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Welcome. Um, my name's Shash. I'm a core trainee at Ain Brooks. Um, and I suppose that's what I think gives me a bit of uh experience with the CST interview, um, enough at least to, to give you a few words of wisdom. Um This is on behalf of the Southwest Foundation, er, training Surgical Society. Um, and I suppose Lara, if she hasn't already spoken a bit about that will be able to advertise um their upcoming events, er, towards the end of this chat. So I thought, um, yeah, so first of all we doing getting this far, so about 2.5 1000 people applied um, for this year's CST er, and only half got an interview. So already you're in the top 50% of people who applied so well done. Um, but the bad news is only half of you watching if your representative will convert your interviews into a training number and if you do get a number, uh 60% of your ranking will be based on this interview. So the point being that, um you know, the work isn't done yet, er, and the interview forms a really, really important er, crucial part of the selection process, er, and determines really to set the next two years. Uh, if not shapes the next sort of five or so years of your life. So, er, it's pretty important, er, away with the doom and gloom. The good news is that this interview strongly rewards preparation. You can definitely prepare for it and in fact, not only can you prepare for it, um, every hour that you prepare for the interview, I think you, you'll be richly rewarded for it because the interview is very fair. Uh It a all the questions that I've heard people be asked, all all the questions I've been asked myself. Um There are questions that I could have expected and that, that I should have expected. Um And nothing there, there are no curveballs, they don't try and trick you. And by now, the format's been the same for so long um that, you know, you, you really can't um claim that there are any surprises. Um And a lot of it is memorization and a lot of it is knowing how to answer how to structure your answer. And there are just so many resources out there that really help you do that, that um the ball is really in your court um If you want to smash this or not. Uh So I'd say treat it like an exam. Um Don't think of it like an interview where you show, show up, you answer a couple of questions on a time you've shown good leadership or whatever, smile, be confident and you'll get the job. But no, rather it's more like an osk um exam where uh you, you really need to prepare for it, have the knowledge and structure. So that said, um the next 30 minutes, uh we'll cover the anatomy of the interview. We'll break the two down into uh segments and uh consider how to approach each part and then we'll talk about resources to use going forwards. Uh So there's no, I haven't got any secrets for you. There's no sort of esoteric knowledge that I'm gonna impart on you this uh, evening that you can't get from any of the books, um, on the topic. But hopefully, I was, I was hoping that this would be give you sort of a skeleton for you to frame your, well, a understand the interview and b be a skeleton for you to form your further revision around. So the interview itself, um, oh, by the way, I should have said. So if you have any questions, uh just pop them in the chat, I can't see the chat. Um, I, all I can see is my slides. So Lara, if you let me know, um, once we've built up a little head of question, then we can tackle them all. Um, like that. So the interview itself. So there's two stations, 10 minutes each, there's a man, a management station and a clinical station and they're two different panels. So there's usually two consultants or a consultant in a senior ed, er, in panel, a doing your management station and then, er, you'll be given a very short break, er, in a waiting room between or um, stations and then you enter into station B virtually, um, which have a different panel, different pair of consultants or senior doctors. Um, it isn't always the case that it's the management station first. It could be that you happen to get the clinical station 1st 5050. but let's, er, for a point of example here, say that you were to get the management station first. So you'd, you'd be welcomed in. Um, hi. Hello. And then the, uh, examiner would read out the question stem, um, that you will get it if you haven't got already, you, you'll, you'll get emailed out to you. Um, it's usually on the topic of leadership has been for, for the last few years. I hope, I don't, I hope, I hope I don't get some GMC S for telling you that. Um, so you'd speak for three minutes and then you'd answer two minutes of questions on the topic of the presentation. So say leadership. Um, and then, uh, you with, with the same panel after five minutes, uh, on the presentation topic, you'd move on to a management scenario that's entirely unrelated, um, or not necessarily related at all to the presentation short break and then clinical station in the clinical station, you've got 25 minute um scenarios. Uh usually or often um one's a atl S scenario and one's a crisp scenario. We'll get to that later on what that means if you don't know. Um And each scenario is um unrelated to, to the other. So we'll begin with the management station. So the presentation, so, uh just a couple of tips. Um So the topic has been l leadership for the past few years, as I mentioned, uh I'd suggest 3 to 4 headline messages. Uh So prepare, obviously, prepare a um a little spiel that will, will take you about three minutes or will take you under three minutes to deliver. And in that spiel uh cer there should be three or four clear distinct messages and cut all waffle, er, really know exactly why you're saying each sentence and what each sentence adds to the overall um picture that you're trying to, to give of yourself. So your response needs to be personal and it needs to be specific. Um So it needs to be specific to you in that. Um It, it's best if you don't say things like I have good leadership skills, but rather, you know, give examples of um what h how you can prove that or what people have said to, to lead, lead you to believe that and a useful way of doing this is narr your response. Um We'll move on to the star framework later on. Um But a narrative is a good way, you know, so story with a beginning, a middle and an end. So the issue, what you did and how that fixed the issue, um that is just more d more digest, more digestible generally for people um to understand and it shows it sort of hints at progress, er, it provides sort of optimistic, um sort of color to your response. Um And yeah, it, it makes things personal and sometimes memorable if you've got a particularly interesting story. Um or, or maybe an offbeat story. So, you know, some people uh make theirs, er, not necessarily, er, obvious so they might use uh things outside of the medical, their medical er sphere, their, their, their careers and talk about, um, you know, how, how their love of baking has uh has led them being good leaders or whatever. Um, and that sort of stands out but obviously be aware of what you're doing there. Don't under seller. It's easy, I think for most of us um to be a bit shy about um seeming boastful or arrogant, but certainly, you know, don't do that but there's a lot of space for you to confidently express yourself and confidently state uh what you have achieved. Um So, so do that, uh have your consultants give you feedback. So, yeah, so once you've got a draft redrafted, it pretty confident on what you want to say, uh make sure that you have a couple of trusted registers or consultants, uh have a read through and um tell you what they think. Uh I can remember certainly that I had to pretty much uh start from the drawing board cos I um II II sort of got the wrong end of the stick. And um I had a very, very boring, er, three minute presentation initially. Um, and I suppose I was all the better for getting feedback on it. And then there's this question about over rehearsing. So some people worry that if they, oh, it's a very legitimate worry that if you, uh, over rehearse then you'll sound, um, robotic or you'll, you'll sound monotonous as I probably do. Um, after this long weekend of nights, um, the alternative II would suggest is under rehearsing and losing a thread. 2, 2.5 minutes in or two minutes in, er, and then, because you aren't really speaking off the cuff, you're, you're, you're sort of trying to half remember or maybe trying to e even des desperately remember, um, where you were and what you're trying to say next and how that links to the next argument you're about to make. Um, it can be a very uncomfortable period of silence or maybe even worse of IMing and eyeing and getting increasingly flustered, uh, that could, you know, set you off for the rest of the, the 20 minutes because it, the whole interview is only 20 minutes long. So I would suggest, you know, memorize it, really know it inside out, uh be able to recite it in the shower and um be on top of it. Uh So then after the presentation, after a three minute presentation, um they'll ask you two or three further questions in the two minutes. Um afterwards, there'll be stock questions so they won't be related to your presentation. So if you talk about, um, you know how you're great at leadership because you've started a global spy agency and they won't ask you about your spy agency, they'll ask you about. Hm, tell me what makes a good leader. So it's quite general stuff. But, but always related to the, the general topic of the presentation. So I'd suggest for these few questions, read widely around your presentation topic and think of or steal a few, er, insights you can talk about or frameworks you can use, er, to answer the, the questions. So, for example, what I mean by that is if the topic is leadership, then, you know, have a think, er, to yourself, um, re really contemplate and examine uh within yourself. What you, what do you think are the qualities of a leader? Uh, maybe what's the purpose of leadership, er, think of an example of leadership that you've witnessed? That's been good. Maybe one that's been bad. Um, it's just sort of think around the topic. Um, and have maybe a couple of avenues that you could go down no matter what they ask or how they phrase the inevitable question um afterwards and then maybe look at one or two frameworks. The NHS has I was talking about my reg when I was er in your position that there's a NHS nine pillars of leadership. Um So then if it's a lead leadership question, you can maybe lead the question towards this nine pillars of leadership. And you've got a few, you know, seconds of um uh oh to talk about that and it may seem a bit more uh knowledgeable. So all of this, I suppose is what, what I'm trying to say is you can definitely prepare uh easily for the presentation questions after your presentation. And often these are camp or star questions. So those of you who've been revising um intently for the last week or so or longer, you, you'll know what the camp or star questions are. But for those who don't, so a camp question, uh when you get a question that questions your innate skills or motivations, then you can use the camp framework, which is clinical academic management, personal. So for example, if you get asked, do you think you're a good leader? So you can, you one option would be to give yes, I it would be safe. I think I'm a good leader because um I set up this global spy networks. I solved an issue there was a gap in the market for spy networks and I set it up and it was very difficult and we, er, overthrew some African dictators, let's say. Um, so you can tell like a story. Um, but if they're asking, do you think you're a good leader often? You don't just want, perhaps you don't just want one story, er, you want to show in a, in various different domains, in all domains in medicine, maybe or in your career and outside of your career that you've got these sort of enduring, persistent, er, sort of global quality. So then camp says, er, excuse you might say following camp. So, yes, er, clinically. Um I think I'm a good leader because, er, I've got, er, tab feedback from all, all people that worked with me. This, I'm a good leader cos I attended to a crash call and I did this XYZ academically. Uh I've led a medical students in writing a paper and, er, or the data, data analysis for a paper and I had some issues because this happened. I solved them cos I'm a really great leader. Um I also run this um society, er, for the prevention of injury to bats and uh we solved the bat crisis in Vietnam and also personally, um, you know, II play hockey and XYZ. So that's why I think I'm a good leader. So it shows a sort of rounded um persona uh and equally you could, you could apply that to are you a resilient person? So clinically academically, in terms of management and personal life, the other option is you want to give a narrative. So a specific example. So if they ask give an example of a time, you've seen bad leadership, so you could say situation, task action result. So yeah, so one such instance is this time when the situation was this, um what we had to do was this what I did was this and what happened was, was that? So basically, just um a narrative for you to not a narrative, a framework for you to concisely tell all parts of her, the story of, of, of a compelling story. Fine. Any questions on that Lara or so far? No, no, no questions for you. I think someone's asked if they know if anyone knows the presentation title has been released. Um But I don't, I don't know if you'll know about that because you're not interviewing this year. So, yeah. No, I'm, I'm not. So I asked one of the CST S this afternoon and he said it hadn't been for him at least. Um So I hope that's reassurance. But yeah, everyone else on the chat, please help, help out your, your mate. So we'll move on to the next part, the next five minutes or the final five minutes of the management station, which is the scenario. So then, er, they'll probably cut you off um halfway through an answer and say, right. That's the first five minutes up. Let's move on to this scenario and they'll, they'll, they'll, they'll be quite a long stem. Uh, lots of bits of information you have to remember and try and collate together to, to build a picture of what's going on. And it'll be a non clinically centered ethical conundrum as per all the S JT S that you've sat since medical school interviews, um, the usual, you know, drunken consultant or problems with consent or the usual stuff. Uh So it's always a long open spies question to start with. So I'll go over what makes the spies question later on and how to answer so on. Uh And then there will be further standardized questions that require uh short clear answers, er, often you can answer them in two or three sentences. Um And I'd say my for the, so for the big long spies question to start answer in a spies format, we'll go over that and for the follow up questions, um it doesn't need to be, er, anything too long. It's just um a few short sentences describing what you think a sensible person, er, would do. Uh It can be easy, I think for these shorter questions, for shorter follow up questions to start to waffle, er, just be mindful of that uh two or three sentences um saying something vaguely sensible. So spies, um this is probably the most important um sort of framework to remember because you, you know, for a fact, you're gonna get asked a question in which this will be useful. Your your management scenario will be a question in which this this um framework can be used. So let's say the question is you see dot A dot Lots of extraneous detail, the O and G reg smoking on the maternity ward, lot of dot Lots of extraneous detail. How would you manage the scenario? So then you'd say situation. So situation means um that you would state clearly what you, you, you understand the issue to be. So everyone knows that you've got the right end of the stick that you aren't, you haven't, you know, fundamentally misunderstood the situation, patient safety. So you'd make your patient safety concerns um clear how exactly does this um affect patients uh initiative. So what are you going to do to address these patient safety concerns? What can you do as the F two or the core surgical trainee in that moment? Um to make things better escalation? Um So what, what escalation, who, who can you speak to um to make things better often the consultant um and try and make use of the MDT. So they really like um uh you to get the nurse in charge involved or get the, I don't know, irrelevant OT or PT or whatever involved. Um and then support. So, you know, you, you, you don't just wanna come across as um mean spirited to your colleagues. Um, and the sort of, er, holier than thou whiter than white but, you know, try and say, er, that even, you know, the, the drunk colleague you'd speak to them later or maybe get, um, get their es, to speak to them or a friend that knows them well to speak to them and recognize, um, the burden that the scenarios placed on them. So. Oh, is that what I've got for that? Um Fine, I suppose that, that, that, that's all I've got for that. So, ask any questions if you want any further clarification on that. Uh And then there's a break. So you've done your 1st 10 minutes, you get about a minute or so while you're shuffled into a waiting area, while both your panels, um sort of discuss and mark you. Uh And, but we won't take a break. We'll m march straight on cos I've got a night shift to go to um with the clinical scenario. So the clinical scenario, as I've mentioned is, are 25 minute scenarios with the same panel and the same uh sort of virtual room. Er, they are often one crisp and one atl s um scenario. So crisp is care of the critically ill surgical patient. It's a course run by the Royal College, um, the Royal Colleges. And um it's what the clues in the name, it's critically our surgical inpatient. So things like uh low urine output post you know, day three post T hr or um you know, stuff like that. Er, and then you've got ATL S which is um trauma. So, uh you, you, if you, the stem will be something like you bleed to attend a trauma call. Um, and you know, the patient's got a open tib fib and this, that and the other, how do you manage them? Um So the first question in both of these scenarios uh similar to the management scenario is always an open ended. How would you manage this patient? Uh And the answer is always the same, it's always an A to E approach. Uh And you have to recognize which algorithm to use and state that you're using it. The algorithms really aren't very different. Um But I suppose it's shows the examiner that um you aren't at med student level, you're at sort of ct level that you're thinking um about these algorithms. So get your A to be recited in under a minute. It really has to be completely fluent with no ums ahs and pauses because you know, everyone's gonna be able to, everyone listening to this um talk tonight is gonna be able to deliver an A to e of some, some manner, er, and probably a safe A to A to e what's gonna separate the half of you that get the train number and the half of you that don't get the train number is how slick and fluent and um confident your A two E is, er, and if you can get it done in, in under a minute, that means you've got more time than you've got four minutes to grab all the extra marks. Um And so I suppose to demonstrate what I mean by that. Um, so I'll, I'll try and give you an example. Uh You'll have to excuse me because uh I've not done this in, in, in a, in a long time but say unpracticed, your A two E might sound something like. So how would you manage this patient? Well, I would, um, attend to the patient first. Uh, and I would, um, well, II, I'd take an A to B approach, I'd, I'd assess the airway, er, and I'd, I'd speak to them. So if they were speaking back to me, I'd know that their airway was patent. Um, but if they weren't speaking back to me, I'd, um, maybe use a Cadel airway or I could use a, a NP airway. Um, but, but not if they've got like a, a basal skull fracture, um, II wouldn't do it if they had that. Um, but yeah, II could use those two things. Um, and then if I had any concerns I could speak to the anesthetist. Um, but if I was happy with a, uh, then I'd maybe so. So that, that's what you don't want to do. You don't wanna be bumbling and taking up time. Uh, it needs to be and this isn't gonna be what it should be. This is gonna be my attempt at what it should be to something like how would you manage this patient? This patient is a critically unwell surgical inpatient. I would manage them using an A two E um protocol. As per the C crisp algorithm, I would first attend to their airway. I would uh make sure it was patent using simple, simple airway adjuncts if required. If I was happy with A, I would move on to bi would inspect palpate per carcino cult their thorax. I would and so on. So it needs to be no one's in ours fluent. Um So have your A to be memorized. So well that you can recite the skeleton A to e on autopilot, giving you the time to think how to tailor your skeleton to the specific patient hand. So um yeah, as I said, so it needs to be just second nature at the tip of your tongue. So you can just blurt it out or start blurting it out. And while you're speaking, you can think, right? OK. So this patient's got abdominal pain, maybe I need to get a bladder scan or maybe, you know, I need to get uh ankle, brachial pressure index because I think or maybe I maybe I need to get uh I need to look at their passive stretch in their toe because I think they've got compartment syndrome and so on. Um, what you don't wanna be doing is thinking what you should be doing and it showing through that your, um having to think on the spot like that. So the way to get that A two E fluent is to recite it on your commute in the shower while you sleep. It needs your, your A two E needs to be your mantra for the next couple of weeks to get it to the stage where uh it's far more confident and far more fluent than what I tried to demonstrate just a few uh well, a minute or two ago. So remember, uh you're not being asked to definitively manage the patient only say how as act one, you would realistically initially manage the patient. So, you know, don't get into the habit of even though you know what the patient with a compartment syndrome might need is a fasciotomy. Don't say I do. I'd I'd prepare the patient for a fasciotomy and then undertake a fasciotomy. It's uh it's obviously I'm gonna do that but it's unsafe. The remaining four minutes would be further short questions again. So how would you classify acute kidney injury or where would you insert a chest drain? Um There's so yes, all, all the clinical knowledge you need is contained in the resources section. Next, there's plenty of good books with an almost exhaustive list of all the possible short questions you could be asked asked reasonably. Um So I'll not, you know, rehash all of that. It, it, it's not really worth your time or mine, uh, cos you can go in and read that in the books. Um, I suppose my point really, my, my main takeaway for the clinical scenario is, uh, have an autopilot A two E and, uh, read the books and you'll be fine resources. Uh, so these are the, the, the, the resources in green are the absolute non negotiable essentials that you must read slash utilize. So, meta body, er, it's online what it was a website, it's pretty good. These, these are the two books that I use. There are a number of other books, I'm sure they're all basically the same thing. They all have a bunch of scenarios, um, that you can read through and test each, test each other with, um, ATL S and Crisp handbooks. Er, if you've got access to them, if you've got, er, I think they're both available on the shadier, darker parts of the internet as downloads. Er, but also if you've got, um, Regs or co trainees who your friends would be willing to lend you the handbooks, er, for the next couple of weeks and that's quite useful. Um, I would ATS particularly is pretty thick. Um, uh, just skim, read it. You don't need to know how to, yeah, the, the, the nuances of pelvic, um, uh, pelvic injury management. You just need to know, uh, that, um, let's say a, a pelvic binder is a thing that could be used. Um, yeah, but definitely skimming. It would be worth your while, uh, core surgery. Interview.com, uh, pretty good resource, um, can be quite expensive, uh, more expensive than Medi Body. But, um, if you find you've got time on your hands after you've gone through Medi Body, the, the various textbooks and the handbooks, then certainly give it a go. Then there are more expensive courses that, uh, Royal College of Surgeons of Edinburgh runs a course. I don't know if it's still, if, if you still got, still got time to get onto it now. Er, and also, of course, I do your interview, I think you still do have time to get on to one of their courses. Er, I didn't use it. I don't, so I can't really claim any knowledge on how good they are. Um, but, you know, if you've got time then why not? Uh, but what's really, what's really, really crucial is that you vocalize all of your answers and by preparing with other applicants or with, um, people who've gone through the process that you are friends with. You know, I can't stress enough. Um, the, the difference in reading one of these books and thinking. Yeah, I understand the scenario. I understand how to manage the patient, um, versus actually being on the spot in front of your computer, looking down the camera of your, um, webcam and trying to verbalize all of that in a coherent affluent manner. Uh, there's a big difference and you really don't want to be doing that for the first time on the day of the interview itself. Um, there's a, there's a whole sort of, I suppose technique to, to vocalizing your answers rather than just, um, thinking them more ticking the right box on A, on AMC Q. So please, please, please definitely get a gang of your friends, er, in the same deanery maybe or people that, you know, and just start, um, you know, rinsing the, the textbooks have all sorts of all sorts of er, scenarios, just um hit each other with the scenarios and um you'll do well. So I think OK, yeah, final thoughts. So some key takeaways, uh this exam rewards preparation. So prepare for it. It's crucial to memorize your presentation, your answer structures. So, um the star and the spies and so on. Uh your A two E spiel, it's crucial to practice vocalizing your answers to another person. Uh, stay calm, stay measured and practice safe medicine and you'll do well, any questions. Um I can't see any questions in the chat but if anyone wants to, you know, um, ask some questions, feel free to. We've got quite a nice, nice little turn out. So Michael's asking how much detail is given in the clinical question stem? Uh is it similar in length to the green core surgery interview? Booker Clinical question stem. Let me just get my green book and see what they give you. Right. So I've got it here. Um Yeah, yeah. So it's pretty much identical to how much um, detail you're given in the clinical question. It'll be maybe four or five sentences uh in the interview itself. Um with salient details. They, they certainly don't, you know, talk you through a whole set of obs or a whole, you know, past medical history or anything. Is the question is show on the screen or is it asked by the, it's asked by the panel? So there's pretty much nothing on the screen for you. You just have to look at the faces of the interviewers and they're pretty dour faces as well. So, you know, when you're practicing, don't, don't make it all palli palli and nice. Make it, you know, professional in air quotes. Cool. Well, I suppose, um, if anyone has any further questions, but I'll tell you what, I'll pop my, I think if anyone has any further questions they can, they, no doubt has they, they no doubt have um, a bunch of uh seniors by now that they can ask. Um Yeah, why not if you do have any questions for, for any reason that need to come to me in particular, that's my email address. Um I can't imagine that you would, I'm sure you've all got uh mentors. Um Oh, hey, Emma, how's it going? Thank you. Um, fine. If no further questions, I'll head off. Thank you so much. Sh That was brilliant. Hi, everyone. My name is Lara. I'm the President of Swifts at the moment and sh sh you don't know is our ex president from last year. Um So yeah, thank you all for coming. And I think the feedback form gets sent to you at the end. When you leave the group, you'll get an email and then you'll be able to download your certificate after you filled it out. Thanks everyone. Bye now. Brilliant. Bye bye. Uh, walk.