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Ok. I think we are live. Um I'll just check. Yeah. Ok. Do you want me to start? Um Yeah. Yeah. I mean, I'm happy to introduce whichever. No, it's fine. I'm, I'm happy to make a start. Um Good evening everybody. I'm assuming that there are some people out there, I can't tell, but I expect there are, I hope there are. I hope that there are lots of people out there interested and excited to hear about a career in anesthesia. I'm Nikki Hickman. I'm a consult anesthetist at Leicester General Hospital. Um, and I'm also the deputy head of School of the East Midlands School of anesthesia and I've been involved with recruitment um training and trainees in anesthesia at every sort of step of the way. So, um I'll try and excite you all about the prospect of possibly enjoying a career in anesthesia. So, um what we're gonna cover is have a think about who anesthetists are, where you can find us what the subspecialty interests. Um um what po possibilities of subspecialty interests. There are, what qualities make a good anesthetist, how to become an anesthetist. Uh a little bit about the exams and recruitment um and how you can make yourself competitive. Should you decide to pursue a career in anesthesia? And I hope that after this evening you're interested in it. So, what's an anesthetist? And where are you gonna find one? Well, you'll find us, um, pretty much everywhere. Um Here's a kind of a Google, quick Google search image of an anesthetist. Um I'm not sure how accurate it is. We've got a bit of a rep for being interested in cycling. Um, like having a bit of reading material. I think that's just a reflection of how old this picture is because nobody brings paper copies of the BJ A into theater anymore because we've all got them on our phones. Um, we also, er, aren't allowed to wear fitness trackers on our wrists anymore cos we're all bare below the elbow. Um, however, and we also can't bring our coffee into the, um, theater but we might sneak it into the anesthetic room when I was a medical student. Um, back in the eighties, I vowed I've never been anesthetist because in the eighties, everybody had big hair and the prospect of having to wear a theater hat all day and having hat hair really put me off. But times have moved on now and um, we don't need to worry about hat hair anymore because nobody has big hair anyway. Moving on an anesthetist puts people to sleep, don't they? And that's it. That's what my mum thought certainly when I told her that I was going to be an anesthetist, she thought, well, all you do is put people to sleep all day. Actually, we do a little bit more than that. Um We are involved with pre assessing the patients. Um There are full departments looking into rehabilitation and optimization of patients to ensure that comorbidities are in the best situation that they can possibly be before they enter a risky situation. We need to have some kind of objective assessment of risk um and plan to mitigate against that risk depending on what surgery is um anticipated for that patient. And obviously a patient who is high risk is going to need quite a lot of reassurance. They're going to want to know, you know, are they gonna die? What's gonna happen to them? What do they say to their families? Um What decisions should they make and that's where our communication skills and our ability to involve the patient in shared decision making become important. Um We've got quite a reputation for being pretty good at IV access and we are constantly being invited to wards to support teams there when they're struggling with a cannula, often having ruined all the veins before we get there. Um But we're in general happy to help provided. More urgent situations aren't calling for our attention. And obviously we are the hospital's airway experts. We are also pretty expert in planning um analgesia and fluid balance both intraoperatively, preoperatively sometimes um in emergency situations and definitely postoperatively. And we are pretty heavily involved with postoperative care, whether that's in the for a sort of pretty straightforward case or whether that's longer term for patients who need more intensive care. Um And that's kind of it, but there's still quite a lot of other stuff that we do. Um We are involved in a lot of nonclinical areas of work as well. We're involved with teaching quality and safety. We um work hard on teamwork and resuscitation. So there's a little bit more to it than just putting people to sleep. And where do you find us? Well, as I've indicated, you will find us everywhere. Obviously, the big three are the operating theaters, the intensive care units and delivery suite. I don't know if you're aware of that, but we have a pretty heavy presence on delivery suite. Um But we also have our own clinics, our high risk assessment clinics, our prehabilitation clinics, our post itu clinics, pain clinics. Um There's, there's a long list of different clinics where we might get involved. Then that's an option. It's not something that you have to do if you want to be an anesthetist and if clinics aren't your thing, there are plenty of ways that you can avoid them. Um You might find us in X ray or other non theater environments. Um ECT for example, um can require uh anesthetic input. Um We can get involved with MRI S for Children or uncooperative adults or just adults who are very sick. Um So, you know, we have a presence in X ray and endoscopy and A&E we are called there for a variety of reasons, usually as part of the resuscitation team or if they want us to take the patient to either theater or intensive care. Um I'm sure you're aware that we're on the cardiac arrest teams and you'll see us around on wards where we're doing our pre op assessments and perhaps reviewing patients postoperatively looking into pain management, um situations, fluid balance situations. As I mentioned, IV access, you're perhaps not aware that anesthetists are often also involved in hospices. Um Pain management is a subspecialty area of interest for some anesthetists and um its value in palliative care just can't be underestimated. So hopefully, I've given you a, a feel for the variety of areas of work that um we are involved with and the number of subspecialty areas that we um participate in are innumerable. Really, some of them are kind of linked to the type of surgery that's taking place. So we've got, I don't know if you can see my arrow, my cursor here, but we've got in the middle, we've got general surgery, bottom, right? You've got cardiac surgery, um, which is pretty exciting with lots of tubes and machines. And then in the bottom middle, you've got neurosurgery, which is altogether a much calmer, quieter environment usually. And then we've got bariatric surgery which presents some really particular challenges and that's the bottom left if you haven't guessed, um, uh, both for the surgeon and for the anesthetist, you know, bariatric patients are particularly challenging for us. But so then are some of they are plastic surgery patients. So, top right, we've got this baby with a cleft lip and palate. You know, you've got a challenge there, not just linked to the um surgery that's required, but also to the size of the patient. And then some of our trauma victims um really do present pretty significant airway challenges for us and where else? Well, here we have areas which are not necessarily linked to the type of surgery that's conducted, but they're areas that we get involved with. Um, you know, we, we are lots of intensive care consultants. The majority of intensive care consultants are also anesthetists. I've already mentioned to you pain management as being a particular um subspecialty area for that an tend to gravitate towards um sleep medicine, um requires a sort of detailed understanding of sleep physiology and brain physiology. Um and it has impact and consequences for anesthetists. And as a consequence of that, again, anesthetists are often involved in sleep medicine clinics, um of the airway is the big thing, you know, being able to manage a any patient's airway is a particular skill. But even more. So if you look on the top, right, being able to do that in the field as part of your subspecialty interest in pre hospital emergency medicine is even more valuable. And then we've got subs subspecialisation really in part as a consequence of the patients that we are looking after. So rather than the surgery driving the subspecialty, um we've got the patients themselves. So you can see pediatrics on the top, right, that covers quite a spectrum. You've got very tiny patients and you've got some much larger patients, all of whom fall under the pediatric umbrella and some of whom have got some really quite significant um physiological challenges. Um for both the anesthetic and surgical teams. Obstetrics is a big part of obstetric of um anesthetic training. Um It's a big part of our service delivery. Um And for some of us, it's a big part of our ongoing consultant careers. And obstetrics is interesting. I'm an obstetric anesthetist myself. But um it's interesting because it covers you looking after not just one patient, you're looking after two and a big part of obstetrics is pain management and we operate under a lot of regional anesthetic techniques. Um but regional anesthesia where we just numb parts of the body is again, another area that's where skills can be applied in a variety of those other subspecialty areas. So that's something that's sort of more skills based rather than patient based. But we do have our regional anesthesia experts who get to stick needles into interesting places using ultrasound guidance. So let's move on a little bit. What else do we do? I mean, I've talked, given you a bit of a shopping list of clinical environments where you'll see us working. But we are also heavily involved with teaching and training, not just of our own trainees, but we're involved usually in um a lot of other environments because people like to see what we can do in simulation. And a lot of the foundation program, teaching simulation teaching is delivered by anesthetists and anesthetic trainees. But within the anesthetic environment, you can get involved as an examiner or as part of the training program. And as a training program director, there are innumerable educational roles available. Um Same goes for leadership. The fact is that anesthetists are the most numerous specialty in any hospital. And as a result of our sheer volume, we are often involved in leadership areas and management areas and both within our own specialty and other specialties. And then like any other subspecialty area, we get involved with quality and safety and of course research and academic activity. So what makes a good anesthetist? Um it helps to be calm. Um It certainly helps to look calm even if you don't particularly feel it. I mean, that's the key skill is making it look as if you're calm and you like a swan gliding on a pond when actually you're peddling furiously under the water, but nobody needs to see that because actually when the ship's hitting the fan, um what you need is a calm leader who can take a good helicopter view and doesn't get diverted into the minutia of what's going on and in and often that's the role of the anesthetist. It helps to have a degree of manual dexterity. Although we're not getting involved in detailed procedures in the same way that some surgeons do. Um we do still undertake quite a lot of practical manual procedures with our cannulation, our regional anesthetic techniques or some of our airway techniques. Um All need a degree of um careful manual dexterity. It helps to be curious about what makes things tick, you know, how do things work? Um We use quite a lot of machines. Um And when you're training to be an anesthetist, you've got to have an idea about how they work because you need to have an idea about what to do if they stop working because, you know, they're not just interesting add-ons, they're key to what we're doing. And if your anesthetic machine stops working, you need to know what to do about it and what functions it fulfills. You need to be a good communicator. We see patients at one of their most vulnerable times when they are feeling quite um scared, um anxious, worried, they don't know what's going to happen. I mean, we've got a really, really short time frame in which we need to get all the information that we require from them and provide them with all the information that they require to allow them to enter the anesthetic room with in a sort of calm frame of mind, feeling, you know, uh not too anxious um and feeling confident about what's going to happen to them. And that takes a bit of skill. Um I think some people think, oh, and these cysts don't need to be able to talk to patients because the patients are always asleep. And I would always argue about that because actually, we need to be really good at communicating with them because we've got a lot to do in a very short space of time. I've already pointed out to you the importance of being able to lead a team. Um, so I'm, I'm not going to go into that any further, but it is key. You need to be able to take a helicopter view, see a view of what's going on. There are, there is no question that some of our surgical colleagues and absolutely by no means all are still slightly pre Madonna. Um, and most anesthetists tend not to have that big an ego, but they're still pretty good at, um, steering the ship. Um The other thing that you're gonna need if you want to be an anesthetist is uh a bit of academic ability. Um, cos the exams are quite hard. They're, they're good exams. They're fair exams, but they are big exams and they're quite difficult. Right. So let's have a little think about the pathway to becoming an anesthetist. Um First of all, you've got to complete two years of foundation training just like everybody else and you may or may, may or may not want to do a little bit more. Um A lot of increasingly, I'm finding that a lot of our new CC ones have actually done a third foundation year whilst they build their CV. Um But either way you'll get recruited into anesthetic training. There are two core anesthetic training pathways in which is called stage one of anesthetic training, you can either enter it as a core trainee or you enter it as an A CCS trainee. The difference between the two, it's one year. Um the content, the anesthetic content of both programs is the same. Um But if you enter a via the A CCS pathway, you have an extra year during which you do six months of acute medicine and six months of emergency medicine. And then the rest uh is actually pretty much the same. There are some sort of slightly different competencies that you need to do as an A CCS trainee. Um But essentially the anesthetic bit is about the same. So for A CCS stage one takes four years, but for a core trainee, it takes three years. During that time, you undertake flexible broad based training, you learn the basics of anesthesia. There are a number of high learning outcomes that need to be achieved as well as the primary F RCA. And at the end of stage one, which is gonna be either three or four years long. We um you then need to apply to enter stage two or specialty training. So we are an uncoupled specialty and you are at the end of stage one, you do need to reapply. Um And then stage two last two years, you build on the knowledge that you got in stage one, develop your subspecialty interests a little bit and you then you also need to pass the final F RC during that time before progressing to stage three, which is when you learn to become a consultant. And then at the end of that, uh you've got your CT and I think I'll say all of this again here and this, this slide, I don't think I need to say any of that again. So what is a school of anesthesia? The schools of anesthesia exist all around the country in different regions. There are different schools of anesthesia. Um Within each region, there's a postgraduate dean who is responsible for all of the schools or for all the different specialties. We have a head of school of anesthesia and then on the deputy head of school, our school covers the region from Chesterfield. Um I'll kind of give you north so north is Chesterfield. Our western boundary is um Burton Burton on Trent, our eastern boundary is Boston in Lincolnshire and our most southerly boundary is Northampton. So any big hospital in our region that you can think of has got ESA so East Midlands School of anesthesia trainees in it. So, Boston Lincoln Nottingham, uh where else have you got? Chesterfield Kingsmill um Derby, Burton Leicester, Kettering Northampton. I don't think I've missed any out. Um Anyway, so we cover quite a big area and as a trainee, you would be expected to move around the region, but most regions are included, sort of split the region up a little bit. So we've got a kind of northerly rotations and southerly rotations. You wouldn't be expected to commute between Northampton and Chesterfield because that would be unreasonable, but you would always be expected to spend some time outside the central hospitals. Um Lots of other people involved in training within a school. We've got the training program directors who decide where everybody goes. Um We've got college tutors who are based in the individual hospitals and then we have consultants who function as leads for the different subspecialty areas of the curriculum. Um And your responsibility is as part of a school of anesthesia is to maintain your portfolio throughout your training on the lifelong learning platform. Love it or hate it. It's what you've, what you've got, right. I did mention some exams. Um You're already going to have to do your um medical degree exams. Um If you want to become an anesthetist, you're gonna have to do at the moment, you're going to have to do the M sra I can't see that changing anytime soon. And that's part of the selection procedure for the anesthetic training program. I'll tell you a little bit more about that in a few minutes. Um Then you do the primary F RC which consists of a written element and then, and an oral element. Um The written element is evolving. It's no longer purely MC Qs. It's got single best answers um as well. And it's moving towards a fully single best answer approach. Um But, and the oral element is moving a lot more wholesale towards Aussies. But at the moment, it is still an Aussie and Avior and you need to pass all sections of the exam. Um But sort of slight, you can do so in slightly different sittings if needed. If you've only passed one part and not, you say you've only passed the old ski up but not the vivo, you wouldn't need to sit both of them again, you could, you only need to sit one of them again or the one they tend to succeed in. And the final F RCA is also a two part exam. There's a written and an oral exam. And again, I'm not going to tell you too much about that because that is definitely changing. Um So before any of you were to get to a point where you were going to be sitting in the final F RCA, it will have changed. Um, but I suspect it will still be a written element and an oral element. Um And then depending on what your subspecialty interest is, you may end up having to take a specialty exam. If you choose to do pain medicine, you'd be well advised to do the pain faculty exams because they're the ones that give you better jobs. Um And if you want to become an intensivist, then, um, you would need to pass the fam exam. So do you want to be an anesthetist? Because if you do, there's a few things that you should probably be thinking about doing unaware that Leicester medical School doesn't really give you much time doing anesthetics, which is a bit of a surprise. Really, as I said, we are the biggest hospital specialties. So you'd think that you've got a little bit more time than you do. Um, there's an expectation that you'll, you'll get to do a bit of anesthetics whilst you're doing your surgery attachments. But I'm not sure that the surgery attachments have kind of worked that out because certainly the medical students I see in theater tend to glue themselves to the surgeons and pretty much ignore what goes on in the anesthetic room. But if you want to be an anesthetist, just talk to us, we are on the whole, pretty approachable. As I've said, we don't have much in the way of egos. Um and always want to encourage new blood to enter our specialties. So use your time during your surgery attachments, cos you are supposed to be getting some anesthetic exposure during that time, come and visit us, you know, come and talk to us in the anesthetic room. Don't just barge in when there's a patient in there, get there early, we get there early and um and see if there's anything that you can see or do. Um, I'm not too sure what the mechanism is for organizing taster weeks, but I'm aware that a lot of, um, medical students do do taste a weeks in anesthesia and generally enjoy them to a great deal and electives. Um, whether you do an elective in this country or a different country, um, doing an elective in anesthesia is not gonna do you any harm if that's what you want to pursue as a career. In fact, if you wanted to do any acute specialty, doing an elective with anesthetic involvement isn't gonna do you any harm at all because a lot of the skills and knowledge that you acquire as an anesthetist is really transferable to other acute specialties if you've had a chat with some anesthetists and have suggested that you'd be interested in doing a quality improvement project or an audit, um, that would be really good for you to do a little bit of CV building. Um, you also need to be able to prove that you're fairly bright. Um, and a little bit of academic achievement isn't gonna do you any harm? The an aro is the anesthetic national recruitment office and it coordinates anesthetic recruitment for the whole country. I've actually spent most of today sitting on teams, uh, doing interviews for ST four applicants and that was all coordinated by an, um, but they've got a website which has got all the information that you need. It's got the person's specifications. Um It, it tells you what's essential and what's desirable as an anesthetic applicant also when it's gonna happen. Oh yeah, that's my blank sign. I bought that by mistake. I'll move that through that quickly. Right. So here we go, er, recruitment. Um It is a national recruitment process. Um As I've said, it's coordinated by Amro um before, as part of it. If you want to apply to core or CCS A CCS and core, it's the same pathway, er, application pathway, you need to do the M SRA exam. And um the M SRA exam was introduced a few years ago as our shortlisting tool for CT one recruitment. Um It's been validated pretty well. Um Although a lot of the questions aren't super relevant to anesthesia um that is changing and the Royal College of Anesthetists are having a bit more input into the, what goes in the questions in the M SRA exam so that they're a little bit more relevant to the acute specialties and to anesthesia in particular, um Either way you shouldn't be put off by the M SRA exam and feel that it's a, a bit of a blunt tool. What we found is that the candidates who sit the exam and who subsequently get appointed to anesthesia are usually the top scorers. Um So if you got a good score in the M SRA, you're very likely to get an interview. Um We do our best to interview everybody but our who we interview is determined by interview capacity. So the enro will ask all of the regions, how many interview slots they can provide and that's the number of interviews that they will um offer and during the interview which will be held online, um there'll be an assessment of your, the commitment, you've been able to evidence your commitment to the specialty. They want to recruit people who really want to do it, not people who've just applied to cos we didn't know what else to do. Um We want to have an idea about your clinical knowledge and um what other activities you've been doing to build your portfolio. Whether you've got any evidence of leadership, which doesn't have to be in a medical field, you could be a scout leader or um play in an orchestra um or you know, do something, be a field, first aider or some kind of sporting achievement. These are all relevant and they're things that we're interested in. Cos we're interested in the whole person. And as part of the evaluation, we'll be looking at your communication skills and try to get in a feel for what your performance under pressure would be like in a clinical environment. But also how aware you are of what's going on around you. So, um this is just some information about the M SRA exam. It's, it doesn't actually contribute all that much to your, your overall selection score, the interview um contributes more and I I've already alluded to why that might be because currently the M SRA exam doesn't actually contain a lot of acute um relevant material um for us as anesthetists. However, it is a really useful tool for shortlisting and stratifying out applicants who probably wouldn't be suitable for us at interview. Essentially people who haven't scored as well in M SRA don't do as well in the interview. It, it is a very clear relationship. Um at the, this is kind of what the interview looks like at the moment. There's a, a general interview which could be, which is going to explore why you want to be an anesthetist and what your commitment is. Um And then there's likely to be a clinical scenario. I don't really want to go into too much detail about that because it, this may well change. Um So you would be advised to look on the college website and on the ARO website um for more up to date information. Um because I think, you know, these things are evolving all the time and the recruitment committee at the college is doing its best to make it as valuable and discriminatory a process as possible so that we can really tell the wheat from the chaff and get the right people in the jobs. However, what I can tell you is what the competition ratios look like. We are a very popular specialty. This is data for 2024. So this is this year's competition ratio data and we had 3.5 1000 applicants for 542 posts. So that gives us quite a sizable competition ratio, 6.5 applicants for every post. And if you compare that to internal medicine, um more posts, less competition for them. I'll just put that there as an example. Um uh but you shouldn't be put off by these competition ratios because there will be within those that number of applicants. Um Some people who, who are just kind of doing the M SRA and they'll be putting a tick in the box for anesthesia who don't really want to be anesthetists and they're just kind of filling in the, you know, filling the application form. So we're well aware of that. Um And on the whole, those people don't do quite so well in the M SRA test. Um And which is why we interview a smaller number. So we wouldn't be interviewing all 3.5 1000 applicants. We certainly wouldn't have that interview capacity. We would probably be interviewing more like, and I am plucking a number off the out of the air, but I think probably between seven and 800 um would be the maximum in that we would interview. So if you, once you've got an interview, you're in a much better position to shine and get yourself um appointed. Uh I don't know how well this slide transfers, but that's just an indication of the number of posts available across the country. But the, again, this varies depending on the time of year in which recruitment round it is, whether it's August or February. Um and what's going on with the curriculum and the nation and political, politically and pandemic wise and things like that. So we'll just move on from there, right. What can you do now if you want to be an anesthetist? Um Well, there's things that you can do that you haven't done already. Um If you haven't done an intercalated degree, um it might be helpful to you to do one. It doesn't give you extra points if you do an intercalated degree, but the experience that you gain enduring an intercalated degree might so it's, there's a, it's a points based ranking system just like all the other specialties. Um But so an intercalated degree could be useful provided it was in the right um area just doing one isn't going to help. Um If you however, are lucky enough or clever enough to get some academic prizes during your undergraduate career, then that will help you. Um somebody who's demonstrated a lot of commitment by ensuring that they have done an elective or taster sessions or special study unit um in anesthesia that will be good for you in getting you shortlisted. And it will certainly give you something to talk about when you have your interview, your fy choices um can be useful to you as well if particularly if you do one with a degree of ICM and or anesthesia as part of it, whether you do that in F one or two, or whether you do that as an F three post or a standalone fellowship after your foundation years is up to you. There are a few courses that you can do a TLS. That's a good one to do, but it's expensive. So you need to get somebody else to pay for that ideally your employer. But then there are a few things that you can do online which just again, they demonstrate an interest, they demonstrate commitment. There are other specialty areas which are useful and have got complementary transferrable skills. Um I've listed a few here and neonates is a particular one because the skills that you learn there are incredibly transferrable. So too is experience that you some of the experience that you gain in the emergency department postgraduate. There are exams that you can do. Um probably at your stage, you might not be thinking about doing a masters or a phd but doing M CM or um paces. These types of things are um valuable. Um and they're kind of, they're good currency when it comes to applying for anesthesia. Um you might want to get involved with teaching, teaching, junior colleagues, teaching peers. You might want to get some kind of qualification in teaching or at least do a small course so that you understand the principles of teaching. Same goes for research and publications. If you're lucky enough to, to get to do a qi project that is subsequently presented as a post to war as a verbal presentation, that's good currency too and that helps you in the recruitment process. Um And I've already mentioned audit, I don't know if anyone is listening, I hope that you are. Um And if you've got any questions, I would be more than happy to answer them. My email address is on that slide. The Association of Anesthetists is a great resource. There's lots of information there, Royal College of Anesthetists has a really good page on um uh guiding you if you're considering a career in anesthesia. Um And I think I'm hoping that I've been able to share a little bit of my enthusiasm for the subject. You know, I've been an anesthetist for probably longer than most of you have been alive. Um And I still love it. I still enjoy what I do. Um Part of the reason for enjoying it is the variety and the people that I get to work with. Um And it's a great job, come and do it, come and give it a try. Uh And if you wanted to leave some feedback, you can use that QR Code, right? I can see a question. Does it matter too much? What was presented or? P No, it doesn't actually. Um when you uh so for um CT one applications, um your opportunity to talk about what's been published is really only at the um interview. So at interview, they probably won't really be asking you about publications anyway, for CT one, it's when you subsequently move on um and apply for ST four when you're getting to the next step, that's when publications can score you points. Um There's a self scoring matrix that um I mean, and it's too early now to be thinking about it, but you know, you're wise to be considering publications um and the scoring matrix is um would would place value on any publication, but it gives you less to talk about at the interview. It gets you the interview, put it that way. So a publication is gonna help you get an interview for ST four but not particularly for CT one. Whether or not it's anesthetic. Does anyone else have any questions? Um Thank you for the talk, Doctor Quinn. Yeah, II. Do have a question with something you mentioned. Um So you mentioned doing uh when you were explaining the specialty exams that you can do after F RCA final, um you said that pain management would get you the better jobs. What did you like? What did you mean by that? So if you so to become a pain specialist that requires an extra, it requires a year of training in pain as part of the um as part of your anesthetic training program. Some people do that as a post CCT fellowship. Um And if you then, so that will then qualify you to apply for jobs with a big pain management element to it. So pain manage management is a pretty focused subspecialty interest area. The exams, the pain faculty exams are quite hard hitting, they're quite tough exams. I wouldn't want to do them. Um But if you, if you then get a job applying for a job as a consultant, it with pain management sessions, you're just like anything else, you'll have a better chance of getting the job if you've got the exam. But having the not having the exam doesn't prevent you from getting the job. It just makes you more competitive, right? Olivia's on the, on a roll. Any concerns with regards to anesthetic associates and future recruitment numbers for doctors, honestly. No, I don't. Um What I thought, what I didn't tell you is that I've actually got a um a bit of a role at the college in addition to my regional role as the head of deputy head of school. So I'm a little bit hearty to some of the discussions that have been going on about anesthesia associates. Um At the moment, the training of anesthesia associates has been paused whilst the GMC um and the college give some thought to exactly what their scope of practice is going to look like. Um They, the numbers of anesthesia associates are fairly small. Um And their role isn't actually all that well defined because they can't under the currently scope of practice guidelines work independently and therefore, can't work out of hours without with remote supervision. So they need to have directly available um supervision and um because of that, their role in anesthesia services is kind of limited um and doesn't really impact, oh, I'd say no, it doesn't, is a bit too strong a word. It is unlikely to impact significantly on anesthesia training. It is very much in this country, a physician led specialty. And I don't see that changing in the near future. I see the number, the requirements for anesthetic numbers rising rapidly um because our population and demand is rising all the time. So it's a good question. Right. Year one, Derek, year one graduate student with a pharmacy background, do it, do it if you've got a background in pharmacy. Um Yeah, it takes seven years. Um But if you know any hospital subspecialty or any hospital specialty is gonna take you around that length of time. The fact that you've got a pharmacy background is gonna help you because you are going to find the exams much less challenging than many of your peers. Um And that background is going to be um really, really useful to you. Your maturity will be really, really useful to you as well. Um If you, if you really like anesthesia, um you could go through the core training program so that cuts it down by a year. There's no need to do a CCS. Something that I perhaps didn't make clear to everybody was that if you're interested in a career in intensive care as a dual trainee dueling with anesthesia, you probably should do a CCS. Um That would be a better pathway for you than doing core. Um So sorry, I did mean to emphasize that point, but I forgot, but Derek, you don't need to do a CCS if you want to be an anesthetist and not an intensivist. Um So that makes it seven years. Um And uh it's a great job at the end of it. Um And having a bit of maturity and having a pharmacy background is a huge advantage. Um So do it. Is my advice. Is there anyone else out there with a question for me? I just had one do Hickman if that's OK. I know in a lot of sort of medical and surgical specialties there's a trend of as everything becomes more specialized, people start needing post CCC fellowships to sort of find consultant jobs. Is that a trend in anesthetics as well or? No? No, it's not yet. Some people might choose to do that because of the interests that they've got or just that they, they want to spend a little bit of time before they join a consult, get their consultant job because they're gonna be a consultant for a very long time. Um But no, it's not, not yet. Um And I don't see it yet. Um We've just, so we've started our new curriculum, we're still calling it the new curriculum in 2021. Um And we fought quite hard, the college fought quite hard to retain a seven year training program. The GMC wanted us to shorten it. Um And the reason that the college wants it to stay seven years is that they, or one of the reasons is that a, it takes seven years to train a consultant anesthetist with that whole skill set that that involves, which is not just about the clinical work. Um And what they want at the end of seven years is a fully formed product. They don't want to be kicking people out after five years who then need to go and do something post CCT to make themselves comparable with consultants who spent seven years in training. Does that make sense? So, yeah. No, thank you. Unless you want unless pain might be something, you know, there is the old subspecialty interest, but on the whole, no, absolutely not. Now, Olivia, how easy is it to go less than full time and have a family in training? Ok. Bear in mind that I started, I qualified in 1990. Ok. So I finished my medical degree in 1990. Started my anesthetic training in the early nineties. I had two Children during my, um anesthetic training and I worked less than full time and that was in the nineties. Ok. Um So you could do it then. Uh You can definitely do it. Now. Anesthesia is one of the specialties that um welcomes less than full time trainees um with open arms. Um I just, my role at the college is actually as a representative lesson, full time training. Um I am a bit of a national expert on the subject. Um um The, the number of less than full time trainees is rising throughout all of the specialties. I mean, anesthesia hasn't got the most. There are the most are in peds, pediatrics, but that's mostly because there are more women doing peds than men. So, whereas in anesthesia, um we're not quite 5050 there's still more men than women doing anesthesia, but we are also approaching 50% who are working less than full time and that's of both genders. Um And at the moment, it's not limited at all. So, um if you ask to train less than full time. Um It will usually be accommodated, particularly if you have a family. I wouldn't say it's an easy thing to do to have a family in training, but it's definitely doable. And I know that cos I've done it, II would recommend that you do the exams first. Cos trying to do exams when you've got a baby is not much fun. Any other questions I just want to ask. I noticed a slide that talked about um A CCS post versus core training posts. Um So is there a reason why there's a discrepancy between the number of posts available by region? So I noticed that West Midlands had quite a few A CCS post compared to core training versus some regions in some regions. A CCS is the only pathway into core anesthetic training and that's just a regional decision. Um I'm not sure which regions do and which don't. I think w West Midlands is one where if you wanna do anesthesia, you have to do a CCS but not all regions do that. Um Within the East Midlands, we take around 24 core anesthetic trainees on every novices, every August and there are around 10 A CCS trainees start. So we're more in the East Midlands, there are more poor than there are a CCS um around the country that balance varies. Um And some of it will just be to do with which school is in charge of the A CCS program. So here is the E it's emergency medicine. So emergency medicine are the training of the P TPD S who look after the A CCS program. So they kind of, they're not interested in expanding their corp, their anesthetic posts. Um In West Midlands, the training program director is an anesthetist. And um so it, the balance goes the other way around. It kind of makes sense because in emergency medicine always makes sense because for emergency medicine, A CCS is the only pathway to enter, run through training. So if you wanted to do emergency medicine, you have to do A CCS and then you have to do six months of anesthesia. And you would be astonished how many emergency medicine trainees um change their mind about their preferred specialty after they've done their six months of anesthetic. Oh, that's really interesting. Thank you. Um Last question for me. So why are there two different kind of application cycles in a year? So does that mean they start at different points within the year? I think you mentioned like October. Yeah. So the big round is in August and that's the same for all the specialties. So there'll be a big recruitment round in August because when you think about it, you all come out of university in the summer, you start your foundation jobs in August. There are two, you know, you've got two years of foundation to do and then you're ready to start your specialty training. Um So February, August is the big intake. Um But there'll always be people who maybe needed to resit an exam in medical school or who wanted to do something else. They weren't quite ready to enter specialty training in August. Um Maybe they wanted to go traveling. Um So there's another recruitment round which takes place in February. Um What takes place for February? So this one that's currently in progress at the moment is for next February. Um And that's usually a smaller recruitment round. So the numbers involved are a little bit smaller. Um And may it might improve, sort of the competition ratio is a little bit because it's a smaller recruitment round. So that's all. And actually, you know, it's good for people who've taken time out of the program, just taken time out to have a baby if they were ill, whatever. Ok. That makes sense. Thank you. Ok. Does anyone else have any questions for Doctor Hickman? Ok. If not, can you please scan Doctor Hitman's QR code and give feedback, please? If you could do our one as well. That would be amazing. Thanks for listening, everybody. However many you, you are got no idea and um good luck. Brilliant. Thank you very much, Doctor Hickman.