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I will get this um get the talk started. So see if I can do it this way. Maybe, maybe I can't, my tough to, I need my slides too. I know I can just do that. That, that's fine. Cool. So, welcome to our talk. We're gonna spend roughly 20 minutes, probably less actually, 1015 minutes each. Myself and Alex talking about two different topics. So I'll cover the radiology specialty application and then Alex will tell you more about life as an ST one what it's like day to day. We are both ST ones based in Cambridge. Um And yeah, without further ado, I'll get that started. So the problem is the, is the fact that there is an increasingly competitive application. So if you go on to get into radiology.co.uk, you'll see that the competition ratios over the past three years have um gone through the roof basically. And that's for a multitude of different reasons um which we won't really touch on, but we just recognize that it is, it is becoming increasingly competitive. So the reason for doing this talk is to try and put you in a good position when it, when it comes around to applying, say what hurdles do you face? I think they are subject to change every year. And actually we saw that in our cohort, the application window opened on like the 20th of October. And they released a document the day before saying we're changing how, how we're going to rank you. Um So it didn't give you time to prepare. But I think if you expect change and if you've heard of the book Black Swan, it kind of talks about having a mindset where if you expect change, you can kind of use that to predict the future. Um So another just a little tip is to use your personal email address when you have to create an oral account and that will probably be in final year of med school, you can create a new one in future, but just for ease on your part. So you don't have to make another one once you've lost your university email address, sensible to just use a personal one. So what hurdles do you face? Um There are three main hurdles, I'll come back onto this slide in a moment. But um here is Aureol, this is what it looks like. It's a terribly designed user interface. Um This is just a screenshot from my Aureol. Um and you can see in the bottom right corner there, there's one application here called Clinical Radiology, ST one and then there's one called Clinical Radiology ACF which stands for academic clinical Fellow in specialty training year one. And that runs, I think throughout the first three years. Um if you get that job and that means you get a 7525 split, supposedly, but in reality that you don't necessarily afforded that time in your job plan. Um And none of these sort of normal competencies which Alex will talk more about will actually change because you're the academic anyway, needed to say I didn't get the academic job, but I did get the the standard clinical radio radiology job. Um So begin with the end in mind. This is something I always like to say. I think I had um and tackle one hurdle at a time and at the right time. So most people watching I think are probably still medical students. So for you guys, it is tackling the things that you can tackle, which is kind of looking ahead at the portfolio section. Er cos you won't be able to, there's, there's three pillars, there's the multispecialty recruitment assessment, the exam which you can only sit after you've actually made your application. So that will be roughly in January the year after you've applied in the October November window and you can only apply for it and it happens automatically and it's free and they'll give you a code to book it once you've applied through oral. So all you can do really is, yeah, think about portfolio because the other section is the interview, which I'll talk a little bit about in a second. So as I said, subjects change every year. This year, the 2023 2024 cycle um has changed again. And there's actually less waiting on the multispecialty recruitment assessment. But there are fewer interviews than last year. There was around 900 interviews last year and now there's only 850 the interviews are only decided based on your multispecialty recruitment assessment score. So despite the waiting, having dropped, the importance initially has actually gone up in terms of how important the M sra is, say. Um yeah, as I said, if you don't do well on the emissary, you won't get an interview regardless of how amazing your portfolio is. It's really important to spend your time during that um Potentially 2 to 3 to 4 months before the January when the emissary usually is sat. So thinking, thinking ahead, beginning with the end of mind, that will be during your F two year. What job can you do if you're going to be a full time F two trainee? And you want to go straight into radiology, which not everyone does. But can you try and get a relaxed job during that first block of your F two? And that would be really crucial and your second block as well. Um Because it'll be that December transition from one job to the next. Um And then, you know, myself and Alex both took an extra year to get there. So II think that is the majority of people who take at least one year extra. Nowadays, the fact that you guys are already watching this talk indicates that probably, you know, you already know what you want to do, which means you're probably gonna be better prepared than we were. Um And hopefully can, you know, there's nothing bad about taking that year. It actually makes you more of a whole person I would say. But if you want to power through then being prepared early on is a good way to do it. So talk about scores. Now, I think 630 is like roughly the top score you can get in the multispecialty recruitment assessment and it is an ex it is an exam that has zero radiology in it literally zero. It was first designed for GPS and then was just like everyone else piled in cos, it was a, it was a, it was a throw the C VS down the stairs and see which ones land on the bottom step sort of test. So, um yeah, you've got a study and you've got to do pass med and past questions are ba is basically the best way to tackle it that I found I didn't do that. Well, like I did. All right. Um Alex, what was your score if you don't mind sharing 615? So the it's a normal shape distribution and I think the cut off for a radiology interview was somewhere around 745 maybe a bit higher even. And yeah, Alex obviously scored in a higher percentile than me quite significantly because it, it really to be fair. But I think, I think because it's normal distribution, wasn't you clear a lot of like kind of the um kind of the bulk of the middle one extra, you just more normal each is really and a pattern that has been sort of anecdotally noticed is that UK graduates regardless of how much they study will score much higher in the situational judgment section because of who knows what factors. But we've, we've been sort of indoctrinated into the NHS way throughout our med school life and you'll sit an S JT as such situational judgment test. No. Anyway, reading good medical practice and like having an awareness of that is important. Um And that has shown up that international grads don't do as well. Um So do well on the M SRA is basically the first hurdle once you're af two don't think about it until then though. Cos it, it may well completely change. Hopefully it will change to a, a more relevant hurdle for radiology, but we'll see time will tell. Um I think it would be fairer if it were like a mini F RCR part one that was relevant. So you had a bit of anatomy and a bit of physics or something like that cos then you wouldn't be wasting your time. Not that it's a complete waste of time, but yeah, relatively anyway, portfolio. So I'll move back a few slidess to this lovely infographic and you can scan this QR code at the bottom, right? If you want to get up the full six page PDF um from the NHS. Um So there are seven, seven domains. Now, I think for um if I can count correctly, maybe it's six one, first one is commitment specialty and that is 10 points. So that is quite straightforward to get 10 points. You need either a student selected component or any three day exposure within radiology. And when they first published last year's portfolio, they had to re retract it and then put a new one out cos they had written a, a taste a week at a tertiary center and a taste a week at a non tertiary center or something along those lines. And they realized that wasn't fair because people were gonna be in different places and have different access. But an awareness of that might help you when deciding where you do your taste. Two weeks. Um And taste two weeks is literally a case of either showing up or emailing people and making contacts at conferences or, or at other events. And just um yeah, asking politely. Can I come along for a few days a week is ideal, but you might not be afforded the, the time to have a whole week because of your busy schedule leadership. This is kind of quite amorphous quite. Um I think, open to interpretation. If you're in a radiology society at med school, I think that would probably qualify um for the seven points or, or potentially maybe two points. It, it really, really depends on how you're reading this and it's good to actually have a, a look and read. There's loads of different societies you can join committees for and most of them have a medical student representative or committee role. So BSI R have um BS RT and I think they have a medical student um committee member, et cetera, et cetera. Loads of committees. I mean, I would say do things meaningfully, don't just join this for the points. Like do it cos you have an interest and you would want to spend your evenings like at least one evening a month on a meeting, you know, it's a bit of a trade off but being aware of it early on helps. And generally these are, I think you have to do it for at least a year for the top point. I could be wrong on that. It might be like six months, six months um teaching so major contribution to a national or international teaching. So this II looked, I guessed this, this was my like crystal ball moment. Cos I thought they, the radiology portfolio is likely to change and I wanna cover myself in case I wanna go for surgery. So I went for a teaching program that was about radiology, but covered the tick boxes for surgery as well. So it was longer. Well, it was three months and it was a weekly teaching session over three months. So it was, that was all the tick boxes and it was done virtually, which meant it was international um teaching qualifications. Now, these, this is probably the highest apple to reach. And I wouldn't necessarily advising you can get two points very easily doing like online courses or just courses during your F one or F two. potentially even at med school, you know, there's lots of opportunities to teach other students in younger years. So getting a formal qualification or a or a letter written from a more senior person is a way to evidence what you've done. The rest honestly are not worth bothering unless you have a real, real interest in teaching audit and Q I. So leading to radiology audits that change practice. So that means two cycles of an audit and presenting your results. This is the bit that really can be done. It's quite easy and accessible, not easy really because audits are very bureaucratic and slow. So you just need time on your side for this. So this sort of thing that starting in med school is really helpful and your first audit might not tick the box, but you would learn skills that will help you definitely tick the boxes for future audits. And again, like doing something meaningfully is the best way to do it cos then you're more interested and passionate about doing it and it will actually instate a positive change in radiology or, you know, in, in med school. So you could, for example, audit, medical, teaching on radiology, do an intervention, teaching session, reaudit, see if people are doing the same, er, giving the same feedback after the second session or whatever. So that's just a easy idea. There's also RCR have a page called Audit Live that is potted recipes for audits. So, um yeah, that's a good place to look. Another good place to look is unite is a national audit in radiology and IR specifically. So um OK, academic, this just means publications or a phd or further a master's degree. I think the top five out of five is pretty uno unobtainable for most people. Um but getting one first author, radiology publication is actually quite achievable. You can write a letter to the editor. I've not done this to be fair, but it is very doable. Um You literally just need to sit down, go on the journal's website, read the letter to editor, writing guidance, find a letter or an article that you want to write something about either saying, yeah, this is a great article or no, this is a really bad article. This is why here's a load of references. It's very obtainable. It takes a bit of effort and a bit of time. But, um, and actually getting, getting it from draft to you submitting it is not the time consuming bit. The time consuming bit is all the slow editorial stuff. On the other side, they'll, they'll be re, you know, they'll send it back and forth at least twice, um, to make sure it's edited correctly. Prizes. Er, the e, sort of most obvious one here would be a prize for doing well at med school, like a distinction or merit. But actually there are loads and loads and loads of prizes now from radiology societies. Um So just have a little look um online and I'm sure you can find something. And so, yeah, I'll speak anecdotally about how, how I sort of did in this now, portfolio wise, I got a pretty high score, 84% roughly. Um And that was cos I did a three month teaching program. I became one of the meal exceptional educators as a result of that just through their metrics of like content production. And that because it was on radiology could use for the six points. So that got me six points for the prizes that got me five points for the teaching. Um And it was within an IR society Ir Juniors and that got me a seven points for the leadership and also contributed to what I had to speak about in the interview. For the commitment specialty and then I did a separate audit. Um, but, you know, I could well have used that as an audit potentially if I really wanted to sort of, er, killed two birds with one stone safe interview. This is something that's changed this year again. Um, so I won't go over what it was last year because I don't think that's very helpful cos it's, it likely subjects change. But the most important thing to remember here is you can only get an interview if you have scored in the top 850 in the M sra and you will only find that out about a month after sitting the M Sary. So you're thinking February after you've applied for, um, for radiology training in the previous October. So basically, don't worry about the interview, worry about it when you get the email saying you've got an interview and then see what it is. This year. It's 2 10 minute interview stations last year. It was a teams meeting that lasted 15 minutes and there were four sections. It was very, very, very objective. So they had a mark scheme and if you didn't say the right buzzwords, you wouldn't get the tick in the box. But actually you can kind of guess what they're gonna say cos the, the criteria so obvious, er, there was a commitment to specialty, there was a teaching, there was a ethical scenario, you know, you can kind of figure out what buzzwords they're gonna need. So yeah, overall I ranked 100 and 51st out of 3068. That initially was not enough to get a job in Cambridge, but someone higher up changed their job and I got bumped up Alex. I don't know, he would probably hire cos he had a higher M sra score 40. So shows you the importance of sitting there and being a really good GP. So yeah, do meaningful, full things you're passionate about. This is especially for the portfolio things. So um Alex disagrees with this statement beginning with the end of life. He thinks you should focus on the journey. But um I think, yeah, you can do both, you can look ahead, see where you want to be and then in the moment do things that are meaningful to you and focus on that as long as they're getting you on the right path. And uh yeah, going in the right direction. So I've mentioned a few of these things that help me. I had an idea. I had a platform which was Ir Juniors and Metal. Um I went less than full time um during my F two uh that was for a multitude of reasons, but essentially it, it helped me get into radiology. Um and yeah, friends as well and network. So Jade is a current ST four radiologist in Cambridge and I've met her through doing some of this like e-learning stuff. And yeah, she was helpful in just helping decide where to apply and um not necessarily pitching my application for that, but it was just really helpful to have someone here who knew what I was like. So yeah, that is it problem increased in the competitive application, the solution beginning with the end of the mind and the summary, do meaningful things that you're passionate about. All right, I think I'll hand over to Alex. So I mean, this, this part will be a bit quicker, to be honest. And it's more just to let you know what life is. An ST one is like, I think, you know, obviously, if you're here, you probably think about radiolog, your career, but it's important to sort of actually understand what the components of that. So the camera is on the Oh, hello. So um I'll sort of speak a little bit about what it's like at Adam Brooks given that you guys are Cambridge trainees and then I'll talk a little bit about what it can look like elsewhere. Uh Depending if that's something that interests you. Um So one of the nichetes about Aem Brooks is that it's a transplant center and it does a lot of transplants of varying different forms. And so one of the consequences of that is that as part of our training program is a lot more emphasis on ultrasound um than there would be sort of in other centers. The reason being that uh sort of one of the major things that can go on with a transplant within the sort of 1st 24 hours if the surgeon has sutured the vessels too tight effectively. And so that's sort of one of the, the key forms of assessment, which sounds quite easy but is annoyingly frustrating and can take quite a while to, to double check. Um So to sort of reflect that our training structure, Adam Brooks looks with six months, ultrasound, three months new and then three months general. Um, but one of the nice things and I guess it's taken a little bit of time to get used to is that there's actually no service at the start of radiology and you'll have come from sort of, you know, maybe an F one F two, potentially even, you know, a couple of years in between F two and radiology where you'll be doing effectively all service. Um, and very little training. And so it feels very bizarre. I mean, thankfully, Chris is all back to being medical students again where we have zero responsibility in the grand scheme of things. Um, and I'm purely there to learn, which is very nice, although all good things do come to an end and we will be doing service come February with our, you found ultrasound skills. So I've got some example, rotor's, oh, it's on here. I got an example, rotor's. Um So this is sort of what our general week to week would look like at the minute and I'll sort of talk through this so portable ultrasound name on tin, um, that's going around to patients who are too sick or isolated to come down to the main department, er, with that you're typically attached to a more senior registrar who's ultrasound certified. Er, then in the afternoon sort of general ultrasound, which is again, sort of working with senior registrars or, er, sonographer to learn how to scan CT. It's just ct reporting again, quite supported at the ST one level. None of our reports go anywhere without somebody seeing you having looked at them, which is quite nice. Um, and in physics, so a big part of being a radiologist is understanding how the actual imaging modalities work, er, to thus enable sort of advising other clinicians better about what sort of scanning they want. And so all I touched on this now, is that one of the requirements or not requirements for something you were expected to achieve during ST one is to pass or F RCR part one examinations which comprise sort of two exams, a physics exam, er, as well as an anatomy exam. So it sort of things that people sometimes don't like that much but it's sort of quite important to the day to day job, er, and then sort of following on typical week you might have something like normal ultrasound session and an F RCR two A um A R is quite nice in the sense that you actually get sort of two years of teaching on this. It's the exam you take in your third year. Um, and I'm told reliably by those who have just sat that it's really quite challenging. Um, but, you know, there, there is quite a long lead up to it for us, whereas I've got colleagues in London who didn't actually get any teaching for the exam in general, er, Thursday, on this particular week, I had plain film, so I'm just looking at x rays uh as many as possible and then sort of more of the repeat. And our days typically start at 815 for teaching, which I say during term time tends to happen more days than not and finish around five. Although on Wednesdays week, on a bit later, this all trend follows onto neuro as well. Um So it's all main focuses in ft one are looking at like CT heads effectively to try and establish sort of major neurosurgical pathology or strokes. Um Again, similarly, we'll have a mix of CT and plain film alongside that and then there's a general block as well, er, which looks at fluoroscopy, um, and sort of more emphasis on plain film and CT during that time than anything sort of particularly specialists kind of sexually learning the uh general radiology take if you were sort of to compare it to medicine. Um, outside of Cambridge there are other options though. Um And to be honest, in some sort of retrospect, I kind of wish I maybe apply for this structure. I don't know if anybody here has heard about like academy training, somebody who's nodding their head. Um you know, further ahead than I was effectively, it's like going back to university where it's a structure teaching program which sort of integrated clinical placements. Um The benefit of that is, is that like sort of working someone like this is quite a special is that it's, it's quite hard to actually find just like basic scans of people. Like some people have had so much stuff done to them. It's actually quite hard to start to unpick that um as somebody in their first year of practice. Whereas, you know, for example, up the road in Norwich, they have a completely curated set of CT scans that you can work through just to understand what this is, what this looks like. This is what that looks like. And in some respects, I can see that being maybe a better way of learning to be honest, but I guess there are also benefits to being in the center like this. So that's something to think about as well. Um You know, if you want a sort of maybe more traditional or sort of more progressive style, sorry of uh teaching something like you experienced at university. And then I must be honest, my experience is sort of exclusively throughout university and postgraduate being in Cambridge and London now. So this is, er, rota, which isn't projecting that well, but from Saint Thomas's Hospital, um, I'm reliably informed by friends at Barts that theirs looks fairly similar. Um, and just in terms of plan. So they, they split it up into mumps that they rotate through. But igloo at Saint Thomas's is reporting essentially, uh, they have an afternoon for audit. Um, I can't actually see what that says but something GH er, ultrasound but less, but the sort of main importance about sort of training in London, is that something you were considering, if there's a lot more emphasis on CT scanning and actually at the end of their ST one, unlike us, they have a sort of Pan London CT assessment before they're put on the on call ROTA. So something to think about what you want. I think there's nice aspects about the sort of training we get in Cambridge but there's, you know, sometimes you do feel like you're missing out on more of the general stuff. It is quite a specialist, a specialist, a specialist which, you know, has its pros and its cons uh fine. I think that's all I really had to say. So I think the main takeaways are, you know, research a little bit about where you're gonna be because that can look very different. But ultimately, as an ST one in your life, it is pretty good to be honest, particularly compared to what you've been doing in the last few years, there are some exams but, um, I think generally it's quite a supportive environment. It's a good time to actually kind of like you guys can do now and have the freedom just sort of meander and see, see what finds you as it were any questions about all of that? If I just add a couple of points, I would say that. Yeah, think about where you wanna live as well. That's such a massive factor. Like for me, family is close in Cambridge. So that's my main reason. It's very helpful that it's like a world leading university. But um that's kind of the main reason. And another factor that I learnt from Jade was that here, you only have to rotate out for six months over your entire six years. So out of 72 months, if this is, if you're doing interventional radiology, you only have six months out, which is like unparalleled. To be honest, even in London, you'll be going from this hospital, this hospital, this hospital and Bristol, for example, you rotate through like Bristol is a lovely city to live in and I went to UNI there. So I know that but you are living in a suitcase because you moved to Gloucester, Cheltenham, Weston Bath, Yeovil Taunton and Swindon as well, an enormous area and you get thrown left right and center. And by the time you are in your late twenties. You're kind of fed up with that. But that's just, um, yeah, my two cents on him, I think as well. The Norwich scheme, as Alex has sort of said already, they have a much more university style campus thing. I'm as a, a wannabe iri think the fact that we get hands on ultrasound skills for six months is incredible. We have to do, like, uh, we have to do 100s of ultrasound scans. Whereas in Norwich, I think they have to do 200 total in their first year, which would I feel confident after doing 200 scans to be independent. Probably not. But they, that's, that's the way they do it. So, um you know, there's, and then thinking about on calls this year, we are doing only a five day work week. There's no weekends until your ultrasound proficient. Um which for some, for half of the year is all year. Um Which is a really, yeah, it means you can go back to having a, a relatively normal life which you won't have had an F one left to. Um, so that's a real, really important factor um, to add as well. Yeah, I think unless, yeah, I think we'll open up to questions now if, if you guys have got any questions or anyone on the uh on the meal has as well online. Let's have a look, see if anyone's dropped any questions. We've got a few questions in the chat. Can you send this score? I don't know what you mean, Rayhan. Can you clarify what you mean, Ryan? Um How about you guys? Um just before. So you're thinking about what you can do now, why should you with someone else? Yeah. So um the way I think you can prove it is being like first author when you present um for me, I'll just talk about what I did. I went down to my IR department, I saw that they were using Order Coms which is a system for requesting any imaging for their intervention request for their procedure request. I was like, oh, that is wild. People write like two words and then someone has a procedure. Um And then I found out by doing a little bit more reading about audit live and um RCR have something called IER which is a, a set of national minimum guidelines for um for requesting ionizing radiation and procedures. Um And I realized locally most of the requests weren't meeting those. So I audited it. I gave the data to someone made an intervention and then reordered it. Um And we managed to increase the compliance with the National Guidance. Um So I think what you're maybe alluding to is so say if you're doing an audit with a consultant, for example, or something like that or like a seeding reg. So, um yeah, in terms of leaving the audit, so there's sort of different priorities you get through different stages of training. So, like at our stage we sort of more juniors you want to be first. All that's what they kind of mean by being and it doesn't necessarily mean you come up with an audit completely independently or anything like that. That could be a registrar coming up to you and being like, oh, I need somebody to help with this. Can you do all the data collection? And you know, that will be fine. You'll, you'll be, if you've done all the work, you'll be first war and then sort of as you get more senior in your career, um there's sort of a bit of an academic convention where the most senior person who sort of overseeing the project is like last offer. So it's kind of different priorities in a sense. If you look at like your professors who like you, like, they'll always be last ta on papers versus at the minute, you wanna do all the grunt work and be first offer. So that, that's kind of what lead alludes to. So it doesn't mean you have to come up all there, et cetera, et cetera, et cetera. Like if somebody offers you the project, you do all the work, you'll be first offer for that. And there are also different types of audits. So there's like, um I've mentioned, Unite, which is national thing. So they do a multicentre audit where potentially you could be your local lead and still be first author when you had to present it despite not actually coordinating the whole thing, but practically what that means is finding the email address for your audit department. And that can be called all sorts of different things. Here. It's called Q SI S. And then you have to go through literally like five or six different forms to register as a user on the audit database. It's almost like, I don't want people doing improvement, work the amount of, uh, barriers that occur up. But you've gotta like to see what your local thing is. Sit down, take the time to actually just crack on and do it. And once you've got yourself registered as a user, you can then register your audit and there is a lot of paperwork and, you know, it's hard when you're down in the weeds of this, it's hard to realize the meaning of it. But actually when you then go to a conference maybe two or three years later and they're talking about this multicentre audit that has changed practice. And now they're doing, I don't know, maybe they're doing, starting to do splenic embolizations on kids whereas they used to just recept them. Um, it's this sort of thing that actually the grunt work you collecting 100 cases. Um, and, or I think the minimum generally is 50 you'll have to do for a kind of accepted level of audit. And, um, yeah, generally if you pick a meaningful thing, you can see a meaningful outcome in the end. Um And, and you get your points. Yeah. Any other questions? I think Rayhan, if you're referring to the score, I'm gonna go back to the slide that had the QR code on so you can scan that and get the full formal document. Um It was just hopefully it'll scan, it'll scan, ok? Um That is a self assessment guidance, like I said, subjects change, but it's good to kind of at least have something to aim for and then this score, if this is what you mean is on the Ir Juniors website. It's infographic. Um So yeah, I think we'll wrap up there. Thanks for everyone that joined online. Unless there any, any more questions, we will er call it a day. So thank you all for joining.