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Hi guys and welcome to the Unexpected F three for surgery. Um We'll just wait for a few more of you to join. Um And then we'll get started. Okay guys. So thank you so much for joining us. Um This is a talk about um surgical F threes and with, it's on a series title, the Unexpected F three. Um For those of you who may have found yourself trying to navigate and work out an F three year when maybe you weren't anticipating doing. So. Um today we've got myself, Holly Myers who has just been successful in um securing a CST posting orthopedics and doctor Tom Hatfield who's just been successful in securing a C S T post E N T both. After taking um some years out, I've just, I'm currently on May F three and Tom's done a couple of F S. So we, we'll hear from him in a little bit. Um But just whilst more of you are logging in, I just wanted to let you know about our mentor mentee scheme. So we have as part of the Portfolio Clinic, a free mentor mentee scheme whereby you can sign up to be mentored by one of our mentors who will give you 1 to 1 support with grants to developing your portfolio um with personalized feedback, helping to set goals for you and giving you advice on specialty applications. And assuming that you might be interested in court surgical training, given the fact that you're in a court surgical training talk, and there'll be people that have had experience with court surgical training, either registrars or course surgical trainees um who have been able to develop their own portfolio. They've kind of been through the experience will be able to help you navigate that too. Um Yeah, and just to make you aware that feedback forms mean certificate. So please, once with this talk is finished, please fill out our feedback form would be really grateful of the advice so that we can then develop future series going forward. So Tom, would you like to introduce yourself? Um Yeah, so I'm Tom. I am a currently working as a teaching fellow in E N T in Derby. Um I came into medicine through graduate entry medicine. So I started a little bit older. Um did my F one F two in the East Midlands and then have ended up doing an F three and F four and now um my teaching fellow years. So three years out of training post um foundation years. And as Holy said, initially, uh I've just been successful in of course surgical application to get into an E N T themed job sticking around these Mittens. Congrats. So I'm going to ask you quite a few questions, but if you could just briefly summarize your F three or F four and F five, and then I think we'll do some digging from there if that's okay. Yeah. So during foundation years, um, probably about halfway through F one really? Um I made the decision that I wanted to take some time after training and ideally I wanted to go off to New Zealand. Um And so during F two, started looking into going to New Zealand. They're, um, uh, my F two year was when COVID initially hit. Uh And so I had a lot of disrupted training in F two. Um, but then, um, at the end of my F two year hadn't yet secured a place in New Zealand. I said I'm going to take a little bit of time out, took a month off in August Post F two. Uh And then managed to find a locum job in orthopedics in the hospital that I've done my F one in. Um, and stuck in that locum job because they have lots of rotor gaps. So I was able to stay in that locum job until the December of that F three year. And then I went out to New Zealand. So I did, I managed to get a job in New Zealand that lasted 12 months because that was because I started that in January that then pushed me into an F four year, um, sort of automatically, basically because I went over the August of the next year and I didn't really want to go to New Zealand for any less than six months. And so I ended up staying in New Zealand until the March of the following year, came back. I had another month off at home to sort of settle back again again and in the same hospital again doing E N T um just as a, as a locum attic show. And then because I had been there before and I had actually done one of my foundation jobs in the Ent department. Um I then was invited to apply for this teaching fellow post and have been in the teaching fellow post since August of last year. Um So yeah, foundation years as planned and then f three f four sort of to a plan but not quite tidily fitting into a box. I think initially I wanted to go in the August just hop straight over to New Zealand. Do a full year there, come back and get straight into a core training program, but that didn't happen. Um And then this teaching fellow year that I mean at the moment was also somewhat unplanned um in terms of my core surgical application when I went out to New Zealand. So I knew that I wasn't going to go into a court surgical job for um f four as it were because I knew that was going to be staying in New Zealand. But whilst I was in F three, I threw in an application just to sort of get used to what the application cycle was like. Um So I applied um during my F three, um didn't get anywhere, basically, didn't get shortlisted for interview. Uh And so that was a bit of a setback because although I knew that I wasn't going to take it because I was staying in New Zealand for the year. Um I, I still was surprised at how high the cut off mark for invite to interview was and then sort of during my time in New Zealand, I applied so that I could hopefully get back in at the end of my four year, get into training then. Um but realistically hadn't really changed anything to my, my portfolio in that year. And so that wasn't successful as, as well. Um And then I sort of made the resolution at that stage that, you know, this is, this is it now need to focus on what I'm doing and plowed everything into building as as good a portfolio as possible to apply for this year and, and they've been successful this year. Yeah, so that is a brief summary. Even there is quite lengthy your years out. So I'm sure. Um and just to let you know the audience know if you do have any questions, please pop them in the chat box. Um We love interactions. So we'd be very happy to answer your questions as we go slash at the end. Um So please pop them in any questions at all, no matter how small. Um if they're burning little questions and would, would love the interaction. Um But so you've done quite a few things. So, first of all, let's go to your, your, your locum job in orthopedics. Now, did you know at that point that you wanted to do E N T? Um, and that job, tell me about that. So what had actually happened is that my orthopedic job from F two hadn't happened because of COVID. So I hadn't rotated at that stage when COVID hit the sort of rules from the up, I was that if you were in a job, you stayed in that job and no one rotated. Um, so I didn't rotate onto orthopedics as I was expecting to at the end of my F two. Now I'm really keen on orthopedics, I think at this stage, I'd probably decided that I wanted to do anti instead, but it's still something that I wanted to explore orthopedics. And so I was upset to have not been able to do that as a job. And so I was actively seeking out an orthopedic job to do as a, as a locum because I still wanted to make sure I had a taste of it and knew that that was, or wasn't what I wanted to do long term. Yeah. And I think that's really important, isn't it? So, um, for me as well, I knew I was going to go down the surgical route. I did an F, one job in orthopedics and an F two job in breast surgery and I quite liked both. Um, I was also quite interested in plastics as well, but I decided to do a year round because I'm, you can't tell me I'm really petite. I'm only 448. so some people suggested that orthopedics might be quite hard specialty, given the fact that you're sometimes logging hips back and forth. Um, so I wanted to get that experience. So I know some people that have done their threes with regards to surgery to help them narrow down their options, um, to decide which kind of route they want because with course surgical training applications, I don't know whether some of you guys in the audience. No, but a lot of them now are themed. Um, so they, you do have some general ones are very broad specks of six months in a different specialty and for lots of different specialties, but a lot of them are pretty themed now. So if you're looking at taking an F three, um, I don't know what your advice would be with this Tom, but, but it is useful to look at specialties to help you narrow down which part of surgery you want to go into. And I think that's different with us uh as called surgical training applicants compared to things like I M T M P s because they generally rotate through everything and don't have to kind of make that slightly more narrow decision that plays into that plays into sort of one of the points that I was one of the larger points I was going to make in that. Um It's useful to know what you want to get out of this F three year. And this session is sort of labels, the unexpected F three. So maybe you've applied this year and you're hoping to get in and you haven't got in. But then you need to say, what am I going to get out of doing an F three? And if you decide that what you want to get out of doing an F three is that you want loads of money is locum fine, you can go learn loads of money as a locum work as much or as little as you like. Maybe you wanna get as much time out in medicine as you like and you want to locum, you know, uh six days a month and then spend the rest of your time relaxing or, you know, working on some other projects, that's absolutely fine. Um But if you want to use that F three to be useful in terms of the progression of your career, just think about what that means. So does that mean, I don't know what I want to do yet. And so I should try and actively seek out a longer term locum in this specialty or this specialty. Um or does it mean I want to build a portfolio in terms of teaching and audits and stuff and audits and quips a super, super important points wise on your application because not only to score them as points for audience and quips, but they're the easiest way to get presentations and you can get them published orbits from them published. And so, um, you know, is that something that you want to focus on because you're going to struggle to do that if you're working two days a month in, in the department here, one week in the department there, the next. And so think about what you want from it when, when it boiled down to me. Um, what I wanted from my three was to have a good time in New Zealand and I had a great time in New Zealand. But before I went, I had, you know, four months to kill. And so for those four months, I said, right, let's actually say I still haven't got a taste for orthopedics. Let's go and get an orthopedic job and I was able to find a long term locum post in orthopedics, um, and got a bit of a taste for that. And that was super useful. I really enjoyed the job, but it did also sort of play into me saying, you know what I enjoyed it, but it's not what I want to be going down to do. Um, and I said, you know, it doesn't matter what your, what your plan is to get what out of the year, just make sure that whatever that plan is, you are focusing on it because if that plan is to get teaching experience, you're not going to be able to do that as a locum. If that plan is to get a house deposit, you are going to be able to do that as a locum. If that plan is to do audits, then you want to try and look for long term post, that might be a locum post or it might be like a J C F post for six months or a year or something like that. Mm No, I think that's really useful because, you know, as you say, you were looking to kind of fill a gap from between ending F two and starting New Zealand for me, I was looking to gain experience and confidence. So a lot of my thing was about gaining confidence in orthopedics. So that when I went into court training, I went in new, knowing that orthopedics was, was where, you know, the the angle I wanted to go down and I felt confident in that I could do the job physically and just that I was interested enough in it, that it was, you know, spark my, whatever you want to call it continuously so that I enjoyed the actual workload because there's an F one, a lot of my job was more Ortho geriatrics. So I didn't get that experience of the surgical side of orthopedics and I didn't know whether I just like the kind of Ortho Jerry side of things or whether I actually liked the surgical side. Um So that's why I did my A three and that's what I wanted to get out of it subsequently because my job was a J C F. Um I got teaching experience out of it because um I was then employed as a teaching fellow. Um and then I was able to inform connections with consultants because I was working with them day in, day out and get involved in projects in joint infections, um tibial nails and doing a project on at the minute, um MRI scans and shoulders, etcetera. So you can kind of accumulate these quips audits projects as well. And I think that's really useful for those of you that perhaps have had an unexpected F three. You'll be able to look at your portfolio now and see maybe where you fell down slightly and we all fall down on certain aspects. And there's, you know, there's things that I wish I'd have done in my F three prior to applying that would have enhanced my portfolio better looking back. Um So everybody falls down on certain things. It's very rare to be the perfect top score and everything, but it's looking at where you potentially could make up that mileage. Um because realistically a Masters and Energy Education will get your big points, but you're not going to be able to do that in the three months before, you know, November date. Um However, equip presented locally slash regionally you will be able to do in that time. Um So if you've fallen down on both of those, it's worth investing in the thing that you really more realistically, we'll be able to do. And that's one of the things that we do in the mentor mentee scheme is is that realistic goals as well. So again, just plugging that it's definitely worth signing up. So Tom, tell me about your experience in New Zealand and how a whether it helped you for course surgical training applications. I know that you went out there for your own enjoyment and experience and that's great. And I think we shouldn't take away from being able to have your own life a little bit alongside medicine but and your experience other and be whether it helps you at all with surgical applications. And looking back now, is there anything that you would have done with regards to it? Um So the short answer I think is no, um I went out there, as I said, with the motivation to have a good time, enjoy myself, get to explore the country, get to see healthcare in a different environment. Um And because of that, I didn't um I didn't set out to say, right, let's go and take this thing off or take this, this thing off, build this part of my portfolio. And I have, I don't, I don't sort of have that many regrets over that front. But what I would say is that if I were to do it again, there's some low hanging fruit. Um, as you mentioned, you know, with, with the men Mentor program, there's some low hanging fruit that it doesn't matter where you are in the world, you can tick boxes without too much work that would, they're going to be really beneficial to you. Um, so I ended up doing six months in A and E and then six months in surgery and I think during that period in A and E because I hadn't had any time in A and E in the UK, I think that was really useful. And, um, I know a significant number of the people that end up going to New Zealand and Australia from the UK, end up working in A and E S S H O s. Um, it's a great sort of general experience of medicine, surgery, Pedes, everything. Um, you have to be a big boy, you know, in my hospital overnight. It's suddenly like, oh, yeah, you three are now running the emergency department. Okay. I'm the most senior person here and F three. And this is sort of a trauma center hospital and you're like, oh, right. Okay. So you have to grow up a little bit and you sort of become a little bit, um, more confident in your abilities and aware of what ability do you have and what you are lacking in. Um, but, you know, during my time there, I got involved in some work that will probably end up being published in the future. But I was data collection. Who knows whether I'll get my name on a, on the paper from that. Um But that didn't really progress me in terms of doing a any. Um It will help me later on in my applications because in the E N T E S T three application, you get points for doing um allied specialties and one of those allied specialties is A and E. So I will score points for having done six months of A and E previously. So that wasn't a deliberate thing, but it is a beneficial thing for me. Uh And then I did six months in surgery where again, I was focused on getting away at the weekends and maximizing the time that I had on leave to go and explore New Zealand, which um, did me great on my insides. I didn't do it, didn't do me much good on paper. There was, you know, when you're over there, there's a lot of funding available for study leave and stuff like that. And so I did try and sign up to a load, of course as whilst I was out there. But because of COVID, having cancelled everything the year before they're uh sort of Royal Australasian College of Surgeons um website was like Glastonbury when they opened up the course registrations. And although I was on it at seven o'clock, it crashed and it crashed and it crashed and by the time it loaded for me, they were all, they were all gone. So I, I, I did try and get some stuff done, but it wasn't too successful, I think, although, although my portfolio itself didn't really progress in that time, I do think that it taught me a few things though. So it definitely taught me, um, you know, the, the value of the time that you're spending in hospital, I think, um, living in the UK, you know, when we're in hospital we do our job and then we leave an hour or two late because things over ran and then, you know, we're not able to get the leave that we want because someone else has taken leave that day or you can call. And despite the fact that you emailed four months in advance, you're still, you're road coordinator, didn't book you off or whatever. And one thing that, that year sort of hit home to me is like, you know, having your time off is way more valuable than being paid for doing extra days or whatever. Uh And, and using it effectively is very slow. Um The portfolio was, as I say, I didn't, I didn't progress at all, but it, that's the time that I applied to the Court surgical program whilst I was out there. Um very quickly highlighted what I needed to do because when you look down at your score breakdown on the self assessment and you see what the cut off score is for interview and your half the number of points needed to get there. Um You need to have a look down that list and say, okay, here's what I need to focus on and you can do that without being in a structured job, you can do that. If you're in a, in a local job, you can do that if you're in a trust grade job in a teaching fellow job, anatomy demonstrate or whatever. So long as you say, here's what I'm going to get out of this. I want to do an audit, I want to do a presentation, I want to get some feedback for some teaching, then you'll score the points for that. So, and I think that's a good point. So when I came to apply this November for CST and I looked at my portfolio, even things like um for the audience, the, the small print and addendums, two things. So for some of the conferences, an undergraduate surgical conference doesn't count. It has to be postgraduate um etcetera. And it's only when you come to applying and looking through everything that you realize. Oh, okay. So, actually I thought I had my conference numbers and I didn't because one of my surgical conferences was an undergraduate one. And so I missed out on a point and that's an easy point that I could have gained. Um because literally the week before there was a conference I was looking at going to, but I thought I've got my numbers. It's okay. Um But they're easy point that, that, that you can, you can gain. Um So it's worth looking at the application um specification, etcetera. And also for, if you've got an idea of whether you want to be what kind of specialty you want to be in registrar, wife, having a look at their application as well because I've just had a look at orthopedic registrar training and I need a lot of papers. So now I'm like, okay, right. Going forward, I need to look at trying to get my name on a bit of research. I've got four months before CST start, see if I can get a couple of projects I might be able to get some papers out of here. Um And it's that method of thinking that particularly for course surgical training, you need to start thinking that way because it is a lot of it is points. Um and point means jobs um obviously, they've added on the M S R A and R application process and point scoring system changed quite significantly this year. So it's worth noting that things may change with regards to courses coming back in potentially leadership management wasn't in this year, but it could come back in. So there are ways that you can get those points just to make sure that you've got them in the background and you're not kind of trying to last minute pick them up, but it's worth looking at a job that potentially can I can if you know, as Tom said, working out what you want from your, eh, three year and looking at the application and whatever you want from your three, trying to tally that up and see where you can get the point that you need. Um I think, and Tom, you mentioned as well, you did a teaching for note role and you're, you're currently in it. How have you found that with regards to applications, has that enhanced your portfolio at all? It has. So this, this year that I've been in this post, my portfolio has just gone sort of double or troubled in points because of being conscious of what I'm doing. Um That didn't, that hasn't taken a huge amount of effort, but it's just about directing it in the right place depending on where you are and where you're doing, you're teaching post, it will have, it will, you know, it'll look different in different places. My, mine is that I'm 50% clinical, fifth percent teaching, but I actually have some CPD time built into my timetable so that I can do a PG certain medical education as well. And the, because it's a teaching fellow roll, it's funded as an academic role and therefore they have agreed to part fund my PG certain med ed. Uh And so that is hugely beneficial to me. I don't have a study budget. So going to conferences or going on courses is my own sort of self funded, but they, they are paying half of my PG certain fees for the year, which is 1900 lbs. So that's, you know, a significant amount that I'm saving my money on and yet getting the PG set is very valuable, not just from my courses application, but for my S T three application. And then I can if I want to progress it onto a diploma and then the masters, if I keep it going, which is going to be hugely helpful um when applying even at the top end for consultant posts. Um One thing I would say Hori is that you mentioned the uh portfolio changing and I think that's something to be really aware of. And it's something that I have spent most of the last 18 months moaning very loudly. I know anyone that would listen is over and over it is that it has changed so much because the only sensible thing to do is to look at last year's self assessment and say, where am I missing points from that? Let's target those things. That is, that is a good thing to do. It's a sensible thing to do. But unfortunately, what you actually have to do is say, how can I do as much as possible all the time basically. And so that means if you've not done an audit, do an audit, don't say, ah, you know, I can, I can manage without doing an audit. Do a simple audit. Do a how well are we documenting our ward rounds audit that takes you two days to collect data from two weeks and then you're put up a note in the doctor's office saying we should be documenting with the date, the person's name and signature and contact details. You know, there's a Royal college resurgence, there's, there's very clear information about what you should be putting on a ward round note. And so you just do the audit, put that note up in your office recycle the audit. You've got a complete cycle of one audit, you know, that is done and that took you two days to do. And if you've not done some teaching, find some medical students or find some F ones or whatever, find a group of other F two S or F threes and say, let's all get together and do teaching every month, every week, whatever it is that you want and we'll get a consultant to say that they're supervising it. And, you know, you only have to teach once or twice in a six month period. But if you've been involved in organizing this thing over that sort of time, which takes you sending off enough emails to get, you know, 10 different people to speak. If you've got 10 mates, that's 10 different people that can speak in a, in a teaching series. And each of you only have to prepare, you know, a couple of hours to give one or two talks. That's your teaching done. Get some feedback from your colleagues, get some feedback from your medical students that you're doing a ward round teaching for, that's all valuable. The going to conferences and courses is also valuable. They dropped the points for courses this year because they wanted to make and their reasoning behind that was that they wanted to make it a fairer system where it wasn't pay for points effectively. Um So I don't think that they're necessarily going to bring those points straight back in next year. But conferences, they did have, you know, one point per conference up to three conferences for this year. You can find a free conference and go to it, look for three online conferences and sign up to them. And then, you know, you've just got that in the bag. So just think as broad as possible, how can I be doing as much as I can all the time without busting my balls on every aspect of it. You know, you don't have to work super hard or doing a research project that's going to get you published in BMJ Open. But you know, if you can work with some red who's already doing a project and you do some data collection for them and it ends up being published and curious, you know, it might not screw quite as many points for an S T three application, but it's cause you a lot of points for a course surgical application. If you see one interesting patient in outpatient clinic, write them up as a case study. That's, that's points on your application. Um I think that's really important as you say, because I've learned the opposite way. So I did from medical school about six years worth of research into like a, a massive database. I did all the data collection things and I've got two papers out of it, second author. Uh And that's great and it will help me with red applications. But for now it's not scored me any more points, the presentations of those have um but it's not scored me points for my portfolio yet. My relatively simple quality improvement projects have scored me 10 words and if you look at the kind of time balance, it's trying to juggle your time to make sure that it's really important to get involved. I'm not saying don't get involved in more detailed, more nitty gritty research that's going to actually make proper change. Um, always properly investigating something new or up and coming. But it's worth having both. I think what I thought and kind of got lulled into a sense of security with was that because my, the research that I was involved in was quite, um, I don't know how you word it without sounding, it was quite substantial research that I thought, oh, that will shine through. It would be amazing. Um I didn't mention it once an interview because there's no portfolio status station anymore. And so whilst I'm really glad I did it, it didn't score me really any extra points for applications. So it's useful to be aware of all the different aspects of the application process and getting involved in these things is fascinating. I just really like data collection, which is bizarre but it's useful to, to also have your quality improvement projects and your your your things that will help you with your portfolio for court surgical training applications. Um rather than looking in the future and thinking of a consultancy that will really help me because that's quite a way off. We need to get through or you know, get into court surgical training burst. Um On the basis of portfolio Tom, what do you think was the hardest thing for you to obtain for your portfolio? What point do you think were the hardest and can you give any tips on that? Um, I think publication is probably the single hardest one to get if you haven't got any experience of having done that before. Um, I, I had no experience in my previous life or in my undergrad of doing any research that's gone on to get published. Uh, and so that wasn't something that I already had in the bank and it's not something that I really knew how to do. Um The way that I got my publication points is the easy way in and that is with the case report. Um So case reports and case series get, you can get them published fairly easily, but um they won't score you as much as a first author paper doing an actual sort of research project, but it's a publication and just squeeze some point. Um There are some journals that are much easier to get into than others. So as I said earlier, you know, you don't have to write for a massive paper. You're not looking to get published in the lancet or just about the same, same thing J Open. But if you can find a paper that is sort of relevant to it, a case report were, you know, is a fairly, fairly um sort of short timeframe to get it done. I think one of the main issues to getting things like publications done when you're in your foundation years is that four months on a job is not long enough to do any significant important research, basically. Uh And so being able to write up case report is the, is the sort of sidestep around that one. As I say, it doesn't score your maximum points for publication. But if you've got non and you see one interesting patient, but you see three patient's with the same pathology within a couple of weeks, talk to your consultant, talk to a registrar and say, look at these worth writing up and they might say, yeah, yeah, you can write them up and get them to supervise you, whack their name on as the final auth on your paper, whatever. And then, um you can send that in and have a chat with your registrar's because your registrar's invariably will have had to publish themselves. And they might be bitter old men like me who had to find easy papers to publish it easy publications to get their papers into. Or then, you know, maybe they're sort of rigorous academics who are publishing in super important papers, but they'll be able to give you some tips as to where you could apply. Um And if you're, if you know which specialty that you're going to apply to look into the smaller journals in that, in that sort of specialty, you know, if, if you're applying to E N T E N T as a, as a specialty, you know, you know, you don't want to send your things off to nature, send them off to the British Journal of Lauren Geology or BSO, whatever, you know, a small English or British paper or, you know, if you're not, if you're not in the UK, send off to a local paper, um, as in your nationality, in your language, get it published there. Just make sure it's got a pub med idea. Yeah. Oh, my goodness. Yeah, because the pub med idea is super valuable in terms of schooling your points, you score less points if you have a paper published, but it's not pub med and findable. Yeah. Um And on the back of that, I was just about to say the exact same thing about discussing with your registrar's. I think a um particularly if you're F one F two. Um because you guys rotate. Um people are just naturally just being brutally honest, less likely to give you research projects because they know that you have to do that specialty. Whereas if you put yourself forward and say I'm really interested in this specialty, please, you know, give me a project if, if there are any available, sometimes we feel a bit bit odd and a bit, you know, as if we're coming across a bit arrogant or, or, or forward asking for research project, but actually it flags to your seniors that this person is interested and if they might have a project in the back of their mind that they're thinking about. Um And then they'll put two and two together and say, oh, actually, can you do some data collection for this? I think this is really, this would be really useful. Um And so then it, it gets your foot in the door. Um So for example, I work as a J C F um, in, although, um, and one of our f ones I only found out about a month before they rotated that they were really interested in surgery. Um Now I'm doing some data collection for an I AM mail audit and at 100% have gotten alongside and crap through the data together. But with three weeks to go, there wasn't really much point. But if, if you as an F one F two shout, you're kind of name out early on saying that you're interested in, that's a specialty you want to go into potentially people will then have you in the back of their mind for projects that they're doing. Um And I think that's really useful and then escalating to your reg. So I will not escalating. See, I'm an interview goes still um the chatting to your reg. So I had a chat with my registrar today about registrar replications already because my brain is already thinking about that. And I said, look, I need to get uh three more papers. Can you, can we go through journals together? Which ones are relatively good to get into? Can we go through how I've become co author of certain things because they've done the process before they have tips and tricks um that they'll be able to tell you with a specialty specific. Again, with our mentor mentee scheme, you might be able to, you probably will be able to get the same thing. They will, they will try and attach you to someone that is um specialty specific, if not at least surgery and who will have contact with people who are specialty specific. So for example, if I was mentoring you and you were wanting to go into E N T, you wanted some journals that perhaps were a little bit more easy to get published in. I'd call Tom and be like, hey, tell me your journals. Um So chatting to seniors and other people is, is just really good and it just puts your, your name out there that you want to do surgery. Um which again, will just only get you more opportunities um because the surgeons will invite you to theaters and um that will just grow your confidence as well and help, you know, and learn if that specialty is something that you're interested in because surgery is so broad. Um So for me, when I was an F one, I started shadowing the on call S H O and Uncle Reg. And then I got to do quite a few procedures that way I was then able to go into theaters. And um now because I've expressed my enjoyment in research front of some of the consultants in the uh theater breakthrough. Uh They're now discussing potential projects with me. Um So putting your name out there is really good, whatever you do, whether you choose to do a locum, a teaching fellow, A J C F, just expressing that interest in a particular area or saying I really need some teaching points and then finding out who your teaching consultant is for your department. I'm just saying to them, look, I'm really interested in teaching. So I um am our junior teaching fellow. Um I teach regularly twice a week, but there are teaching opportunities. If somebody said to me, I'm really keen in teaching, we could plug them into straight away. Um But because no one's put themselves for with that, I'm not going to say to somebody please do this teaching for four hours. But you could find yourself in a position quite quickly thinking, oh, great. My portfolio points are ticked but it's just so bad that I am. I tell the students that I teach all the time. Um How important it is to be keen and you don't need to, you know, brown nose and suck up to someone that you don't respect or don't like, you just have to go in there and say, you know, here's, here's what I want to get out of this, but I'm keen to do this. Um If you end up in a job. That isn't the specialty that you want. That doesn't mean you can't get anything out of it at all. You can get all sorts of things out of it. Um, it's just about going in there and, and showing that you're keen because if you express an interest, people will express an interest and invest in you. They, oh, you, you know, a registrar, a consultant owes you nothing. So if you go in and you say, you know, one of the things that I'm interested in, one of the things that I need to get is to do this research is the only thing that I can help you with. You know, I'll scratch your back, you scratch mine. And if you show that you're interested and you show that you're willing to put some work in, people will very quickly get you on board and, and, and people will be keen to sort of pull you over to them. If you, if you do it right, you'll have other people saying, oh, do you want to work on this with me or you want to work on this with me? And suddenly you're having to turn down opportunities a good place to be in. It's true. It's true. And as Tom said, expressing what you want to get out of your f three to some of your seniors, it's just really important. Um So for some of you have joined slightly ladies wrong because I'm recognizing some different names on the people, um, list that we have. Um I did an F three in orthopedics for the actual experience, um to see if it was something that I could do. And one of my big concerns rightly or wrongly was whether I could physically do it because I am for, for eight, I'm quite small. I have size 1 ft, I'm very direly. Um And so actually telling my consultant that and saying to a couple of the consultants, this is the reason why I'm doing it. Um, because I need to know that I can do orthopedic surgery physically, I'm, then if there's ever an emu a hip that's been dislocated, they're all right. Holly, get on the bed, do it. Um You know, you need to prove to me that you can not prove to me, but you need to do it, do it. I'm here if you need and then I'm popping hips I/O and then I've got more confidence, but that's why I wanted to get out of that. And if I haven't said that initially, people wouldn't call me to do an M U A of a dislocated hip or say to me, right, you're gonna manipulate this ankle because that takes quite a lot of strength as well. Um And say, look, I'm here if you need, but you're gonna manipulate this ankle. Um And so expressing those, those wants and desires out of your F three is really good. I think one thing that I really kind of wanted to express to you guys is that potentially if you are taking an unexpected death. Three, I understand the disappointment. Um and I get the frustration and sometimes it can feel like the world has ended um because your plans are no longer viable, potentially for right now for the timeline that you anticipated. However, there is a lot that you can get out of an F three, you can get points for your portfolio to mean that you're a much stronger applicant coming into the next application season, meaning you potentially would get a job in a better place than you ever thought you could. Um So my core training post is in orthopedics in Liverpool and I'm ultra excited. Never been to Liverpool Boathouse. Great. I've got my fifth choice. I'm very excited. Um But it's something that I didn't anticipate, you know, the year prior I didn't apply. But if I was looking to apply, I probably would have taken anywhere and not thought that I'd have really got anywhere. Um But now, you know, I have choice because I've developed my portfolio really significantly in this year that I've had, I've gained so much experience that now orthopedically on the wards, I'm very comfortable managing things that a year ago, I would not have even known where to start at. So things like a wound review, a skin check, looking at an X ray POSTOP or post manipulation manipulations themselves. I now feel much more comfortable in that I wouldn't have. So going into court training, I'm going and feeling a lot more confident surgically than I would have done a year ago. Um And so for those of you that are thinking, oh my goodness, I've got to do a year. I don't know what I'm gonna do. It could be and hopefully will be a brilliant year where you can really develop yourself and your own confidence and your portfolio and you may come out of it thinking great. That was a really great year. Um And feeling much more ready for going into court surgical training, which I don't know about you, Tom, but I know that I am definitely a lot more ready than if I'd have gone in post F two. And that's not a reason to, you know, delay the year if you've got, if you're an F two and you've got a post and your thinking or should I take an F three or not? That's not necessarily a reason to delay it, but it was a real benefit for me going forward. Um I have one more question for you, Tom. Um And then I think we'll just see if there's any questions from said audience. Um How, so obviously you took an F four applied? Um Didn't get in, how did you pick yourself up after that news to go forward and start developing yourself for the F five because I think what some of the guys here might relate to is that feeling of feeling a little bit lost in directionless nous direction. I don't know what they, I don't know what the word is but, you know, I'm trying to say, lacking direction that I knew you were going to answer me. I knew it. So I think it's different for different people, isn't it? Some people went to medical school because they were smart and they're locked science and then they just end up and suddenly a junior adopt and you're like, oh, what did I do now? I've wanted to do surgery for, you know, pretty much forever. And so it boils down to, you know, I didn't get in, I still want to be a surgeon. So, what are my options? Well, I can either go another route in that is not down the court surgical training pathway as in doing a caesar or trying to get a quest form, um, to show completion of my core competencies or I apply again. And for me, I've been really lucky in that. The job that I'm in at the moment is with the department that I know and like, and they know and seem to like me because they give me plenty of opportunities. Uh, and actually if I hadn't have got in this year and it may even have worked in my favor Timewise because I probably would have, then spent another year just trying to build up a portfolio to go into an S T three application, which is an option. Um I am now uh come up to five years, post graduation. And so this is the last year, three years after F two, this is the last year that I'm allowed to apply for court surgical training. And so keeping an eye on those sort of time frames and those limitations is important because you may think, oh, I'll go off and have a great time in Australia, New Zealand. Can ID A whatever. That's great. Do it. Absolutely. I recommend that everyone goes and does something like that. See why, uh, just quite how easy it is to learn lots more money and have a nicer life in the, in the different country. Um, but just be aware of the fact that by doing so there are some time restrictions. And so for me, I've always wanted to do surgery, I'm not gonna sit here and say, right, I haven't got into a court surgical program. I think that the application process a bit silly. I think it's a bit unfair because they keep changing the goalposts. Um And so is that all my fault or is it, you know, a bit of the fault of the system? So yes, I could go and talk about it or I can say, right, what are my options here? And my options were try again, try a different route or go down G P or A and E or something like that and go and do a GP special interest or something on those lines. And for me, um, my admin skills stopped me saying, let's go down another route because actually I think one of the benefits of being in a structured program is that you get an educational supervisor and they sort of poke you in the right direction, keep you ticking over rather than you having to do it all off your own back. Um And the other route, there's sort of G P special interest or whatever alternative route there is. Um My thinking about that was that I can do that later. You know, if it doesn't go well, if I don't get in through this sort of alternative pathway, I don't get into a course surgical training program. Um They're desperate for GPS in the UK. You can still go down the GP route two or three years' time. You can drop out halfway through registration and you'll still be accepted with open arms into the G P route. And so for me, I think it's worth keeping on trying. If you find what your passionate is, you find the area of medicine that you really enjoy doing, then keep going for it because you almost certainly will be able to get there. It's just a matter of being tactical about it. Oh, that really warmed my heart. So guys, and I think that's all from her. Can I just add another? I know that this is the portfolio clinic, but I just want to make another couple of pushes for or just another couple of things about doing an F three year particularly, it's unexpected. Um that are not necessarily portfolio base. We've spoken a lot about what you can do to build yourself up and make sure that it's worthwhile um academically and in terms of applications. But there's a few, few other things to consider, I think, um, in terms of picking up jobs, you've got a few options available to you. You've got things like what you could, you could not work, which is a perfectly valid option or you could go into a different line of work. That's fine. You can take a year out and go and do a ski season. I think that would be a great thing to do with your time. I would have considered that if I don't get in the end. But, um, the sort of standard route if you're going to, um, do an F three in hospital and being a structured job would be to do a junior clinical fellow or a junior teaching fellow post. Okay. Those will be advertised locally and they'll be advertised nationally if you keep your ears to the ground in the hospital that you're already in. If you like the area that you're in or you like the hospital that you're in in F one, F two, if you're already doing an F three, just see if you can get back into those hospitals, see if you can get, you know, talk to people that are in a department that you've known and you worked in before because being able to work in a department that you're already familiar with and hit the ground running where you're not having to spend three or four months learning the specialty is also really valuable because then you can, if you want to get on with portfolio, so if you can really plow into the portfolio stuff. Um So for J C F post or teaching fellow post, that's sort of a consideration to have if you are looking to do locum work. Plenty of people, plenty of friends of mine, plenty of people I know have done sort of ad hoc slocum's throughout a year. If you're able through the bank at whatever hospital you're at or through an agency to find a long term locum job where you're covering for someone on long term sick leave or big rotor gap or someone is on maternity or paternity leave or something like that. Um I think that is in my mind, a preferable locum situation to find yourself in rather than just saying I'll pick up a shift here and there. Because again, by doing so, you will familiarize yourself with the people that work in that department and you'll be able to get more opportunities that way if you're a locum and if you're an ad hoc employee, you can still say, you know what I want to play golf on Thursday and you don't have to work the Thursday. You can still do that. Um, but being able to say, like I've got these 10 shifts locked in. Um, but also I've got 10 ships locked in next month and 10 shifts locked in the month after that. And they're all in the same department is going to be really, really helpful in terms of the way that you're able to approach the year and, and sort of reducing your mental burden of sort of stress and learning and being competent at the job that's really useful, but it's useful as well in terms of, uh you know, if you want to do audits, if you want to do teaching stuff like that. Um And then the, the other thing, so I mentioned when, when you asked, how do I feel and how do I pick myself up? I mentioned going an alternative pathway. You don't have to go through the course surgical training pathway route. You know, it is possible to skip that step and go straight to an S T three application. It might be a bit hard, it might take you more admin off your own back, but you can try and find yourself structured J C F post if you start your J C F post and you go to your supervisor, clinical educational supervisor and say, look, I've not got into the court surgical training program, but I really want to apply to, to be an orthopedic reg or a plastics read or whatever. Um, from this year, what I'd like to get out of it is a certificate of readiness to enter higher surgical training. And so they will say okay, that is, or isn't something that we can facilitate, but then you can go about setting that as a target for yourself and trying to tick off your core competencies, getting a supervisor that is keen to help you and being able to get yourself into theater, get yourself doing some small procedures yourself, doing someone calls where you are sort of supervised to the extent that you can get many Texas or cbds signed off, get yourself a portfolio early on. So the I S C P portfolio, make sure you've got a log book that's active and keep it going. All those things you can do all these when you're not on the court surgical program and then you can land yourself an S T three job having skipped a couple of years if you want to. So if you want to make use of that time in terms of just progressing your career do that, let's say if you want to go and get your house deposit do that, it's up to, you don't feel I'm older than time itself, but you don't need to feel like it's a rush to get to consultancy. You know, you just, you need to take your own time for most people. Unless you entered graduate entry medicine at 35. Plus, you're still going to spend probably the majority of your career as a senior doctor that is a senior registrar, a consultant. So don't rush to get there. Enjoy the journey. Wow. Cheese. A li you're so inspirational, Tom. Thank you so much. So, guys, on that note, does anybody? We'll just leave the chat box open just for a minute or so. Does anybody have any questions at all um about anything that's been discussed today or anything that's not been discussed? And you just wanted um some advice on at all. Just drop your questions down if you do have any, if not, we'll let you go. Um But while we're waiting for any possible questions, I'll just put this um oh present now um feedback forms mean certificates and then back this reasons to register as a mental a mentee even it is that that personalized portfolio feedback. But I think is, is really good and it's something that you perhaps think you're gonna be okay at until it comes to applications and then you realize there's a lot of small print, but perhaps you didn't pick up on. I know I had that and then you're trying to navigate evidence and things. I didn't realize a G M C number A date and a consultant and full name is important on literally everything and four times trying to get my log book signed before I had everything accurately done. So it's things like that that people will be able to tell you and your mentor will be able to tell you. So you're not rushing about a couple of days before evidence submission going. Oh my goodness. I need to find a surgeon that will write all of this down that can write it on eight sides of paper. Um And is happy to do that. Um So yeah, it's just getting things in a timely manner which I think is really, really important and, and you know, the mentor mentee scheme can help with guys, nepotism is live and well in medicine, I don't have any family that are able to hook me up or any godparents or anything like that. But all of the jobs that I've picked up that have benefited me, whether that is my long term locum in orthopedics, the job that I got in New Zealand, the teaching fellow job I got here is all just because of me talking to people on the wars, talking to people that I work with and finding out, uh did you know that there's this job available or I did a job in this hospital? I can put you in touch with the, you know, wrote a coordinator of this specialty or, you know, the job that I got in New Zealand. I applied in the New Zealand National application process. Didn't hear anything back. Wrote 2 20 different hospitals, didn't hear anything back. And then a friend of mine in London said, oh, I know a guy that used to work out there. I sent him one email and then with a week later I had a contract signed. So, just tap up the people around, you, tap up the people that you work with that have got places that have done good jobs and they'll be able to sort you out. Yeah, and talk to some of your core surgical trainees that you, you know, because they'll be able to give you kind of up to date advice on lots of different things. But yeah, thank you so much guys for your time. Thank you for watching. This was um the unexpected death three surgery brought to you by the Portfolio Clinic. I am Holly and you've just heard from Dr Tom Hatfield and this is run um and been able to be delivered by medal. So thank you very much for your time. Sign up as a mentee. It only going to be beneficial and it's free. Um And we've got an unexpected death three talk on I M T next week, Wednesday at seven PM and then um the F three you haven't heard about before, the following week, same time, same day at seven PM. Okay. Um Take care guys. Thank you. So much enjoy the rest of your evening. And thank you.