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Surgical Training in NI



Join us at 19:30pm Tuesday 15th November for the second instalment of our online teaching series; 'Surgical Training in NI' with special Guest Mr Trevor Thompson Head of School of Surgery at NIMDTA. Sign up to this event via the MedAll link

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

Hi, everyone. Welcome to the Northern Ireland Foundation Training Surgical Society, Second webinar. And we're absolutely delighted to have Trevor Thompson, the current head of school of surgery, and Nemsila with us tonight. Um, before I hand over to to Trevor, Um, if anyone has any questions that we go along, feel free to use the chat function, and we can have a question and answer session at the end. Um, and also appreciate if you would fill in the feedback as well at the end of the session. It really helps us. Um, so over to you, Mister Thompson. Thank you very much. Well, thank you, Kyle. And thank you to all at n i f. T s s for the invitation to speak. I'm greatly excited by your society because it gives us another way of, uh, interacting with people interested in surgery within our small region. Uh, we talked to the undergraduates, uh, and now I am delighted to talk to postgraduates who have an interest in surgical training and a career in surgery. Uh, and what I'd like to do is to take you through recruitment for surgery in 2023 um, August 23 then hopefully have a discussion questions and answers, Uh, at the end of it, uh, and hopefully we'll have plenty of questions. And hopefully I'll have some of the answers for you. Any rate. So, uh, I, uh if we go to slide to please Kyle, uh, I'm, uh, here representing the school of surgery at nine. To as you'll see, there's a lot of admin, uh, information. So I I've spoken to the admin team, but some of the finer details that you may wish to know. Then you will get from the Orio website, which I'm sure you're well familiar with, and any specific questions that you don't find from there. I can take them back to admin and email you with, uh, with a proper answer. So what I'd like to talk about Slide three is, um, where to apply, when to apply how to apply, and then a little bit at the end about the structure of surgical training as it exists at the moment in Northern Ireland. And then we'll go to questions. So slide four, please. Um so this archipelago of islands that we live in off the west coast of the main continent of Europe contains quite a few jurisdictions, and each of them has their own way of training, uh, surgeons. But in terms of recruiting surgery, it distills down into three regions. So if we can go to slide six, uh, and the three recruitment processes that exist at the moment and will exist for August 23 are Northern Ireland, run by Nim to, uh, G B, which is England, Scotland and Wales, which is run by London and the Southeast. So that's the London Dean Ary and Kent Surry Sussex, K S s. So it's a hugely resourced, um, a couple of Dean Aries to run the inner enormous court surgery National recruitment system who are looking, I think, for around about 1600 people to fill jobs. Both Northern Ireland and G B are accessed through the Oriole system, which I've mentioned already, and you'll be very familiar with. And don't forget, there's a third, uh, iteration of recruitment, and that's in the Republic of Ireland. Run through the College of Surgeons in Dublin. Uh, and information on that can be obtained through the college website. Um, slide seven. Please go, and very important to note that if you apply and are successful in getting access to one of these, uh, court surgery or basic surgery training schemes, then are eligible to access any of the higher surgical training schemes within Great Britain, Northern Ireland and the Republic of Ireland. So at the moment they have parity with one another. Uh, Brexit. It's begins to stress that we haven't really seen Brexit yet in its full glory in dividing us into EU and non EU doctors and some of the problems that that may have in the future in terms of recognizing professional qualifications. I think the pandemic has muted Brexit's distinction between the EU and non EU doctors, but I think that will evolve as the pandemic disappears behi find us. But at the moment, these three processes have parity. So if you become a Republic of Ireland basic surgical trainee and complete training, you can enter cardiothoracic training. Um, so we'll say that's not a good example. You say urology training in either Northern Ireland or England, Scotland or Wales. Um so you've got three different places to apply to and then slide it, please. So when do you apply? Well, slide nine. Please call applications have opened. Opened on the third of November in Northern Ireland and for core national recruitment, and we synchronize our dates very closely with them. So at the moment, recruit applications are being accepted. Uh, and the application window shuts on the first of December 2022. So you don't have that much longer to apply in this window, Nim to will begin long listening applications. Um, looking at, uh, things like your visa suitability language, fitness to practice qualifications. Uh, completion of a valid foundation program. All of these sort of hard pieces of data which make us sure that you are able to work as a court surgeon in Northern Ireland. Um, uh, What we are then going to do for the first time this year in G B and Northern Ireland is use this assessment tool, which again you'll be the you'll probably be familiar with. It's called the Medical Selection and Recruitment Assessment tool, which we hope will provide us a means of short listing candidates. Last year, we had over 400 applications for around 40 jobs, um, and last year and hopefully this year, we will be able to shortlist fairly and properly down to a manageable interview cohort off around in about 100 and 50 people. And we're going to use M S R A in order to do that. And maybe we can talk about m s are a afterwards, it's widely used by general practice and radiology. Um, as their means of sifting candidates for interview, we can't interview everyone Nim to has a significant admin. Stress is around this time of the year when we're, uh, recruiting for different schools. Different specialties. Uh, and we've got a capacity of around in about 100 and 50 to interview, um, there will be probably 35 to 45 posts. Um uh, to fill, uh, and we fill by rank order of, uh, the interview scores. And then hopefully our offers will go out admin permitting towards the middle or end of march with a date then given for your acceptance to start work on the first Wednesday of August 2023. So that's the timeline, and the timeline is active at the moment. So slide 10, please. Kyle. Slight. 10. Uh, So how do you apply? Uh, so slide 11. Well, I'm sure you've already done this, but the place to look at for all recruitment in G B and Northern Ireland I e u k is health education England, who are funded, uh, to recruit for us all the fact that we've opted out for our own interests. Uh, we we have done so with the blessing of H E and the G M C. Uh, so they permit us to do this, uh, and we remain in there. Good standing. But everything is funded. Um, by h e. Um, So go to the M d. R s website, medical, dental recruitment and selection. And you will navigate then towards court surgical training. And you will see the person specifications for which is a long form, which changes slightly, um, every year. But the application form that you will use, uh, to to put in your your your bid for recruitment is pretty much modeled on the person spec form. Uh, and the person spect form, therefore, is your guide to how we score the application form. You must complete it carefully and fully. Some of the things that we don't like uh, lead to immediate rejection of an application is if there is evidence of gaps in employment, um Nim to ultimately are an employment agency, and we want to recruit people who are employable and trustworthy. So if there are people with unexplained gaps in their employment history, which I accept is is not likely when you're not long out of medical school. But if you've gone away for a year, um, if you've locum for a year, then you have to be able to explain what you've done, where you've done it and what sort of, uh, dividend you've had from that work in terms of professional progression and also give us an idea of how you have been appraised and validated by You're a responsible officer in your year away in Australia or working for your locum agency. So a short note on what you've done and what you've gained from it, no gaps. And the other thing that's changing now is emphasis and courses. If I was giving this talk five years ago, I would have told you to get on as many courses as you can in order to show that you have a commitment to the specialty of surgery. But the G. M. C have taken another view on that. And that is this. That if you are a rich trainee or a trainee, perhaps with rich parents, then you are able to buy courses more than a trainee who perhaps does not have the financial wherewithal to buy courses. Courses are expensive, and deep pockets can make a portfolio look better, even though the trainee maybe no, no better than the trainee with shallow pockets who can't buy courses. So increasingly. We are using other indicators for your suitability for training other than a groaning portfolio, with every course under the sun bought and paid for with thousands of pounds, perhaps of your parent's money. So this is something that the the GMCR very strong on. And, um, certainly in my experience, this is a big thing, a big change this year, even compared to last year. So slide 12, please. And next thing is, as I've said, the short listing to will be. This m s are a We'll talk about it perhaps afterwards, but you can go onto Mgrs or some of these more specific websites and start doing practice tests. Um, it's it's a test of your character as well as a test of your clinical skills. It is not particularly a test of your, uh, surgical aptitude. Uh, but it's a character and generic skills. Uh, sifting test. G p, uh, and radiology are very keen on it. So this is our first use of it in, um, court, surgical recruitment, G B and Northern Ireland this year in G B. I understand that they're going to use the m s are a score, uh, as 5% of the overall interview score. We've thought about it, uh, here in Belfast, and we think we will not do that this year. We will not do that this year until we see how m s are a works. And we probably will do that next year. That will include the practice score. Uh, the M s are a score into the overall recruitment score, but they are doing it in G B. 5% of the, uh, score. The overall score will be M S R a. So slide 13, please. Unfortunately, uh, what we're, uh let me see. Slides 13. Is that where we are? How our interviews will be by zoom and we will have three stations. One a portfolio check to go through, uh, the portfolio that that you do provide for there will be a management station with two questions and a clinical station with two questions in G B national recruitment. They will also have a presentation where you'll be asked to provide a five minute presentation, usually in something woefully and wooly, where you can either XL or hang yourself something like leadership or something like that. Um, and you've got five minutes to to talk to the panel on leadership. But again, we aren't going to do that because we don't think that's a particularly good way of picking surgeons. It's a good way of picking lecturers, but we're not training you primarily as lecturers. We're going to train us surgeons, so the common sense questions of a management station and then the clinical knowledge of a clinical station are the way we're going to stick with it. Uh, this year, the management and clinical questions that we use are from the question bank used by national recruitment. So in UK recruitment processes, you'll get asked from the same question bank. Um, so if we go to slide 14, so what are you applying for? Um And if we go to slide 15, this is what you're applying for. Um, and this is the current model of, um, training for hospital surgical specialties in the UK at the moment, um, the Republic of Ireland is fairly similar, but as you'll know, their foundation program is a single year as a house surgeon or house physician. Um, which is the way it was when I was at your stage. But our foundation program now is extended to two years for your generic introduction to practice. Um, So what happens for those of you at this junction between F two and the, uh, court stroke run through specialties is that there is a competitive interview, and that's the same across all the countries of the British Isles. Um, what you go into their after depends on the specialty that you choose. Some of the specialties have already opted into so called run through training or R T t. Um, something like neurosurgery is well established and run through training. Um, cardio thoracic surgery. It starts run through training from ST one this year. E n t is edging towards it. Um, and, uh, ophthalmology is has been doing probably probably longer than anyone else. The other specialties, such as general surgery, urology, trauma, orthopedics are all done through so called uncoupled training, where there is a two year program of core training, which is generic surgical training. Then another competitive interview to go into your higher surgical training, Um, program, UH, such as orthopedics or urology, general surgery, vascular surgery, etcetera, etcetera. Um, I think ultimately everything probably will go to run through training. But at the moment, I must say, I'm a great defender of uncoupled training because I think every surgeon should have a point in their career where they know how to recognize an incarcerated hernia or know how to put in a catheter into a difficult patient for catheterization, just simple generic skills, which are wide spread across all the specialties. But that's not necessarily the view of the J, C, S T or some of the colleges who believe it's more efficient and and more less time consuming to put three people through, perhaps shorter duration run through training programs. And I think I fear that's what's going to happen and that the court specialty training two years will probably disappear. Uh, perhaps in the next few years. But that's what you're That's what you're applying for at the moment. And therefore, you, uh if you're going into court surgical training, which is what we're talking about today, then the specialties that you are aiming for are the big ones. Like, uh, t. You know, general surgery, urology, vascular, etcetera, etcetera. Not neurosurgery or ophthalmology or cardiothoracic surgery, Uh, which are all done through run through training. But I'm sure those of you who are interested in those specialties have already worked that one out. If not, I'll happily talk about it later. Uh, so slide 16. So why choose, uh, Northern Ireland? Uh, slide 17, please. Um, I think Northern Ireland has a very high reputation around the world, but certainly through the British Isles at training surgeons. And I think part of that is because that we are small and personable and that we get to know you. So once you enter court surgical training, you're part of a very small club of people who depend on one another. And perhaps for the first time in your professional lives, you will truly feel part of a team or what used to be called in the olden days, a surgical firm, and you are highly valuable to that firm. And the quid pro quo is that if you help the firm do its work, the firm takes great pride and pleasure in teaching you the craft and the art and the science of the practice of surgery. Um, and and we do get to know each other very well. Um, other good thing about Northern Ireland again because we're small is that you can complete all of your eight years of surgical training, um, without moving house so you can buy a house somewhere sensible on the outskirts of Belfast and essentially commute for most of your jobs. Some of the bigger geographic Dean Aries in England and Scotland especially. It does require, uh, moving house, renting and moving as you move around one of these huge geographic areas of a dean aree the next. The next thing that we do better than anywhere else of the other 17 Dean Aries or the other 16 Dean Aries rather, is that we have a single lead employer model where your employer is nim to not the trust or the hospital that you rotate around in Northern Ireland. So that makes it easier for you, for example, to access financial services to get a mortgage or to get a car loan or life assurance. You have two years or six years, um, security of employment. Uh, and we found that the feedback from our trainees in Northern Ireland to be super in in how it changes your ability to get a mortgage the big thing at the moment, if anything, can. If anyone can afford to get a mortgage these days, then you will be better placed to do it in Northern Ireland. Then you would be across the water. Next thing is the national training Survey. The G. M. C. Has a national training survey that all trainees have to complete, Um, and in 19 of the domains this year, Northern Ireland trainees came top, especially in the sort of subjective morale domains. And again, I think that is purely due to the fact that we're small. We know each other and we support one another. Next thing Consultant engagement in Northern Ireland. Northern Ireland has a reasonably small world of private practice. Therefore, almost all consultants almost always are on the deck. of the ship in the NHS, it's hard to move around the royal or the city or Craig Avenor, the Ulster or Altona Galvin without tripping over consultants. So you are always led by consultants in the operating room and the outpatient clinic. Uh, and our ratios for that are much higher than G. B. And lastly, we encourage people to take time out of, uh, program hoop or 00. P. And there are several different hoops. We have management. Oops, we have a fellowship called the Adept Fellowship, which surgical trainees actually have taken, Um uh, more than medical trainees. Which surprised me, I must say, when at the adept fellowships began. But we have had multiple successful, adept fellowship, uh, graduates coming back into surgical training without losing their craft skills. And these are people that we hope will become the the clinical directors, the medical directors of the future and as a surgeon. It always pleases me when the medical director is a surgeon, because that means that they have an empathy for the problems that we face specifically in practice, especially at the moment. Um, we encourage research. At the moment, we would have probably uh, more than a dozen trainees across all the higher surgical specialties doing either MDs or PhDs. And we encourage those people to go and do this and take, uh, the time that they need to produce good quality research, hopefully with a dividend with paper, some presentations and perhaps prizes. They're training, numbers are kept, and then they come back into training. And we have a very definite return to training scheme so that you're not dropped in the deep end on a Saturday night. The first night you come back after completing your your PhD. So we have a return to work scheme to ease you back into the craft of surgery. It's interesting, even if you go on holidays for two or three weeks as a consultant, when you come back for the first day or so, you are slightly rusty. So leaving for three years to do a PhD, you are completely seized up surgically by the time you come back and we ease these people back into the craft of our our work. Um, so I I think Northern Ireland is a good place to to train in surgery and also to to practice in surgery and the next slide, please slide 18. So I thank you for your your time and listening to me. And I'm very keen to answer questions or or chat about anything in relation to recruitment or anything else that you can think to to ask. And thank you for listening to me. Thank you very much. That was very informative. Um, if anyone has any questions, um, probably to put them in the chart, and I can read them out. Can I start off with a question just to give people some time to think of any questions? I suppose it's the first interview that I live done. And since starting medical skill, um, is there any sort of top tips or best ways to prepare for the injuries? Well, I I think doing your job well as an F two is probably the best, um, practice you can get for it. The, uh, to have worked in a surgical firm helps you with the clinical questions. The way we set up the clinical questions is that there tends to be a pre op question, which is a diagnostic one and a POSTOP question, which is a management one. So, uh, if you haven't opened a book in surgery and thought about the craft surgery or managing complications, then perhaps that would be a good way of looking at the clinical station. The management one is, uh, more difficult to prepare for, uh, again, if you're working in a day today, uh, roll on award, you will see the management questions rolling out in front of you every day. What do you do if you have six patient's to admit and you've got five beds. So can you on your feet prioritize, uh, the patient so that you have to disappoint the correct patient. So it's that level of questioning where you're thinking on your feet in a very pragmatic, uh, sense. And if you've worked on the wards, then you will be able to answer questions like that. I don't think there's any way beyond having actually done the job to to work through those questions. The portfolio that you produce will be one, uh, based out of your application form and what we're looking on. The portfolio minus courses is, um, commitment to specialty. Um, so what we like you to have done is, um perhaps to be a member of a society in, uh, surgery. Asset is probably the biggest one for the general surgical specialties. And Botha the biggest one for orthopedics If you can pass the exam before you do the interview, so that's MRCS, part A. And this is where it helps if you've decided early, um, so that you can prepare for and pass the exam. Um, that's probably the single greatest indicator of who's going to do best in court. Surgical training is that we know the guys and girls who have the exam before they start tend to have a much easier time and a much more productive time in the two years that you have in training, rather than spending time trying to clear MRCS part A. So get it early. Um, have a log book. Uh, if you're an F two or an F one in a surgical form, a surgical firm, um, get e log book and come to theater even as an observer. If if we see you in theater, we will grab you and get you to scrub and get you to do something. And then you start racking up these cases in a log book. And if you've got 15 2025 cases in a log book, um, that you can show to the interview panel, then that is a very impressive indicator that you have, uh, an interest in our specialty, um, to get involved in audits, um, and Q. I projects. If you can get presentations and change and trust policy out of those, that's another very good way of determining your commitment to our specialty. Uh, teaching. If you have teaching projects where you teach medical students or F one's, um uh, surgical specific topics and get positive feedback for them again, that's a very good thing for us to see you in your portfolio. Research is difficult, and indeed, as as you've seen, the, uh, the the conventional training pathways don't include research that we certainly encourage our trainees to take time out if they can get a good research project. But having 100 papers does not necessarily make a good surgeon and uh, doesn't necessarily make a bad surgeon either. But the the way training is organized now, there's no great value put on that unless you opt into one of the academic training posts, which we don't have in Northern Ireland, so you would have to go across to England, Scotland and Wales and some of the big academic centers to get into an academic training post. Another good thing we like to see is if you've done tasters, um, in particular surgical specialties, uh, and got something out of it. So, uh, that again shows a commitment to specialty all of these things that you can't magic up between now and, uh, February. Uh, these are things that you have to have worked for, essentially from medical school through F one and into F two so that you have your ship properly together before you appear in front of the interview panel. That's a very long answer to your question. Um, open a surgical book and read about diagnoses and complications would be the one practicable thing you could do between now and February 20. Is there any other questions in the child folks? The the MSRA is going to be new for us this year in surgery, but not new to Nim to or to London and the Southeast. So if you haven't spent any time learning about this, then perhaps that's another thing you could do, uh, prior to your interviews. Um, so it's a Pearson Vue multiple choice type, uh, day in front of a PC 170 minute long test in two parts. Uh, one part professional dilemmas and another part clinical problem solving. So I think if you get your application away, then it's probably worthwhile sitting down and starting to work through m s are a practice tests. Um uh, and I would urge you to do that again. I say we're using it as a short listing tool this year. It will not be part of our overall, uh, interview score, but it will be 5% of the G B interview score, and we possibly will do that next year. Once we see how it runs this year, can I ask about the white space questions on the application for Memorial Day again? Can I ask about the white space and questions on the application for memorial? Yes. Do they count towards anything? Are they scored in any way or ranked in anyway? Yes. Everything you put on the application form is potentially score a ble. So what we will do once all the applications are in. Um, we have an idea about the numbers is that we sit down and set, Uh uh, sort of, uh, sifting or filtering mechanism, which is done before we start looking at the applications so that they're this is done prospectively and fairly so everywhere in the application form, you have an opportunity of putting something positive about yourself. Do so, Um uh, and I've mentioned the big ones about audits, Q eyes teaching, membership of learned societies, papers, presentations, prizes, all of these things. So it's the application form is your shop window, and you should fill every part of it with good things about you. So, yes, Um, there's a question in the chat box there about, um when will we be able to provide evidence for the portfolio or for those application questions? Say again, When When do you provide the evidence for those accolades? That that the evidence you put on the application form If if we require to check it, we check it. Um, And if you look at the person's spec, it will will tell you at what point of the application process that these things are being looked at, but every application form is read by more than one person, and one of the people reading each form will be a consultant surgeon who is part of the court surgical recruitment team. The team is chaired by Nile McGonigal that this is in Northern Ireland. He's a consultant thoracic surgeon in the Royal Victoria Hospital. Um, and, uh, he'll be chairing the first. I think two days of the interviews and I'm doing the last three days so either Nile or I will read your application form and score it against preset filters that we will use to get our 150 people for interview and this. So it's all part of the the sort of fair employment that we use, uh, in Northern Ireland so that we're trying to interview the best people. The commonest cause of injecting a application form, as I've mentioned before, is a form that has employment gaps, which you may think is not important. But it is extremely important in terms of us choosing employable, trustworthy people, and the the other thing is improperly or incompletely filled out forms. So filling out the form is a fairly solemn undertaking. You should take plenty of time to do it. And as you say, you should fill every space with good things about you. So can I just clarify, then, is it MSRA score plus portfolio is invitation. In two years of just the MSRA score alone know they will be looking at the portfolios as well. Okay, thank you. Just going to see if there's any other questions in the chat box. And does anyone have any other questions? Okay. And I Can I ask you a question? Is is everyone applying for one iteration of recruitment or or people applying for two or three within surgery? Um, our impression as recruiters is that because it's so easy now to do interviews that people do multiple interviews and surgery, maybe they do court selection in Northern Ireland and in g b. Perhaps some people also in the Republic of Ireland, And then people go to other, uh, other special studies like anesthetics or radiology, uh, as well. And people are doing multiple interviews over this, uh, month of, uh, February. So how how many recruitment programs have you applied for each of you? So we've done a pool there in the in the tube. Um So 62% of people are applying to one specialty, one specialty and one of recruitment. Or if it's surgery, are people applying for national and N I, uh, nothing. An r o I very good. Can you see the pool? Mister Thompson? I can't know if you if you hit the chat button at the top, right? And you should be able to see with chat button messages, feedback and pools. There's a light open to people on a little box chat function on the right of the screen. Joyce, keep No, I don't see the pol. Um, I can I can read it out. Mm. So 41% of people are applying to N I only write 58% to UK, and then I okay and 0% to UK alone to UK alone. And how many people are applying to Dublin? Um, we can start another question. I think it's a good thing to apply to more than one iteration within surgery. Um, if for no other reason, it gives you interview practice, so you tend to do better. Perhaps in the second, um, interview you do than the first one. Um, and certainly Our perception is that our interview process is used for that reason by people who probably want to have their job in G B rather than N I. Which concerns us because we put a huge amount of effort into interviewing 100 and 50 people. And if a significant portion of that 100 and 50 have already decided that they're not going to come to Northern Ireland, then we are, as you'll appreciate wasting interview slots. Um, so we'll see how that goes. I think ultimately we want to go back to face to face, um, recruitment, which we haven't been permitted to do this year. Uh, but we hope will be back for next year. Uh, and that means you have to come to Belfast to be interviewed, which gives, perhaps, uh, some degree of commitment not just a specialty, but also to the region. Um, so I think we miss out on that, and I look forward to next year when we're back in Raven Hill Stadium or King Span Stadium, where we before the pandemic. That's where we used to do our recruitment. Mm. So the sooner we are back there, the better. Um, Katherine Sheridan's asked a question. Um, how long could you go out of work before it is deemed an employment gap? What is an acceptable amount of time? Well, I would say about a month if you're out for a month or more, without a reason than we want to know why that is. Four weeks is probably a long holiday, but you should not have gaps in the employment. And if you're working as a locum where you are working I/O of work, then you just say that you are an agent of a locum agency working, uh, agency shifts through the months of whatever February March April may. Um, but you have to account for the time that you've spent, um between These are tend to be people who have already left F Y two and are doing F y three type work or f y four type work, so you have to be able to account for all of that. Would you be in any way disadvantaged if you were unsuccessful in your application this year and looking for a year whilst building? Um, you'll see that there is a an exclusion criterion on the person specification. And that is that if you have worked in a surgical job for 18 months or more than 18 months Uh um, so it's more than 18 months, which is 36 month jobs than if you haven't got, uh, successful, uh, interview by that time. Then you are excluded from the interview process, uh, as having failed to progress in a surgical career. So if you are in the circumstance where you have to to earn a living, which we all have to do, um, but are still interested in getting interviewed and getting into court surgical training. Then you have to box clever about the jobs you do so you could do gynecology or emergency medicine, uh, to get relevant skills, but without chalking up time on the 18 month clock for surgery. So, uh, do not do more than 18 months in surgical jobs or you will. Your application will be ejected. So working in a locum agency gets around that because you're working for the locum agency, you're not working in surgery, although you may be doing surgical shifts. Mhm. Does anyone have any other questions they'd like to ask? Mhm. Yeah, I don't think there's any further questions in the in the chat books. Um, well, I I wish you all well, um, recruitment is open. Um, so take care and filling in your application form. And once you've completed it and submitted it, then get to M S R A. And start doing some practice on it. Um, And I hope to see you, albeit remotely, at the interviews. Um, and I would be very keen to be a frequent visitor to the, uh, the Northern Ireland Foundation, Training trainees, surgical society, and anything I can do to help you, Uh, I would be delighted to do so. It's in my interest that we catch enthusiastic, uh, future surgeons as early as we can and in your interest that you're preparing your, uh, portfolios, Uh, as early as you can, Uh, so that you are successful at the various recruitment exercises. So I wish you all well, thank you very much. It was very informative and very engaging. Thank you. Thank you. Mister Thompson, You have my email address, so I'm happy if you give that out to all your members. I'm happy to talk to anyone anytime. Thank you very much. All right. Well, good luck to you all. Thank you. We'd all appreciate if you would fill in the feedback form. And for tonight's webinar. We really appreciate your feedback and help improve your future Webinars. Um, I think in the next sort of 4 to 5 weeks, we're going to aim to have a separate webinar looking at the MSRA alone. And we're hoping to have, um, at least two, um, trainees who have recently sat the EMA Sorry for a bit of extra tips and advice. Yep. G p and radiology seem to be the experts at it. So I think that's where you should mine. Yeah, exactly. Thank you very much. All right. Well, good night, everyone. Thanks very much. Thank you.