigma before I joined Urology that I had was that urologist are not kind of serious surgeons, you know, love endoscopic stuff and like I said, stents and maybe robotic surgeries, but not a lot of open surgeries. Uh but that's actually not true. And there are a lot of cancer urologists or reconstructive urologist that do very serious operations in an open setting, which also means that as a urology trainee, you will have to in your specialty training, go through the learning curve of open endoscopic and robotic surgeries. Laparoscopic surgeries are on the way out for urology in general. And if you are trained, especially in big cities in the UK, you probably won't use too much of lab skills. Um And that's certainly not in your, in your career as a, as a consultant. Um So I think that could be quite challenging, but at the same time satisfying. So second thing about complex surgeries, I briefly touch on we are surgeons that do abdominal surgeries, we have as BS um to do uh cystoplasty. Uh and we do work very much in the pelvic area. So, Pelvi oncology or pelvic surgeries are part of kind of urologist. Um um um well, within the, the domain of urology really, and there are emergencies that could be quite high pressure, not quite as, you know, airway compromising maybe. And, but we are talking about things like obviously caution and other things would include pre penile fractures, uh fourniers. Um and in fact, obstructed systems uh as well as obviously hemorrhage post off. So these are emergencies that that could be challenging on a kind of day to day basis by the same time, quite satisfying at uh for, for, for you as a, as a trainee at every stage. And then lastly given that we do deal with a lot of cancer uh patients uh that will be mental challenge in you having to break bad news to, to, to patients and have to see very unwell or operate on very comorbid patients as well. So that's something to, to take note of if, if this is for you as a career. Uh Next is that we are academic, we urologist as a specialty, especially in surgery is one of the most academic uh specialties. So I believe based on last year's figures, NH R MRC and uh cancer Research, UK, uh Urology as a as a surgical specialty has acquired the most amount of money um for, for research in general. And there are very established kind of collaborative just within the UK institutions that will allow you to get your hands on to high quality research um at different levels um for you to, to contribute and, and build a career that way, which also means that a lot of the things you would end up practicing in your clinical day or, you know, clinical practice would be evidence based and they change very, very quickly, especially in cancer setting, uh especially prostate cancer. And this kind of range of research opportunities truly go from exploratory science in the lab to you doing maybe clinical work as in um observational studies could be um trials and to, you know, population screening trials like transform, if you have ever heard of it, we have recently just achieved or rather been avoided 45 million lbs uh to run over the next five years. So if you think research is for you, no matter which kind of research you're interested in, that would be somewhere within the urology specialty that that will fit you in as long as you have the mind for it. And lastly, I think probably most importantly for any job is is is the reward that you get. And I tend to see this reward as um in in different domains. Really, I think, you know, this is my slide and this is done by me. And so I told you very, very early on that cancer was my main interest. And so to me, one of the most rewarding job is to be able to treat and cure cancers. And I could, I would even go further to say that you could do it at a very junior level as well. So, uh you know, as a maybe a core training trainees, you might be scrub or you might even be the main operating surgeon for radical Orchidectomy uh in a very young male patients. And once you finish that procedure, at least I did in the first one, I did uh assisted by a urology consultant. You do feel that you have just treated and cure someone of testicular cancer that could be life-changing for them. And that is uh that is a good feeling uh to me and other things would be, you know, things like uh Tur BT which is trying to recover resection of bladder tumors for non muscle invasive bladder cancer. So this is a procedure done by every urologist and you will be a core procedure. If you are a trainee, these are procedures you can treat and probably cured and in about 50 to 75% of those patients. So again, this goes back to the point of what gives you that satisfaction and reward when you go to work. And to me that is what I was looking for. And secondly, with the learning curve that I described earlier as challenging with you learning and seeing yourself doing better and better uh in the comes with a level of uh satisfaction or gratification as well. Because you would eventually find in every specialty that there are parts of the domains of parts of the work that you do could that could only be done by spec specialist like yourself. And in urology, that is very, very clear, there are things that only a urologist would do and you will feel that very, very early on. And I think that sometimes could be rewarding because you then find yourself in a position where this is a specialization and you have truly developed that and getting better at it, see that you are getting better at it as well. The the mastery of the skills um can be quite rewarding. And finally, I think as much as you would like to be, maybe one would like to be more focused on just clinical work at the end of the day, it is work and that is life uh urologist as, as, as a whole, as a career and do do, ok, I think financially, at least you will have the option to be quite comfortable with your living. And if you go, if, if you become a consultant, especially if you go beyond the NHS uh wherever that could be, whatever you practice. Um So in private setting, um there are plenty of work uh in different subspecialisation of, of urology. That could offer that um extra um support, II guess um that could make this quite rewarding as well while you do something that you, you end up liking. So I think those five reasons, you know, for being fun, progressive, academic, challenging and you know, rewarding um would make urology quite appealing. I think as a career if, if those are what you look for uh in, in, in your work. So the next part is generally on to what the urologist do. I said earlier that it is more than stents, catheters and stones. And maybe some of you don't really believe me. At least that that's what your experience is in the hospital and nobody pick up a phone to refer someone, someone to the urology, registrars or, or urology team in general. So on the left, they are benign urology and these are tend to be the high body urology. Uh So the first one being endourology, so they focus on stones a um being kind of operatively that would mean things like um uh cystoscopy, urethroscopy, both rigid and flexible, that would be like PCL and and um some stone surgeons also do uh complex kind of open surgeries uh as well, but they are rarer only in tertiary units. And second is andrology. So, andrology, in other words, will be men's health uh looking more into fertility as well as uh erectile dysfunction um is operatively quite in, although quite limited to kind of um kind of genital area as well as kind of penile scrotal really. Um and also treat testicular cancer and can develop that as a, as a subspecialty within Enterology um functional urology, uh urologist that do help with kinda essentially neuropathic uh bladders. Um any kinda um things like voiding dysfunctions. Um and operatively, this could mean a whole range of things really. It could mean from putting sacral uh neuromodulation uh into uh a patient. Um gi giving Botox um as well as big operations like uh forming a new bladder, uh cla ileocystoplasty where you basically augment the bladder by using part of your small bowels to make it bigger uh and full language plus minus reimplantation of your ureter. Um and lastly, cystectomy. So taking out the the the bladder as well, other things would include kind of uh artificial uh urinary sphincters that you can do for both male and female patients. So that, that all kind of falls under functional and reconstructive urologist are more those that focus on um urinary reimplantations, um uh bladder reconstructions as well as trauma cases uh within the pelvic areas. Um They have a bit of overlap with functional urologist uh in terms of what they operate uh on. Uh ultimately, we also have pediatric urology, um which is quite interesting on its own, quite a subspecialty within urology, uh mostly actually done by pediatric surgeons that then develop uh an interest in urology. Then urologist that then go into pediatric uh uh urology. Um But essentially what you could do with that is also things like um renal transplants, you could do mieno copy uh or mieno formations, uh neobladder, um posterior retral valve ablations. Um and, and, and the such so quite interesting operations, definitely very self specialized. And the next one, gender information is something newer. And this would be for uh patients that would like to be um basically converted uh from a gender of birth to the opposite gender. And this is obviously very specialized usually as a branch for reconstructive fibr. Um And we do it now in the UK both female to male and male to female. And, and that is the gender information service that's um kinda in the budding stage at the moment. And lastly, probably the highest volume of all pro if not the same as stones would be uh me urinary tract symptoms or just generally co urology uh which should generally means things like P RP uh resume uh which is the steam ablation of the prostate um relief um as well as uh something called whole LA where you use laser to enucleate, uh the prostate as well. On the cancer side is I think, I guess a bit clearer. It's the five type of cancers that, that we, I talked about uh within urology. Uh But in terms of training, it tends to be broken down two ways. Either you could do upper track and lower track or some would say pelvic oncology where you do bladder and prostate uh or kidneys uh on its own testicle. Cancer tends to be done by everyone with some andrologist doing uh more extensive uh surgeries, including maybe retroperitoneal lymph or dissections. Uh penile cancer is highly specialized. It's done only in tertiary Quain centers. Um and, and that will include kind of penectomy as well as formation of kind of perineal urostomy alongside it. Um putting in uh penile implants and, and things like that. So that is a wide range of what urologists do. Uh It's definitely more than um maybe the higher volume of what one c which is, you know, scope stents and catheter. So this probably is what everyone would be interested in in terms of how can you get that done uh to be a urologist. So I guess everyone here should be quite familiar with this pathway. Um with course that you could train going to specialty training. There is no run through programs within England and there are still a few run through programs in Scotland and Wales, which means within England, you would need to apply at least twice to get into urologist. Uh but it's called, um will you only need to do that once? So, co training is increasingly them. And what that essentially means is that within the two years, of course, surgical training, that will be one specialty that will stand out or would have or you'll be allocated to one dominant um uh uh uh surgical specialty. So if you are them to that specialty, then you would do at least 12 months in that. Um In that, in that uh specialty in itself, I would recommend probably do. If you are thinking about doing, doing urology as a career, you choose a urology theme called surgical training. Simply because when you apply to S D3, there are operative experience that is based on your uh competency. And it is difficult for you to achieve those competency realistically under 12 months, if you want to maximize your points and portfolio. Um So that is important. And if you were to end up doing a urology, the course that you're training and you are or rather you are ranking them and you are thinking how you should prioritize them, definitely prioritize having urology in your city one year because if you were to then have to apply in your city, two, you at least have done actually those, you know, 12 months to, to get the competency up. So in terms of course, surgical training, I think about one in five or six CST job is urology. The I applied to London and I could only tell you a bit more about London as a diary. So within London, when I applied, there were 110 jobs and of which only nine jobs were urology. So that's not quite the 15 20% but having said that I do know candidates that eventually managed to swap some of the irritations to get the minimum number of months they need um to eventually then apply to ST three urology. The process of course surgical training. Um I will leave that more towards the end if you have any specific questions on it because things have changed since I applied. And also I believe mindedly has a separate um talk focusing on how you could do do that. Well, in terms of your portfolio as well as your interview. So I leave that a slide but last slide check is about 1 to 5.25 efficacy job ratio. And obviously in this climate, there are many people that would apply to multiple training programs. So that number in itself might not be fully representative specialty training, which is a three I think. Do most people that want to do urology is probably where the last hurdle is and to, to get it is really the golden ticket, I would say do not be fooled by the applicant to job ratio of four or 1 to 4, which look a lot better than maybe called training. But in fact a different um a different ball game altogether because you will be looking at people that have committed part of your career into wanting to be a urologist. So the caliber of applicants as well as the work people have done to put in is quite different from co surgical training. When um things are still quite generalized and not specialized. And when it comes to specialty training for urology, if you look through the report for the assessment, the cutoff points is actually quite high is I think 50 of 76 total, you could, you could get to get a shortlisting for interview and to get to 50 you pretty much have to score um four or five if not all. Uh so five out of five in, I would say 80% of things that you have to get done that. So that is excluding kind of publications, extra degrees um and, and prices. So pretty much and everything else is almost compulsory for you to achieve before you can really look into applying it seriously. And obviously, like any other surgical specialties, you would need MRC S um to, to, to enter. And my general advice for anyone that maybe have set their mind to do surgery is to get MRC S off the way. If you the, the sooner the better I personally would even go further to say if you can get MRC S done before course surgical training, you will find the training a lot easier and and more efficient uh along the way as well. At least that's my experience to it because the last thing you want is to have to develop or get used to the new surgical environment while you develop skills and your portfolio for the next part of your training while at the same time, see two exams that could be quite taxing uh part of the exams as well would have kind of general medical knowledge that you probably would know a lot better or anatomy knowledge that you would have maybe remember better. And since you graduated from medical school instead of later on, and you finish specialty training in SD 607, you would then have to say two parts of Fr CS for you to exit and complete your consultant training. So to achieve CCT uh the general program is broken down within specialty training to S D3 to 5 where you are expected to achieve kind of phase two competencies where technically you would then be a core urologist. And within SD six and seven, you are then allowed to kind of choose a self specialty uh like the one I've mentioned earlier and develop that as well. So you would then by SD seven be completing your training with uh call urology as a background as well as a specialty module of interest, which would be your self specialty. So although fellowship is very, very common in urology just to generally get the operative skills up and to, you know, get different combinations of um self specializations within your or within your practice. Um it, it is optional. So there are people that would do ST five to SDS D3 to SD seven and get a subsensitive post uh right after. Um but this is rarer uh if you were to choose to do cancer work uh within urology, simply because of the extra learning curve of robotic surgery, um where it's difficult as a trainee to maybe, uh get to a level where you will operate independently in, especially more than one cancer site, I guess, alongside these conventional trainings, uh especially for surgery, there are alternative route that are becoming more and more popular. Uh The first one is Crest Crest is actually a CST equivalent uh where you have to be very organized, you have to go through uh different surgical specialties. Obviously, you can see me as you wish based on your, your, your trust grade jobs. Um you then get the competency to get into to, to be signed off the important things to know about Cres is that there is a timer on it. You still need to do MRC S. You would need an overarching educational supervisor that would help guide you to get the signatures you need. And lastly is that you may not, you most likely will not get equal amount of training funding to go into the courses that will help you prepare for the next stage, next stage of your training. Uh as compared to a CST equivalent in terms of Caesar. Caesar is a route done after course, surgical trainings where you is essentially an alternative to specialty training where you uh have to again be very, very organized with uh timelines um to achieve different competencies that you are allowed that you are expected to achieve as a urologist within the UK. And that usually is kind of based in a tertiary center and you would then do different jobs rotating through them and you will need help and support from very many uh consultant colleagues um to get you to that point. Um But it is um similar outcomes as a specialty trainees towards the end, especially if you practice in the UK. But do know that your certificates to enter the specialty uh register within the UK is different from someone that will have CCT, which means that there is a slight difference. Um If you were to look to practice elsewhere, that's outside of the NHS, uh if you were to go through the Caesar pathway, so I would leave that generated like this. Uh But if you have any questions, I'm happy to delve into it at every stage of this. Um uh Yeah. So I think I cover this mostly, but I would just run. So for CST, like I said, do MRC as, as soon as you can, if you're interested in urology, I would definitely recommend the bowel course which is four days long. And if you are a CST, you will get money compensated for that, you want to start doing some urology based all these or creeps the, the the importance here is to do urology. All these quis because what I didn't do was um essentially a urology base. All this I did all these quis, but there were no urology base which I then found myself in a position where I have to repeat, uh you know, up to four of these res to get myself ready for S D3. So if you can do that sooner, the better, then the last thing I mentioned this as well is to prioritize the sequence of your training within CST. If you can do urology first, get them out of the way because you want to achieve level four competency, which is you being independent in the operative procedures for expiration, circumcision, stent and cystoscopy. This will be generally enough to get you to uh to do CST at uh ST three, at least for an interview and clinically for work as a junior registrar. So for S D3 preparation itself, one thing to note is why your portfolio could be very good for you to be shortlisted. The moment you are shortlisted, really the playing field is event, which means your, your performance generally will be based on your interviews and interview in itself is an experience that I personally think would come back if you were to practice with other registrars, especially for seniors. One as well as those who just did it as well as consultants. Because after all, you are marked by consultants and I will tell you that for my own interview process or preparation, I have spoken to in excess of 20 consultants and registrars in combinations just to get a feel of what everyone would like to hear in your answers in those interviews. And they are obviously very helpful interview courses as well. They do run out very quickly. If you are looking to apply, you're probably a bit late already this year. But these are the few stars urology B ri um ST three courses to, to look out for, we already talk about, talk about the portfolio cut of points. And the last thing that a lot of people forget really is to get the clinical experience in outpatient clinic, which is a quarter of the points when it comes to S D3 application. And most of us, if you haven't done a trust grade registrar job would have very limited experience in outpatient clinic and you will come through very quickly in interview if you haven't got those experience. So after you have submitted your evidence for portfolios, it's time for you to go to outpatient clinics in real life to get that experience in while you prep for more interviews uh for the for S D3. So depending on what stage you are, I think these four things, if you haven't already done them could be things for you to get started at any point of time, you know, meaning even now um to, to, to make a his spine in urology. So if those are of interest, I would generally recommend these things uh depending on which things appear to you the most. And I have to give a special shout out to Duba, which is the British Association of Urological Surgeons, uh which is a very united uh association as, as a specialty. And it provides a lot of support and the conference itself lasts for three days and it's very, very eventful. You don't have to be a urologist for you to experience what the the width and depth of urology is and also the fun because that's always social uh after those conferences as well. So I hope this has been a bit helpful uh or at least shed some light for you in what urology means as a as a career really. So that is part one of my talk before I move on very, very quickly to share my personal research experience, which I hope would maybe inspire one or two of you to maybe pick up research as something more of an interest. Uh If you are not thinking about doing an academic uh career. So anyone has any questions at this point of time before I talk about something else altogether. There are no questions in the chat at the moment, but please feel free to post your questions in the chat and we'll make sure to cover them. OK? Sounds good. So next part is about research and I will tell you this with a very open mind. I think the main question I think is, is why are you doing research? And are you doing it mainly for your portfolio or are you doing it generally thinking that you would want to eventually become an academic consultant which could well do. And then the following questions is if you then haven't gone through the research pathway or academic pathway, you know, as a in my time, an E FP academic foundation program which I think they have now abolished altogether um to maybe being an ACF and ACL clinical scientist, associate professors. Could you then do research um as um as a, as a meaningful uh part of your work? And can you truly be serious about it? Um T this, I don't know, but I will share my anecdotal experience as research, which really is something that I can support and I will tell you how I did that. So just going back to my F one year, I told you that I did a taste a week and at the time I was thinking, you know, definitely clinical oncology. So I did that. So I took a, a week of my third rotation in F one. I think this was kind of April time. Um In, in F one in clinical oncologist, I simply reached out to my education supervisors that knew a clinical oncologist that was happy to have me on for a week to shadow her basically. And then when I was shadowing her, I was in the department, I was then speaking to registrars that, that were doing different things with different consultants. And I was, I had my interest mainly in kind of oncology in, in a, in a global setting, especially in deprived areas. And so I was recommended to meet professor um on the third day of my state to wait and that's how it began. We had a coffee that morning when he was on call during a ward round, he then sent me to his office while, while wait for him to, to finish his ward where I met his counterpart, Professor Sullivan. Uh we had a chat for half an hour. Then he sent me um um uh uh uh basically um an Excel spreadsheet with studies that have been done and screened for a systematic review and say, why didn't you give this a go um and send me the, the methods and some visuals afterwards to see how we can frame this paper. And the systematic review essentially is in the use of virtual reality in oncology setting. Um And really before that, I've only published a case report and that case report was from the very first um patient I saw as F one and that, that wasn't kind of what I would say a proper research. So that is how it began. So the systematic review took, you know, eight months 12 months. That's one thing that, that happens in research, things take time. And the second thing to, to note probably from my experience is you have to take learning uh as um you know, we within your uh you, you have to take ownership of your own learning. Uh which means when it comes to your research, there are a lot of steps that you have to kinda troubleshoot yourself and learn those skills and or pick up as you go. Uh And it's important to have someone quite senior as a mentor to, to, to get you through those steps. Um But essentially as a non academic training, I managed to kind of get a system review after uh over the line uh with a lot of help and that essentially got published. And then following which um I was offered an honorary clinical research fellow job with the Institute of Cancer Policy in Kings College, London, which was essentially headed by Professor and Professor Sullivan uh for them to allow me to access the data that they have uh within the the system at ST thomas' while I have moved on with my work. And so with that, we have started on a couple more research um and because they are also organizers of London Global Week or Global Cancer Week, uh I was kind of help uh organized and participated in that which I found really, really helpful uh and eye opening really uh to be working with people from different realms altogether. You know, they could be physicists, they could be uh anthropologist epidemiologist. Uh they could come from all over the world in different settings to, to describe what cancer is. Um And that, that was one of the most satisfying kind of experience that I have uh in my career so far. Um So I kind of kept going with that kind of in the background. I was 100% I was 100% trainee all these years. And then I realized in my core training year that because I haven't taken any year of, you know, any indication or any kind of master's program in research, I was actually, you know, lacking those skills that I need in research and there are many skills you could think of and I personally am someone that would only learn the skills if I need to use them. And if not, I would learn, I will forget. And so with these two other projects that came on each of them in different kind of spectrum of research, one being very qualitative and the other being, you know, quantitative that requires statistical analysis. I and took on all these courses. Uh And the helpful thing really that I should mention here is that if you are attached to a developed research team, especially if you're a clinical research fellow, you mo most of the teams who have some level of funding that would allow you to take on short courses. And that would help both with your portfolio and also for you to develop those skills to do research. So you do not necessarily have to have those uh skills by doing extra years. Like masters, you, you will probably develop better or more comprehensive skills, but just those few days of courses with very active application and guidance from someone more senior than you to get you to a good level where you could, you know, get to the end of your research with results that you, you you designed to achieve. This is from my personal experience. Um And so I'll recommend uh in kind of in the in the RS of your jobs. Uh if you're doing a trustor jobs or if you are in years that you don't have to apply for the next part of your training to, to get this under your belt, if you are interested in research, especially if you have a project already that's ongoing. Um In my C D2 year, I basically took uh a while shot really and a grant. So with my kind of systematic review done in Pr and oncology, I then was spying or looking at this 50,000 lbs grant that was offered by Basil, which is British Associate of Surgical Oncology at Rose Tree, which is a charity uh which li literally looks at surgical oncology and innovations. So they were basically giving out up to 50,000 lbs for you to, to do original research for innovations in surgical oncology, which was basically ticking all my boxes. And I then use the systematic review as the groundwork that I've done with help from Professor Solian because he has done work uh with other people that can kind of two years before I joined them really uh in virtual reality to then um basically designed and implemented a study which helped me secure the grant. And this is truly the, the the turning point I would say or where I get to a level of maybe freedom uh to do research uh as, as as a doctor as compared to you being given projects uh all the time and not having really love autonomy over what you want to do. Um But essentially long story short, it was looking at the use of er to build surgical capacity in Zambia, especially in hysterectomies. Um radical a dominant hysterectomies for early stage cervical cancer and also postpartum hemorrhage. So you could tell that as ac D2 urology, uro urologically minor trainee, that is quite a different view, which I quite enjoy. And I know I will tell you why because a lot of the things here that you want to do might not be especially research might not be fully aligned with what you do clinically. And that is absolutely fine because you will find your expertise helpful at some point. Uh you know, within this experience as well, and it's important for you to, to broaden your mindset and to look beyond your specialties, to know that uh there are things that needs, you know, a cross specialty solution for so doing this VR trial and we are based in Zambia, essentially, I had used this as an as an opportunity to fly out. This is the first time I was in first time for me to, to be in Zambia and you will find II was finding myself in, you know, different cities in Zambia. And that's, you know, outside of Lusaka as a capital, seeing district hospitals, knowing that as a country, they have only got one cancer hospital was, was achievable. And what is known and that kinda aligns your expectations and that was what I enjoy doing. And so this is where I kind of research has, has led me from, from that path. And obviously alongside II was always worried that, you know, this part of research really has not got a strong connection with urology and I still am thinking about these things because if I eventually want to maybe perhaps take some time out to do an MD or phd with that align with urology, but I'm keeping my mind open and I think everyone should because you never know where it's gonna lead you and where it's, you're gonna find your urology focus and it, it might, it, it, it might well happen in the next couple of years. So alongside it, I obviously would in my clinical work still do urologically based research and that we've uh improved prostate, which is a very different kind of environment altogether. You're doing kind of now clinical trials and they are not the same as you doing trials with the implementation focus. Um But this experience taught me different things and gave me different skill sets that will allow me to build or the design that I want eventually. And from those, I got different kind of exposure as well as different kind of academic uh achievements or outputs like papers out of it, uh which I found very, very helpful and obviously is different because if you are not an academic trainee, you don't have, you know, you're not like a acf that will have 25% of the time secured away for research, you will not have the same uh funding. Although funding is only a very, very minority minor part of this. Um this, this, this journey I would say. Um and then a lot of these things you have to do either on your own time or you have to take study leaves for you to achieve those. And you would need someone quite supportive as your education supervisor to, to, to achieve those things uh as well. So it is something that would take uh a lot uh especially more than your contracted hours. But you, if you enjoyed it, I maybe the the reward is, is worth it. So essentially now with those two things uh running in parallel, it basically has taken out most of my, I would say my own academic time, uh even with the studies that I'm allowed. Uh But it has given me more opportunity opportunities to do the research that I want. Um and get that over the line to, to form papers uh and output. Um So research is a, is a long process and there are research that would take 1 to 2 years that researcher can be turned around in six months. And my general advice is to be open minded about it because it will give you a lot more experience to your job, more than more than your clinical work essentially. So this is the talk or rather the, the presentation that I gave that gave me the money that isa before was the infliction point of the what research means to me. Because prior to this talk, prior to getting this money, essentially, all the research that I've done was directed by someone else and also purely UK based. But with this opportunities and this is s this is basically a research. It was simply based on a systematic review that I've done out of blue from a case the week it has given me opportunities to go and to experience healthcare and even life outside of the UK. So you can see here this is January earlier this year that we as the Global Oncology Group and CAS did a surgical oncology workshop with the Minister of Health in Zambia. And on the right was back in July while we were invited over to do uh to lead the oncology symposiums as they tried to decentralize the cancer services. And you're working with very interesting people. The one next to me was the chief of nurse for the whole of Zambia. They have gone through different paths and is now an oncology nurse. Uh We have got radiology residents from ND Anderson in Texas and we have got um, uh patient representatives. Uh on the left, there was a cancer survivor herself 25 years plus. And here that is the cancer program by the MD Anderson. You're seeing advocates against, uh with the degree challenge. Um You have these stigmatized, uh hair loss in cancer and on the right, you're seeing the surgical clinics where they see 120 patients one morning with one consultant and two reed registrars with no electronic health systems. Uh I can tell you that that was a very, very, very interesting experiences and as a, as a very junior urology registry at the point, uh I was deeply overwhelmed and, and the things I see was was very, very interesting. It does change your perspective and, and that, that stayed on with me. And here on the left, I've been humbled as I walked through the uh district general hospitals to see this male circumcision clinic. That's essentially a nurse led theater under local anesthetics where the nurse would do up to eight circumcisions in the morning. And that's unheard of unheard of even in a Enterology release um in, in, in the UK where you would get maybe four to half a day. Um So that's how you get humbled in different kind of services. And on the right, what you see is the size uh that would in a year hopefully be the second cancer disease hospital in Zambia. So you do get uh a uh a wide range of experience outside of clinical work where you're not just running on the boards uh in theaters and being on course. Um And I find that really quite interesting and open your mind, open up my mind anyways to, to to what a clinical career could be. And these are the good times you get uh in social hours um out there on the right, that was a club in Zambia. That was very interesting and you obviously can do a bit more travel afterwards yourself when you have been flown out there. And on the left is Victor four, you see the white rhino in the middle and right is the African elephant just migrating through the river just happily one day when, when I was there and with the Imperial prostate team, different kind of research, clinical research more on a day, day to day basis. As you can see on the left, we were doing some something called confocal microscopy when you try to get incooperative surgical margins for prostate after prostatectomies. Um and we are very proud to be trying these products that was really just very, very new and just go FDA approval and uh approval to be trialed in, in the UK just a couple of months ago. And on the right was bows just earlier this year where essentially they, we have taken out six out of 10 of the oral presentations, uh, section for, for prostate cancer and won the best prize, uh, the, the Golden Scopes, uh, as well. Uh, that is Professor Ahmed the third on the right. So it's different kind of enjoyment and this is the lead to the day for, for, for me and the other two registrars, uh, and the fellow. Uh, it's, it's all really quite social and I think this really make work a bit less restricted to, to, to, to, to work and, and the stress with it and there is some fun and a bit more kind of investment into what, what you do. And that is what I think research provides and to the career and something more lasting and, uh, something as personal as well. So all in all, I think these are the few things that I have come down to, to, to realize, uh, that I have been very lucky with that I think is what I would like to maybe share with you. The first one is to find a senior mentor. And I say senior uh because a senior mentor by definition will want different things than you. Um They will be looking to more coach and guide you. I expect you to have more independence, autonomy over uh your own learning and, and getting work done. Uh But at the end of the day, in terms of output, uh they will be very happy to be the uh last author while you become the first author, which is quite important if you want to develop your research portfolio and second, only commit to things that you can deliver. And this is very, very important if you want to leave a good impression where you don't overpromise things uh because that would affect your trustworthiness. Uh I think, and generally affect your longevity in, in, in a research uh team. Um So, yeah, and the third thing is be accessible and keep an open mind. I think I've mentioned this many times and I said be accessible in the form of um that certain research don't, don't have the um will will make you work uh at hours that you might not usually be working. And sometimes it is simple things like replying an email uh when you're on holiday. So you can meet a deadline or you know, getting certain things done. So, in preparation for your uh research mentors uh to, to, to get ready for for presentations and to be accessible really is, is that uh is to have that flexibility and you have to kinda build that into your life if you want research to be part of your, for part of your life as well. And the fourth thing I've mentioned this as well is to take charge of your own learning and work. No one is gonna cut your back. No one is gonna, you know, tell you give you the money to, to take time out to, to do this course and that course, uh and after all, you need to bring under belt and it's more than just learning, it's also applying. And if you are someone like me that would only really learn and remember if you have to apply a skill, then I will pick up a research that you have no certain clue uh of how to achieve the end of and try to find a way around it, whether that being qualitative, quantitative implementation or uh or even biochemical or clinical informatics work. Uh There are plenty of courses out there. Um And the second one is if you are ever doubting yourself, you know. Right, and submit. That is what I would recommend for everyone. And that's how I got my first or presentations. That's how I got my first prize. That's how I got my first grant and that's still how I'm trying to bring it now to get more to, to, to support the things I want to do. And lastly, it is a journey. It's not just about the papers you get out, it's not just about pro points. In fact, those are very minimal things after you get through that. Obviously, I say with, you know, the comfort that I have now uh with the numbers I got, but I do seriously think that we should all enjoy the journey and take research on something that's more lasting, something more like a legacy and something of a journey where you work with people better than yourself. And that usually means very, very good company. And this again is good times that I had while I was technically doing research on study leaves on the left. Is this done that really wouldn't stop for 34 hours. And on the right here is shows that we share with the consultant on the right and plenty of registrars and even point ones that were, that were with us last year doing very serious research, meaning a lot of data collection between 5 to 10 p.m. uh after their, their, their award day uh to get to where we are and present that over about 24. So really that is all I have. I'm sorry that I have black on for, I think probably an hour. Um I probably brought all of you to to sleep, especially after your work day. But I'm very, very open to questions and I want you to try to keep this light and that was a fantastic talk. Yeah, really enjoyed it. Thank you. Thank you. That was a, a really great talk and you can see the passion you have for urology and research. So that was great that you shared that with us. We have a quick a few questions in the chart. Uh The first one is you men mentioned, robotic surgery is robotic surgery included in urology training or do you need to do fellowship separately? Ok. That's a very, very good question. So from uh if you are trained in London, I think you can confidently um be trained up to an independent level for one cancer site. And that usually means prostate. So you will in your essay, six and seven year, be given opportunities to operate uh robotically. So robotic prostatectomy and to a good level where you can do that independently as a consultant with our fellowship. But it depends on where you want to work. If you are, if you are training in somewhere less su specialized or centralized, then people tend to do a fellowship to, to complete that. Um because different cancer services or robotic services have different set up. So for example, in Oxford, they do pelvi oncology and upper tract. So, Pelvi oncology means cystectomy and Prosect toy, which means if you are only trained a prostatectomy, you, you wouldn't really fit that, that, that that goal. So we would then need a year of fellowship to do reporting cystectomy as well. Um But this is not the same everywhere. Um Well, upper tract tends to be just upper tract. So you would do robotic uh nephrectomy robotic pylas um and some retroperitoneal work uh uh alongside that. So to answer your questions, I think in most of the country, this type of the training, uh you will need at least one fellowship to be robotically competent enough to get a consultant job. Thank you very much for that answer. The next question we have is, did you not consider ACF given your research experience? No, I have considered and in fact, I'm not sure to share with you that I did not get a ACF even an interview that was shortlisted, but I didn't get an interview for the ACF job. So my experience with ACF is that most of the ACF are all of the ACF are attached to a professor and most of them are already set in, set towards a project. Um That was designed by the professor, which means that whatever that you have set up will be helpful, but they will expect you to do things um that are aligned to, to the line of work. Um So essentially the keeps to getting an ACF job really is to always have a coffee talk with the lead modules, um lead ACF uh person uh before you actually go for your interview. Uh If you don't know that already because they will want to know what kind of person you are, what kind of experience you have and how much interest you really have for, for the work that they have proposed with you. So when I applied to S D3, the ACF job was in clinical bioinformatics. So a lot of genetic stuff um that I have no clue how to do at all. Um um which wasn't really my passion given that m my focus was really in more kind of global oncology uh and as well as implementation and integration implementation or, or clinical research. So uh I have applied, I didn't get it. Mhm Thank you very much for sharing that with us. And the next question is, are there any specific urology workshops, online courses or certifications I can complete, for example, basic urology skills, bladder management. Uh Yes. So two that came to my mind straight away uh depending on level if you're in kind of level. Uh The emergency urology workshop is a one day course in Cambridge that I will recommend it will definitely make you feel more comfortable when you're doing a urology essential job, especially when you're on quote. And the second was the one I mentioned before is the bowels called Urology modules. That's a four day course uh that will teach you most of what you need to know to a level of a junior registrar. And alongside which a half day kind of more interview and a practice um uh for, for ST three. So that is what I would recommend. OK, thank you. And last question we've got is how did you go about starting your systematic review? How did I, how did you go about starting your systematic review? Right. So, uh this is an interesting process. So I was given, like I mentioned in this spreadsheet with about 90 papers on it. So essentially what uh my mentor has done or Professor Sullivan has done was that they have found the keywords for the things they're interested in meaning, virtuality and cancer. And they have got someone to run this search already. Usually you can have the librarian to run the search for you, but you will need to, I have your own search terms and these search terms needs to be discussed with someone senior before you start doing your system to review. This is very important because if your search turns miss out very important keywords, then you might miss out on a lot of the papers out there which then will compromise the impact of your or, or the or the or the robustness of your study. So what you can do really at this point, either find someone like uh academic mentors that will have access to, you know, developing these surance with the uh yeah, their medical statisticians and, and experts. Um and from that learned to screen papers um develop inclusion exclusion criteria. I personally did it by reading the most recent reviews in those topics and see what the inclusion exclusion criteria were, have a general field of these topics that is extremely new to you and go from there because you don't really want it to be fully rigid to what you already knew about the topic because then you'll be missing out. That is the good thing about not knowing too much about a topic you're gonna research on as compared to being an expert in it. So essentially search them. You can use actually chat GPT now to help you. If you ask the right question, you can say you can prompt it, saying I would like to do a systematic review in this and that for the past 2030 years um with papers included on Web of Science, uh et cetera. And could you provide me with the search terms uh with, you know, focus on maybe cancer, focus on virtual reality and see what that brings you. But ultimately, the sur should be agreed by a group of experts in those topics already before you you delve into do more work. That was interesting. I think having a I as a tool as well can, can help quite a bit. So that's, it's really interesting. So you can use that for systematic reviews. Yes. And you can do that for statistical analysis as well. So if you use R or if you use data R, especially if you, if you copy and paste an error code when you're writing it and say you were trying to do this, this came out. Could you help me troubleshoot it? You tend to get the answer? Ok. That is very, very helpful to know. Thank you very much for your time and for the brief presentation, uh I think those are all the questions that we had. Um please, for everyone that's still at uh on the call. Can you please fill in the feedback form in order to receive your certificate? And if you have any questions, feel free to, to email us or let us know. Thank you very much again. Thank you.