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Okay, guys, welcome to the locum F three talk. It's lovely to have you all with us. Um, today we've got Doctor Sergeant Vasi and Doctor Will, um, Fields, Jewel speaking to us. Um, they've both ones doing a locum year, and one has done a couple of locum years. So we've got a wealth of expiry and speaking to us today, and hopefully it'll be really insightful with lots of different tips, tricks, um, and advice on how to manage a locum year. So first, we're gonna start with the lovely will. Um, who's gonna talk to us about his locum year, His experience and everything that's gone on with his locum year? Um, this is run by the portfolio clinic. Um, there's lots of different things that go on with the portfolio clinic. So please check out our website and we've got mentor mentee schemes, etcetera, and we run this series twice a year to give you more information and guide you on your F three year. Okay with them. Hi. Hello. Thank you, Holly. No, thank you so much for coming, So I'll start your slides, and then you can start presenting if that's ok. Absolutely. Yes. so good evening, I hope I hope we can all hear me. So my colleagues said my name is will and I'm currently a locum. More specifically, I'm a hospital bank locum uh, f four as you if you were to put a name to it. So basically, I've been asked to talk today about local life and how this compared to my clinical fellowship, where I was more hospital owned. How that compared to my foundation years and what local life is like, I'll also touch upon how you can stay local to a familiar hospital, then look, Or perhaps look at, uh, going abroad. I'll also look at the different ways you can also locum as well. So So yes. So before we get started just a little bit about me. So I am a postgraduate medic. So I did a medical science degree before I moved on to, uh, study medicine at Cardiff. I did my F one at the University Hospital of North Midlands Trust, where I completed rotation one in Upper GI surgery. Then rotation to was Jerry's. And then a little thing called covid came along, meaning we weren't allowed to rotate, So I was put on to an emergency covid rotor, as you were for about 88 months, meaning that I missed out on my last rotation. Um, I'm sure you guys probably did interim or something similar. F two I also stayed at the University Hospital North Millions Trust where I did hematology Oncology is my first one. Uh, my second rotation was U P. With any weekends on call and then my third rotation was general internal medicine. Between December and February of that year, I was looking at jobs. Uh, I knew I wasn't quite ready to go into train just yet, so I wanted to look at other pathways. So I looked at becoming a J. C. F. Or Junior Clinical Fellow or F Y three. And a really good job came up at the University Hospital of Derby and Burton Trust, where I can pick and choose my rotations. It was 9 to 5 Monday to Friday, one in five weekends, one in four weekends. So applied for that, managed to get it. And then I picked rotations, neurology, geriatrics with a bit of covid 19 ward cover, followed by CCU and cardiology. When I finished that I still didn't apply for training because I still didn't think I was ready. So I thought, You know what? I'll give this low coming ago, Um, and it turned out to be a really, really sort of like, successful guess job so far, Um, I managed to stay on CCU for a month, so I finished my last block in August, and then I basically carried on the same job for about a month, and now I'm currently on winter pressure wards. So what I'm personally interested in terms of medicine is I'm quite interested in sports and exercise medicine, being quite sporty myself, cardiology, and to spice things up, a little bit of aviation medicine as well also. So why locum? First of all, I'll touch on what a locum is. So for those of you who don't know, a locum is basically a non training position where you your primary role is to fill in rotor gaps and vacancies. Let's say so. The good thing about low coming is the pay. That's one of That's one of the great things that is attractive towards it. Um is the pay you get paid a little bit more. Let's say, then you would do if you're in a training position? Um, another massive advantages. The work like flexibility. You can pick and choose your hours. You can work as little as you want. You can work as much as you want. Um, I found as well another reason why to locum was just time out the training pathway. You get to pick a bit more variation, particularly, let's say, if you missed out on some of your rotation, such as I did, Um, and if you don't feel as if you're particularly ready to jump on the training treadmill, then you can take some time out and perhaps perhaps locum. It gives you that time to focus on your portfolio, and I know we have allocated SDL time, particularly when you are in training. But sometimes you you may feel as if you're lacking in a particular area of your portfolio so you can have that time for clinical practice. But you can also have a lot more time to focus on portfolio. Let's say you're missing clinics or you want to do quips or audits publications. You have that time to fill in whilst also keeping your clinical knowledge up today. Um, obviously another massive attraction is the traveling as well. Some people would do, let's say, six months of low coming. And then for the remaining six months, they want to travel and experience other things accosted well, also as well. If you have a family, um, it's perfect time to catch up on that as well. So another big thing, I think, particularly in this day and age in medicine, is attempting to avoid burnout. We've all been there. We've all had tough shifts. We've all had good shift. So I think it's a really good way to avoid that. That that burnout feeling of, I just feel fed up. I want to do this. I want to do that. But with with low comming, you can have that time out while still learning relatively good money. So so personally, why I picked low coming instead of continuing on my my clinical fellow. Yes, So as I mentioned, I was an F three and it was a Monday to Friday 9 to 5 job that was contracted, um, for which I decided to pick one in five weekends, which I was working on cool so as I mentioned before, the biggest attraction to me was this flexibility. I have loads of other hobbies, such as running. I'm an avid runner footballer. So I wanted that time to focus on that for a bit, Um, whilst also getting a relatively good amount of payment for it as well. So I was able to work much less hours for equivalent amount, amount of pay, if not a little bit more. And it allowed me to invest in things that I wanted in my life at that time, such as investing in a house or a car or or so forth. So that was the two biggest reasons I wanted it as well. This this this year of low coming, I wanted a bit more very clinical experience as well. So although I was I I like to think that my my portfolio looks quite varied as well. Um, it also gives me a chance to to catch up on other areas that I perhaps missed during during the covid, um, experience. So I've done some one respiratory as well. I've done a couple of local ships on on respiratory as well. That was one of the rotations that I missed out on as F one. So it allows me to to keep that general knowledge up to date as well. So a table there just kind of is a very brief summary of just the differences or the main difference is I wanted to highlight. So as I mentioned before the hospital Bank is is better flexibility with your OTA. I appreciate the fact that a genie clinical fellow position although it is a non training position, you are still contracted. And it you could argue that yes, it was more structured. You had more, um, structured teaching sessions that that you could attend more structured clinic work that you could attend and the the same wards are used to that familiarity. Um, I still found as if the flexibility in the better payment was still much more of a an attractive aspect of low comming versus staying on the junior clinical fellow job. And yes, I was contracted. So it didn't mean that I had to worry about, uh, sign off sheets. Um, Loka means typically run on sign off sheet. So you do your shift and you have your sheet and you go to your supervisor or a sister on the ward and you ask them to sign you off. And you typically have to get that in between a set time period. Let's say the end of the month in order for you to get paint essentially obviously, with a junior clinical fellow job, you didn't have to worry about that. Um, they both came or junior clinical fellow came with an appraisal, which is very, very important in in the medicine world. And this this local imposition also comes with an an appraisal as well. So that's the reason why I wanted to stay in those jobs so well. I wanted to change. The locum inverse is moving away from a junior clinical fellow job, so just highlighting some of the advantages and disadvantages. So I'm going to talk a lot about the flexibility of becoming a local because that, like I said, it's one of the fantastic, fantastic reasons to become a locum. So once again, the flexibility of your road to you can work nights. If you fancy, you can work weekends. If you If you prefer that you could do 33 days, one week, five days the next it's it's great in that sense, The pay pattern. I know everyone's obviously quite interested in the pay, but I I don't want to spend too much time on that. But typically, a grade that I'm at, which is an S H O. It's typically around about 45 to 50 lbs an hour. That's normal, sort of like day working time hours. Obviously, it varies if you do a night shift or an evening shift, and it obviously varies dependent on your grade. If you're a registrar, a consultant, Um, like I said variation as well. One day you could be asked to cover the winter pressure towards the next. You could be pulled across the do cardiology. You could be pulled across the respiratory or that that I think is quite useful in keeping your knowledge up to date as well. I think I think that's very important. I'll touch on a bit more about this a bit late. Later, on something called the Hospital Staff Bank, which I'm currently on versus, uh, hospitals tend to look at external companies such as agencies that can fill vacancies, so I'll touch upon that on the bit later on. In this power point. Like I said before, it gives you that extra time to sort of focus on your portfolio on on the things that you think are missing, particularly relevant for training projects such as Q. I. P s audits, research publications. It gives you that time to do that. And I know lots of low comms like it as well, because it allows you that extended periods for prepping for your exams. Let's say it's the M r, C, e p or M R S or G P exams. Whatever it is, with all the advantages, there are disadvantages as well, so availability. Sometimes it may not be a shift that you were initially looking at. Maybe you're looking at day day shift. Unfortunately, this week were taken up, so you may have to look at doing night shifts. It does vary time to time, and it's generally a first come first serve basis sign offs and handing in your your sheets on time. It's almost like feeling as if you go back to primary school and you have a register that you have to get signed off for each shift and you have got to make sure you hand it into whoever you need to hand it into in order to get paid. And if you don't, you kind of miss your your your vote for that payment. So it backs up onto the next one. You could argue as well. Obviously you're not in a training position, so your time teaching you could argue you're always learning you're always being taught something, but the structure teaching sessions is is obviously a disadvantage or becoming a locum. So you you're not. You're you're designed to sort of fill in the gaps of the training positions rather than to attend the structure teachings. Although there is the options to do that once again with the variation, as I mentioned, it could be that lack of continuity. One day you could be cardiology. One day you could be respiratory or whatever, so some people enjoy that. Some people don't like it because of the continuity. Get to know your patient, and you get to know the team surrounding you, particularly how that Ward works as well. Let's say some people find it quite isolating in that sense, so you work by yourself kind of thing, even though you could be possible team. You're only with that team for one day and, uh, low comes typically don't in their pay three it they From what I understand, some of them don't contribute towards the NHS pensions as well, so that you could argue that that's one of the good things about working for the NHS is the pensions but low comms? Um, some, I believe some trust might so something to look into. So I've touched upon this briefly. So there's two broadly speaking, two types of locals. You can be a hospital bank or you can be an agency. So hostile bank is what this slide is about. So it's typically a trust pool of doctors, uh, many of them who have rotated through out that trust and are able to pick up locum jobs. You you typically, you may have to sign a form when you first join join, join a trust saying that you want to work against the working time directive, and that typically means that you can sign up to the local um, staff bank, so that's typically what that is. It means that you directly work for the trust and they're in charge of all your compliance is so whether or not you're doing, you're learning and you're you're registered and and so forth just breaking that down. Looking at the advantages and disadvantages, let's say, working with agencies who are more external companies. So the advantages of becoming a hospital staff bank doctor is the flexibility, the familiarity, particularly if you've gone through that hospital through that ward or, you know, the different. You know, the different systems. You know how the structure works. You have that familiarity about it. You don't have to pay agency fee because you work directly for the hospital. You don't have to worry about paying a consultancy fee, which I'll come onto in a bit, which you typically get when you sign up with an agency. Hospital. Bank staff typically have the first access as well to the shifts because they'll send the email out to the locum as the locals or the Hospital Staff Bank prior to the agency. Not always the case, but that's typically what what happens. Um, it's a better way of building relationships as well, particularly, let's say, in my position when I was a C, C, U J C F, for four months and then I could continue on building those relationships for another month when I was a locum. So I think I think that's a fantastic way of building relationships and keeping that that that going really once again as well. If you work a certain amount of shift with with with the hospital, they tend to offer you appraisals as well, which is, like I said, it's very, very vital in the medicine world. You won't get far without an appraisal. So and once again it's that better support, particularly if they know you and you've worked through the hospital versus the agency. Disadvantage is once again availability. It's a first come, first serve basis. Um, it can be quite isolating. In that sense, you may. You may not see colleagues for some time, and if you're not used to the team, you can find yourself in quite isolating position because you're not paying somebody to look for the work. You're constantly on the lookout for that email or that text message saying, Oh, there's a shift coming up so some people can find that quite stressful that they have to keep looking, looking forward to finding shift, really and they do get snatched up sometimes quite quite quickly, particularly some shifts over others. Once again talking about time sheets as well. So looking for sign off, looking for getting that time sheet incorrect in prior to getting paid by the end of the month. Let's say, um, if it is run poorly, the hospital bank, it can be very difficult to to arrange shifts and and and get paid and so forth. So all right, moving on to the agency now. So that was Hospital Staff Bank. And now this is agency. So agency locum are typically an organization that specialized in filling vacancies with these local doctors. So typically, when you sign up to an agency, you get allocated a recruitment consultant. So this job of the recruitment consultant is to make sure that you're up to date and you are compliant with looking at the the jobs that you'd like. So let's say you want a job in cardiology. Their job is then for to try and find a job for you. Um, so and obviously they want, they want you to get a job because the more you sign up for, I believe they also means that they get paid as well due to the agency fees. So they typically charge trusts as well, fulfilling in these gaps and vacancies and typically the job of the agency to make sure that you are compliant with what the trust wants of you. Um, examples of these are halt and MP healthcare as well, so the advantage is is they want you to get registered quickly, and they want you to have long term placements because it means they get a better agency fee. They're really good at finding work for you because, like I said, you're essentially paying somebody to find some work for you. Um, once again, they they quite enjoy making you get paid promptly as well. So sometimes they can do weekly payment's instead of monthly payments as well. You could argue it's a bit of a wider opportunity of work as well. I don't know how true this next. This next one is about negotiating rate, so I won't spend too much time on that. But I I do. I do know that sometimes you do get referral bonuses. Let's say you sign up with one agency and you get a colleague to sign up with it, and they do a certain certain amount of hours. You typically get a financial reward for that. Some of the disadvantages of obviously you get paid less. It's less take home money because you're a little a little bit of that fee goes towards the agency. Um, sometimes it is the second selection of jobs. So as as as I mentioned, the first lot of jobs typically go out to the hospital bank staff and then the If those aren't field, then they typically go to the agency. Not all the time. I appreciate that. But most of the time can be quite location specific as well, so it depends on what company you sign up with. So that's that's agency work. In a nutshell, really. I won't spend too much time on this, obviously staying local as a locum. But there is the option to go abroad. So, um, I know lots of people like going abroad Australian, New Zealand, very popular destinations for going abroad as as a locum. So it's whether or not you want that familiarity of a trust, you know, versus a new experience, Let's say, in Australia in an a department. Over there, you get to learn new concept. No idea is a different healthcare system. You might be able to take that back with you if you do eventually move back to the UK or stay out there. Um, I know that it's quite a lot of logistics. It's like anything, particularly you. You might have gone an elective somewhere, so it's lots of logistics to arrange that, such as visas, compliance is accommodations and so forth, and particularly job out there. Some might only have a three month post or a monthly post. So, um, there is there is the option to go abroad, so but it's it's whatever you feel as if it's best for you, really. So, in summary, I do really highly recommend you you consider a locum year due to its flexibility. I cannot. I cannot stress that enough that the pay obviously is brilliant in that in that in that sense, compared to training positions, let's say and it allows you that time to catch up on portfolio as different ways you can locum such as hospital bank versus agency, and you can look about staying local to a familiar environment or going abroad and learning new ideas, new new experiences and new new concept. So, yeah, thank you very much. Is a couple of useful websites which I'm sure can go out a bit a bit later on. But there's there's loads of resources out there. Loads of locals like to talk about their experiences and why? Why? They recommend it. So, yeah, that's it. In a nutshell. I'm gonna I'm gonna hang around for a bit. So if you do have Do you have any other questions? Please fire, fire away, or you're more than welcome to email us a bit a bit later on. If you're if you're shy over over the website. So cool. Thank you very much, everyone. Thank you so much. Well, thank you so much. That was really interesting. And I have a lot of questions to ask myself, so I'm looking forward to the question time. Um, now, Sergeant, if you like to just introduce yourself and tell us a little bit about yourself, if that would be Yeah, it's a bit odd being on this end. After imagine, uh, so, uh, yeah, My name is Sergeant. I am one of the co founders of the portfolio clinic. Um, I did my foundation training back in 2018. Now, Uh, yeah. Gray hairs. Uh, result. Uh, that was in, uh, Nottingham in Derby. Uh, so there's a bit of a derby theme going on here, Uh, this evening and falling on from that, I also did an F three and an F four, And I did a few things in that time period as well. So, uh, I think I've got a mix of everything that will, um, has, uh, mentioned including agency and a junior clinical fellow role and a bank role as well. And I did a p g cert as well, Which is where I met Shiv, who is the other co founder of the portfolio clinic. Uh, without him, we probably wouldn't be here tonight as well. So, uh, yeah, Emotional time. Yeah. So a very sort of f three and f four. I think that's really interesting as well, because I think a lot of us actually don't necessarily do one pure, locum pure J c F year pure teaching fellow year. A lot of it. You know, for the viewers, a lot of it is quite dynamic. So you can pick bit of each job that you like in your F three year. Emerge them all together to make something that works for you. So I do a J C F three days a week, and then I locum the other four. If I decide I want to look. And I liked him in area specialties or is are my J C f is in or Phoenix. So, Sergeant, tell me what you did. Post F two. Yeah. So, um, Post F two I was sort of forced to take an F three in a way because it's I'm a bit of a complicated case. So at the time when I was in foundation training, I was quite interested in, uh, well before foundation training as well. I was quite interested in going, um, to see what work was like in the United States, and I was sort of semi interested in moving abroad. Well, you could say, quite interested. So I ended up. Yeah. Yeah, exactly. And so during my my F two managed to take time out of the program to pursue clinical placement in the United States. Um, just before covid, actually. So I was very lucky cause that when I went through the meetings and the process, they gave me a set, period, and I could have either chosen the end of F two and extend deaf my F two further or the start of F two. And I went with the start of f two because if I wanted to launch an application for the United States, it would have made more sense because I would have been more prepared with all the experience that I had. And I returned a week before, everything just shut down completely. So I was very lucky. In that sense, I was able to come back, Uh, and I wasn't trapped out there. Um, yeah. So in that sense, my F two was extended, so I knew that I was definitely gonna have to take an F three and my f two finished instead of finishing in August. It finished in December of 2019. So I knew I had at least eight months where I needed to fill time. Essentially, And I initially went to do a a junior clinical fellow, Um, and that was arranged, actually, through an agency as well. Um, so I did that in Chesterfield for a bit in acute medicine. So that was a sort of a set block and a set rotation. Um, but I also knew that that wasn't all I wanted to do. And actually, um, in the F three, I also pursued a PG cert as well. Amazing. So how did you arrange that local work in your initial F three years? And how did you go about arranging that? Cause I think that's what quite a lot of people find difficult. Is that starting process of I'm going to be an f three locum. Yeah, you start that process. Yeah, and it can be quite daunting as well, especially when, as I think, as medics and as clinicians were with people who like to follow a structure and a pattern, you know, you go through medical school, you then automatically into foundation draining. You automatically have what theory. Basically, it's a bit more difficult these days, but theoretically is that automatically have a foundation post. And then from there, it's the assumption that although a lot more clinicians are taking F three and F four, it's the assumption that eventually we'll get onto a training program and sort of climb the ladder in that sense. So, um, I think that there's it's always gonna feel daunting, but I think it's always good to step off the ladder because, as Will um mentioned, there's so many different experiences that you can gain and so many different avenues that you can take the clinical experience that you have. Uh, so initially I came back to England and I carried on with my F two, and I was sort of sort of going in our ng about going into a bank post, uh, which was sort of in in the hospital that I was at in in Nottingham at the time. Uh, but I decided that I want I wanted something a bit more sort of stable at that point in time because I didn't feel that there were persistent shifts. Um, which is something that is difficult when you're a local as well as to sort of think sometimes can be really stressful to think. Oh, where's the next shift gonna come from or I don't really want to work on this ward. I don't really want to work nights that I have to in order to keep some sort of stable income. Uh, coming through, Uh, that's one of the, uh that was one of the advantages of, uh, eating, uh, coming across an agency and actually, the agency that I joined, I gained that through word of mouth. So I just sort of asked around. And, uh, colleague of mine said, Oh, there's this agency that's really, really good. Why are you trying to contact them? And what was that process like? The process was fairly smooth. To be honest, I feel like most agencies are quite keen to have individuals because then they get paid as well, so very sort of direct with all the forms that needed to be filled out, uh, in terms of signing on with them. And they also were very interested in the mandatory training that you've conducted because I've been out of the system, sort of out of the system. And my my training was extended. There was quite a bit of a mandatory training that I needed to do, but they were very good learning all the learning. Yeah, everybody always has. Safety is the first one most sort of, uh, distinct training that we have to do potentially never, but yeah, fire safety, all of that sort of stuff. Uh, it's really good in that sense, joining an agency because they will make sure that you have done all of that in order to onboard you across very quickly and very swiftly. Um, the other thing about pay, I know that will, um, mentioned that, uh, sometimes they take a fee from your pay. Some agencies actually will take the fee from the hospital instead. So when I actually did my my J c, f, uh, post in chest field, my pay wasn't deducted at all. From what? What a bank local would receive because they actually added that to the hospital and the hospital. So that does that actually happen with agencies as well? Uh, yeah. So that's something to consider is they don't necessarily always take take the fear away. Um, but they were very good at putting me in contact with the hospital. And then from there I started my role, and it was a bit daunting because it was a new hospital. I was an S h o. So I was a bit more experienced. And there's I think there's a greater expectation sometimes when you're in S H. O who's had a bit of experience. And I remember my first day there was nobody there. It was a snow day. It was It was snowing so heavily in Chesterfield, sort of very hilly. And I was the only one that was there who made it on time because I was coming from a different direction. I think I remember this day. I think I worked this day. Probably, Uh, that's quite stressful. And I think that's one thing as well is you don't get a formal induction as a locum sometimes is. The flexibility is great, but you join at random times so this for me. I joined in January and it was a very random time. Um and I just sort of slotted into a role. Um, but depending on the type of person, you know, I feel like if you're somebody who it's quite forward and we're not. Yeah, well, I don't know, maybe, um, but somebody who's like is keen to to get involved and ask questions and and learn. Most clinicians are really receptive to that despite not having sort of a training post or a training role. So I I learned a lot from that experience, but it wasn't what I wanted to do long term in terms of locally. But it was sort of a good re introduction back into the NHS blessing that silence. So going on to your p g seven you mentioned about PD set. And I'm quite interested because I know that now with a lot of your applications to your course urge your i m. T. S etcetera. They like a PG set. So when did you decide you wanted to do a P g set? Yeah, So I think that when I was so when I came back to the UK, I I felt that my experience in the U. S were great, but it wasn't sort of the direction I wanted to go into. And I think that actually working in the UK and internal medicine was the direction that I was going in. Um, I felt that having the initial experience of the locum at Chesterfield was a good opportunity, but I didn't want to just leave it at that with my f three year. I wanted to try and build upon that. And so I remember initially, I was I was thinking a P G. So it would be a good sort of alternative thing to do, especially if you can do it part time. So mine was part time and I also got the opportunity. I wanted to work in London. Um, but I wanted to it to be flexible. Um, and I wanted to learn skills with regards to sort of leadership and education as well. And I remember Googling those specific things. Google is absolute magic when it comes to recruitment as well. And I came across. I was very fortunate to come across the PG certain which it was in healthcare leadership and innovation, and it was also linked with working at an imperial trust as well. So I did that. And it was also where I managed to come across shift as well. And it's also where we started the portfolio clinic through the work that we didn't come about then. So that was an issue as part of the PG. So one of the leadership modules was too come up with an innovation, uh, an innovative idea in order to, um, benefit healthcare workers and the field of sort of, um, medical practice and clinical practice. One of the things that we wanted to focus on was well being. And one of the things that we wanted to focus on in particular which related to us as F threes was career uncertainty and career guidance. Because we, both of us, are in a position where we sort of we knew what we want to do. We didn't have all the information and there's so much information out there, and there's so many information about what you should put in your portfolio. But it's not really sort of tailored, and it's not really sort of personalized. And we felt that we could create a service, and I guess we did at the end of the day where we could provide personalised and practical support. So it came from one of the modules, and then it sort of just expanded. Um, we took it beyond the PG sets. Actually, PG sense are pretty good because they can. They can, you can use the skills and they can take off. So I'm I remember I applied for that in January, so I I started my locum job actually in Chesterfield, knowing that I didn't want to carry on with this, Um, as well. Um, so I applied in December. Sorry. And we had interviews in January, and then it was to commence in sort of April time. So, actually, the other good thing about being a locum is that you can decide a lot of the times you can decide on when you want to terminate a post as well. Um, and so I went into this job in at the start of January knowing that eventually at the end of April, I would be able to work there anymore, and they were completely fine with it as well. They were very appreciative, actually. The fact that I worked in that post, um, in acute medicine and I learned so much from that job and the hospital was really, really friendly as well. But, uh, yeah, it had me to, uh, learn and then also move on pretty, pretty smoothly Come the end of April And then from April, up until, uh, September, I was I was doing this, um p g cert it, um Imperial and yeah, that that sort of took on the rest of my f three. Mm. Amazing. So then why did you decide to do an F four because you mentioned that you did an F four? So what? Why did you decide? Okay, an F four rather than training? Yeah. So I think to be honest, one of the main reasons I had was, um, disappointment. Disappointment, I think, with how I had initially done in my application for specialty training for for internal Medicine because I felt that as though the application that I launched for when I took my F four. So I was only meant to take an F three. Really, I felt that I could have done a lot better if I had the information and the understanding of of the portfolio requirements. Uh uh, and and yeah, essentially the portfolio requirements at that point in time because the year that I'd applied for training was the year when we were in the the Covid pandemic. And actually, at that point in time, there were no interviews. So it was based on your portfolio, and I think my portfolio two guys was quite average. And and I think that simply because I didn't really understand what I needed to put in from when I was in F two. I was also focused more so on potentially moving to America. Um, so that was one of the one of the reasons why I was like, I feel I can do a lot better in this process. Um, and I'm not particularly fussed about going to training immediately during the Maya four because it was still a bit sort of covid e um, in terms of restrictions and the quality of training, I felt was sort of dampened by the fact that there was a lot of covid and a lot of service provision rather than a focus on teaching and training. So I wasn't overly fussed, and I felt like I could have done a lot better in myself as well. And I think that that's a that's a key for a lot of people who are out there. Is that just have a firm when you're applying for specialty training, have a firm understanding of the portfolio requirements? And actually, um, there's so many things you can do in a short space of time to improve your portfolio because I think that I was probably about average and then, in about a space of eight months. I've done so many different things, which just boost it massively. Um And to be honest, being a locum really helped with that because you have the time and the scope to dedicate towards certain projects. I'll give you an example. Um, So when I was at Imperial and I was doing my PG hurt, um, I wasn't on a rotor. It was actually, it was a bit of a weird PG cert. Where they wanted you to do a certain number of clinical hours. So but you could choose where you want it to work, and you could pick and choose shifts, So you were basically like a locum, but you had to have a certain number of hours in a certain period of time, and that was a six month period. And so I fortunately, was able to have quite a consistent stint within acute medicine. And on my first day, I was very keen to do a Q I project and I they had they had an issue at that point in time where, um, HIV testing was particularly, um, low. It wasn't routine, which it should be in London, because the prevalence of HIV is greater than 200,000 and and that's the cut off going to the batch diamonds. So I basically without really having much context of how the hospital worked and the systems that they have in place, I said, I'm really interested doing, equip, really interested doing the project. I think that the project with regards to HIV testing sounds really, really interesting. I would love to get involved with this and some of the so the consultants who were there in an acute medicine that were very interested in, um, having me sort of lead this. And I think just grabbing opportunities and just sort of rolling with it and learning as you're going along is really, really valuable because I think if I was, if I was a foundation training, I probably wouldn't have done that, to be honest. But at that time I felt quite, um, reassured that I understood the healthcare system to a certain a bit more and, you know, you sort of you learn as you go along and I learned so much and actually I didn't have a particular interest in HIV or infectious diseases, but it was really interesting, actually, sort of learning about how the logistics of actually, uh, understanding why people are so, um stigmatized and why there's a stigma against sort of HIV testing and stuff like that. So, uh, it was such a great opportunity. There's so many different opportunities within low coming, um, and and taking time out. So I had the J c f. I had the PT set and then doing my F four. I was doing stuff to build my portfolio, but at the same time, I was sort of picking up bank shifts back home in in Derby as well. So you mentioned a few things about what? Help boost your portfolio. So your your PG set your Q I, p s and audits and things. Were there anything else that help to boost your portfolio during your time for applying for I M T. Yeah. So, um, some of the work that I did during my p g s that I was able to present at a conference, so that helped because that was a normal presentation. Um, when I was working in Darby. Fortunately, as as well, um, mentioned when you have a good relationship with a with a trust, as as I did because I did my foundation training in Darby. You come across clinicians, or you come across sort of departments who are more willing to take you on for shifts. And I'm also more willing to sort of involve you into the day to day activities. Um, so I managed to sort of when I was in acute medicine. Conducted a teaching program there as well, which, which helped for for medical students. Um, so that helped and was very interesting as well. To sort of gauge the the thoughts and the opinions of medical students rotating an acute medicine, uh, so blow coming. So, yeah, that that's sort of picking on bank shifts and working in that sense in a place where you're sort of familiar. A bit more well known. Uh, definitely, I think has an advantage. But also, when I did that, I was in a place where I wasn't known, and I had no context at all. But I think most if you're keen on doing something, most clinicians will take you up on it. Yeah, I 100% agree. I think so. I'm doing a junior clinical fellowship rather than doing a locum year, But I've already been given quite a few projects, Um, etcetera because I've done it in a But I've done it in a department that's completely new to me. But I trust that I knew so I knew the systems in the way the hospital worked before going into this role. So even though I was new to the department, I knew the trust that I was in. And so you kind of hit the ground running, so I I'd agree with both of you in the sense of sometimes it's great to go further a field, but also, if you can get your local work close to home, where you kind of already known you've already started off on a good foot, and people will sometimes give you more things. Or if you're really keen and expressed that interest quite openly. Um, then people go, Oh, I've actually got this project. But I've been meaning to get done for years, and I've never got it done. Would you like this one? Which just get many consultants. A uh So why did you go into training then? Uh, essentially it was It was to climb the ladder. I think I've worked as an S H O for quite a long time. I knew that I wanted to work within internal medicine and then, um, specialty wise. I'm not entirely sure at this point in time, but I knew that I sort of had to get on at some point. It's a lot more, although there are avenues to demonstrate that you met competencies to apply for registrar training and specialty training. Um, but that's a lot. It's a lot more difficult in terms of having to arrange appraisals demonstrating, um, your clinical commitment and your clinical hours if you have to do a lot more of your own back in terms of being organized, whereas being in a training program and you have a supervisor that set for you, you you automatically have your appraisals arranged as your A R C E p. And there's always evidence of your clinical hours because you're in, you're in the post and you'll be reviewed. Um, so, yeah, I felt that I wanted at this stage to have a bit more structure with regard to demonstrating that that I'm making the the requirements for higher training and registrar training and who knows Maybe at the end of the S h O stint, I may decide to actually try and do it myself and go through potentially a Caesar pathway. And I think that is it's becoming a lot more feasible for clinicians because at the end of the day, people have things outside of work that they are interested in. They have a family, they have hobbies, They have other things that they want to want to do and want to pursue, and sometimes working in medicine or a specific area that they want to live in. And sometimes working in medicine is a bit restrictive in terms of in a training program. When you're in a place for, say, three or four years and you're you're traveling across massive Dean Aries in particular, your chain Humber is a huge scenery. Um, it can be quite difficult, life wise. And life gets in the way sometimes, I guess. Yeah. So give me your best thing about local me. The best thing, uh, the best thing is the variety of opportunity, Uh, the flexibility as well. I felt that I did so many different things in two years' experience wise, um, even like teaching wise. Q. I wise where I think that if I was in a training post, sometimes the amount of on calls that you're doing and service provision is difficult to actually focus on on those things. Ironically, I feel like it's more difficult to focus in the training now that I'm in a training post to work on things like Q I and education and teaching. Then when I was a locum, which is completely wrong, you shouldn't feel like that, actually, being on nights being on long days and things like that, which you don't necessarily have to do as a locum if you don't want to actually restricts you to a certain extent with regards to other opportunities. But a good time to experience, I guess. I mean, of course, what was the What would you say was the worst thing about low coming? They're kind of Yeah, The worst thing, the most disappointing or annoying thing about low coming, Uh, I think the sometimes the lack of continuity and not feel sometimes, depending on where you are, not feeling as though you're part of a team and actually just being service provision, um, I think that's the worst thing because, um, for me personally as a clinician, the work is is great. Fine. That's one aspect. But I I sort of like everything I like a bit of teaching. I like a bit of, uh, weird way. I sort of do like the Q. I work as well, uh, depending on what it is, whereas when you're a locum and some people they just want to be service provision, enjoy their life, that's fine. But that's it's completely individual individualized decisions. But sometimes just being purely service provision is very monotonous. And, uh, something that, uh, at times I was thinking I'm not particularly enjoying this and, um, being have been, uh, potentially being sort of carted two different wards as well. The water is when it's on the morning as well. So you think that you're going to one ward and then, actually, you know, be in respiratory today, we're going to put you in, uh, s tech, and you're like, what? That is a completely different a different change change in my day, I didn't sign up for a shift that you you purposely trying to avoid. I'm not big on s tech. I think. I think it's a good learning environment, but like you, completely, you you want to avoid it, and then they just start putting you there. What you're doing to me, Uh, not knowing where the shift is going to be, Uh, essentially your you're a piece in the service that is missing. Yeah. Whereas I think as a junior fellow, you are You almost have more rights to your placement and to kick up a fuss and say, no, I'm employed as this, so don't move me here. Um, and with regards to what you're saying about teaching, So I'm a junior fellow for three days a week cause I teach for two days, and I have a clinical, um, for the middle day. So I've kept that as my then get to do some projects in that as well with my trust. And then I locum in different specialties as well, because I do a JC F as I said in orthopedics. Um, so I get some theater experience and I teach in orthopedics around the orthopedic teaching fellow. Um, but then I'd like to dabble in medicine and dabble, dabble in neonatal intensive care as well. I did a weekend shift in the nation. Very niche. But but because they can't hire many people because not many people have a NICU experience, it's quite a nice locum that I can jump into because I'm not on a full J c f rotor. I can jump into those shifts and still get that experience and keep that experience up in that hand in. Whereas if I was on, as you say, a full J c F rotor, I would not have time to work a weekend shift or a night shift in NICU, so those it's it wouldn't as a locum. It's keeping your hands and specialties that maybe you don't want to pursue. But you have an interest in you like to kind of keep on the side a little bit to say, uh, you know, I I really like this. I'm going to have a day here as a refresher compared to my more medical or orthopaedic life. So thank you so much. Both of you guys were going to open the floor up to questions. I know we've got one already, but if you guys could, viewers could pop your questions in the chat box um, and we'll answer them as best as we can. So we've got one already. That said, could we hear a bit more about the clinical placement you have in the state? And is there a series covering this? So there will be we've had in Australia, referee. But if you guys have any suggestions for series episodes, then please drop us an email at the portfolio clinic. And we definitely look into providing more for what you guys want because we're completely guided by you as a company, so to speak. Whatever you would call it as an organization, that word were completely guided by what you guys need. So, yeah, tell us a little bit more, Sergeant, just quickly about your United States experience. Yeah. No, that that's fine. I think that, I guess if you're happy to invite you back at some point, I wouldn't mind, uh, talking about this in a bit more detail because I think it's something that is, uh, not It's very foreign, I think, for UK graduates, Um, and I actually got to the so I I got to the point of actually applying for residency as well. Um, so I sort of have a good understanding of the full process. Clinical placement wise. So this was in my in my F two, and I knew by F one when I was at med school when I was in 50 I knew that this was something that I would potentially want to do. Um, I took the US Emily exams and then in foundation year One, I knew that if I wanted to launch an application in the end of F two, I would need to do some sort of, uh, clinical placement in the US all to gain experience. Show that I had US clinic experience and also obtained that as a recommendation, which is a critical part of the application process there as well. Um, so in terms of, um, experience that I had the clinical place in terms of arranging that I emailed hundreds of hospitals, hundreds and hundreds of different sort of, uh, program program directors and also, um, administrators. There's a website, um, which is the I think it's the A. M. C. Website, which basically has a list of program directors and, um, the administrators, and it has the emails. So I e mailed and I would say probably about 99% of those, uh, said that they don't have any placements for foreign, uh, students or foreign doctors because they barely have any for their own sort of us graduates. Um, so it was very difficult process. And I think in the end, I sort of went with an organization, actually, in order to arrange the placements because they sort of get they got my foot, um, in the door. And then once I was there, I was able to sort of make contacts and, um, network a bit better. Um, and all you need really is the foot in the door when you're there. It's a very, um, it's an odd system. It's a system in which, who depending on who you know, you'll be able to gain a place. Um, a certain residency program in terms of getting time out of the foundation program very briefly, very briefly, because I I feel probably that I could talk about this for hours, but I I had to fill out of applicate out to a foundation program, uh, form and I had to justify the reasons why I wanted to take a certain period what? The amount of time I want to take out When I was going to come back, if I was gonna come back, which I was and following on from that I had a meeting with the, um, foundation director of the Trust. Um, and we went through it together. She was very amenable to it. She said it seems as though you've is thoroughly planned. You've not just sort of done this off a win. We want to take that time out. It seems like it really thought about this, Um, so she was happy she supported it and then went to the clinical director of the Dean Ary, who put the final sort of seal of approval. And I got my time too, to leave, and then I had to arrange the placement. Otherwise I would have got into a lot of trouble, which I did going in. So I think maybe we should have a United States talk. I think that would be really interesting. Um, whilst you guys think if if you guys have any questions, as I said, please pop it in the chat box because then we can ask live. But will I just have a couple of like a question for you. So you said that you wanted to go into either same aviation medicine or coronary care. How are you in your locum year? Developing your portfolio to those really quite niche specialties. Um So, like like I said, with that J c. F. Position that, let's say first, I managed to get a position on CCU. So you get you get a taste for it, and I feel as if I wanted a tab bit more experience when I was a J C F. Sometimes you can feel a bit hospital owned as you were. So you you can they expect a little bit more of, you know, sometimes you you couldn't go off and do the things you wanted to do. You wanted to go off and do some angiograms. You wanted to go off and do a Q i p for a bit and like like you said as well as sometimes when you're in training, it's very difficult to arrange. Q. I. P s publications which whatever is when you're you have a Yeah, I'd agree. As a junior fellow, I'd agree. Yeah, so, um, I wanted a bit more experienced to be like, actually, is this Is this what I really want? Um and yeah, I think that that helps towards it, particularly with stem and aviation, where it's as you said, it's very, very niche. Um, it allows you to gain a bit more sort of understanding of the specialty. Look at different courses. Perhaps. I know, I know you mentioned a P G, C and and so forth, but you can look at Masters, for instance. I've been looking at a masters in sports cardiology, Um, and you can look at different ways, and it's obviously talking about money, and it's it's these things obviously do cost a reasonable amount. So when you have that locum income, you're able to afford that a bit better than as you were on a training position. You could you could say, Actually, in my F four year, I want to go all out earning as much income as I can so I can afford this to put towards my sports and exercise career or or so forth. I think with aviation medicine, it tends to be a bit more sort of forces based, Let's say wrath based so you can look about perhaps doing experiencing that. I know it can be quite limited, um, with that. But I think the biggest thing is the free, the free time, the flexibility to look at these courses. And let's say particularly to those those need specialties you need, you need your projects, you need your courses, you need your additional experience. What can you bring to this job? Because they are very challenging to get into their very limited posts. Um, so I think it allows you that time to do that as well, Because as soon as soon as you're on the training treadmill, um, you can get off. There is no denying that, but I mean less than full time as well. Yeah, there is that. And I I think it's when when you're in training is where it's very difficult to to arrange those those those kinds of projects. And those, um, those things. But I do like the idea of, like, a hybrid like you mentioned. So your J c f for a couple of days, and then actually I'm gonna will open for the remaining three. Or I know that a couple of people in my J C F position they did. You can do less than full time, or you could do actually want to do 88 months on this contract and then the other 44 months. I want to do low coming. I think I think I think that's a very clever way of doing it. So, yeah, once again, I'm I'm hey going back to it. But it's for me. It was It's the flexibility and it's the income to afford that. Those Those projects, of course, is to go towards eventual careers. Let's say it's about agree, and I think, with flexibility as well. Um, it's being able to dictate your shift. So I know that when um NRCs was coming up for me, the low comms there could say, Well, I'm not not working for two weeks beforehand. Um, and I could tell they were my My chest was really good with me and they allow me to take some study leave, but I can't say I'm not working for two weeks because that's like all my study leaving annually used up in in in one session, whereas the locals can just say, That's it, I'm not. I'm not. I'm not coming. And things like that are a benefit as well, because passing your MRCS is four points. I think on the CSE applications so that four points are the same amount almost as a uh, some of your other big things. Um, I did the same thing as well. I i when I was revising for m r c e p. I actually told when I was low coming at the time, and I actually said, These are specific shifts, which I just will not be able to do. And as a locum, do you have the right to do that? So, yeah, and it's it's always owning yourself. As you say, you feel hospital owned, whereas if you are a locum you own yourself and your own ability to work and what you feel comfortable with and what you're happy and not happy to do. Whereas as a a junior fellow in any specialty, you are kind of dictated by the trust what you will and won't do and and and things so it's quite an interesting dynamic. So that's why, for me working a few days a week as a J CF and then having the other days that I can locum in my department if I want to. Picking up on calls and things in other specialties, etcetera means that I can then do other things. And I've got a national leadership course that I'm doing. And I've got one of my study days tomorrow because I only work three days a week. I don't have to take any legal studying for that. I can just do it. Um, so it's that flexibility. So if anybody has any more questions than speak now, uh, but thank you so much for listening. We just also wanted to highlight reasons to register as a mentee. So in the portfolio clinic, we have a meant torment e scheme. Um, and in this you can have virtual clinics with your mentor. Um, it will help support you with your clinical development and your professional development as well. So your portfolio, you get personalized feedback on that, which is it sounds small, but it's so significant because people have gone through it and seen it. And it's only when you really had that experience that you know exactly what's needed in a portfolio. As Sergeant said, you know his portfolio wasn't as strong as he wanted it to be the first time around. So if you sign up with, uh to your mentor mentee scheme, then you can have almost like a heads up of actually build on these areas and you'll have a glowing portfolio so that if you decide to go straight into training, you've got that glowing portfolio behind you. And even if you take a year out, you'll still have that glowing portfolio. You also have advice on specialty applications, so we try and tell you towards someone that's in the similar kind. Of course, surgical training I M. T etcetera for you, and we get smart goal setting. So it's something that's really valuable, and we have a lot a range of mentors available for you, so please sign up for it. It's free, and it can only really be a benefit. So why not? We have feedback forms, which will mean certificates for attendance, so please fill in your feedback forms. I will send that feedback form on the chat now, and it goes via email as well. Um, and please come to our clinical F three next week, so we'll be discussing more in detail about your doing your clinical fellowships. We touched a little bit on it today for but for more, uh, detail on those and the different types of clinical fellowship. Then please come along. We've got someone that's done a palliative care clinical fellowship, so that will be really, really interesting. Um, and their experience on that. So thank you. So so much for, um, coming. And we wish you all the best take care of this was provided by the port.