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Surgical Training in NI with Mr Thompson



This on-demand session will give an overview of the recruitment processes and training involved in becoming a doctor and/or surgeon in the UK and/or Republic of Ireland. The session will be chaired by Sarah, with the introduction given by the head of the School of Surgery, Mr Thomson. Mr. Thomson will discuss the requirements of the recruitment process such as the Specialty Recruitment Assessment instrument, the jurisdictions that recruit into surgery, and the requirements of the General Medical Council. There will also be a discussion of the role of the trainers and how they are chosen and trained. Ultimately, the purpose of the session is to provide an understanding of the processes of recruitment and training into surgery to those who are considering it as a career.
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Mr Thompson, Head of School of Surgery at NIMDTA will be discussing surgical training in NI

Learning objectives

Learning Objectives: 1. Understand the processes involved in applying to become a consultant surgeon and the organizations and regulations that govern them. 2. Become familiar with the Joint Commmittee on Surgical Training (JCST) and its associated website. 3. Understand the General Medical Council's role in overseeing medical training from medical school onwards. 4. Familiarize oneself with the Intercollegiate Surgical Curriculum Program (ISCP) and understand the use of an E portfolio to demonstrate progression of knowledge, skills, and experience. 5. Become knowledgeable about the Multispecialty Recruitment and Assessment instrument (MSRA) and how to use it properly as a sifting tool for recruitment.
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Computer generated transcript

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

Hello, everyone and welcome. Um Sorry for the slight delay. Um My name is Sarah and I'm the chair of N I FT Ss this year and our teaching leads Grace and Kerry have organized tonight's session. Um So I want to ask them all to that and I'm just gonna now hand over to Kerry who's um going to introduce tonight's session. No. Ok. I think Kerry's like, unfortunately has just um broken. Um So tonight, we have um Mr Thompson with us who is the head of the School of Surgery. Um So Mr Thomson, um, welcome and thank you for joining us this evening. Um Thank you, Sarah. It's my great pleasure to and great honor as well to be invited to speak to the Foundation trainee Surgical Society. It's also in my interests uh to support you in your choice uh for surgical careers. And what I've been asked to do tonight is to talk briefly about the, um the things that you need to know before you apply. Um given that your applications are coming up horribly soon and maybe sooner than you think the delay in starting the talk is all my fault. I had some, er, device problems. So fourth time lucky I'm on my own phone and I hope you can hear me clearly. So, the, the, the, er, if we go to the first slide, please, sir, I represent nit which you now know about as foundation trainees. You're now one of the many foundation trainees in our foundation program. And I represent the school of surgery. Um, we are 217 trainees strong out of our round and about 3500 medical and dental trainees in Northern Ireland. So we represent a very small proportion of those in training to be doctors and dentists in Northern Ireland. And next slide please. Um The overseers of all surgical training in the UK and the Republic of Ireland is this group. Um There's going to be plenty of acronyms tonight. I'm afraid this is an important one and perhaps an important website for you to become familiar with. And it's called the Joint Committee on Surgical Training. And it's an administrative body which represents the four Royal Colleges of Surgery. Um one in Glasgow, one in Edinburgh, um one in London, representing England and then one in Dublin, uh representing Ireland. And we all join a Royal College um when we are training and doing our exams. Um uh and then stick with that college. It helps give you professional information and professional support um throughout your professional lives. And I am a fellow of the Royal College. Of surgeons in Ireland based in Dublin. Uh We're very proud in surgery of our intercollegiate nature for a training organization. Therefore, um if you're training in England, your training should be the same as it is in the Republic of Ireland, Scotland or Northern Ireland or Wales. Um So we try and stick together and that has become increasingly important after Brexit and some of the stressors that it has provided in the recognition of professional qualifications between the, the, the uh jurisdictions within these islands, let alone um beyond these islands. Um And the next slide please. Another acronym, this one is the Intercollegiate Surgical Curriculum program. Um This is the E portfolio which is run by J CST for which any surgical trainee I think pays 280 lbs a year to access. And this provides a platform for you to collect and curate your um training advancements such as passing exams, attending a course, um publishing a paper, presenting a poster, um uh the E log book that we produce for our, our operative um um information. When we attend an operation, we log it in the E log book. So all of these things are placed on this E portfolio to demonstrate progression of knowledge, skills and experience, which can be assessed um annually and indeed, in Northern Ireland biannually um at an A RCP. So we do an interim ACP each six months and a an annual formal ACP at 12 months. And this is what we use to, to show, I call it the shop window, but it, it allows us to look into your shop window to see how things have progressed for you. So next slide please, everything that you do from medical school onwards is overseen by the General Medical Council. So was the J CST offers advice on things like curriculum exams um and whatnot. The the GMC signs everything off um from medical school through your foundation program and through basic and higher professional training to the point where you enter a specialist, register on uh on the GM C's list for who is competent to practice within UK. Um And uh they follow you to the grave, almost certainly to retirement and a few years beyond. So they oversee everything. Uh Next slide, please. So next slide, now, what I'd like to do is to talk briefly about trainees and your perspective of surgical training, the trainers, at least in northern Ireland, the process involved in getting you from a foundation doctor to a consultant surgeon. And um the future what is likely to happen and what is likely to change within your clinical lifetimes, indeed, within your training lifetimes. So, Nick slide, please. Um So I'd like to, to talk about uh trainees um recruiting into surgery. So next slide please, when you consider a surgery as a career and of course, I believe it to be the best of all the, the clinical careers open to a medical student. Um Then you have to work through a number of recruitment processes to get to consultant level practice. So next slide please, this is a map uh illustrating the jurisdictions that offer recruitment into surgery in the British Isles. Um And essentially there are three of them. Um Great Britain, Ie England, Scotland and Wales recruit as a unit, which is called core surgery national recruitment, another acronym CSN R. And you'll see that once you start looking at websites um uh to, to introduce you to recruitment, Northern Ireland has opted out of CSN R. So we don't recruit with GB, we recruit on our own for various reasons which I can go into if you want to, to, to develop that afterwards. And then the third um recruitment process is in the Republic of Ireland, uh which recruits in a similar fashion um to surgical training. Um So next slide please in Northern Ireland, roughly each year we recruit about 40 to 45 trainees into a surgical training. Um Next slide, please. In the Republic of Ireland, approximately 100 trainees are recruited uh each year and uh and GB Core Surgical National Recruitment, somewhere between 657 100 new start trainees are recruited next year. So next slide, please. Um And the slide beyond that, please. Now in Northern Ireland, in the last couple of years for our 4045 new start surgical trainees, we have amazingly had about 400 applicants for 40 posts giving a ratio of some 10 to 1. Now, the reason for so many applicants is that surgical trainees, junior doctors in fact, are part of a home office shortage occupation list, which means that the visas that are offered for people um taking up this post um are available for anyone in the world who can show that they have met the criteria for appointment. So the 400 people applying for our 40 odd posts are from every corner of the globe which increases the the the ratios and the ratios can seem quite frightening. But in fact, once we start to work through the 400 applicants, we um determined that not all are suitable for employment or have, in fact um achieved all the competencies necessary for employment as a um general surgical or other basic surgical trainee. Um So next slide please. So what we do is we use this er sifting tool. Um So this is shortlisting by another means, it's called the Multispecialty Recruitment and assessment instrument. And it's used widely around recruitment in the United Kingdom and II, trust that some of you at least have, have heard of it. Now, it's a bit like doing your driving theory test. It's run through Pearson view centers, which I'm told can be accessed uh pretty much anywhere in the world. So it is fair to people who are recruiting into core or basic surgical training from other countries. If you are going to Australia, for example, there are Pearson view centers which run this system and so you don't have to come home to do it. Um It's um I think 100 and 47 questions. Um One part relates to professional dilemmas. So those are sort of management questions, ethical questions. And then the other part is clinical problem solving, cross diagnosis, investigation, um treatment and things like that. So testing your clinical skills for most people graduating from a UK and Republic of Ireland Medical School, then this should be fairly easy because it is uh empathetic to the way that we're taught at medical school. So as a local trainee, you should actually be very good at it. And what we do is we use that as our sifting or shortlisting tool and next slide, please. So from the um 400 applicants, um we then use the M SRA to pick the top 150 people um for interview, why? 100 and 50 well, 100 and 50 is the maximum amount that we can interview, given the resources and the personnel that we have at nit to do the interviews. And when I say interviews, we have been told this year by another group overseeing recruitment in all specialties in UK. It's called the medical and dental recruitment and selection service or MDR S that all recruitment interviews this year will be done remotely online. Therefore, it will be something like. So we are nowhere near back to face to face interviews. And I think this is going to remain an online recruitment process because it is cheaper. And, and I think now that COVID is disappearing behind, behind us, um we are using this type of remote interview simply because it's cheaper. Um So no face to face interviews, I'm afraid. So in order to get to interview, you have to be good at M SRA, which means one of the things you have to do is practice M sra. Um And there are mock papers available online for you to practice on. But as I said before, local um UK and Republic of Ireland, um educated doctors at your stage tend to do very well in it, but that's our sifting tool. Um So next slide, please. So what about the people who teach you uh Nick slide, please? Um In Northern Ireland, we're very proud that anyone who is er in contact with a trainee full stop, but a surgical trainee in particular has been trained to be a trainer. So they go through a fairly strict faculty development program which begins after appointment to consultant posts where the trainer is taught to teach and also taught things like equality, diversity, inclusion, um recruitment and selection and how we manage trainees who may be in some difficulty. So there are quite a few courses that they need to take before they can be included in a GMC recognized trainer status which appears on, on the specialist register beside your name, once, once you're a consultant. And the other thing about them is that they are paid to teach. So each consultant has a job plan or hopefully each consultant has a job plan. Most do some of the newer ones that can take a little while for the job plan to appear and that tells the, the trust and the doctor together what is expected of them both. Um what sessions the consultant is doing and also what teaching and training responsibilities that the consultant has. So one consultant may have two foundation doctors as their trainees, a core trainee um and two or three higher surgical trainees. So a rather mixed economy of junior doctors, all requiring different um training and training needs in order for them to complete their competency progression and the individual consultant is paid for each of them. So there aren't really any excuses when your job planned um to teach and train and paid to teach and train. And I think we're fairly unique uh in the UK and certainly in the Republic of Ireland in, in doing this. So uh if someone isn't turning up to teach you, you can jolly well give off to them because they're getting paid to come and teach you and train you. Uh So next slide, please. So what does the process look like um that we use at the moment to take a foundation doctor, indeed a medical student to consultant level practice. So next slide please. Now, I hope you can all see this. It starts at the left and works towards the right. And it's the current um organization of UK progression through the ranks if you will from medical school to consultant practice. And um it's fairly simple once you get your head around it. So uh at undergraduate medical training, um you do your final MB and get into foundation training, which is where you are at foundation training. You have two years to find yourself or work through the generic skills that you must possess to progress further into the the medical or surgical hierarchies. Um And two years may sound a very long time to work out your career intention, but I can tell you it is not. Um and more of that later at the moment, surgical training is um divided up into two types um at the top, right, you can see run through training and essentially run through training represents those specialties um um within surgery who take you at one interview at ST one level coming out of foundation training and then take you from ST one all the way through to consultant appointment with no other interviews. Thus, the run through description and the specialties that do that at the moment are um neurosurgery um ophthalmology um and cardiac surgery has just moved to a pure run through system. So I say again, that's one interview, um, fairly stiff interview after foundation years and then no interviews until you get to your consultant interview. Now, most surgical specialties don't do run through at the moment. We, uh, practice so called uncoupled training where you have one interview to enter a two year core or basic surgical training period where you learn basic surgery. It's called basic surgical training in the Republic of Ireland and core surgical training in the UK. Um And it's two years. Um and er, in those two years you learn the basics of surgical care, generic surgical care, you learn a bit about emergencies and um most people by that stage are starting to recognize um consultant job they want and what higher surgical training program they need to get them there. And once we know that then you will be wanting to pick placements where you have access to that um training there is then another interview. Um, so uncoupled two interviews, one to get in and one to get out and into higher surgical training. Um um which takes place after ct two year again, another very stiff interview where you get into the uh five or six year higher surgical training programs of which in northern Ireland we have 10. Um So um next slide, please. So the, the future, how, how will that um Satnav, if you will of where, where we are and where we're going to become consultants change um in the next few years actually within your training times. So next slide please, there are two things to be aware of. The first is a report called The Shape of Training Document, which was published in 2013 and is only just starting to affect the way uh medical surgical gynecological training is delivered within the UK. Um And the other II say again is Brexit. So next slide please. So this is worth a read. It's written by um a professor of pediatrics, it called David Greenaway. Um and it was written for the David Cameron um Nick Clegg um government um um 10 years ago and what it does is it identifies what sort of doctors the NHS needs for the future. And what it says is that it doesn't need super, super specialized doctors. What it needs are good general doctors able to cope with the um emergency, um unselected, unscheduled admission to a hospital and to deal with that group of people. And we train therefore doctors to that level of competency and then we only train above and beyond that level of competency as the system needs it. And that's the shape of training review in a nutshell. So what that means in essence is that your training time will shorten and the curriculum to which you will be trained will become more general so that you're capable of dealing with what used to be called the take in the unscheduled, unselected admission to hospital and then pass that on to other doctors who have achieved more um subspecialty training um so that they can deal with the um the niche problems or the rarer problems that arise out of a take in. But in general surgery, for example, appendicectomy, acute appendicitis or cholecystitis or would be things that the shape of training uh consultant should and would be able to, to deal with, but they may not be able to, to deal with a um let's see, an an ul adenocarcinoma or a head of pancreas carcinoma requiring a whipple operation, which would require um referral to an H PB specialist. And from this emergency trained group of doctors, um shorter, more general trained doctors, then we will recruit and select people to train into the more niche parts of the specialty. So you can still progress beyond the so called emergency consultant. And that is coming, medicine are doing it more quickly than surgery, but it is starting in, in surgery. And the first ripples of it are run through training and then run through training will shorten into a new curriculum. But we're, we're certainly nowhere near it yet, but your generation will probably be the first to be affected by it. So the next slide, please. So this is Henry the eighth painted by Hans Holbein. It is uh a memory to me that the current Brexit is the second Brexit, the first Brexit was in 1536 when Henry enacted the act of supremacy where the church in England left the church in Rome, which was Brexit 1.0. Brexit in northern Ireland, we haven't really got over Brexit 1.0. So Brexit 2.0 is uh not particularly welcome to me, but it is here. And from a professional point of view, it makes it more difficult for us as um UK medical graduates. If indeed, you are a Belfast graduate um to interact with the Republic of Ireland and beyond. Because now the European Union to include our, our neighbors on the island, um consider us as international medical graduates. And at the moment that hasn't created um a problem yet. But in order for someone from Northern Ireland to work in the Republic of Ireland or vice versa, it is necessary for the receiving system to recognize the professional qualifications of the doctor seeking employment. And I predict that will become stickier and stickier as the years go by at the, at the moment, it hasn't created too much of an issue, but I think it will do so consider yourself an international medical graduate. Um um So next slide please. So how to get ready to be a successful applicant at surgical recruitment? Now, the two foundation years may seem like an eternity to you. Um 24 months, lots of time to decide what I'm going to do and prepare the things that I need to get done in order to be successful at recruitment. Well, you are like a super tanker in order for you to change direction, it takes many, many months. So in order for you to be successful at recruitment, you kind of have to have your course set now, um such that you can fill your portfolio with the necessary goodies in order to be successful at interview, whether that is radiology or anesthesia or pediatrics or general practice or surgery. Each requires a portfolio that demonstrates a commitment to the specialty that you're applying to. Um and also an interest to the specialty that you're applying to. One of the problems with online interviews is that people can take many, many interviews and fish for successful appointments across the various medical specialties and uh and in surgery as well. So we have um good data showing that people are taking six or seven interviews um across the specialties and within surgery and also interviewing between GB Northern Ireland and the Republic of Ireland. So this is something that's easy to do online, not so easy to do face to face. Um And um but my advice is that you shouldn't fish, you should choose what you think you will be happy at. Um And we can discuss that maybe in the questions and answers. How do you know you're going to be happy in a specialty? Um So that you pick what you want to do, what do you think you're going to be happy at and you go for it. Um, and you have to start going for it. Um, from the beginning of F one and what you have to do in surgery, which will take your, your, your full two F foundation years. F one and F two is on the next slide. So if we can, now this is a very long list. Um, the first is at undergraduate level, if you recognize surgery is your um career. And it's interesting in surgery, we are a specialty um where most people who want to, to be surgeons know this at medical school. And indeed, um before medical school, so up to two thirds of surgical doctors know they're going to be surgeons um before they qualify. Um So the sooner you know, the better because you can point your super tiger at the right direction. Next thing is as you've already done, joined the Foundation Surgical Society. Um and that gets you into the um the correct um sort of paradigm of knowledge that you require um making the correct contact that you require and enabling you to have the right networking that you require. In order to proceed successfully into surgical training, I would advise also that you join one of the Royal colleges. Um One of the four I know that the Edinburgh College is um most linked to N I FT Ss. But um any college will have an associate member program where you join um you get access to learning materials. Um you learn about courses that are being done. You also learn about the gossip on the politics of surgery um through the journals and the um the social media that comes with being a social uh an associate member of the college. Next thing would be to try and pass the um MRC S exams. Um MRC S part A is a an exam of multiple choice design that tests preclinical and simple clinical knowledge. So therefore, as a recent medical student, you have that knowledge um more than you will have uh when you are an F two or act one, that knowledge will decay somewhat over those couple of years as you're learning so many other things. So our advice would be that you prepare for and try to pass MRC S part A as a foundation doctor. Um And that is um a huge evidence to us as recruiters that you have commitment to our specialty if you've already passed or at least taken um let alone pass that exam. Next thing through your foundation years, you should arrange surgical postings if you can or surgical testers or surgical attachments, again, demonstrating an interest in our specialty and um and a commitment to our specialty. And again, you have to start arranging that um at day one F one audits and qi projects. If you are in a surgical placement, then you should do your best to get involved in qi projects and audits, which hopefully will permit you to present at audit days, regional audit days or even national audit days where you can use your audit project to score points on portfolio. Any audit or Q I project is good, but if you have a surgical audit or Q I project published presented, um then that scores quite a lot of points on your portfolio scores at recruitment publications and presentations. Again, if you can get surgical versions of those, all the better, but any publication or presentation will tend to score points on portfolio. I've mentioned this already. E log book is an online um means of collecting all your operating room experiences. Even if they're just as observing or as assisting at operations, then you can log those. Again, it shows your interest and commitment to the specialty. Um And what we like to see is 20 or more cases on a log book. Um So, and that can be obtained online. Um And then it's linked to I SCP once you get into surgical training, teaching is a very important thing for all of us who practice in surgery. Um And if you have a teaching project where you've taught um medical students or other foundation doctors or nurses or physiotherapists or whomever else, and then uh if you can demonstrate that you have organized teaching and that you've good feedback from your pupils, then that scores points to in a portfolio for recruitment courses um are becoming less important named courses um less important because the GMC is moving away from um ways and means where people can enhance their portfolio based on how deep their pockets are. So in the past, there would have been courses that would have been mentioned by name that we would have used to shortlist potential core trainees. Um But at the moment that isn't the case. So once you can take courses, it does demonstrate um that your interest and also some competency progression. Hopefully, if you've listened to what you're being taught at the course, it doesn't actually score much in the way of points at portfolio. So it's better to teach a course than it is to attend a course in, in terms of points on portfolio. And last and certainly not least is the ability to demonstrate that you can work in a team and even better still, if you can demonstrate that you've been a leader within a team and that's inside hospital, but also very importantly outside hospital. So if you've um worked in a charity, if you've sung in a choir, if you've played sports in a team and obtained some sort of officeholder status or leadership status within that team to include N I FT SS, then that scores a lot of points on our portfolio scoring systems. Um When we're, we're marking you at interview. Um So I urge you if you haven't joined a choir, joined a football team or join the surgical society as an office holder and that scores you a lot of points. Um Surgery is all about teamwork and as you become a more senior surgeon, then the leadership within the team becomes more and more important. So being able to demonstrate that from the beginning is a very important characteristic in your make up that we're interested to, to, to see. So next slide, please, I'm not gonna say any any more now. So if you have questions, then I'd be delighted to try and answer them. So, thank you for your attention. Thank you very much, Mr Thompson. Um If anybody has any questions, please feel free to put them in the chat. Um I already have some questions that have been sent through to me. Um So the first question is, what ways would you recommend preparing for interviews? Um Well, uh the we first of all talk about what the interview consists of. So the way we interview, uh we uh do a portfolio check and we score the portfolio. So if we go back um the, the couple of slides to the list of things to do. Uh The first thing you do is attend to that list because the first station on interview is scoring a portfolio. Um And where do you find the portfolio scoring system and the criteria that we're marking you against? Well, you can go to the J CST website, which is easy, J CST dot org. Um and look at person spec uh and it will identify what I'm showing you on this slide for the year of interview. So at the moment, the 2023 person specs for all medical and dental recruitment in the UK is up and available for you to look at and it's accessible via the J CST website. Um and it's called medical and dental Recruitment and Selection and it's in the health Education England part of the website, but J CST will take you there. So the first part of preparation is having a buffed portfolio which I say again, starts at foundation year one day one and our interviews um um are being recruited for er about now, the applications are opening um in your year, which means if you're an F one just started now, you don't have two years to prepare. You've got a year and a bit, a year and three months before the recruitment is opening. So, um and a year and three months isn't a huge amount of time to obtain and all that sort of commitment and interest in surgical scoring that I've listed there, passing exams and teaching projects, qis audit projects and whatnot. So you've got to get your skates on from day one, F one, the, the next two stations are a management station where you would be asked questions um that you're dealing with day to day as a foundation doctor. What do you do if you've got three patients and two beds, um, that sort of thing. What, what do you do if you see a doctor drinking whiskey out of a bottle, um, on their way to work? So these are management and, and clinical ethical dilemmas, um, that you have to have a, a reasonably linear, logical lucid. Um And um, ethically sound answer to, um, and the other station is, is clinical. Um So we tend to have a question on diagnosis and a question on POSTOP care. So if you've worked in a surgical ward, then that should be fairly straightforward. There, there are very basic things that you see in each day in a surgical ward. So making a diagnosis and looking after a patient with a complication after an operation. So doing your job as a foundation doctor, um helps you with uh management and clinical stations and the best job for you to do as a clinical uh as a foundation doctor would be a surgical placement. So preparing for the two stations management and clinical best if you have surgical placements in your foundation years, but you have to start now wherever now he is for you. Ideally f one day one, I hope that message is clear. Yes, thank you. Um So another question is how does the Northern Ireland application process differ from the National application? That's a very good question. My answer to that is as little as possible. So the first thing is we synchronize the timings so that we're recruiting at the same time as um core surgery, national recruitment, the GB recruitment, we've opted out with the goodwill of the national recruitment system. We use the same question bank as the national recruitment system. We score uh the same as the national recruitment system. We have opted into M SRA as our sifting of applicants to, to interview same as national recruitment. Um and we are interviewing online, same as national recruitment. So it's um an iteration of national recruitment but it's held um in Belfast. Um and the importance of that um indeed, between GBN I and Republic of Ireland is to try and um keep us as an intercollegiate specialty within these islands or someone who graduates in er London um can work in Dublin or someone in Dublin in Belfast or someone in Belfast in Glasgow or Cardiff. So that is very precious to us as a surgical community. And this inter coe is something that we have that many of the other specialties don't have. And it's based with the four Royal Colleges of Surgery through the J CST. So the answer as little as possible, all the processes are synchronized and equivalent. Great. Thank you. Um Another question is um does whilst the M SRA or um contributes to the interview, does it have any overall impact on your score after interview to get your place in Northern Ireland, it, it hasn't done, we haven't incorporated it into the, er, interview last year but in GB, they did. Um so this year there will be a contribution to the overall interview score from your M SRA score and the interview score is important because uh you're ranking at interview, er, determines the job placements that you pick. So we, we start at the most highly ranking um, recruiter who picks first all the way down to the person who comes last but is recruitable, who picks last and the CT ones pick first and the CT twos. Um, for next year, at any rate, will have picked already what they're going to do for the, the two years in, in England, especially in, in very big training deaneries. There is a move and has been for some time to theme core surgical training where if you wish to do orthopedic surgery, for example, you and you, you have a high rank in the recruitment process, then you can theme your placements towards trauma orthopedic surgery. So that would be, everyone has to do six months of general surgery, but you may choose to do six months of plastic surgery and a year of trauma orthopedic surgery. So that would be the way in some of the very big English sceneries in Northern Ireland, we grasp on to the generic view that you need to do a little bit of everything in order to be a complete surgeon. So at the moment, we have 46 month placements chosen by, by interview rank. Um, and um, we try not to theme our program and that is a view held by other deaneries in England and Scotland and Wales. Um, but uh we tend not to theme here. We are generic uh trainers. We are trying to produce a pleur potential ct two capable of doing anything and not someone who's already blinkered into one specialty, er, which um and, and we will likely change when it goes to run through training. So shape of training will bring everything to run through eventually, perhaps in your training time and will shorten your training and generalize your training, but that hasn't happened yet, but it's not far off, I imagine. Ok. And another question is when are you required to submit evidence from your portfolio uh from the foundation portfolio? Uh No, we, we have an application form where you um transcribe any evidence uh onto the uh application portfolio, which is done through Aureol, which you'll be familiar with. Um So there's no cutting and pasting of uh your good deeds uh from uh your e on to an application form. Um The application form is quite complicated. It has to be filled in perfectly and or properly. If you don't fill it in properly, then we may not offer you even a slot for M sra. Um One of the things we don't like on the interview on the recruitment um is gaps in employment. So if there have been long unexplained gaps in employment, that may also eject your application before you even get to MSR. So filling in the recruitment um application and doing it properly um and carefully and explaining any gaps that there may have been in your employment history is very, very important and we know that you can apply from essentially any country in the world at the moment. That means New Zealand and Australia are the um the countries where many people are recruiting back into Northern Ireland. These are people like you who have gone for the Mystic Fy three year to Australia, New Zealand or elsewhere. And we know that one of the great benefits of the online system and the online remote interviews is that you can interview from Australia or New Zealand. Um And we've seen that over the last year, uh interviewing many people, locals and others from far distant locations, but usually New Zealand and Australia and Pearson view for M sra is set up around the world. Thank you. Um Leading on from that is if you were to take a year out, does a regular locum post within surgery count as an employment gap or in your application, does that still count as employment history so long as you can explain what you were doing? Um then no, that's not an employment gap. But if you disappear for uh a year um holiday or six months holiday, then that is an employment gap. Um uh So we like an explanation of what you've been doing. So we don't like gaps, but a locum, a period of working as a locum is not a gap. So long as you explain it so long as you have a responsible officer. And so long as you've been properly appraised throughout your uh period of locum, so that's fine just to explain what you've done. Ok, thank you. Um Another question is what makes an applicant stand out? Well, most of us are very similar in our clinical experiences um at medical school and through foundation years. Um the things that make people stand out to me and score points on the um application are exactly those which show commitment to specialty and interest in the specialty. So back to that long list of things, the things that make you stand out are if you've got MRC S part A and this year we had people with part A and part B um achieved both through their foundation years. Um If you have tasters or placements that you've organized in particular surgical units that you can talk about with interest and enthusiasm at, at interview, if um you have a life outside medicine. So if you play sports, sing in the choir, work in the charity run the N I FT Ss, then those are things that stand out because they tell me that you are an organizer. You have an ability of putting yourself forward to be a leader and that you enjoy and cherish working in a team which are things that are very hard to, to, to measure. But if you've demonstrated that sort of life in the hospital and uh outside the hospital, then that tends to shine out of an application um document. Um but essentially anything that demonstrates interest and commitment to the specialty, so that you're not one of the guys doing the 10 interviews um across anesthetics, radiology, pediatrics, general practice with a generic CV, um which may not get you into any of the above. Um So I hope that answers the question and it, it does then put it back to you that in order to achieve such a a portfolio, you really have to have considered our specialty for some time in order to, to, to fill out your portfolio accordingly. Um So the earlier, you know what you're gonna do, the more you focus your portfolio development in that area and the more likely you are then to get a dividend in the um the interview and be successful in the interview. Great. Thank you. Um Another question that's been sent through is if you have previously sat the MRC S for a but had failed it. Should you still mention that in your application? I'm sorry. Yes, because it demonstrates that you've had the courage and the foresight to try it. Um you're allowed to, to take MRC S part a, believe it or not six times. Um So that's a lot of money and a lot of effort. But we know that if you can get MRC SA and B, if you can out of the way before core surgical training or at least early in core surgical training, it gives you more time to develop all the things that you need to be successful at the next interview, which is the higher surgical training interview. So if you've passed it and failed it, I would certainly, um, advertise that in your portfolio because it tells me you've, you've chosen surgery, you have an interest in it, you have a commitment to it. And um, there are very few people go through um, medical or surgical training to consultant posting without having failed some sort of exam. Um, this as you're discovering you're now in a rat race. Um And there's a lot of very sleek, clever rats running in the surgical rat race and you have to become one of those rats. So playing the game, doing the exam early demonstrating that you've done it, even if you've failed, it helps you in that little rat race. So don't be ashamed of failing an exam. Thank you. And I think this is maybe one last question. Um, where should we look for courses? Well, courses, as I've said, are, are, are not, um, uh, something that you really need to look for because the GMC are reducing the significance that they have in any progress through recruitment or selection. And that's for the reason that if you are rich or if you have rich parents, then you can buy points on your portfolio by going to courses that someone whose pockets aren't that deep cannot afford to go to. And the GMC probably quite rightly say that that is no longer acceptable or fair. So, however, courses are, are, are not just there to get you portfolio points, they're there to develop you as a good doctor. And, and if you were going to go to a course for your own good um and development, then probably the first one to go to is a basic surgical skills course um in Northern Ireland. Um the, the probably the seat of um most courses is the Kingsbridge Academy. Uh They have developed AAA part of their company, it's a private company which will be spoke and deliver courses in most things. Um um Getting into medical school, I know is one of the things they do, but if there's a need for it and they can make money for it from it, they'll do it now and they're very good at it. Now, probably the only course I would mention by name, therefore is the basic surgical skills course which is run through Kingsbridge Academy and it teaches you how to use surgical instruments. Um And that is a very good thing to learn as early as you can. Um, so basic surgical skills, but GMC aren't too fussed about courses. Ok. That's great. Thank you very much, Mr Thompson. That's all been very helpful and I'm sure everyone really appreciated everything that you've said to us this evening. So, thank you very much. Well, thank you. And I wish you all every success as doctors and also in, in your application to your various specialties and II leave you with this thought that the sooner you know what you're going to do, the, the easier it is to develop a portfolio to bring you success at interview. So f one day one is when you have to start forming your, your portfolio and it isn't two years to interview or to recruitment. It's a year and three months from day one to F one. So you don't have that much time and you're all super tankers, it's very hard to change direction. So go for it. Great. Thank you very much. All right, good luck. Uh and good night. Thank you and thanks everyone for joining us. We'll have a feedback form um sent out if you wouldn't mind. Um filling in. Thank you very much. OK.