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Hi, everyone. We're back with our next couple of lectures on our specialty series as part of preparing for a Korean surgery. I hope you guys all had a good break. Um Yeah, we've had a couple of vacant spots in our portfolio clinic session today. So if there's any open spots, then yeah, it'll be added to a waiting list if you message in the chat and we'll um, invite you accordingly if there's next up. We have family J Kumar who is a registrar telling you everything you need to know and want to know career and trauma in orthopedics. So I'll hand that over to, uh, thanks Jonathan. I'm Shama. I'm one of the ST five S on the Southeast London rotation. I am the Education Representative for British Orthopedic Trainees Association. And um, so here I am to talk about trauma and orthopedics. So, trauma and orthopedics. Um What, what exactly is it that we do? Well, uh in summary, we fix bones, replace joints and get people hopefully walking or using their hands and that's basically what we do. Uh as you know, people are always going to break their bones and unfortunately accidents do happen. So there is always a job for orthopods and we, depending, you know, sort of which kind of hospital you do or, or, or which subspecialty you go in, there's various aspects to orthopedics and it's quite a varied specialty which is quite nice. Um, there's a lot of things you can do and you can see from the pictures here. We've got an X fix for an ankle for someone that's most likely broken the ankle. You've got a knee replacement. And I think one thing I really like is the CMC J replacement. So that's the one where you can see an X ray of the hand. And that's because someone's got arthritis at the base of the thumb and having this replacement gives them that mobility that they need for their thumb. And the thumb is very important just as much as the knee. And you can see someone um on the bottom left having a shoulder scope. Uh And that's, you know, arthroscopic surgery that is a big part of orthopedics as well. So you can do shoulder scopes, you can do knee scopes, wrist scopes, even ankles. And that's, you know, repairing some kind of soft tissue stuff within uh the joint. Um And then you've also got someone who has got a frame. So these, the picture in the middle is basically for someone that's got a kind of a complex fracture and, you know, their skin condition might not allow them to or the fracture itself might not allow it to be openly, you know, open the ear, so you cut and then reduce the fracture. That's not always a possibility. And so you sometimes do this kind of long term kind of management with a frame and over a period of 34 or more months, the fractures sort of healed. And, um, it's pretty cool. There's a lot of options in orthopedics. And again, you can see there, there's a, a wrist fracture that's been plated. Uh OK, so basically there's always a job for orthopedics is what I'm trying to say in terms of what you do and how you get there. So as you know, medical school is, you know, 5 to 6456 years, depending on what kind of program you're on. You do F one F two and during F two, most people apply for core training. Um And then you do CT one CT two and then you apply for higher surgical specialty training, which is your orthopedic training. And there are a few run through posts, not so much in England anymore because they got rid of it because of funding issues. But there are run through posts in Scotland. And what I would say is that each stage you do everything that you do at one stage is to get you to the next stage. So everything you do in medical school is to get you to foundation training, everything you do in foundation training is to get you into core training and everything you do in core training is to get you into high, special uh higher specialty training. So just bear that in mind that you've always got to constantly do something. Um And I think that's just quite generic for most um surgical specialties. So we'll have a look at ST three applications. So SS T three national selection, it's divided into four. So England is separate, Wales is separate, Scotland and Northern Ireland are all separate. And you know, we've already got the dates out for when the interviews will be and when the applications open. So the applications open next Thursday for England and close around fifth of December and then your interviews, you and then your interviews aren't until April. And the thing that you do before your interviews is something called self assessment, which is usually out of 32 marks and there's various kind of um factors to it and you can see that QR Code and hopefully it works, but it's basically the national. Um if you type in York for a number ST three trauma or 3D applications is the first link that you'll see and there's quite a few documents on there. So do have a look. Um So yeah, in your self assessment, things that they'll look into is you'll get points for how many audits you've done, how many uh presentations you've done, how many PUBMED ID you have um, papers you've got. And again, there's all kind of like small print. So with the papers, you know, letters do not count. So just have a look at, you know, what stuff you have and uh mark yourself accordingly to see where you're at. And I would suggest for anyone that is applying that is more junior like, you know, you in CT one or F one, there's no harm at looking at this to see what you need to do. And yes, this does, this does change on a yearly basis, but it's been pretty similar for the last three years and the actual interview itself, there's four stations and they're about 10 minutes each. So portfolio where they kind of talk about, you know, please tell us how you kind of got involved in teaching or leadership or research uh clinical stuff where they'll go through about two clinical scenarios and they would want to see what your clinical acumen is like. Prioritization is usually list planning. So they'll give you a few cases and you will need to basically make a list for tomorrow's uh trauma theater. And again, when you've done orthopedics and when you're in that environment, you get to see um how a trauma list runs or what the thinking is. Um you and again, there's a lot more to that and communications is quite, it's a new station. Uh and some of this includes kind of like consenting a patient for a knee replacement, these are factors. Uh these are all aspects part of the interview and from what I remember it's 50 marks from for portfolio, 50 marks for clinical 50 for prioritization and 50 for coms. And then your self assessment is 32 and all of that counts towards your final score. And the one thing I would say is the self assessment is, you know, people always freak out about what the kind of, what score you need to go, er, is need to get. But usually from what I've been told is that most people average around 21 out of 32. So it's not as high as you as you would expect. Um And some people, you know, might get a high self assessment score but not do so well in the interviews and vice versa. And within England there's a lot of deaneries and this is, you know, on the, the list on the right was basically kind of the main sort of headings, er, for these deaneries, London itself has seven rotations. Um We, so there's seven rotations, there's, er, which is quite broken up, but that's er, how we like to do things and Yorkshire and Humber is north and south. So again, bear that in mind when you're looking at these er, rotations and when you choose them, so we'll go on a bit about Northern Ireland. So again, they've got sort of a different um, application process similar, but slightly different and they've only got four posts in the country for Northern Ireland. Um and they rotate every August, whereas in England, it varies between April October and um and August and September as well. So it's quite depending on which rotation you are. But yes, back to Northern Ireland again, you get a few more points if you have scored level three B um in your ICP for some certain operations in Northern Ireland. So there is slight nuances to the application process. So just note that Northern Ireland, Scotland, Wales and England are different, will go on to Scotland. So the I must admit these slides were made by um So Northern Ireland was done by Jag uh who's the Northern Ireland rap for voter and Scotland was done by Dom, who is the Scottish rat for voter. So Scotland as mentioned, does have training um run through posts from ST one and you can go via ST three as well and highly competitive is the ST one application. Some people go uh from straight from F two. Some people you know, go post core training and there are about 20 spots roughly. Um And there's four dries in uh Scotland and the interview format is slightly different, but again, we'll go into that and the dates are also slightly different. So 21st November is when their closing date is in terms of ST three applications, you can also go um into Scotland Scottish training via ST three and again, it's four. Gene. So, so do you remember that? I feel like one of my sides has been messed up. So, apologies if I'm repeating myself. But the benefits of being, being in Scotland is the scenery lifestyle. It's lower cost of living. And I think the pay day pay deal is slightly different. What, what the BMA has negotiated in Scotland? You've got great colleges there. So R CS Edinburgh and Glasgow. And one thing I have heard is that even from SD one, you're basically treated as you're taken as a registrar. So that's quite, um, important to note. And there is kind of variances in training, uh, depending on which region you are with Wales, you're sort of expected to be able to do a hemi, a nail, a, an ankle, uh, simple ankle fixation, wrist fixation quite early on in ST three. Whereas in England, depending on which area you're in thing, um, you're not as expected to be that independent early on. So, orthopedics, um, depending on where you are, where you're working, you can have resident and non resident uncles. It's, I would say this is one of probably the more chills surgical specialties. So resident being, you know, you're on site. So usually that would be a 12 hour shift, uh, during the night. And, um, then you also have non res, er, and that's pretty hands on. So it'll be you and your sho and you'll be seeing all the kind of cases, er, together and then there are non resident uncles, this tends to happen in your district, general hospitals where things are a bit calmer and, you know, you would do a 12 hour shift and then you'll have an sho one second, so sorry, apologies. Uh, so non resident on calls, you would have your sho doing the night shift by themselves and then you would be, you know, you would have done the day shift and then you're kind of on call for the rest of the night and that you can do that as long as you're about 20 minutes away from the hospital, that's fine. So you can go back home or you can stay on site, uh, but you can sleep through it and unless it's an emergency, they don't really tend to call you in and usually around six o'clock in the morning, you would go around and make sure the night sho has been happy and there's, you know, everything's ready for the tr meeting cos the most important thing is making sure everything is ready for the tr meeting and the trauma theater list is perfect and ready to go. And obviously there are things that do change during meetings, but you want to try and make it as efficient as possible. So, in a typical week, uh your a session is a half day. So generally you tend to do about three clinics. So three, you know, um three clinics and 430 sessions and you might get a y you'll probably get a half day for admin, half day off. Um and you might get an extra theater or an extra clinic, but that's usually what happens. Uh And depending on which hospital you're at, you might do ward rounds and stuff, but you, and you'll usually um allocated to a consultant that you can constantly work with. So it's always good to know who uh the patient of that consultant. And again, your work life also depends on which subspecialty you're in. So, one thing I forgot to mention is that from ST three to ST 8, S3 T, ST three to ST six, you've got very subspecialties, you need to tick off. So hands, shoulders and elbows, one, pediatric spine, major trauma, hips and knees and foot and ankle and these are all subspecialties you need to tick off. So depending on which subspecialty you're in, um it can be quite busy or less busy. So hands, hands there are rarely any inpatients. So that's quite nice. But when you're operating, you're, you know, sometimes doing up to 7 to 8 patients in a, in a full day theater list, whereas limb recon um is long term follow up of patients. So, you know, your patients get to know you for a lot longer um in terms of emergencies within orthopedics, aseptic joint, again, if they're truly septic, you will take them overnight um, but if someone has grown something in their knee aspirate, depending on how stable they are, it can wait till, you know, uh in the morning. But again, that's something to wear, er, note of neurovascular compromise. Again, that's something to be, you know, if the vascularity is gone, um, then you wanna get into theaters ASAP with your vascular colleagues to sort them out. And compartment syndrome is basically the heart attack for Ortho orthopods. That is something that needs to be sorted out. ASAP. Otherwise you will lose that limb. Er, and that's something that can't wait and needs to be done urgently. Uh as an emergency, an orthopedics generally is pretty simple. People either stay home or they um, come into the hospital and that depends if they need surgery or if they don't need surgery and how, uh, you know, for example, someone that's got a wrist fracture needs surgery but they don't need to be admitted and they can go home. Uh, whereas someone with a neck of femur fracture again, needs surgery but needs to stay home. Uh sorry, needs to stay in hospital to be managed with pain management. And also, um, they're in a lot of pain and they need to be operated on soon. And again, there's a lot of opportunities in orthopedics. You can, uh there's a lot of conferences, there's a lot of outings, these are just a few pictures over the last few years and, um, it's a fun specialty. It's a good group of people and there's a lot of boys and girls and it's, uh, it's nice. Um, and it's a good, it's a good mix of people from all sorts of backgrounds and it's, everyone's generally quite nice is what I would say. And in terms of subspecialties, uh, we've touched upon this but you've got a huge variety also. So generally as you progress through the years you sort of decide what you want to do. And your last two years of training ideally is kind of um focused around these uh focused around the subs question of your choice. Um But that doesn't always happen again, depending on which uh area you're in. But huge variety is what I would say. Some people go into sarcoma surgery. So that's tumors, uh sports and exercise medicine. Some people are more into their uh research, but there is pretty much everything for everyone in orthopedics and trauma generally covers, you know, pretty much, um, all the limbs. And most of the time when you start off as a consultant, you do trauma, so you fix acute fractures and then you also have an elective self specialty of your choice. And, you know, as time goes on, most consultants tend to kind of um leave the trauma to the young a lot and they tend to go into more, do more elective practice. An elective practice is what I mean by that is planned surgery So, you know, for example, for hands, if someone's got carpal tunnel syndrome, that's, you know, you would then do a carpal tunnel decompression. But that's again a planned elective procedure. So as mentioned, trauma elective and after ST three to ST eight, most people go on a fellowship. I think that's sort of a kind of standard requirement now. Um and that's usually a year or two. Most people do two. they do a national one and an international one most of the time. But again, it va it varies, some people do two national, some people do two international. It doesn't matter. But, um that's what I would say and there's always opportunity for education, research, leadership and private practice if you're into that stuff. Um, but that again is a lot later on. Uh a lot of, a lot of consultants do medical legal work. So with orthopedics, there generally is a lot of opportunity and the future of the specialty, I think further subspecialisation, there's been jokes going around that some people only do left knee replacements, some do right, knee replacements. Er, I wouldn't put it past them but, you know, that is a possibility. Robotic revolution is, you know, something uh that is coming, um that is happening in orthopedics, you know, robots are being used for knee replacements, er, shoulder replacements and, you know, i it's basically aiming to give the patient the most appropriate implant that's appropriately aligned in them. Um So that's pretty amazing in terms of how we're going ahead and also A I and DR are becoming more and more part of surgical education, career advice. I'll end it very soon. So E log book is something I would advise anyone to have from medical student onwards. Er, you know, keep a track record of your stuff. Um And all you really need to know for your E log book, it's free to register and you can uh you just need to have the patient's M RN number or NHS number. You need to have what operation they had and the date of the operation usually. Um I mean, there is a bit for like, oh who the consultant is, but you can always add that in the operation comments. Uh I have a tendency of copying pasting all my operation notes into E log book just so I can go back at it and have a look. Um But yes, for medical students, I would say get involved surgical, get involved in surgical society or if you're not sure, get involved in research and teaching everything you do will are transferable skills and will help for other stuff. It's quite nice to, you know, you've got time to kind of see what you want to do, whether it's if you're a surgeon or a medic or a psychiatrist or, you know, explore things and is what I would say. The foundation is, I would say a to do two surgical jobs. I would recommend starting off with a surgical jobs, uh a surgical job in F one purely because I feel like if you start with a medical job in F one, it's quite hectic and it's, uh, it's a bit mad whereas surgical jobs generally tend to be a bit calmer. Um So it's kind of a nice way to ease in, into F one and then your second surgical job ideally do it during um you know, your first placement as F two. So because January is when you start doing interviews for like core training and stuff, so you're sort of in that surgical mindset. And for the FY doctors, I would say aim to get your MRC S done early and dusted if you know, this is what you want to do. Um And whilst you're in core training, you can then focus on, you know, learning how to do clinics and operating. And I think for the core trainees, what I would say is learn how to do some clinics. I did not learn how to do them until ST three. So it was a bit of a struggle and um operating will come. One thing I would say it is a wining and dining process. You need to get their trust. Um The scrub team consultants, your registrar, like so be patient. And I would say this as a reg as well. It it's a constant um building trust process. So that's what I would say. Um, and again, get involved in research and audits and stuff as you're progressing through the years, medical students, I would say audits that can wait purely because you, we as med students, you tend to move around quite a lot. So you might not be able to complete the audit at the hospital, but research is doable. Um Anyway, what I would say is so BSA is the Medical Student Foundation, uh, uh, Doctors kind of, um, association. Um, for all those that are interested in or in orthopedics, bota is the British orthopedic trainees association. You know, we are mainly for the registrars, but we do things for our juniors as well and B OA is a overarching, you know, mother of all, uh, the British Orthopedic Association. So it's quite good to go to these Congresses. B oa boa and bombs tend to have, you know, have, um, a few days for themselves in bota as well. And then one thing I'm gonna do is a shout out to fundamentals of orthopedics. Um, that's a group of people that organize free teaching, free orthopedic teaching and, um, I'm involved in that as well. So, er, shameless plug. Um, but yes, there's a lot of teaching, uh, for everyone available through that. Um, and there is ast three application, er, session this Tuesday on the 14th, sorry, on the 12th of November. So Tuesday, 12th of November, um, and if you go and you can sorry. Um and we'll be talking about ST three applications there in, in a bit more detail. So yes, all the best if you need anything, please do feel free to contact. Um And if you've got any questions, please do let me know. Thank you. Lovely. Thank you so much for joining us today presenting on what I can most definitely empathize with you whilst I'm competent rotation. Um Yeah, but building those relationships, no one's gonna let you do anything until we know that you're what you are as a person. Uh Very true words over. Um I can't see any questions in the chat. Would you be happy for extra? Just a couple one pops and just type in your answers? Is that ok? Yeah. Yeah. Yeah. Lovely. Thank you so much for your time.