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so Hello, everyone. Welcome to the third webinar in the chest Total Siris, which will be on European audit. Welcome back to those who have attended our previous to on general pediatrics and teaching. This is number three of five webinars on PT after career voting for medical students and f wise on, um, these This Siris runs every Wednesday from now until the 23 through at 78 PM So pleased to join us as if you attend three out of five webinars. You'll guess Fear accredited certificate Little bit about you. Guess to begin with um for those of you know, you get inside you for anyone interesting, all things pediatrics. So the year we run a busy schedule posting tutorials, talk socials and fundraising events to raise money for edema. Children's Hospital charity. If you can take your coat, you get to our length tree and get our membership in parks for only 3 lbs. We run quite love events this year on, but if you're in an Edinburgh on, do you want to dust off your dancing shoes? We've got the number University, Pediatric society and Heber hosts. So Adam, about charity clearly fret about Children's Hospital charity, which is happening, I believe late eight proof. So pleased you check out our social media for that. We also host this total serious. But the doc is well, is our Year five revision with dinner, he's due for your social. You got to keep up to date with any events, updates and opportunities we weren't completely free of other than the membership. So we do appreciate anyone joining. Speaking of running for free, we do all our events to raise money for it. Um, attractions, hospital traffic, um, which and transform the lives of Children by complementing the work of numbers were almost over Children, young people. So if you have anything to spare, please do donate. That would be very, very grateful. Like they're So what we link into the, um thank you very much. Um, just a brief run through of what will be happening today. This obviously the introduction. Then we'll have a talk by Dr I. A bath bigger on day, I talked to Doctor Abby Bracket, followed by Q and A an ultra usual etiquette. I'm sure everyone's very, very familiar. Any inappropriate language or offense content will result in you being removed. But please do have fun and please do ask questions. The chat for both of our love with speakers. If you don't want to ask your questions in the full chat, please do. Just message one of us individually and I will pass on to a doctor about bigger toe. Start their presentation. Thank you very much. Thanks for the introduction. Can never even seen my presentation. Yes, thrill. Uh, right. Let me just, uh good. So I'm I am one of the ST twos and pediatrics currently working in a book. And I was working at this Children's hospital, but I just started over the new needle units Simpsons Uh, so that's slightly day. Anyway, today, I'm gonna be talking to you guys about Q I and Audits s Oh, these are just some of the objectives. I feel like we could also cover. So by the end of this talk, I'm hoping that you have the basic understanding of what Q I and audit um both are on building blocks of serve, carrying out a Q and a lot of projects how to get involved in one's on, then that. Then there's a debate about the pediatric training application and like the portfolio alongside and what you might ask interview. So just help prepare you guys if you are interested in applying for peace, which she should be because it's the best specialty. But there there might be varying opinions. Wish I will respect and so feel free to just raise your hand at any point, or even just like I'm get yourself. Ask questions. But I can't really see the chats that's not keeping my eye on it. So I'm if you do have any questions on there, I'll answer them at the end of the talk. And so first I thought, we just cover about but the basics of quality, improvement and all tipped and so starting off with what exactly is quality improvement? And so essentially quality improvement has been defined in many different ways, and essentially all of these definitions basically mean the same thing. So the point of carrying out quality improvement project or the concept behind quality improvement is that you're trying to make a difference in two overall sort of patient care as well as and the environment in which you're like managing patients as well as you know the health care environment, so you're trying to make an overall improvement on to do that. There's a lot of different ways, but essentially you're carrying out a systematic approach on designing and testing and implementing changes using really time. And most of the time there is some kind of measure that you were using to assess this. And and that's basically all of these death, different definitions on our alluding to so moving onto the basic principles of two I go for you to want to carry out a quality improvement project that you have to have an intention. So you've got have some kind of motivation. Teo begin the project and want to carry out and the necessary work to do so, and you've got take on an attractive process. Essentially, it's one that requires lots of repetition and going back and forth and just reassessing constantly with time. And you should use a agreed serve methodology, so that just means being structured in your approach and we'll touch on in the week. But, um, the best thing about Q is that it's improvement in the work area from the bottom up. So the people that are carrying out quality improvement projects. Most of the time you'll find are the foundation doctors or the junior doctors that are on the shop floor and that in itself, being able to be the one to notice, um, a deficit within the system and to be able to carry out a project and improve it can really empower you as a junior in your department. So has lots of benefits as well. And and finally, you know, it's a really good way to scale up and spread. Um, you know, improvements through a doctor, a shin in a specific context. And so when we were talking about taking on a structured approach, the main approach that quality improvement projects take is using a PDS a cycle. And what that is is planning doing, studying and acting accordingly. And and that that's pretty much it. It is exactly what it means. So and from the start, you wanna have a look and you think to yourself, right, what exactly my trying to accomplish here and that begins to start planning phase of your quality improvement project. And then you're just trying to justify why you're carrying out the project. Does it will be a lot of work and you don't wanna just waste your time. And as a result of the work that you're going to do, what kind of changes will you make? Teo result in an improvement And and then once you start, it starts with the planning process. You start to put things into action, and so you know, you start to recruit people and get people involved in your project, and you start to collect to be better data, and then you implement a change and then you go back and you do it all again. And the point is that PDS cycles are quite quick in terms of turnaround. So actually, and you don't need to wait a significant period of time in between repeating them on. That's what makes it quite a dynamic process. And actually, that's one of the best bets about quality. Improvement is that you can constantly just improve the process on down, make changes according to the effects that you're beginning to see. And so because we know that culture for Ms it essentially weights and improve practices or two just overall make and positive changes. There are actually alternatives because you guys, actually a relatively newer way of improving practice on been the past, different ways or alternative secure. I used to be research. So the difference between researching your eyes and research you really just trying to generate a new knowledge. So you're asking specific question and you're going through the literature or you're carrying out a study to generate new information and clinical all that which we'll talk about in the bets on, then their service evaluation. So that's basically just having a look a service that you're provided. But it usually comes from higher up rather than from lower time. And and there's usually a bit of a local approach to doing that. So it's quite, um, area dependent on then clinical transformation, which, essentially, the and I would say, innovation in clinical transformation basically kind of fall within the same category. And so that is, um, meeting, making certain radical changes, and they're quite dynamic. Teo Sorry, dramatic to the current practice. On a lot of the times, it means employing you practices, but it's not very evidence base, so you're not really collecting information before 100 proving that they changes that you're suggesting are worthwhile or proving that they've made also have been packed. So that's the benefit of July over those kind of a book. And this is just a reflux chart diagram bit complicated, but essentially it compares cute toe all of those alternatives. So I'll let you guys, you can have the sides, and you can have a look at them in your own time. Eso then moving on to audit and which I'm sure you have heard of before. The water is very much closely related to cure I, and actually, and it also follows an interesting process, and the point is to improve standard health care. But the main difference between quality improvement and and audit is that in when performing an object project you're essentially just trying to establish is the current practice that's being used in my department or my units, in keeping with the gold standard that we should be following. So you're just trying to see if people are following the local guideline that's currently in place, and I'm that's what I meant here when I said, in relation to predetermined standard of breast best practice and so in audit can be used to establish a baseline and to analyst impact of tests on. But that's why it can be sometimes the first step performing a cure. I project I am. But unlike you, I with audit the interval of time that you then have to come back and repeat the cycles is usually a bit longer. So, for example, you perform one cycle and then you come back to see if you know whatever change that you have implemented. If you have implemented a change, has made an effect on you, then repeat the cycle and maybe a month or two months or so I am. And then the other thing to say is that clinical audits quite often used in healthcare, Teo assure function on. But that's why, unlike in Cure I projects, it doesn't really focus on like empowering staff and services. And it's not always about making positive change. A lot of time people are just performing projects. Justice get the data. But then we'll talk about whether or not that's useful in a while and feel so just like with salt improvement projects, that cycle's also follow structured process and these air just this just a wee flu shot with a summary of carrying out an audit cycles. So essentially you start by identifying a problem. And so, for example, and you have you're working in a surgical ward and you find that there is quite a lot of hospital acquired infection going round. So you wonder if this might be related to hand washing and improper hand washing techniques on down between different patients. So that would be your problem. You know, people aren't washing the house. You define us that a certain standard or criteria you need to wash your hands before and after interacting with patient or their surroundings. You collect the dates. Us. You're on the wardrobe. You just basically collect data on C. Has the consultant your arm or ground with wash your hands pre and post interacting with each patient they analyzed. The state's in whatever way you want and whether you decide to create a bar Char char ever on, then implement change. Not this. That of the audit is quite variable. And this one is what distinguishes a meaningful audit on one that is useful from one that really isn't so. If you found out that maybe, you know, people were only washing their hands 50% of the time. And if you don't make a change and you come back and you re auto in about a month, nothing's getting a have changed and you'll still find that it's still there's a hand washing percentage of 50%. So if you then, for example, decide that you want to have supposed to hers or, you know, you decide to, um installed little sanitizer holders on the end of every bed and then you come back and you you know, reality. In 23 months, you'll find that hopefully, you know, had washing would have gone up to, like, 80% or 100% or something like that. So it's about and riata taking following, implanting a positive change. And by doing so, you're closing the loop on your producing and meaningful audits project or second. Mm, So this is just a little example, And if you guys I mean personally, I don't really ever interact when I'm on these kind of things. But if you guys could, if someone could maybe on mute themselves at some point and say something would be really nice, because I feel like I'm talking to myself and so your enough right to and you're asked to complete on audits of a pre surgical pathway by looking retrospectively increase of documentation. And the conclusion is that adherence, the best practices mixed. And the recommendation is to remind the team of the importance of being thorough in respect to, um in respect to that. And you really did it in six months. That's your recommendation. Following your first cycle. The results are presented at our audit meeting, but the reality is a year later, buy a new FBI two shows similar results. So just thinking about that scenario and what approach do you think should have been taken? And actually, how can this audit cycle or this Although, yes, it was a closed loop audit. How could it have become a more meaningful audit on? How could it have been been transformed into accu I project? Does anybody want to, like, show that could blow answers, please? I mean, there's nothing here. Um, please do pop. Any comments you have in the trap? I've also changed the security. So you can, um you can, um You yourself now, if you'd like to share any of your pills. Yeah, That's okay. I won't waste more time. So, um so, in contrast to the above, basically carrying out a rapid cycle audit and which everyone contributes. So getting the rest of the team involved would be really good and actually getting their views on why adherence was low would be good and then may be distributing information about that. So essentially implementing a change before you reorder it and educating everyone would then mean that a the team is involved. So again, you're empowering everybody. Everyone's getting involved. You're making a positive change on. Then it's likely that the reality it will show, um, an improvement. Um, so then, expert of the presentation is about getting involved in clipped and audit, um, and have to do so when you are either medical student or foundation doctor before you decide to apply for a pizza. And so why should you get in an involved in auto and Q. I D. And we all know that it's quite boring too sometimes and collect data on None of us really particularly enjoy it. But actually, it's really rewarding because you know that if you make, if you do perform at, um useful audits and it's quite meaningful. You can contribute to improving patient care, which is something that I'm sure we all want to do is we're all doctors are doctors in training, and it also is a really good way to show interest in a certain field quite early on. So, for example, if you're in Matt School and you know that you like Pedes performing a pizza, all that while you're in med school would look quite good on your CV. And when you then come applied it, come to a pizza and you'll learn quite a lot of skills depending on and what type of project you get involved in and on. It's also a really good opportunity to start right up here where can present it in the form of like posters or or or presentations at conferences. And that in itself means that you can get a publication. And again that looks pretty good on your CB. I'm once you're in training and is actually good mandatory for you to perform on audits or some form of Q I or get involved in some form of water or pew I every year, if not more than once a year eso understanding had to do so. It's quite important as so How do you get involved? So basically, there's two ways. Either you can join and already organized audit project or do I project or you can just that one up yourself. Both have their pros and cons. So if you decide to join and already organized audit, the best way to do that is to just ask the people arriving juice. So if you're honest or emplacement, disaster doctors and then you know and most of the time every specialty or department would know of a national audit that's currently in place or going on that you could maybe get involved in cause a lot of the times with these type of projects there multi center national audits. And actually, they just need people from each centered to Actos data collectors. Um, and by doing so you can get involved on. But the good thing about it is that it's quite a nice, easy and true to sort of disc election, although saying cure eye on bit less of the time commitments because you're just working as another member of the team. And but the bad thing about it is that you can't really pick what you're working on. And to be honest, you'd learn less from that process, and and it's not like you can angle and present it, and then you can add it to your CVS. But it doesn't give you as many points as have being set up your own. Which basically would mean that if you use smart criteria so and making sure that they're whatever you decide to do your audit honest, specific, measurable, achievable and realistic tightly and then you can basically pick any topic that you walked on but that can be inspired by your placement at the time. Or it can be inspired by your own interest or a little bit of both, to be honest, And it's also really important when you're doing so you remember to get permission of whoever is three audit lead or UM sort of the person that manages quality improvement within the department, cause most of the time, each department has the one that has taken on that roll, and it's just important to do so because a they can provide you with a valuable information on and how to go about it. so if you've got an idea, but you're not 100% sure which way to go about it, they can guide you from that perspective. But also they can make sure that you aren't wasting your time and just starting and all that that's already been done. And it's also really important to get everybody in both so engaging all the state holders and the team. Whether that's like the nurse, says the physios, pharmacists of the doctors and and sometimes even the patients, too. And re auditing is a dust, so it is a tool to least of your time. Teo perform a single cycle, not closed and actually re auditing more than once is even more beneficial because you're managing to no only prove the direction or the trajectory of improvement that your change was made but also, um, managing Teo evidence that actually that changes sustained, which is really, which is really helpful and actually looks very good on your CB to and and then once you've done that, you can always write up your work and publish it or get it presented at meetings and conferences on. Just remember to use the Squire guidelines when you're reporting your audits. And so the pros of setting in a setting up in office it yourself, his flexibility and more severe points. But obviously, on the diet side, you know there's bigger time commitments. Actually, it's a lot more adamant and lot more effort and planning from your end schools. Eso next. I was thought we could just go over and the Byetta, but Q I and audit in relation to the pediatric portfolio. So when you're coming to apply for Pete's, I am. So this is just a little bit from the pediatric person specifications, which essentially talks about what the requirement is on the side. On the left hand side, it's just talking about the basic requirements. So you need to have an understanding of research and, um, a basic understanding of the principles of all of it, as well as medical risk, evidence based practice, patient safety and quality improvement initiatives. But then the desirable and features or skills are listed over here, and basically, they just want they want to see that you have carried out a project on that you have, um, done one well, so a meaningful project, but it's also really good to snag more points if you can. Eso If you've managed to take the time to carry out a project, do you take the extra bit of time to write up on, you know, submit it for a conference, a presentation, anything? Really? There's so many, and it's actually quite easy to just get and even a poster, if not a normal presentation and from And this next day it just talks about the scoring criteria. So your scored basically based on two components, So that would be the online application portion and which I will show you guys in the little bits on then also your interview performance. So both of those put together will give you a score of if you managed Teo evidence, having designed and lead a good quality improvement project on a Q I ah, local regional meeting. So you managed to present it somewhere or and you participated in like regular audits throughout your training, which is mandatory, so you will have no issue doing that. You get a score of three and of 33 I think, is the Children score, so they're quite easy to get actually on just pre planning and being a bit organized, you'll manage to get those points. No problem. And so this is just a little online, and this bit is the online application portion of audits and equip on. Actually, I've just kind of call peed in my, um, an example, which is my own application, because that's only when I have. And to be honest, I haven't even I don't think I have even done that much. But I definitely did enough to get me and I run through training number and pizza. So, like I said, it's not difficult at all. And you get the opportunity to basically talk about one of your audits or one of your projects, um, in a detail. And then you get to mention other ones. And so I highlighted the one that I had worked alongside of steam, and it had been presented. But then the other ones, As you can see, they weren't even to do with Pete. So actually, this one was a urology one and and then the other ones were sort of oncology based, and one was on colorectal surgery, cohort of patients, and maybe one of them was a pizza one. So it doesn't always have to be pediatrics if even if you are applying for pediatrics, but it is, it does look better. But also don't worry too much if you've done other audits or you want to just keep, UM, things open or your options open, and you're just uncertain at this point because I'm that's also totally fine pill. And then the last that I thought we could go over It was just some questions that you might get asked an interview in relation to audits and try. And this usually comes up in the clinical governance station of the Interview on Dust, knowing that you could get asked these it's just really important because then you're kind of ready to answer them. And you got your answers reprepped that if you're anything like me, nerves will get the best of you and your mind. We're going to measure you won't be able to think on the spot, so it's always quite good. I have a bit of an idea beforehand, so you might get asked was a clinical audit. So that's kind of knowing the definition and then going into a bit of detail about an example of an audit that you've carried out. So always say, going into making yourself look good from the questions that they ask you would be the advice that I would give and sometimes the congested. Absolutely. Can you tell us about an interesting article that you've done? And and other than saying, Oh, I've done lose of audits on day were all closely audits, rather than saying something that's quite generic, may be going into a little bit more detail and specifically highlighting one that you're proud of. You did a lot of work on on, but I'm just summarizing what you're finding some stuff, and so that will be like a good way to start that conversation with them. And they might ask you what the problems associated with an audit. Our and a lot of the times that you can get asked us what the difference is between audit and research. That's then going back to doing the different alternatives to kill eye on understanding with each of these means kill. So in summary Auto and Q Y A very similar. They both look at how to improve healthcare Sanders, and the difference really is that audits compare something to bed practice, and they tend to have longer intervals of times between cycles versus um que eyes, which followed PDS a cycle. And actually that can be done weekly or even daily, and they focus on the overall experience improvement. Going to an auto is pretty easy and very possible when you're working in any department I'm like, except there's a lot of benefits to carrying out a project. And when you're applying, it's so easy to get those marks. So don't let them split the way I am over here. I've just included a couple of online Resource is for you guys. So there is a bit on there's a molecules that you could do on the learning for health, which kind of goes over and the principles of Q. I research and all that. And I think you could get a researcher get once you've done that. Um, me. There is also this guide from that health quality improvement projects, and and it talks a little bit about how to carry out and all that and you I project and and then the last thing that I included was just a little BMJ article, which talks about how to get started in quality and Britain. And so all the links are there for you guys. If you want to have a look at those. Sure. And and that's me. Done. Anyone have any questions? We're sorry where the question is supposed to be. In the end, I could just stay them either, or if anyone has any questions for I right now. Um, please. Do you put them in the chest, Give you 10 seconds or on yourself? Well, no one wants to talk to me today. It's okay. It's just one of those things about online weaponize. Um, either way, please do know that if you have any questions, just call from a try, and we will read them out of the end. Um, Abby, would you like to go next? Yes, sure. Uh, let me she, uh, screen? No. Can you guys say that? Okay. Okay. Awesome. So, um, just to introduce was also my name's Abby. I'm an f two. Um, I work in northwest England. I apologize if I meet myself occasionally. I'm coming out of the back end of cove. It and I've still got quite a bit of a call. Um, so I've just applied for pediatric training this year. Thanks. I've got training number. I'm starting in September, but I didn't know very much about to I order so until I really started my F two year, so I wanted to do is tell you guys a little bit about what I wish. I know when I was at your face a fact that your old in this talk you clearly much more organized and I ever wants so that I already put you on really good stead breast. Let's talk a little bit. It's gonna play Echo Quite a lot of what I said. She's given such an amazing, really comprehensive summary of what your eye and order involves. I would talk about it a little bit from my perspective, applying this year the things that I've learned, the things I wish I had done differently when I was at your guy's stage them and yeah, any questions just shall. But also I do not ask me questions when I'm in teaching, so there's no different from if you don't ask any, so what I want it's cover. But they when I was writing this presentation, I was having to think what the things I kind of I've really learned in the last few months about your eye and order on D. These are some of the main things, so we'll go through these on. Like I said, if it's any questions, just let me know. So they big thing to start within. The thing that I never really understood was a difference between quality improvement projects. In an older, The big thing with an order is order. It's sort of compare current practice against a recognized under good, and that might be a departmental guideline. It might be a nice guideline, but before you start before you start collecting your data, you already know what standard you're comparing against. Call Improvement is a little bit more flexible, call improvements of looks at current practice and comes up with, like, more like, innovative ways, ways that we can design change that we can improve something, but you don't need a standard in place to compare it to. And that doesn't mean that you can have a little bit more flexibility in a little bit more freedom in the way that you change things. The the process again. This Oh, I won't spend too much time on this. But you know the things that you're looking at when you're engaging in a quality improvement process you're looking at, you know, while we try and what are we trying to accomplish? That? That's your big question. And that's kind of the thing that you need to have set or somebody needs to set before you engage in the quality improvement process. And then how will we know there's a change in improvement and you might get you might hear that refer to sort of standard testing. So you know, we know what the issue is. How are we going to know when we've achieved that, then your implantations of what changes we're going to make And then you start your PTSA cycles so you start your loops so each of your plan do study act. That's one loop of your cycle. Once you've done your action and you saw a free assess, that could be you closing your loop, and that's when you sort of done a full order it cycle, something that's kind of started coming off. I think an Oscar play is, and I found this to be a really useful way if evidencing que eye involvement for my portfolio is this concept of in a three. It's something that's come out of t o PSA. I think originally and a lot of the principles of call improvement have actually come from business And, like manufacturing where people have kind of relentlessly issuing efficiency on ways of not like solving new problems and healthcare started started to take a lot of these approaches on board. And I think in a three, if you're gonna be thinking about designing your own order or designing your own quality improvement project is quite a nice way of star. Um, so you saw have come and got with these all of these scenarios and you're thinking about you know, the problem, the background. Why is it important what's actually happening? And then what's our problem? Statement. You know, where's our dissonance occurred between what we want to see and what's actually happening on. Once you've come up with those that issue and you for in your statement, you can start thinking about your goals and you're smart targets. You know, we've seen that there's an issue. How do we want to change it? Why do you want to change it If you want to go into it further and you sort of developing quite a bit of a deeper improvement project, you know, you're thinking about the analysis and, like your route cause analysis and what's contributing to your problem. And then there's loads of other child, some things that you might hear mention things like fishbone charts. And I've never heard of a free cell chart until I looked at this so him and then things like countermeasures, options that you considered. Can you think about why they're good, why they're bad and the new action from You know, how you gonna implant it. He's going to do it. What you gonna do when you going to do it? And these all sound like really obvious questions with the nice thing about having it in this sort of problem. Solving Templar is it is really good for kind of like for future reference and for having his evidence for your portfolio on also. So when that somebody asks you in an interview, tell us about an interesting quality improvement project you for it's on on interesting order. It might be nickel players. Oh, But before your interview, you can sort of read this, refresh yourself and actually be able to have a really nice structured and so see your questions and then so but the end thinking about follow up. And that's where your PDS a cycle starts, come into it. So you're PDS a cycle. So once you got your issue, you know you come up with your plan, you carry out your plump. He then study what happened with your pump and see what needs to happen next that carries on. And that's the continuous cycle. Other thing that's quite important. And the reason why we keep harping on about PTSA cycles is that that sort of form to the backbone of having a successful order. So there's loads of literature about like, How about this? I'm gonna put you guys towards some, like quite good resource is but kind of understanding. The Plant Do Study Act cycle also ties in quite a lot, with your applications and your portfolio quality improvement really important. Part of what we do is conditions. It's you know, it's the way that we identify issues on the ground and we fix them and we rectify that and we make them better, and that is the most important thing. This land I'm taking with this talk is slightly different because I think it's something that's quite will be quite useful for you guys. And it's how your eye and order is an important part of your application process because what I've learned. So it was a trainee. You know, I've learned over the last year is those other projects and things. I got involved with that medical school that because I didn't evidence them in the right way, and I didn't complete the correct steps and get the right evidence I've been struggled to use, Ah, in my portfolio, And that's kind of what what it's talk to you guys about. So, like I said, appliance pediatrics. So they tweet applications, but every s is a bit different in my ear. He didn't get quite as much space in your applications. Talk about, um, order were a 400 word question, which was describing your involvement in order and quality improvement. Under loaning from this, one of the reasons they stripped this back a bit might be because of Cove it so in our portfolios are cute I and Order requirements came down quite a lot. And so last year. But this year they sort of gone back up to normal, and we're all expected to carry out quality improvement project. It's part of our Syria. This is a 400 word part of your application, and it links into person specifications. This was a person's back for this year, which you guys have already seen. So it's looking at your essential Christ area, and that's kind of demonstrating and understanding that I think that's something that's quite difficult to do. I think it's a lot of ties in with your desirable if you prove your desirable course area. If you've done a quality improvement project, if you've done an older, then you're already demonstrating. Understanding. Um, but yeah, it's looking at something which focuses on patient safety, the patient experience or clinical improvement. Pretty much any clinical order, a clinical Q. I projects you do a song that's a meaningful project should take one of those boxes on, demonstrating an interesting commitments, a specialty doing a pediatric order. Our pediatric you, I project will demonstrate it and trust me on the Monday trickery killer because It's not in your guys' curriculum to do a pediatric your projects, and that's so the same for other specialties. A swell the other thing that useful with so order and Q i D. Isn't it content quite a lot of your other criteria on your selection form as well? So abilities show leadership, make decisions, organizing most other team member through for the benefit patients, for example, through order and cure. Managing and prioritizing time and information. Using logic and lateral thinking to solve problems and make decisions, involvement and monitor mint commensurate with appropriate for your level of experience. Organizational skills. Working as a team, effective leadership, demonstrating I t skills and understanding of any chest management and resource is these are all points so directly pulls from the pediatrics. Testy one application quite area this year and for me. When I was applying, I used my research. My cue. I experienced kind of indirectly mark into some of these criteria because I think they're things are quite difficult to kind of map to on their own. But also, you know, you only have 400 words in a question. If you can take a few of these points, and you make sure when you're applying whatever you end up applying for that you're hitting all of these points. I think that's quite useful. The other application that I found that I used when I actually based the project that I evidenced for my application off is not this one. I forgot this side was in here. Um, again. So this is the score incarcerated. You've already seen this word of advice from something I really wish. I don't look at this before you submit your application. Know after I didn't find a stock, you in until a month after I submitted my application and I was absolutely kicking myself. Um, it's really useful. All the specialties have some. It might be sort of buried in the back of a website, but there's gonna be a document that say's how they score you for your application and against the for pediatrics. There, looking at somebody who's designed, let him presented a good quality order or quality improvement project you to have done the Q. I project. You need to have presented a good cue. I project a local regional, may sing and then uh, participated in regular old it's throughout your training. The definition of regular is a little bit, um, flexible. I'd say if you're getting involved in something in your wallet in your after year, so two separate things and you get involved with something that medical school, in my opinion, you doing really well. And that's so if I could, really good things ain't for this is what I thought I was leading up to. I based a lot of mine off the I. M d criteria because I found this really clear. This is the application Chrissie A referred to a little medicine train and and they've given very clear instructions on you need to sort of participated in all stages of a PDS a cycle as well as a further cycle of it, least day, a collection and analysis, and that you need to have evidence your own role quite clearly. So I sort of made sure that the the order I submitted my multi talks about takes all of these two criteria because I thought that this one's sort of gave very concise. You need to have done the plan do study act, plant do study, act twice on the evidence of X, Y and Z. Again. These are all available a month here, but I thought might be helpful was I talk a little bit about my curx periods, and the things I got involved with is a medical student in a training just so you can sort of see what sort of things are on offer, things that you guys can get involved with. I see my experience is quite unique. The's also projects that came up while I was in medical school while stopped being at work. The first one that I did it on my psychiatry rotation and forth here, and it was a service evaluation. So is across trust service evaluation. About about was mental health liaison access you see in the emergency department. This is just my personal experience, and it may not be the case for any of you guys. When I was a medical student, I found it initially quiet, starting to get involved with things like quality improvement in order. I sort of felt like I wasn't attached to a team for long enough there. I wasn't trained that I didn't know enough that it was hard for me to sort of get involved and make of meaningful change. Thie projects I got involved in and this was a really nice example was actually using my possession as a student to my benefit. So the reason that this project work quite well was that as a medical student, I had access to the knee nose because I had a lot going for that system. And I don't access to the psychiatry notes, which is a completely different I. T system with a completely different set of Logan's on the psychiatry team only had access to one, and the any team only have access to the other. And the reason that we came into the students was because we actually had access to both systems so we could collect the dates that they were looking for, cause they wanted to see. How often is the mental health team being called into 80 sort of use. It's evidence how busy their services there, staffing numbers. So I developed a spreadsheet, started collecting the data, worked with psychiatry and any to sort of find out how the notes were kept, what they wanted to know and then passed this project or with one of my colleagues when we finish. It was only four week rotation. Sorry. And this was a project that I did before. I really understood Q I and the PDS a cycle. And I wish that I had because it meant that the evidence I got even I got a letter from the consultants saying that I'd developed a spreadsheet, collected data. It didn't talk enough about the audit cycle in the audit process. To me, to be able to use a spoon a z, good evidence for my portfolio. And I never did find out the outcome of the evaluation and the difference that it made. So I think one thing that's really useful for you guys is if you do get involved with any orders, you know, try and stay in touch, see how things are going on. Don't feel like you're pastoring people if you want to. So I got back and ask what it came to you, what the outcomes were. If you frame it in the cold text of one, I'm really interested. And number two I need this from a portfolio. You know, most people be happy to tell you the second one that I got involved with was What I'm a pediatric rotation, which I initially got involved with an education project but then very much turned into a Q. I spent a BM. It was looking at an innovative way to conduct student hospital induction using a virtual tour and patient entities. So I traded nothing him on. But we started our child health rotation. We didn't get it. Or Children's Hospital. The group was too big. The corridors were too narrow, Mind a and it wasn't feasible. Sort of take 40 students, like wandering down the corridor, want every two months. So the teaching fellows wanted to do a quality improvement project to improve the quality of the induction on Do. They sort of spoke to agree Provo's. Some of us follow politics. Get involved. What we ended up doing was doing patient interviews and filming of virtual tour on do interviews with parents where parents on Children told us what would be useful, what they like about how the medical students around we had over chew a walk around. The whole thing was near a advice to kids it was absolutely adorable on, but, um, we actually managed to get the work presented the to teaching fellows presented it at the Association for the Study of Medical Education On your meeting, and having a presentation in my portfolio own really helped me out when I was applying by no means is it necessary, But it's something that is really useful. If you can get involved with some of the projects that get she a PSA of recognized presentation. This one was quite different. It kind of turned into quality improvement projects before I knew what WalMart because we have they taken issue and come up with quite a novel way of fixing it. And again it was something that was really useful to be involved with us a student because we were sort of saying these with the issues with our induction, the's of the things that we didn't like and the reasons that we felt a bit nervous turning UPS award because we didn't know where anything wants. We didn't know which one was which I'm actually managed. Just I'll make something quite meaningful from up and then my big cause improvement projects has come from my academic and clinical blocks from an academic. FT's have spent eight months working in pediatrics four months doing research informants working clinically. And we've been looking at implementation of an Elektronik handover system on Elektronik task messaging in a general pediatrics team. And this time I knew exactly what was going in for. I knew I needed to do so. I made in eight we made in a three. We did weekly PTSA cycles and we downloaded a PDS a form online and fill that in every week is part of our me Sigman. It's we collected pre and post infant a shin survey data. So before we start, our change were you did a survey, so I get everyone's opinion to understand what the issues were were on training sessions before we implanted it. We met up with stakeholders three. Trust. I work and actually has a quality hope, and city has it employees, people whose interest is helping with quality improvement in the hospital. So we met with them, have some teaching from them, got quite a lot of inside and their expertise and again, who worked with quite a big teams, was working with one of the F three research fellows. Some of the consult since the research nurses and the MPs and this has been going on since about September time. We've been doing weekly PTSA since then, so it's actually going to sort of a massive que i system. But what happened for this one was I had all the evidence that I needed. So when it came to me a flying I had my psh cycles to reference, I had the A three that I could talk about in my interview. So with all of that in mind, just some tips. A really good thing about your eyes. You can collaborate and cooperations really useful. You know, if your guys medical school experience anything like mine, you're rotating your swapping every month, every couple of months you can take on a project, and you can pass it on to a friend who's rotating into the same thing. And you can complete PTSA cycles together. You know, I haven't done any Q I projects or any order. It's where I've worked on my own. I've always worked. It's part of the team. If you're struggling to think of something, a lot of consultants or so see doctors, research fellows, they might already have something in mind. I've had quite a lot of projects offered to me that I've not had time to engage with things like data collection and order before we introduce new guidelines. So I make sure that things like standards of being in the department that need to or just to evidence that, you know, things need to change the Actually, we're getting a lot of bleeps, and we don't have enough stuff on the wall to answer things. You know, these are all projects and ideas that people have and you can get involved, and you could work with them and make some change. And if you have a project, if you come up with something that you see and you think actually I think we could do that better than it's amazing get involved. But getting consultants on board and that could really help get the ball rolling. And most consultants when they found out there interest. If you're interested in their specialty, they're absolutely thrilled. They get so happy, so excited as two most of the trainees. Because, like I'll say, I love pediatrics. I'm so happy. If anybody came to me and asked about a pizza injury so it projects or order, I'd be really happy to help them because, you know, we want to encourage people we want to help him do. Oh, but on that no, your project doesn't have to always have to be related to the specialty you apply to. There's a slight copy out to that and that this does change every year. They changed the surgical applications this year, so that to get maximum points your order your cue. I did have to be surgically themed. Well, you can argue. A lot of your common clients can be argued from just other orders and other Q Y projects you've done so Don't feel like just because you don't know what you want to do. Yeah, you don't know what you don't specialize and don't feel that you can't get involved with things you know, because a lot off it is transferable skills. It can feel like something that's a lot of work to take home. There's normally some quite good times when you're a student to get involved in things, so if you'd gets doing elective, if you do so I have, like some they call them in Liverpool or an SSM or like a student selected module. If you're doing a research project, if you're intercollegiate ing, you know they can all be really nice times to work on something and then put a bit of like a Q I ordered spit on that, and then the other really big zip is Make sure you define your statement. Come up with your question before you start collecting the data because there's nothing worse and collecting your days to and then realizing you're not collected the right later and having to go back and do it again. So that's just from personal experience and then the other. The only other test that I have is a someone who's just applied. Be kind to yourself as you start doing these things. You guys are clearly very proactive. You're giving up your ones, you know. It's a listen to us. Talk about all this and your eyes. Make sure you get this evidence collected issue. Go save it somewhere central. So don't tie it to university email, cause you might not have access to that when you graduate. So what? I applied for Academic Foundation, and since then I've kept her Google drive with all of my portfolio in it. They just sort of keeps everything in one central place. You know, keeping your evidence less is is you go Any presentations that you get to do, make sure you're getting letters. Think from the consultants. Things that you can use is evidence for your portfolios that when the time comes to apply, you're not chasing loads and loads of sort of evidence letters because, you know, you've been all these things and you guys are all amazing, but it's struggle toward. It's difficult to argue in your portfolio if you've not got the evidence to back up and then last May, so there's a few useful resets. Resource is tips. Cure is a really nice website is run by a group of Northwest and medical training is who do courses on how trainees can get involved in patient safety in quality improvement. And they have some really nice online stuff. Mindedly is quite helpful writing a medical CD. It's a little bit old, but Consultant showed it to me when I was around solid 3rd 4th year and actually found it really helpful for science to do a very early basis of my portfolio and little things that I could get involved with as a student, cause you come using that even a medical school. When you're applying specialty training, it doesn't have to just be things even enough on. And then your application guidance person's effects If you're at all interested just so you know that they exist. Just so you look at them before you apply and don't make my mistake. And that's maybe that's everything. If there's any questions I'm happy to answer, thank you very much. Happy for a very, very important to talk Thank you to both of our speaker's for your billion talks. In your perspective, Um, if you have any questions, please do problem in the track. But just to start is all, um, I have one question, um, what happens if you try to carry out and audit and you realize the change that you're trying to make has not had any benefit whatsoever? That's a really good question, because I guess a lot of the times that is what happens, isn't it? But actually, I guess if that does happen, my advice would be Teo take a step back and reflects, and actually, could this be an opportunity to think of implementing a different change following your sort of third Riyadh it. And that's why when that's why in my presentation, I've said that it's really useful. Teo close the loop, but not even just close a little, but to continue to reorder it and actually realistic at least three times really helpful because that gives you the opportunity. Teo. Almost adjust the tactic that you're taking to tackle the problem. And so that would be my advice because I feel like if there's a there is a problem and you've identified it, there definitely is a solution. It's just a matter of working through exactly what the solution is and trial and error room. I'm very good defense. Thank you very much. I think of following on. From what I said, a reflection is really important. And the other thing I will say is that was in the interviews this year where they wanted to see you reflect on something that's called well or something that's going wrong in your practice on. You know, things don't always work, you know, things don't work straightaway or they do work, but not in the way that they imagine, too. And when you're presenting and order, somebody's not expecting it to be perfect. They want to see what you've learned and how you've engaged in that. And how is engaging in that cycle going to make you better training? And sometimes you can learn. If you reflect on something properly, you can learn more about the things that didn't work, the things that that and it can actually be a really useful experience, really frustrating what you doing it But in retrospect could be quite useful very much. We actually got one question. What can we do when they're stuck in an unsupportive department that does not appreciate all the work? Yeah, I work. It's been quite challenging for this person. So I would say, if you're struggling, Teo, find an opportunity in the sense that you don't have an idea or you don't know where to start, and you just want to carry out a project. You don't necessarily have to just stick to the department that you're in. And actually there is scope to contact other people that are working different departments because someone out there has a project that they're too lazy to do or they don't have time to do, and they're looking for some enthusiastic medical student or tree me that wants to help them with this. And actually, most of the time they just want the autumn and they'll let you put your name and be first author and let you present it if you want. So don't restrict yourself to just the time and place that you're in at the moment. And the other thing I would say is actually is in the department or, for example, if you're working and pizza and you know the peak and you really want to do pizza. But the team are dressed super busy because it's bronc season or something on DNA buddies. Interested if you come prepared if you like, do a little bit of like your own research before 100 a day. But the let's review. If you come with almost a proposal, there's no way anybody would turn you away. And actually that in itself would engage them. So just coming office. I'm sure you are, but super motivated as well. If that's still the specialty that you're keen to stick to would be the advice I would see. Okay, how do you have any advice for that question? I think that you take. Sometimes you can end up in departments where they're either they're coming across their their know, interested or they like their way of doing things at least what is one of the benefits of being brought a shin elicit? You know you will move. You were going to department. You'll meet different people with different ideas. And what I will say is that I've only shown you, you know, on on your presentation on your application. You only show the highlights you on the show, the things that went well and trust me, there's a load of emails and, like missed projects, things that just never went off the ground. Things that we try to get involved with and never got the ball rolling, and something that I tend to do is if I know that there's something that I need to get done, I'll slightly over email. I'll ask multiple people and then maybe one or two of the projects that you're interested in initially out with maybe five or 10, the emails about we'll get going. It's can be quite hard not to take it personally, but it's definitely something that happens to all of us. You know, this gets like I said, There's gonna be somebody out there who wants to be involved. As long as you know, you come selling a good idea or you find someone who's cane still help. You know you'll get something done, you'll get there. It just might not be with the team that you're working with a minute, Thank you very much. Um, does anyone have any other questions? I have one slightly. It's very specific. But a friend of mine was doing unaudited between the neuro surgeons and the Jerries of how they liaise on and her results resulted, basically said that a lot had to be done, and she was worried about offending the higher ups on with her presentation. A zit picks a lot of things that really required to be done and effective patient care, And she doesn't know how to present in a sort of, um, professional, but also firm way. And well, I would say I wonder what you It's how you would approach this happy. But I would say that is when the benefit of having a supervisor or more senior member of staff. So always having either a senior Reg or a consultant on board when you're carrying out these projects really comes into play. And actually they can then take on that burden and take on that rule. And because it's and I also think if you lay out the fax, know ones ultimately going to get offended, cause if you're not waiting fingers and you're just plainly saying it as it is and as your findings show, nobody to really get offended. But we do work in touch your specialties sometimes and and obviously nobody wants to step on anyone's toes. And so I think it's really important that for a change to be made that somebody more senior kind of takes all not rule and and then that that would sort of help because a lot of the times new guidelines can be put in place. And actually, sometimes if you're auditing and you find things are drastically inefficient back and then start that process, and actually writing a guideline involves lots of different teams and just starting Minaj. It could be like take start that process as well, so just making sure you've got the senior support I don't know. What do you think? Copy? Yeah, I think Definitely You utilizing seniors, Of course. You know, you know, with an order with a project that's been sort of run, It's not that you're sort of turning up and saying, Oh, hi, Here's all these things that are terrible in your department. It's a structured processes. You know, We've been asked to look at these issues to do a formal process, and these are our findings and, you know, there's no finger pointing being done. We're just laying out the fact that this is what we went looking for. This is what we found discuss. And I think, yeah, I having someone senior whose who knows what the findings are, And it's going to be there to facilitate, cause these discussions can be difficult. And it can be It can feel very difficult as a junior to sort of stand up and say someone of this is what we think you're doing wrong. I think as long as you keep it formal and you keep it diplomatic and you have the backend of someone who is more senior would be there already. But this is this is how we may change. And, you know, people don't like trains. You don't like being told Give a negative feedback, but I think as long as your professional about it and you keep a structured and you keep it fair And this no accidents. Old finger pointing, I think the layout. Fox, thank you very much to both of you, for your fantastic response is of your fantastic presentations. Um, if anyone has any other questions, please do put them in the trap. But otherwise, I'm just gonna give a week's feel at the end. Um, well, again, thank you so much for coming special on a Wednesday night where I'm sure you have other things to do. And thank you so much to our speaker's again for their fantastic talks. Um, feedback form will be sent out, suit on and a poem completion of that feedback form. You'll be a certificate from medal. If you attend three out of five of our webinars in the series, we have to get a sphere a question certificate. So that's probably a credit for it to get on top of your individual weapon. Our certificates. You can also scan the QR code to get to the feedback for me. Please do have keep in touch. Check out our social media. Um, if you have any questions about pediatrics, I want to get involved in society or get involved in our vets. Thank you very much.