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SFP Clinical and Portfolio Stations Dr Minal Patel (Academic FY1 at Salford Royal) minalpatel977@gmail.comWhat I will cover: •Format of the interviews •coveredio station- how to prepare, what may be •Clinical station- preparation, the A-E approach •My experienceSFP interviews - On Microsoft teams - Book a slot (I recommend earlier in the day, but that’s personal preference) - Dress appropriately, be comfy - It goes very quickly!Clinical scenario station 5 mins preparation: - Clinical scenario and some blood results - FY1 on call Blank paper- write down all thoughts, differentials, management you would do- Utilise these 5 minutes! - Verbalise your thoughts! Questions are generic but will generally start with: - How would you assess this patient? A to E approach! - Differentials - Immediate management - Referrals- to which specialty? An ethical dilemma may be incorporatedYou’re bleeped by the nurse on L2, to assess a patient who has chest pain. Immediately with chest pain- think of differentials- is this cardiac? Resp? GI/other? Things to di before you arrive to the ward: SBAR - Observations - ECG if indicated - IV access if possible - Safety net- 2222 if peri-arrest On arrival: - Introduce yourself to the nursing team, any updatesAirway Are they speaking? Is the airway patent? Look - Foreign bodies, vomit, angioedema Listen - stridor, gargling, snoring, groaning Adjuncts - Nasopharygeal – are there signs of a basal skull fracture? - Oropharyngeal- Guedel - I-gel (contact crash team?) Call for assistance- crash team with anaestheticsBreathing Observations: RR, Saturations Examination: - Look- equal chest expansion, scars/drains - Feel: Palpate and percuss- ?dullness ?hyperresonance - Listen- auscultate- wheeze Interventions - Oxygen- 4L via nasal cannula, 15L non-rebreather mask - Nebulisers- salbutamol/ ipratropium - CXR - ABG/ VBGCirculation Observations: HR, BP ECG, fluid balance chart Examination: - Capillary refill, pallor, signs of bleeding/ dehydration - Auscultation- heart sounds, murmurs - Peripheral oedema Interventions: - Venous access- cannulas - ECG - Bloods- FBC, U&Es, LFTs, CRP, troponin - Fluid resuscitation- 500mls over 15 minsDisability •Neurological assessment AVPU or GCS, neuro examination •Blood glucose •Temperature- pyrexia? Are they septic? •Pain •Drug chart review Investigations: -CT headExposure Look: -Bleeding -Fractures -Other injuries -Calf tenderness Abdominal examination- signs of tenderness, guarding, peritonitis Urine dip/CSNext steps •Re-review! What are your differentials? Have your interventions helped? systematically!shown e.g CXR, ABG. ECG- interpret findings If you don’t know what to do- what would you do in real life? (Contact help!) What is the definitive management? How is the severity of a condition determined?You’re the F1 on call and have been asked to see a 70 year old male with new onset breathlessness. They were admitted 9 days ago following a fall, in which he had surgery for a R total hip replacement. His observations are: Sats: 90% on RA (previously 97% RA) HR: 108 BP: 128/90 Temp: 36.9 RR: 22Introduce self, receive handover from nurse. Wear appropriate PPE and ask to accompany to the bedside if necessary. Then I would begin to conduct an A-E assessment. Airway: Is it patent? Any stridor/additional noises. If any doubt begin to do maneouvers e.g. head tilt, chin lift. Can the patient speak, if so this indicates a patent airway and I will go on to assess breathing. Patient speaking- airway patent. Breathing: Respiratory examination. Rechecking RR and oxygen saturations. Is there any tracheal deviation? Equal bilateral chest expansion? Dullness/ hyperresonance to percussion? Any crackles/wheeze/additional sounds on ausculatation? Ix: ABG and CXR. Can give nebulisers if wheezy. These investigations will take time to return. Equal chest expansion, no added sounds. Circulation: Next I would move on to assess if the patient is haemodynamically stable. -bloods I’d like:l <2secs- centrally and peripherally. HR, BP, ECG. IV access should be obtained and the - FBC, U&Es, CRP, troponin if complaining of chest pain, D-dimer (although non-specific- I would do a Wells’score first) Disability: AVPU, PEARL blood glucose, review the drug chart, temperature Exposure: Any further obvious rashes, signs of infection, calf tendernessBlood results Na+: 136 K+: 4.2 Urea: 5.2 Creatinine: 80 Hb: 145 WCC: 9.0 Neutrophils: 4.3 CRP: 34Well’s score for PE: Clinical signs and symptoms for DVT: N: 0. Y: 3 PE is number 1 diagnosis OR equally likely N: 0 Y: 3 HR>100 N: 0 Y: 1.5 Immobilisation in last 3 days OR surgery in previous 4 weeks? N:0 Y: 1.5 Previous, objectively diagnosed PE/DVT N:0 Y: 1.5 Haemoptysis N:0 Y: 1 Malignancy w/treatment within 6 months/palliative N:0 Y: 1 SCORE >4- PE likelyWhat are your differential diagnoses? What further investigations would you do? What management steps would you take?Common topics for clinical station Upper GI bleeding ACS-STEMI/NSTEMI Acute severe asthma/ COPD exacerbation Acute abdomen Diabetic ketoacidosis Pulmonary embolism Delirious patient Sepsis SeizuresPortfolio station • Be yourself! • Practice the common questions: 1- Why have you applied for SFP? 2- Why research/ education/ leadership? 3- Where do you see yourself in 5 years/10 years? How will the SFP help you achieve this? 4- What experiences have you had with education/ leadership/ research? SMART ANSWERS Practice! Practice! Practice!Integrated academic clinical pathwayMy experiences •North- west application only •The interview was straightforward and quick •I prepared by going through: • Oxford Handbook emergencies/acute scenarios • Geeky medics has A to E scenarios • Practiced speaking out loud with each A to E scenario •It was great preparation for finals! •Be practical when explaining answers for clinical scenario e.g. what you would do in real life-’ introduce yourself’ ’update family’ ‘ delegate tasks’Key tips: •Practice lots of different scenarios- the principle steps are the same! •Be able to succinctly summarise your research/previous experiences- say what you got from it. •Have a brief plan/outline of what sort of SFP project you’d like to do •Be confident and smile! (It’s not that bad)Thank you! Any questions