Surgical Interviews: The Survival Guide

Surgical Interviews:

The Survival Guide

Edited by

SHELLY GRIFFITHS

MB BS MA (Cantab) MRCS

Specialist Trainee, General Surgery

Boca Raton London New York

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British Library Cataloguing in Publication Data

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ISBN- 13: 978 190936 892 7 (pbk)

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Contents

List of contributors v

Introduction 1

1 Core surgical training 2

Euan Harris and Ceri Rowlands

2 General and vascular surgery 12

Shelly Grifﬁ ths

3 Urology 21

Helen Teixeira

4 Otolaryngology 29

Warren O Bennett

5 Trauma and orthopaedic surgery 39

Al- Amin Kassam

6 Plastic surgery 47

James Paget

7 Cardiothoracic surgery 56

Ishtiaq Rahman and Adrian Marchbank

8 Neurosurgery 69

Adam Williams and Laurence Glancz

iv CONTENTS

9 Oral and maxillofacial surgery 79

Mark H Wilson and Tom WM Walker

10 Paediatric surgery 86

Rebecca Roberts

11 Essential knowledge and hot topics 94

Thomas Fysh and Shelly Grifﬁ ths

12 Beauty in the eye of the beholder: a guide to

improving your curriculum vitae 125

Nicholas Markham

References and further reading 137

Index 139

List of contributors

Warren O Bennett MA (Oxon) MBBS

MRCS DOHNS

Specialist Trainee T3 Severn Deanery,

Otolaryngology

Thomas Fysh

FRCS MEd MSc

Consultant Breast and General

Surgeon

Laurence Glancz

MBBS BSc (Hons)

MRCS (Eng)

Specialist Trainee, Neurosurgery

Shelly Grifﬁ ths

MB BS MA (Cantab)

MRCS

Specialist Trainee, General Surgery

Euan Harris MB ChB BMSc

Core Surgical Trainee

Al- Amin Kassam

BSc (Hons) MB BS

MRCS

Specialist Trainee, Trauma and

Orthopaedics

Adrian Marchbank

BSc FRCS (CTh)

Consultant Cardiothoracic Surgeon

Nicholas Markham MB MS FRCS

(Eng) FRCS (Ed)

Consultant General Surgeon

James Paget

BM BCh MA MRCS

Specialist Trainee, Plastic Surgery

Ishtiaq Rahman MRCS MD

Specialist Trainee, Cardiothoracic

Surgery

Rebecca Roberts

MB ChB MRes MRCS

Specialist Trainee, Paediatric Surgery

Ceri Rowlands

MB BCh MRCS (Eng)

Core Surgical Trainee

Helen Teixeira MB BCh MRCS

Specialist Trainee, Urology

Tom WM Walker

MB ChB BDS DOHNS

MRCSI AKC

Clinical Lecturer/Honorary Specialist

Trainee, Oral and Maxillofacial

Surgery

Adam Williams

BSc (Hons) MB ChB

MRCS (Eng)

Specialist Trainee, Neurosurgery

Mark H Wilson

BDS (Hons) MFDS

RCSEd MBBCh (Hons) LRCP&SI

MRCSEd

Specialist Trainee, Oral and

Maxillofacial Surgery

Introduction

Some people are natural interviewees. No matter what happens and

however high the stakes, they will not be thrown, they are able to give

clear and coherent answers to whatever is asked of them and they are

able to come across simultaneously as both conﬁ dent and eager to

learn. The rest of us are human.

The best advice I have ever been given was to treat an interview as if

it were an exam and revise, rehearse and repeat, until you are able to

convey at least a façade of conﬁ dence regardless of how you feel. The

only way you can do this, of course, is to have a pretty clear idea of what

is likely to come up at interview. This book is the only comprehensive

interview guide available to future surgeons, written by fellow trainees

who have recently, and successfully, been through the interview proc-

ess themselves.

Good luck!

CHAPTER 1

Core surgical training

Euan Harris and Ceri Rowlands

Core surgical training (CST) is a 2- year programme that prepares junior

doctors for a career in surgery. By the end of CST a candidate will have

completed 24 months of surgical training and should have the necessary

experience to apply to specialty training. As of 2014, recruitment to CST

became a national process for the ﬁ rst time. Currently, the Core Surgery

National Recruitment Ofﬁ ce (CSNRO) manages applications for CST

in England, Wales, Scotland and Northern Ireland. Make sure you pre-

reminders from the CSNRO regarding deadlines and that you are kept

informed about the progress of your application. Recruitment to CST

has altered drastically in recent years and further changes may well

occur. Checking the CSNRO website will offer the most up- to- date

information.

All candidates who meet the eligibility criteria are guaranteed an

interview. The ﬁ rst round of offers can be accepted (with the possibil-

ity of an upgrade to a higher- ranked post), rejected or held for a ﬁ xed

period of time (if candidates are waiting for offers from other special-

ties). If you are not made an offer in the ﬁ rst round, do not be too

disheartened; further rounds of offers will occur as and when other

candidates reject offers. Any remaining unﬁ lled post will enter a clear-

ing process.

THE APPLICATION FORM

Although the offer of a place in CST is primarily dependent on your

interview performance, the application form is your ﬁ rst chance to

differentiate yourself from your fellow candidates. Read the person

speciﬁ cation carefully, as it will help you to format the answers in your

CORE SURGICAL TRAINING 3

application form. Aim to meet the desired and the essential criteria.

Some aspects of the form require you to upload documents in sup-

port of your application – for example, your certiﬁ cate for completing

Foundation training or achieving full General Medical Council regis-

tration. Allow plenty of time to identify and source these documents.

The most important part of the form is the three self- assessment

questions. These assess your experience in audit, research and teaching.

Make sure you choose the answer that best describes your achieve-

ments, as each higher level is worth another point in your application.

Whatever level of experience you declare will need to be supported by

entering a short summary in the free- text boxes on the form. Focus on

speciﬁ c examples that demonstrate the level of experience you have

selected. Your answers will also dictate what interviewers will be expect-

ing to see in your portfolio during your interview.

You can also use the self- assessment questions to identify areas of

weakness and use the remaining time before submission to improving

these areas, maybe by completing an audit cycle, submitting an abstract

to a meeting or offering to help out at a regional teaching day.

THE INTERVIEW

The whole interview process comprises three 10- minute stations:

1. management

2. portfolio

3. clinical scenarios.

Generally, two examiners are present at each station and will take turns

asking questions. A brief description of what to expect in each station

and the types of questions that are asked is given here. Your own answers

should be personalised, reﬂ ecting your experience, and should convey

your understanding of the subject in a concise manner.

Management station

The management station encompasses your non- technical attributes

and knowledge, and you should be prepared to talk about personal

abilities such as communication skills, leadership and teamworking.

You will typically be given two ‘challenging’ scenarios and asked about

how you would address these problems. In addition, questions may

focus on current topical issues within surgery, including training. This

is an opportunity to show your general awareness, interest and com-

mitment to the specialty.

The following are examples of questions that have come up in the past.

4 SURGICAL INTERVIEWS: THE SURVIVAL GUIDE

What is clinical governance? Why is it important in clinical practice?

● Remember clinical governance fundamentally relates to maintain-

ing high standards of care across the National Health Service (NHS)

while seeking ways to ensure continued improvement. Have your

own way of describing what you feel clinical governance is.

● Describe its relevance in patient care – for example, through regular

audit, and critical incident reporting. Be aware of examples in your

own practice where you have been aware of how clinical governance

has affected patient care.

What teams have you worked in during your clinical practice? What skills

do you have that make you a particularly good team worker?

● This question gives you the opportunity to show your teamworking

skills, such as communication skills, reliability and commitment. Try

to use a speciﬁ c example, such as a research or audit project you’ve

been involved in, or the management of a very unwell patient.

● Avoid listing adjectives of what you think contribute to a good team

worker. Instead, pick two or three features of teamworking and

describe in detail how you display them with examples.

Can you tell me about a time you made a mistake as part of your work?

What was your reaction and how did you rectify this?

● Always prioritise patient safety, taking appropriate reaction as soon

as possible. This may include approaching a senior to escalate the

situation.

● Show how you learnt from your mistake and reﬂ ect on how you will

avoid a similar situation arising in the future. Others can also learn

from your mistake through critical incident reporting.

● Show that you are honest and prepared to take responsibility for

your actions. By discussing a difﬁ cult topic you can build rapport

with the interviewers.

Nursing staff at a busy clinic request that you consent a patient for an

operation you are not familiar with. How would you approach this?

● It will not be appropriate for you to consent the patient, but explain

how you are going to rectify the situation by enlisting the support

of seniors.

● Explaining why you feel unable to consent and also how you could

learn from the situation so that you are prepared for next time will

display initiative.

● You can highlight your communication skills in this scenario by

CORE SURGICAL TRAINING 5

describing how you would approach the issue with the nursing staff

and the rest of your team.

What is capacity? How would you determine if a patient is competent to

consent to a procedure?

● Remember that a patient may be able to consent to some treatment

but not others.

● For a patient to have capacity, he or she needs to be able to compre-

hend the information provided, retain that information and give a

considered response.

● Prepare by reviewing General Medical Council guidance, and let the

examiners know you are safe by saying you would seek help if the

situation is complex.

What would you do if, at the end of a night shift, no one comes to relieve

you of your bleep? How do you think this might affect training?

● Think about who you would contact in this situation (consultant

on- call, human resources/rota coordinator, divisional director) to

resolve this.

● Remember, your priority is always patient safety, so offering to stay

on to work is not always appropriate, as tired doctors make mistakes.

The key is to ﬁ nd someone who can hold the bleep for now, while

you help coordinate a replacement.

● Try to think who is missing out on training opportunities here (such

as the person missing the on- call day shift, the replacement trainee

who will be missing elective work).

If you were my core trainee, how would you approach ensuring that you

learnt from attending a busy weekly outpatient clinic?

● This sort of question addresses a key part of being enrolled on a

training programme: taking responsibility for your training and

ensuring you are progressing while recognising the demands of the

NHS as a service.

● A good start would be to identify which patients you could see unsu-

pervised and which patients you may need to discuss or shadow a

senior for.

● Suggesting that you complete work- based assessments on challeng-

ing cases in clinic will show an awareness of the training programme

and an opportunity to develop your own knowledge.

6 SURGICAL INTERVIEWS: THE SURVIVAL GUIDE

FURTHER EXAMPLES OF QUESTIONS

●

What is a ‘never event’? Describe a directive that has been imple-

mented within surgery to reduce these events.

●

Describe an occasion when you displayed leadership. What

attributes are important to being a good leader?

●

You believe a registrar is bullying a colleague. How would you

approach this?

●

You are concerned about a colleague of yours, who has been turning

up to work late with increasing frequency and is often not ﬁ nishing

his work before he goes home for the day. What are you going to do

about this?

●

What is your opinion of the European Working Time Directive? What

do you think its impact has been on surgical training and trainees?

Portfolio station

The examiners will have to look at countless portfolios throughout the

day and will have no more than 10 minutes to examine your portfolio

before you enter the station. The key to your portfolio is that it must be

well organised and easy to navigate. The checklist that is mandatory to

include at the front of the portfolio should be used as a guide on how

to structure it. Prepare your portfolio well in advance of your interview

and ensure that you really know the contents. Be ready to talk about

your achievements and what you have learnt from each process. The

questions that follow here are examples of some commonly asked ques-

tions, with suggestions of how to structure your answer.

Why do you want to be a surgeon? Can you demonstrate your commit-

ment to surgery?

● Use your experiences to explain your enthusiasm in a career in sur-

gery. Reﬂ ect on what qualities attract you to surgery and how you

display them.

● You may wish to consider the following in your answer: surgical

electives or projects as an undergraduate, surgical skills courses and

meetings attended, research projects and audits, Membership of the

Royal College of Surgeons (MRCS) examination (or intention to sit

it soon) and relevant work- based assessments.

What is audit? Tell us about an audit you have been involved in.

● You get more credit for having led an audit, designed it, presented it

and also completed the audit loop, so emphasise the role you played.

CORE SURGICAL TRAINING 7

If you haven’t managed to complete an audit cycle, show that you

plan to do so.

● Be familiar with your outcome and the standards that were used. If

there was a positive change, say so.

What experience do you have of teaching?

● Include in your portfolio certiﬁ cates of teaching courses attended

and details of teaching sessions you have participated in delivering.

● Crucially you should be prepared to have documented feedback

from students you have taught. Reﬂ ect on their comments and show

how you have responded and developed your teaching skills.

What presentations have you made?

● Emphasise national (or better still, international) oral presentations

ﬁ rst before moving on to posters.

● Often it will be linked to research you have conducted or been

involved in, so you also have the opportunity to highlight this.

● Remember to concisely explain what you did and what you learnt

from the experience.

● Also mention local presentations you have made in your own hos-

pital – for example, case presentations, morbidity and mortality

meetings or departmental teaching.

Can you show us how you have developed your leadership skills?

● You don’t have to be the head of a department or senior doctor to

display leadership abilities. Have you led a ward round? Have you

captained a sports team or taken on responsibility in a society? Did

you lead a project or improvement team in your hospital? You could

also use clinical examples where your leadership resulted in a differ-

ence to patient care.

● Whatever the example, highlight what leadership qualities you

demonstrated.

FURTHER EXAMPLES OF QUESTIONS

●

What experience do you have of research?

●

What experience do you have of using statistics?

●

Describe any publications you have been involved in.

Clinical scenarios station

You will be given a written scenario 3 minutes before entering the

8 SURGICAL INTERVIEWS: THE SURVIVAL GUIDE

station. The examiners will expect you to develop an approach to safely

manage the scenario. This will take up the ﬁ rst 5 minutes of the station,

after which they will present you with a second scenario, previously

unseen by you. Take your time to consider the second example carefully

and plan how you will respond.

These scenarios are designed to assess your management of an acutely

unwell surgical patient. The key is to display a logical and safe approach

to each case. Remember, examiners are not looking to employ their next

consultant colleague. They want you to show conﬁ dence in the initial

management of a patient while asking for help when appropriate.

The following are examples of clinical scenarios. Practise answer-

ing them using a systematic method of assessment and intervention.

The ‘ABC’ approach, learnt at courses such as Advanced Life Support,

Advanced Trauma and Life Support (ATLS) for trauma scenarios or Care

of the Critically Ill Surgical Patient, is a good place to start and will

provide a structure to your response. Consider whom you might need

to ask for help and try to think of the potential underlying pathology.

You are called to see a patient on the ward 3 days following an anterior

resection. They have a fever and are complaining of shortness of breath.

Your registrar is asleep in the on- call accommodation. How would you

approach this patient?

● Clearly describe your ABC approach. While you want to display your

knowledge and comprehensive assessment, try not to be pedantic

and labour each step. Work on describing your interventions in

a concise and ﬂ owing way. By explaining what clinical signs you

would be assessing for you will show to the examiners your clinical

reasoning.

● Consider the underlying cause of the fever. They could be divided

into generic post- operative complications or those speciﬁ c to this

procedure. Basal atelectasis or hospital- acquired pneumonia, urinary

tract infection or a pulmonary embolism are examples of generic

complications. A more speciﬁ c cause in this case would be an anas-

tomotic leak.

● Describe your initial management. If appropriate, give the patient

oxygen, gain intravenous access, take an arterial blood gas and labo-

ratory blood tests, start ﬂ uid resuscitation and request a chest X- ray

and electrocardiogram.

● When considering whether or not to wake your senior colleague, you

could suggest that if the patient was deteriorating or not responding

to your treatment or if you felt the patient required a return to thea-

tre you would then ask for support. Similarly, mentioning a review

CORE SURGICAL TRAINING 9

from the critical care team would also show appreciation for other

specialties within the hospital.

You are the core trainee year 1 on call in a busy teaching hospital. You

are asked by the nursing staff on the surgical ward to sedate a 78- year- old

surgical patient in the middle of the night. The patient is confused, shout-

ing and has pulled out his or her central line. Two days ago the patient

underwent a distal gastrectomy.

● Sedating the patient is likely to be inappropriate and may simply

mask the underlying cause. As in the previous example, considering

the underlying cause of the confusion will give you some structure

when you perform your ABC assessment.

● Important causes of confusion could include sepsis, hypoxia,

hypoglycaemia, dehydration, pain, new medications (e.g. analge-

sics or anti- emetics), alcohol withdrawal or delirium.

● Ensure you completely answer the question and address any com-

plications from the patient pulling out the central line. A signiﬁ cant

concern would be developing an air embolus or haemorrhage. An

urgent chest X- ray would be an essential part of your plan.

● Where appropriate the patient might require one- to- one nursing,

or a family member may be able to help calm the patient. Ensure

you care for the patient as a whole, look to reassure him or her and

ensure equipment such as glasses and hearing aids are available to

try to improve his or her orientation.

You are called to the emergency unit to see a 12- year- old boy who has

fallen from a tree. He has a painful, deformed left arm, tenderness over

his lower three ribs on the left lateral chest wall and is hypotensive and

tachycardic. How would you approach this patient?

● This is not the type of scenario you would normally be expected to

tackle by yourself, so state that you would be requesting help early

on.

● A good approach to this station would be to get the patient moved

to the resuscitation area. Put out a (paediatric) trauma call, specify-

ing the people you need to assist: general surgeons, orthopaedics,

paediatric anaesthetic/critical care team and radiology. Recruit senior

emergency unit staff to help you while the call goes out.

● In the meantime, you would assess this patient using an ABC

approach, according to ATLS protocol (as this is a trauma scenario).

Explain that you would reassess the condition of the patient follow-

ing any intervention, again using ATLS principles.

● Ultimately the patient may have to attend theatre, ideally once he is