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Yeah, And he is currently a CT one in general surgery in Liverpool. Thank you, dear. Thanks, Brian. Good morning. So, um, my name is near, um and I'm going to talk about taking an F. Y. Three years. I've done a bit of an overview of generic information about different things. You can do what you can get out of it and some ideas. Um, so it's not everything that you possibly can do, but it is something that you can do the pros and cons and and kind of the opportunities that you can get from that. So a bit about me. I was a post grad student from Swansea. I did my foundation program there. And then after that, I just thought, I'm not ready to go into a specialty. I want to do a bit more. I want a broader experience. And I worked with people who had done it for three years, and I just thought, Wow, they really good. They just have a bit more experience, a bit more behind them. That's what I want to be. Um, so that was kind of my decision making for why I decided to take an F three year. Um, so I think the important things to think about if you think about taking an F three years is why What? Why do you want to do it? What do you want to get out of it? Um, I think everybody's seen this This graph, but essentially shows that as time has gone on, more and more people are not going straight into specialty training from the foundation program. And what people do with that is kind of a broad range. So think about what you want to get out of it and what you intend on doing after it, and you might not know or you might have some ideas, but you're not sure, but kind of looking ahead and therefore thinking, What do I need to get out of it? What do I need to do? What would help me make those decisions or get into that training or what would help me to progress my career? The other thing I think is really important is what are you missing. And that might be what you're missing from your life. And that might be that it's spare time is free time. That might be that it's choice of what things you want to do. That might be that actually, there's a big gap in my CV. And I'd really like to try and fill that to make me more competitive to make me a better doctor to make me more rounded. So what? What you're missing? What is it going to add to your CV, but also to your skills as a doctor to your life? Um, and then thinking about your work, your life, the location that you want to be in. Um, I'm trying to emerge all of these things so that you're thinking about what you want to get out of it. What do you want to be doing and looking ahead to thinking? Okay, well, I want to apply to see ST So what do I need to do? What do I need to think about and also looking further ahead, if you know already what you want to do as a registrar to think? Well, what else can I do that will make me more competitive but also make me better? What am I interested in? What do I want to be doing? What did I not get an opportunity to do in the foundation program that I think would really help me, and I would be really of benefit to me. Um, so I'm going to start by talking about taking a clinical teaching or research fellowship. So there's lots of these jobs available. They often you might work with people already who are junior clinical fellows. Um, they're often an eight or four plus or minus an on call rotor, so some of them will have you'll be on the on call rotor as well. Some of them will not. Um, it could be that it's contributing towards the research masters if it's a research, fellowship or PG so often in medical education. If it's teaching, you combine your clinical and your teaching work a lot of the time. If you're interested in teaching, then it gives you loads of opportunities but also gives you loads of opportunities to access the local university. Making contact for the future. If you think that's something that you'd really like to be doing, is to be teaching medical students and those more junior than you. It's often a really good place to start to be getting involved, seeing what goes into teaching medical students, creating a medical program. What goes into organizing their own skis? What goes into organizing all of their competencies and how that works, and supporting students and helping people through all of that, You often a kind of a consistent person for the department in managing and organizing the students to make sure that they're getting really good opportunities and working with the team so that everybody knows which students are coming, when what they need from you. And often you're the kind of core person for that, Um, it's quite a good for some people, especially if you're thinking about doing an 8 to 41 without an encore, wrote a component, um, preparing for things like exams having a bit more time. If that's what you want to do a bit more out of work, you're actually a triathlete and you need more time to train because you really good big competition that you're doing and you want to be able to mix your clinical work and your extracurricular. It's quite a good opportunity that if you have an eight or four job without the encore rotor, because it just gives you a bit more flexibility whilst getting something out of it whilst progressing yourself as a doctor and as a trainer. Um, a lot of them will be a mix of the clinical research teaching time. So some of them might be 50 50 teaching and, um, clinical. Some of them might be 80% research and 20% clinical. Some of them might be mostly clinical work with an on call rotor. Um, and that gives you an opportunity often to have a longer period in one specialty. Um, so that you can get a bit more experience in that specialty. The team get to know you. Everybody gets to know you, and you get to develop a bit more and one, uh, specialty. Rather than moving around, how you find them so often you work with people who are junior clinical fellows, and that might be for teaching or research. And you think, Oh, actually, we only see them in here two days a week. What do they do? The other three. So talking to people talking about how they got their job, talking to your local department and saying actually really interested, are you gonna have any junior clinical fellow jobs in the next year that I could apply to, um and then on a lot of them come up on NHS jobs between February of May. So on HS jobs, you can sit like a search so that you can hear and see about what's coming up. And that way it will do. Uh, it will give you the opportunities, and it will flag up things that you said you're interested in. Um, so I'm just gonna before I move on as a couple of questions. So working on the three and proactive medicines kind of surgical experience or not, I think a lot of the time it depends on what you're doing. Um, and it depends what you want to get out of it. So if you're in that year planning on doing some audits that are relevant for your surgical experience because you're doing preoperative medicine, then obviously that's going to be really relevant and really useful. Um, if you're, um if part of it, it's not going to theater and operating, and that's not going to help your log book. So I don't necessarily think about whether it counts a surgical experience or not, But think about what you want to get out of the year. Actually, what you want to get out of the year is being more competent at managing patients in the Peri Operative period. Then obviously, it's going to be really useful for you, and that's going to be really useful skill. You're going to use those skills. It's not just about what it does for your CV, but what it does for your clinical competence. You have to think about both sides, um, and what you're going to add and what you're going to be able to talk about in interviews, what you're going to gain as a person as well as on paper. Um, can you do clinical fellow job in medicine or surgery? Yep. So there's just a clinical fellow jobs in pretty much all specialties, Um, and again, it will be thinking about what you want to get out of that and what you want to progress. What are the gaps in your CV? And actually, if the gaps in your CV you think actually I want to be doing more teaching and things like that, then? Yes, definitely. But you just have to balance what you need. Overall, where the gaps in your learning are and what you want out of. Um, an F three years, Uh, So the next thing I'm going to quickly talk about is, uh, the local life. So a lot of people choose to look, um, for an F three year because it gives you a lot more flexibility if you want to travel. If you want to, just have a bit more control over your working life when you're working and not working over which jobs you're doing over where they are, then a lot of the time. That's the pros for local work. Um, there's pros and cons from a pay perspective. If you take up short notice like, um, uh, shifts, then often they're higher rate. The downside is, if you're not working, you're not being paid, so if you want two weeks off, that's great. You can take two weeks off. You can travel. You can do what you want, but you're not going to be paid in that time period to it takes quite a lot of organization, and it takes quite a lot of you thinking about what you want out of that time, and if you want the flexibility to be able to do courses when you want, because you just don't work shifts to be able to do some traveling, to be able to do some exams and study. Then again, that gives you that flexibility. But you have to remember that in that time, if you're not working, you're not burning. And so it's just balancing and organizing that so that you're getting out of it. What you want. Um, you can look, um, for a local department versus local banks, your local department might be somewhere that you've worked, and they know that you're around and that you're low coming and that you're available for shift. So they've got a rotor gap. They'll ask you that relies on there being gaps and then needing work. So if you only want to work in one area and one special, it might be that you find that actually, that specialty is really full this year, and they don't need any local work, so you need to think about how you're going to balance that. And actually, if you live in an area where there's only one or two hospitals in a half an hour, 40 minutes distance, and you don't want to travel any further. Then you might have to broaden what you're willing to look, Um, for, um, to make sure that you're you have enough shifts, so it's a bit complicated but manageable. Um, it does affect your continuous NHS service. It affects your pensions, and you're sick place. If you're sick, you just don't get paid. You can actively choose to pay into things like pension, but it does affect your continuous NHS service. Um, so it's just thinking about things like that for people who might be then thinking about? Well, actually, um, I need that continuous service for my leave in the future. For if I want to take maternity leave, all of that's impacted, which for most people doesn't necessarily matter. But it's just being aware that there are other things you need to think about. Um, the thing I would say is it takes time. So to sign up to any of the local agencies, it takes time. You might be working in a trust currently, but you still have to redo all of the paperwork. So if you think you want to look, um, for your F three years, start organizing it early. So I would even say April May time, even though you have a job until your foundation job until the August or different job until August, Um, it takes a lot of organization. They need copies of everything. Um, and it does take time, which is completely fine as long as you organize yourself in time. And that's what you know you want to do. Approaching local departments early, that might say, Oh yeah, we know we've got gaps, so we'll bear that in mind. Um, the other thing to think about is an E portfolio. So as you're not a trainee, you don't automatically have access to E portfolio things like considering SCP you can choose to pay for I SCP and you can keep it up to date. It's just a bit more complicated because you're not a trainee attached to a degree, but it's definitely doable. It's definitely something you can do and should do because to keep up your portfolio, to get used to doing that and to have evidence that you've done something with the year, I think that one of the potential cons of low coming is somebody will ask. Well, what did you gain? What did you do? What did you learn? And if you're doing lots of shifts in lots of different places, you might not get the, uh, opportunities as much to do things like audits. People don't know you as much if you don't work in the same department. So you may not be getting the same opportunities as somebody there all the time, which again, is not necessarily a problem, but just something to be aware of and actively make sure that you're like, Well, what do I need to get out of this year? Um, and things like appraisal. So because again, because you're not a trainee, you can You need to still need to have appraisal a lot of trust. Have a system for that. But you just need to be aware of it. You know what boxes you need to take in enough time. If you're with a local agencies, often they will do your appraisal. But again knowing what things you need to sign off. Do they need a multi source feedback? Do they need a certain number of CBDs all things like that, so that you know and are organized because otherwise these things will flag up later in the year, and it will just be a bit more complicated. And so I just got a couple questions, so it doesn't f three Japanese CSD application or excuse me further down the line, you get less points. So for some specialties, they started to do a thing where they divide your points. By the numbers of years. You are post graduate or post foundation program, so you have to bear that in mind. And that's when that's why I really I talk about well, start thinking about the points and the what you need to achieve audit to research. Because if you don't think about those things, then not that you're behind, but that you need to catch up. Because if you take multiple years out, it might, Depending on your specialty, it might be that you're expected to have done something with that times. You're expected to have more points because you've had more time, which is the reality of the competitive world that we live in, which again is fine and something you can definitely organize and do you just need to know about it so that you've achieved some of those things to work towards. It, um is a three the only time to take time out. So you penalized after CT one or later in training, so you can if you completed core training, you can take time out in between corn specialty training, but again, the things with the points and what your achieving from it, but also what you want to gain from it. Um, it's a different it's possible. But again, you just have to be organized, and you have to think about it and how it's going to work. Uh, do you need I s e p? So you don't have to have I s e p i X e p is what the core training and above use for pretty much all of your CBDs many cases like your portfolio, it links to look book so that all of your procedures are on there as well. You don't need it, but you have to pay for it. So it is again a pro and con, but starting to use it early and start. It's a good way you can use to have evidence that you've done CBDs. Many Texas MSF things like that, so that you've got evidence based behind you for what you've done with your F. Y three years. So it's not something you necessarily need to do, but it's something that you can do that then contributes to. Your planning contributes to what you've done, contributes to your evidence of what you've done with that year, and it gives you something to talk about. So next time we'll talk a little bit about working abroad. So lots of people talk about going to various countries to work abroad for a year or two. For a lot of reasons. There's lots of pros and cons. Um, most people choose to go to places that are English speaking unless your first language is a different language or you're fluent in another language just for ease. Um, for a lot of people, that means somewhere like Australia and New Zealand. America is possible that you have to sit in the US Emily, which is a bit of a nightmare, Um, and there's other countries internationally that you can go to. But I would say Look at whether your medical degree is equivalent and whether you can actually go so This is what I did with my, uh, in between foundation and core training time. So I went to New Zealand. Um, and think about what you want from the experience. So do you want medical experience? Do you want to do different specialties or do you want the experience of living in another country, a different culture? Do you want what you want out of it and what you're hoping to gain? Think about the CV opportunities and again, what you want from it. Do you want to do different specialties? Do you want to do more surgical specialties? Do you want to just have a different experience and see what medicine is like in a different country or a different continent? Um, do you want the opportunity to travel and work at the same time so that you're still learning? I'm still working, but that you just have a bit more time to explore somewhere that's quite far away? Um, similar to the local life. I would say it does take time and energy, money and energy to get there a lot of time. Quite a lot of money and definitely a lot of energy. Um, you have to be prepared to plan and be organized. And I would say you have to start organizing kind of February March time, if not earlier, and to get there in, like August September. Um, you can do it in less time. You definitely can, Um, but depending on what you want and whether you're like, I just want to go, I'll do any job and I just want to have a nice time. Then you need to be less organized. If you want specific specialties, or if you want to do specific things to go to a specific places, then you just need a bit more time to make sure that you're getting that. So the things to think about, where you want to go, what you want from it, what kind of specialties and what you're prepared to do if you don't get your first choice And the other things to think about are your GMC time limit so you can only be out of the GMC for a certain time period before you have to start proving that you are still working as a doctor and you're still capable, Um, and then specialty experience limits. So for course, surgical trainee. There's a limit of how much surgical experience that you can do and still apply to core training, because the expectation is that if you have that much surgical experience, you should be applying to register our training rather than core training. So looking at all this and knowing, um, the other thing you can do is do complimentary specialties. So think about E. D. Um, intensive care, other specialties that go well with the surgery that will give you, like, really useful experience that you're going to use. But there is not surgery so that you're not hitting that time limit. Um, you have to register with the medical council. And wherever you go, that all takes time. You have to have health chest X ray. That all takes time. You have to have the I D checks and you have to have a visa. And then it's things like thinking about where you're going to live, organizing yourself, lights, etcetera. So it it does take time. It doesn't need organization, but, um, once you get there, once you've done all the paperwork and it gives you the opportunity to work somewhere completely different in a completely different culture. Um, and it just gives you an opportunity that perhaps you might not have, um, at different points in training. So there's going to be limited amounts of training time where you can leave and come back. Um, I just got another question. How Scripture Surgical F three abroad positions mainly in E. D. So there definitely are more positions in E. D. Um, and if you haven't done any job because I didn't in my foundation program and I did it when I got to New Zealand, it's a really good experience. I think everybody should do an easy job. So even if it's not something you want to do forever, it's still really good experience. Um, there are lots of other jobs other than E d. But if you want to be more selective, you just need to be more organized. Um, the other thing I would say definitely for New Zealand is in New Zealand. The system works a bit different, so you don't have five juniors on the ward who are sometimes on calls and sometimes not there. You have two juniors, but if somebody is on call or on nights, you have a relief doctor who will come and do that job so that there's always two people. A lot of U K doctors when they first go out to somewhere like New Zealand and Australia will go as relievers. And that is because the those countries appreciate our experience and we cope well with being relievers and potentially moving around between different awards every couple of days. So I would say often it's quite common to go to the House officer and be put into a relief job. But there's lots of opportunities for swapping jobs. It's much more flexible than here, Um, and it's much more normal to swap to take to take one job off, so to resign from a job and not do one of the blocks. So then you can do, you know, 33 months ones and then have three months off to travel, and that's quite a normal thing to do. Um, if you tell the, um like the very equivalent that this particular job's you'd really like to do often there's opportunities to swap, so it's a bit more flexible, Um, of what positions there are. Um, and I definitely found ways to do things that I wanted to do or to mold what I was doing into what I wanted to do. Uh and then we just had a question about where we can find some research fellowship. So a lot of them will be advertised on NHS jobs and then looking at who is around you locally and to what the people are already doing. Um, I would say there are more teaching fellowships in there, our research fellowships by quite a significant margin. But they do exist. Um, and it's talking to other people finding out who has done what, where, where they exist, talking to the local departments and saying, Is this something that you have available? Um, and going from there. And they are advertised on NHS jobs. So if you put in the right filters, you can find things, and you can also look on hs jobs for things that are closed. If you look at what was the available last year, that means it does sometimes predict what will be available this year so that you know that area that you work in and would like to work in did have one last year, so contacting them and saying, Hey, I noticed you have this last year. You're going to have one this year. I can give you a bit more information so my top tips will be be organized plan. And even if it's just taking some time to think about what you want, do you want just to bump your TV as much as humanly possible? Look at the gaps. Look at where you have holes in it and try and fill them. Um, do you just want to have some different experience? So I wanted to an easy job, and I wanted to work in intensive care because those are things that I thought would be really useful for me in the future. And things that hadn't done that then also didn't add to my cumulative time and surgery. Um, it was a bit I had to do other jobs to get there, but I got to do them, and I'm really glad that I did so thinking about what else you want, how you want to develop as a doctor, not just how you want to bump your CV. It's got a limited opportunity, so there are only strategic points and training where you can potentially do things like kind of program experience or in between bits of training. So if you want it, use the opportunity. But make sure you're getting something out of it. And it's an opportunity to, I think, keeping on track of things like I s e p in your log book, making sure you're putting things into a log book If you're in the surgical job and you're doing procedures or taking part in procedures because you regret not doing it afterwards, and it's almost impossible to backtrack six months ago, Um, it's a good opportunity for getting involved in teaching in order to try and do some exams. And to think about course is that you can do that. Perhaps you wouldn't be able to do if you were in an on call rotor and you're not in an on call job. And the other thing I would say is so I went to New Zealand, and a lot of the courses are international. So, for example, I did my HDLs in New Zealand, which is equivalent here. So some of them, if you're somewhere else, it doesn't mean that there's things you can't do a lot of things will be equivalent will be like the same version that will be accepted because it's run by the equivalent of RCs. But in New Zealand, um, and then think about extracurricular achievements. So what? Like I said, if you're a triathlete and your training and you want the opportunity to be able to mold your day around that it's a really good opportunity for that. Um, if you a sports person, if you are interested in our culture in whatever, it's a really good opportunity to be doing stuff and a lot of extra curricular achievements. There's lots of things we talked about the training and teaching and training and things earlier in pre sessions. But there's other extracurricular things that you can do during this time. And I think even though the points is it all changes. And it's very frustrating looking at the domains, looking at the things. There's a lot of things that are consistent year on year and looking at where you have gaps and what you can do to fill them. I think last but not least enjoy whatever you do. It's like a really limited opportunity to go and be working as a doctor, but also really enjoying what you're doing. Enjoying the experience, Um, and getting something out of it for yourself as well as as a career and as a CV, um, I'm just gonna answer the last couple of questions you've got, so I shouldn't have a patient for a long time. So you're doing everything because I was limited by CST. So for your surgical training, you can only have done I think it's 80. I think it's still 18 months. Uh, surgical jobs, Post F two to be able to apply to course surgical training. Otherwise, you've done too much surgery and essentially the series that you should be. You should have progressed in that time, and it's not fair to put you against somebody who's, uh, an F two. So during every three, you're fine. You can do a whole year if you start taking it for five or six years, that you start to run into trouble with having done more surgery. The way you can get out of that is you can do a certificate of equivalent if you needed to, because you found you've done too much surgery. But again, that's where you need to have put stuff into your ICP and your portfolio. It does exist. It's a bit more complicated, but it's doable, so don't stress about it if you're gonna do an F three. But it's just if you take an F four and L5. So I went to New Zealand before covert and got stuck there during coated, so I was there for a little bit longer. If I've done all surgical jobs, I probably would have run into trouble. How do you do work in how to work in E. D or Critical Care helped a surgical portfolio. So, um, our patients come into E. D and are seen by ent and then come to us for a lot of them. Not all of them, but a lot of them. Uh, working in the D is quite different to working on award. You come in, you see the patient, you decide whether they're safe to go home or not. I think it gives you a really good understanding of what working in the emergency department is like for critical care. You're a lot of the really sick postoperative patients will go too critical care. Seeing what happens in critical care. At what point is that person extubated? How much in the tropics support is a lot of an atopic support? How sick is that? Patient? Um, all of those things. You will learn a lot more in critical care, and that will help your future career as a doctor from a portfolio perspective. Um, I think it's really important to think about relevant audits, relevant research that just because you're in critical care doesn't mean it's not relevant for surgery. So you might be doing an audit on postoperative patients, so that's relevant. It's the same as talking about perioperative medicine. Um, it's still relevant because it's it's all connected. It's not like the surgery is a single entity separate from anything else. So it's just about what, thinking about what you're doing and how it will help your career. But also your portfolio, Uh, for the 18 months Does that include research fellowship with the clinical, So 50 50 voters? Honestly, I'm not sure. I don't know whether it would count as like nine months rather than 18, because you've been 50 50. Sorry, I'm not sure, but there'll be a way to work it out If you're low coming for six months and include some surgical, does it count again? I think it will be a case of working out what you've done and how you prove what you've done. I feel like my time is up because Brian's appeared, Thank you very much. Near that was a really insightful talk and thank you for sharing your professional journey with us in your F three year. Um, so if you've got any further questions and you can, can you please enter it into the chatter box on the side and we'll in to answer them?