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Um So my name is Alex. I am Act One doctor in Charing Cross Hospital at the moment. Um in London. I did this process last year so it's pretty fresh for me. Um I didn't do an F three or anything. I just went straight from FT um And I remember this kind of time. It was a bit stressful. We're still quite early on way before the interviews. So if you guys know absolutely nothing and haven't done anything before then, that's no worry at all. Um I've done this talk as if you know, we're starting completely from scratch. Um So I thought I'd just tell you a bit about me so that you, you know who you're speaking to. Um I've been in London the whole time so I went to Imperial for med school. I did my M BBS M BSE there. Um Went on to do F one and F two in Northwest Scenery at Chelsea and Westminster and ING Hospital, um which were both really great experiences and then now I've moved on to Charing Cross in Saint Mary's, um doing a plastic the program, um which is gonna be general surgery, plastics for a year and ent as well. Um I only just started but so far it's going well. So if later on anyone has any specific questions, then feel free to email me or message me about that and feel free to get questions as leave alone. Yeah, me to be fine. Ok, basically. Yeah. Um, they even say, hey, identify what you're gonna be assessed on, um, like, um, so my is check. Um, You could ask exactly Alex, you're breaking up quite a little bit. We actually can't hear you. Well, you've been breaking up. Hi guys, I'm really sorry. Um Can you hear me now? Yes, we can hear you. Well, now is that better? Much better. Do you want to try to share your screen? Sure. Thank you. Did you hear anything or? Basically it was crackly from the beginning. I think we texted you but you weren't able to see him. We didn't wanna interrupt. No worries. Um Let's go back. So at least so. Um yeah, I'm Alex. Um I'm act one doctor at Charing Cross Hospital. You see my sides, right? Yes, we see these lights. Um I applied for co surgical training this time last year. I went straight from F two. So it's all very fresh in my head and hopefully this talk will be useful for you guys. Um A bit about me. I went to Imperial in London. Um I ended up doing my F one and F two in not very far away, actually in Chelsea and Westminster and Ealing and then proceeded to um do start my surgery training program at Charing Cross and Saint Mary's. I'm doing a plastic Steam program. I'm doing general surgery plastics for a year and then ent um so if anyone has any specific questions about any of these places, then feel free to message me. I will leave my email at the end. Um, Feel free to ask questions like throughout this, hopefully, an I can um read them out and then we can, I can answer as we go. So I didn't even know where to start when I was preparing for my CST interview. So hopefully this talk will kind of increase your confidence in the content you need to know and how you'll manage your time when preparing for the interview. Um We're gonna go through the structure and the competencies that they're assessing you on. Um We're gonna go through some systematic approaches to tackling clinical and management scenarios using structured frameworks that you can always draw back to um in these open ended questions, we'll get you guys to kind of try and like give some answers um either through speaking or on the chat function um to some frequently asked questions and then can kind of give each other feedback to see what's good and bad. And then we'll also go through the leadership um station and what the qualities of a good leader are and what examples you might be able to use for your interview. So yeah, this is kind of what's up. We, we will do the structure of the interview first. Um We'll go through the clinical scenario and how you can answer this with the cris algorithm. We'll go through the management station and the leadership station. Um And I'm aware there's a new portfolio station which we will touch on. Um However, I didn't do the station myself when I was uh doing the interview as it's new for this year. And then lastly, we'll just go through some resources that you guys can use and some practical tips when preparing. So the general structure um of the interview has largely stayed the same for the past couple of years and is very much the same even for you guys. There's just one edition of the Portfolio Station. Um the first station will be the clinical one. So although actually these can happen in any order in the real thing and you should be prepared for that. It will be 25 minute clinical vignette scenarios um which are usually kind of based around normal acute things that you would see on the tape, like surgical take in A&E things like bowel obstruction, perforation, um appendicitis, cholecystitis, that kind of thing. There may be a trauma scenario, um road traffic accidents, stabbings, things like that and there may be perioperative scenarios. So patients who are unwell either pre or post surgery. Um and asking you to kind of give differentials and how you will assess the patient. In mine. I got an acute and a perioperative. Um but really you can get any combination of these two or you may even get two of the same, the second station um will be leadership and management station. So another 10 minutes, the management scenario is kind of a situation that may happen in the hospital that requires you to make decisions and there'll be some ethical grounding around it as well. Again, they'll just give you a one sentence scenario and they'll expect you to talk for probably about three minutes on what you would do in this scenario, followed by maybe two minutes of questioning. The this station will then lead on to your leadership speech, which you will have already preprepared. Um They send you a uh kind of line on what they want you to prepare your speech on um two weeks before the interview, but it's pretty much exactly the same every year. Um And we'll go through what it was last year during this talk. Um And then you need to get this leadership speech down to three minutes and they will question you about it for two. This in my experience is the best bit of the interview because you've prepared it all. Um It's the bit that you have the most control over and you will have hopefully thought about some questions they might ask you and how you can answer them. And then lastly, there is the portfolio station um which is kind of marked on clinical skills and knowledge. Um There are sections on the marks sheet. One is for clinical skills and knowledge. One is for your judgment under pressure and prioritization and one is for your communication and each of these categories are weighted equally. So it's just important that you communicate well as it is that you have good clinical skills and knowledge. And it's just as important that, you know, you appear calm under pressure and think logically as, as any of these other categories. So don't just get bogged down thinking about all your knowledge, you need to be really practiced at coming across well, thinking logically and speaking to a camera as well in each of these stations. Um You will have two interviewers so you'll get a score from each of them, um which we take to that. And can I just quickly check? I'm going to do a poll. How many of you have actually done the CST interview for? Just so that I know who I'm talking to here and how much experience you guys have. If you guys could click the answer in the poll, that would be great. I know. Is that coming up, by the way? Yes, it's coming up and we've got 11 responses until now and they all say no, we have only had one Yes. Ok. That's absolutely fine. And that's really what I expect. That's, that's great. Um Just so I know where I'm pitching this to. So, first of all, we'll go through the clinical station. Um as I mentioned, this will be two clinical scenario stations lasting five minutes each. It says they are provided during the interview to encourage you to think on your feet. Um These questions are usually like one or two sentences. They are quite general, something like a 79 year old lady comes into A&E with Abdin pain, um a fever and tachycardia, please um say your approach and we'll go through exactly how to answer that. But I've just put, put a table here, which is not intended to scare you. It's intended to be a kind of revision guide that you can come back to when you're preparing properly to see what the kind of common things are that come up. So I've put these into the three categories which are the acute presentation things that you might see in A&E. Um For these, you'll be answering questions using a cri approach which we will go through. You may get a trauma station. Um The most common one by far is a road traffic accident. It comes up a lot. Um but also you can have a fall from height, an elderly person when the fall is sometimes class as trauma or penetrating trauma. And then lastly, you can have perioperative um options which are just general things that you may encounter on the ward every day and you'll use the cri approach for this as well. But yes, we won't have time to go through all of these. Um But yeah, you can look back to this when you get the slides afterwards. Yeah. So I wanted to talk through the at E or the cris algorithm which is how you're going to structure the main bulk of your answer to the clinical station. Now, this is a bit more involved than your typical kind of at E and it encompasses a broader clinical spectrum than that essentially. So I don't know how many of you have seen this before, but it's focused around first of all, the A to E and then the assessment that you will do after and this is how you're gonna structure pretty much your whole answer to the um clinical question. So you'll start by going through your A to E whereby we'll go through each one of the kind of things you're expected to say. So within the airway, you want to talk to the patient to ensure this is patent. Now, for each of the next of the sections you want to think about how would you actually approach this if you were in real life, assessing a patient? And by that, I mean, think practically about the steps and how you would do them. So in breathing, first of all, you would want to get up to date respiratory rate, um and oxygen saturations, you would then want to examine the patient, look, listen and feel. Um if the patient in the stem, they told you that it was the patient had low oxygen saturations. This is the point where you'd like to say I'd apply a 15 L um non rebreather mask. And then lastly, you can consider an investigation such as a chest X ray and I know these are investigations, but because they're kind of critical things in the immediate management, I would say all of this at once, you then move on to circulation. Again, observations first, you would ask for an up to date heart rate and BP, you would then insert a cannula. And I say this because some people say they would give fluids if the BP is low or give antibiotics. But you can't do this if the patient has a cannula doesn't have a cannula. So you need to make sure it's in the stepwise approach. Um So cannula first, then you will take bloods because that's what you would naturally do after putting in a cannula and you need to actually reel off all of the bloods that you want to take. So they want you to say full blood count CRP LFT S vein profile. Um You need to remember a clotting and you need to remember a grip and save because this is a surgical station and they may go to theater and you need to remember a VBG, um, to check the lactate and blood cultures if the patient seems to be septic, which they almost always are. So, don't forget blood cultures. That's one that people commonly forget at this point. Now, you've got your, um, cannula in, that's when you can give the fluids. That's when you can give the antibiotics. Ok. Um, and if it seems that the patient needs that in the stem, this is when you'll say it, you can then consider some investigations like an ECG. Um, if it's a trauma patient and they might be bleeding in their abdomen, you might do a bedside ultrasound, that kind of thing. But just you need to hone into what I'm telling you all the things you might say, but you need to hone into what the patient might need. Given the information you've been given in the stem, you'll then move on to the disability. Um, where you'll say I'd like to conduct a brief neurological assessment. I'd like to look in the patient's pupils. Um I would like to check pain level and temperature and administer any analgesia if necessary before completely exposing the patient. Um, looking for any rashes, looking for any wounds, signs of wounds, infection drains lines, um doing an abdominal exam, doing apr if necessary and very important in surgical patients checking the calves are soft and nontender, particularly post surgically. Then very important you say you have to recover the patients because often these patients are unwell and septic and cold. And if you don't recover the patient, then they're going to become hypothermic. And this is a thing, they get a bit picky. If you don't say, I know that what I just said is a lot, but this is kind of be the main bulk of your answer. You'll then move on on this kind of flow chart to the full patient assessment. And by that, I mean, things like every gathering information, everything that's available to you. You want to check the drug chart, you want to check the notes, you want to check the op notes and you want to check any available imaging or results. And this is gonna be the same for every patient. So you can pretty much memorize a passage for this section that you're just gonna reel off for every single patient. Um because it's gonna be the same, you then want to decide is your patient stable or are they unstable? Now, in the CST interview, they're almost definitely going to be unstable and you're gonna then speak about your differential diagnoses what investigations you'll do um to answer these and then any definitive treatment based on your top differential. Now, the examiner will not give you the answer of what the differential is. So you need to commit to commit to a range of investigations that will investigate all of your differentials and then come out and say my top differential is X and the way that I would manage this is Y and then involve your senior and any wider members of the MDT. On the other side of the flow chart. Here, we have the daily management plan which is more relevant if the patient is stable. Now, this happens pretty rarely but it does happen. Um In which case, you can show off by showing that you're thinking of things like getting a dietician involved for nutrition and oral intake, looking at their drugs, looking at meds reconciliation, looking at PTO T and actually looking at when you can deescalate patients. So when you can move, start to remove things like their catheter, remove things like tubes or drains, um and move them to a lower level of care if necessary. So the structure of what you'll do, we've just been through the A to E bit and the parts after. But what I think is very important is an opening statement that you will make and this isn't just for the examiner, this is for you as well. So you'll speak about what the salient points of that question are and by repeating them out loud, it kind of focuses you before you start your at on what's important and also tells the examiner that you can be trusted, you know what you're talking about. So I would say something like this patient sounds critically unwell and I would attend to them immediately, I'm worried that they're hypotensive and tachycardic and I'm worried they could be septic whilst I'm on the phone to the nurse or whoever's made the referral to me. I would like them to gather the observations, first set of observations and the drug chart and notes at the bedside. Now that took me probably about 15 to 20 seconds, but it already tells the examiner that I know what I'm talking about and I know what I'm looking at and I haven't even started my A to E and in that way, they can relax a bit and know that you're focusing on what's important. You'll then start your at E on based on what we've just spoken about in the cri algorithm and reel that off. By the time you get to your um interview, you will know this, say, well, it's going to be pretty much the same for every patient apart from you might stress some things a bit more for patients who are septic, like antibiotics and the sepsis six and some things a bit more for trauma patients. Um such as doing an A TLS approach, you'll then speak about information gathering, um which will include your history, reviewing the notes and images, bloods, drug chart. Again, you can just reel this off and then you come into your differentials and investigations um and management really, you will then remember to say that you reassess your at e after initiating any management to ensure that your interventions are having an effect. And lastly, you will make sure you escalate and discuss the seniors. And the MDT, the MDT is critically important in this station because this will involve everyone from the nurse at the bedside being updated, your senior people in theater, such as the anesthetist, the theater booking team, um the nurse in charge of the theater and any higher level or lower level care that you may need to transfer your patient on to say IC or um an HD bed. You might want to think about that. These are things that are gonna really set you apart because there's a lot to speak about in this. Um And those who kind of remember all the MDT people, I think they out out in these answers. So we're gonna do a sample question. This is a really common question which comes up time and time again in slightly different ways. Um And it's an important one that people are good at answering. So I wonder if anyone would like to volunteer to have a go at this question. And when I say that you don't necessarily have to put your camera on, but Anna could make you a speaker if you just want to speak out loud. Um Your answer to this question. Absolutely no judgment. And I'm not expecting anything from you guys. Um And this and let me know if there's anyone who wants to give it a go no one has written anything in the chart. Huh? No one has volunteered in the chat until now. That's fine. Um, no worries. It is a bit daunting obviously to speak out in front of everyone. I guess what we could do if some people from the audience are in agreement is that we could all do a little part of it and we could all volunteer some information that would be really good. Would anyone like to have a go at doing the opening statement, for example, or if not, maybe someone could type it. So what in this question is making you worried if you just type that in the chat? I mean, I don't want to have to pick people, but I might, if no one answers because this is quite important. Oh, there's a volunteer George. Yeah. So someone said they're lucky about, they're worried about the lady's vitals and pain in the context of her recent surgery and she require an A to E assessment and full review, which is completely right. Um, we're worried that she potentially a bit septic, um, in the context of her recent surgery, which is great that you've picked that up, Anna. Um, does anyone want to have a go at the, at E George? I saw you wrote, you can give it a go, I don't know if it's possible for Anna to make you a speaker or not. We can see. Yes, I have invited him to the stage so he should be able to accept this request and dear, I mean, it's a really good opportunity to do this because um you have so many people to give you feedback, which is nice Georgi that or if not George, does anyone else gonna have a go? It's just literally speaking through the at, I'm not gonna ask you any questions about it. Ok. Can someone else? I will try to upgrade them now? Ok. All right. No worries George. Thank you though. Um If anyone else wants to try, that's great. Yeah, hello. Can you can? Yeah, thank you so much for volunteering. It's really brave of you and also um you're going to be great. So why don't you talk us through the at E with this patient? And what kind of things you would do when assessing this patient? Yeah. Well, of course, I would introduce myself to the patient. Um Obviously they back in the air patient. Um and then moving on to our first patient um doing kind of general making sure that they are up to date. So they um oxygen calculations as well and yes and then do a general inspection their work then um um the chest listen to equal bilaterally. Um Yes, they give you any information that they don't give you any information. So this is a good experience for you. So you can see how it works. They just want you to talk. Ok, great. So Um So obviously, if they have low oxygen saturation, um it's not written in the system, but there was low oxygen saturations. I would start with no mask. If they requiring oxygen, I would consider doing an A DG and a chest X ray as well. Um And then, and then moving on to see the um circulation, I would check the uh fluid status and check me. And also, so you get an op serv of the heart rate, BP. Um OK. That's uh and listen to their chest as well. Um I can see that they are slightly hypertensive and tachycardic according to the to the stem. Um this could be due to dehydration which is kind of the most commonest cause. Um So I would um uh she's 71. She could be quite frail. So I'll start with 250 um to finish dehydration. Um and consider kind of doing an EKG and uh and putting um two wide four IV Cannulas um taking blood can user name B profile clotting liver function test uh two weeks. So one second now, one second, 1530 minutes later um and a V BG to check for lactate. Mhm I think that's um yeah, let's see. Moving on to d so disability. So um no, so glucose, I would check their glucose. Uh I would check the pupils if they um I would check if they have a temperature. I can see that she is febrile, so possibly indicating sepsis, given that she's hypertensive tachycardic and febrile close up as well. Um And I would then look everywhere else, make sure there's any rashes, any lines. Um So she's had a resection, I'm checking her um uh like wound scars as well if they're healing well. Um And I would ask her she's open her bowels, if not, I would consider doing the pr exam. Um and I need to reassess afterwards as well. Um, so to reassess if anything has changed and continue. Um, yeah, I don't know what more I can add. Sorry. And then I would obviously gather more information, look at the notes, op notes. Um, see if there's any previous blood before she left the hospital compared to the new one. that's all I have. Oh, sorry. Great. How did that feel? How did you feel that went? Because obviously they, they don't really tell you anything except for patients and hypertensive without indicating probably some sepsis or perforation or something along those lines considering that she has a primary anastomosis. And that's why it's useful to do this kind of exercise so well done for volunteering because you can see how strange it feels to, um, you know, just be on your own for three minutes. So I thought you did a really good a you actually put some things in there that I didn't mention earlier say that ABG is really important if they're not breathing. Um, I thought it was really good. How you said this lady? I don't know anything about this lady's oxygen saturations. But if I, she was um hypoxic, I would give the oxygen. You covered the glucose in the D section, which I didn't even talk about, which is great. Um Yeah, I think to improve, you just need to, I mean, I'm not expecting this at all at this stage, but you come to it, you just need to keep rehearsing and get it a bit um more concise and as I was talking about earlier in the right order, practically. So, you know, blood cannula bloods, then um any fluids or anything like that, but really well done. Um That's great at this stage to be able to reel that off. Um And you actually went further and started telling me the information gathering after which is great. No, no, no, that's great. Thank you so much. I appreciate it. Um Thanks for volunteering. So, so, um and she did a really good job there, which is great. Um And hopefully gives you guys a bit more of an idea of what's expected. So this is just what I wrote that I would say this patient sounds critically unwell and I would assess the patient immediately. Whilst I'm on the phone, I would ask the nurse to take some observations and collect the drug chart, fluid charts and operative notes on arrival to the bedside. I would assess the patient in an eight E fashion as per the C Crisp protocol. This is my script that I learned for CST. Um I'm not going to read it all out because I probably bored you guys to death with at E by now. And I think we've all got a good idea of what we need to say. Um But if anyone wanted to use this for reference, um when they're revising or trying to learn a kind of basic script, then feel free. This is just something that I wrote before. So information gathering Ashi to kindly demonstrated this as well. After performing my A to E assessment, I'd asked for repeat observations and reassess to ensure my interventions were having effect. I'd also like to take an ample history review the notes, the operation note if required, if it's there, the drug chart and available results and imaging, that's all you need to say. You just need to learn that bit as well. Does anyone have any differentials or investigations I'd like to do for this patient, put them in the chair and or you can speak. I really don't mind. I'm happy I would be happier if you spoke out, but you can put them in the chair if necessary. So I can go back to the scenario if it helps literally anything, we need to have probably at least three differentials to tell the ala say, what do you think? Yeah. So an has said anastomotic leak CT scan. Yeah, that is a strong differential. Um Does anyone have anything else? Perforation postoperative collection? Yeah, these are really good. So, um I would say kind of come up with three of your biggest ones, but in mine, they actually really pushed me to just list as many as I could. So I found the way to think about this easier as postoperative like related surgery or surgical complications. Um and then kind of um no complications. So, complications of being a hospital like hospital required pneumonia uti after the catheter, um, wound infection would fall into surgical. But you know, you'll get a couple of things that you could say for pretty much any scenario that you'll be able to rule off. Um which is useful just to think of them in terms of medical and surgical complications. Yeah, there's some really good ideas there. Well done guys. So, um just going forward, this patient has an asthmatic leak. Um This is a really common um station day three, post 3 to 5, post surgery is the peak time this happens and especially when you get um, one of the anastomoses, large bowel. Um Other options are septic or hemorrhagic shock. I don't think anyone's had bleeding on the chat postoperatively. This is something that you always need to be thinking about. Um So make sure that you, if you say shock, you categorize it into, to septic and hemorrhagic. Um Other things may be perforation obstruction, wound infection, hospital, acquired sepsis. And by that, I mean, our UTI s and our hats and such. Um, I don't just share you guys the answer. Can people write for me the, uh, investigations that you would consider Kis ct of the pelvis? Yeah, great. Like pretty much every abdominal surgery you're gonna need to get this. Um, I wouldn't go as far. I'd say as every scenario you get, but every postoperative abdominal surgery scenario, you need to get this, um, always a chest X ray as well because of atelectasis or chest infection in the hospital. And uh more often than not a Abdo X ray is useful if you haven't, um, got the CT Abdo Pelvis, the investigations bit is quite easy. Uh Usually, unless they're looking for something specific like pe um they're generally the same kinds of investigations. You'll say something like I've already covered my bedside investigations and my bloods in my A to e approach earlier. However, for imaging, I would like to obtain an Abdo X ray, a chest X ray and a CT Abdo Pelvis with contrast, a sneaky question they like to ask is what if you see gas under the diaphragm on your chest X ray? Has there been a perforation? And you need to be careful because there may be pneumoperitoneum in the postoperative period. So, don't get caught out by that one. Lots of people do. We're then gonna go through our definitive management. You obviously don't have time to talk about this for all of your differentials. So you would say something like having listed my differentials, my top plans and anastomotic leak. Um I would look to be starting antibiotics and fluids for this patient and making arrangements for them to return to theater, the theater. You need the same things every time patients be no by mouth marked. If it's a limb consented on pod and alert your MDT. Um bonus points. If you alert the level of care that they're going to go to you after such as the IC or HD. By this point, this will be the station over. Um There may be a couple of questions, they didn't have time to ask me very many questions at the end. Um So yes, it's a lot of talking, you'll do two of these stations back to back and that's, this will only be a third of your interview. You'll then move on to your management and leadership station. And this will seem like a break compared to the first one. You will do your leadership speech, which we'll go through in a bit, which lasts three minutes with two minutes of questioning and a management station which is one station that's provided in the interview. Um You get five minutes allocated to answer this station. I found this station trickier to prepare for because you don't have the knowledge at your fingertips. But on reflection, it was much easier in the interview. And um they tend to use very similar um content every time. So more often than not, you'll get a station that you've already prepared for with your friends. So every station that you get, you're going to use this framework to ensure that you talk about it in a well rounded approach. Um You may have seen the spy framework before I saw something online where I used, where they made it spy's D IR and I found this a lot more comprehensive um when speaking about these kind of stations. So first of all, much like the clinical station, you want to come in and do a summary sentence about what is the key issue in this scenario that they've just given you. Um it can encompass many things. Patient safety is nearly always one of them. So you can nearly always say this scenario raises issues of patient safety, it raises issues of alcoholism at work, which therefore is patient safety. Um There's honestly all sorts of topics that can come up here. If you haven't said patient safety is a key issue, then you need to think about putting it in there somewhere because it always is, you then want to seek information. So find out more about the scenario. Who can you talk to? What notes can you look out at? Um There's always a way that you can find out more information about the scenario you want to take initiative of how you can solve this scenario, escalate it to the appropriate people. Um might be your reg might be um clinical governance, people or people in admin roles in the hospital, it might be your consultant. It might even be telling the patient, you know, the duty of candor or something's gone wrong more often than not. These are pretty emotionally heated scenarios and support is always a key thing to mention whether it be giving the patient support, whether it be giving a staff member support because they have depression and they can't do their job properly or they're taking drugs and trying to operate. And they need, even though that's completely a scenario that should never happen. You need to think about giving your colleagues and patients support. You need to document any issues that have happened, incident report if appropriate. And I always say this as an extra thing, reflect in your ee portfolio or e log book and thinking about doing an audit. So this thing can never happen again. Um is like a little bonus extra which I think they like people to talk about. I got full marks in this section and this is the framework that I use. So I recommend this sometimes you can't say something about every single category. Um But if you kind of use it as a base, then you can't go too wrong. These are the common topics that come up. Um Again, we won't go through all of these, but if you use this later on in your preparation, um then you can't go far wrong, preparing a, a sort of scenario for each one of these. So, um if someone wants to speak out again, I really appreciate it. If not, what I'd like you guys to do for this scenario is in the chat. Give me a kind of spies. D ir um approach of, what kind of things do you think are covered here? So you are the orthopedic ct 11 of the patients has been admitted with a fall and a fractured neck of femur. Their PMH includes a FCO PDD and asthma and they are very frail. It's the opinion of the Ortho geriatric and orthopedic team that DNA R attempts will be futile. And you've been asked to complete the DNA R form with the patient and her son, the son is extremely angry on the ward and can even be aggressive, but you will not save his mother. How will you proceed? And what I'll do is I'll just go back to the framework so that you guys can see it because I said this is probably the first time you're seeing this. Um And if you can just summarize in the chat for me, some issues that you think come up based on the scenario. So to reiterate, um you've got a frail patient who is on the ward with a neck of femur fracture and um your consultants ask you to put DNA R in and the son is angry and potentially violent. What will you do for each of these things? It's not my joke. It's a DNA R or the CT one, I guess. Yeah, I think if you said that then you're probably not gonna do well in the, in the scenario, this is very similar to what I got in my real thing. So you need to be prepared to um answer these kind of things, discuss what some think clarify any questions, try and deescalate, explain what's going on escalate senior. Yeah, exactly. So, I mean, the key issues here are for patients kind of psychological safety more than her physical safety here. We're going to be having a really emotional discussion and having the sun kicking up a fuss at the bedside is not ideal at all. You want to think about your own safety, someone who's potentially violent, um and even our safety around getting angry in a situation like this. Um It's these kind of things you need to think about. It's not just the safety of the patient, it's the safety of everyone around. You want to gather as much information as you can before going to the bedside to see the patient to make sure that you're equipped to answer any questions that they may have. Um for the initiative there, I think I said in mine, I'd like to take them to a quiet room away from the ward and away from other patients. It's distressing to kind of have patients over hearing this kind of thing as Anna says, issue of confidentiality. Um Also, yeah, asking if the patient is happy for us to discuss this with this aunty. That's a really good point, George. So you can already see by using this framework, you're getting so many ideas of different things that you can say and this is why it's such a good framework to ensure that you've covered lots of different bases. Um If the patient is, you can escalate it to your senior, if the son is not happy, um you can escalate it to security if the sun is violent. Y says, reassure the patient and family saying we will make her comfortable attempting a seat. Yeah, exactly. Reassurance is a massive part of this and that comes into the support side as well, not forcing them into it, giving them time to reflect on the scenario and saying, oh, I can come back in an hour or so to give you a bit of time to think about this um offering like emotional support to the family as well. Um You need to document it, of course, there's probably no incident here but if there was an incident um whereby something did get nasty or aggressive, you would need to report that and your Datex. Um And then reflecting in your port failure is always a good option as well to show that, you know, you're committed to improving in the future, say well done for that guys, there were some really good points there. Um I've put here, we've just been through all of it, but if you'd like to come back for a reference, these are kind of the things that we would cover. So someone actually said, ensuring the patient's happy with the presence of her son yet reviewing notes, quiet room for confidentiality as well, which is definitely an issue that could have been raised at the beginning. So thank you, Anna, um explaining, bringing senior members reassuring, giving opportunity for further questions and stressing it would be unnecessary trauma and then documenting and reflecting they were done guys, he got ready all of the answers there. So I now want to move on to the leadership part. Um They say they're gonna give you the question two weeks before the interview. I mean, it's pretty much exactly the same question every single time which is reflect on your leadership experience when working as a team and how this will be useful as a core trainee. You need to speak about this for three minutes. And I would recommend two or three examples about a paragraph each. Um and each example has to be very like point evidence, explanation of these underlying words to show that you are fully answering the question. So I'm recommending the star um star approach, which is what's the situation the task you did and action reflect result reflect it's really important to put results to show that what you did had a meaningful contribution. Um You need data to back your claims. Any prizes you've won any outcomes of audits or kind of clinical research that shows that what you did is great. Don't hold back like this is the one time in the interview where you just need to say, I'm great. I'm great. I'm great. Um And don't pat it out, you won't have time, you need to time this whole thing to be two minutes 40. I would say in case you stumble in the actual interview, um You need to record yourself doing this over and over again telling anyone who will listen. How do you think I can make this more? How do you think I can get my point across better? Um But in the end, it ends up being the best bit of the interview cause you have the most control and you will to be honest, um be prepared for any questions I'll ask because you will have lived through hopefully these leadership experiences. So I got a little mentee um about just to get you guys thinking like what are the qualities of a good leader. Um And essentially, I want you to think about kind of bars that you might be able to put into your, into your speech, things that you think are important for surgical leaders are you guys getting access to it because I don't know if I'm there some technological issues but I'm not, um, getting any responses yet, so I'm not sure if you guys can see, but I see kind organized, trustworthy, specific, motivating, hardworking. Yeah, these are all really good answers, managing people calm. Yeah, these are really great. Um, and it's kind of these qualities that you wanna get across, think about someone who inspires you and who's a good leader. Um And what qualities do they have? And that's the kind of thing that you want to get across in your speech. And on that note, using the same code, um it's all anonymous. Maybe you guys can give some examples of when you, you know, things that you might use. When have you been a good leader? What have you guys done? And I'll tell you if they're the kind of things that would be good in um this kind of speech, anyone got anything? Surely you guys are all very talented. I'm sure you must have done lots of things. So I'm just looking at the questions guys. Um How much of the teamwork stuff needs to come across? A lot of leadership stuff is very focused. Can I give my examples? Yes, of course. So I, you really need to get within the team. Um I did an example of uh acutely unwell surgical patient on the ward, um how I initiated management and got them to theater essentially and how they ended up having an ischemic bowel and they were saved. Um That, that allowed me to speak about the management I had initiated in my leadership coordinating team and then, um you know, working within the team and the MDT to get the patient to theater quickly, I did an example of working in this leadership collaborative. Um and some of the work that we had done together, which I had been the foundation leader, but I've worked with my team in order to achieve things. And I did a nonmedical example um about uh being in the being in a netball team essentially. And I think they quite like a nonmedical example just to show that you are a bit of a normal person as well. Um We've got some examples, some other people have said, so program organizer for S FP events, delegated tasks to fellow members, successful events or positive feedback. Yeah, that's exactly the kind of thing you can say, say like you organized it, but you've delegated tasks, you know how to work with a team, you know, that you don't have to take on too much. That's really good, raising awareness of junior doctor mental health and improving wellbeing. This is such an important topic. Um I think you just need to pin down kind of what you've done, how you've led and then how you've worked with other people to do that. But that's really good teaching programs as well, always really good. And another chance to show them that, you know, you're doing things outside of medicine, um outside of your designated job to help things. This is another chance to really show off about things that you've done towards surgery that may not necessarily be included in the um self assessment, which I know they don't do anymore, but in the self assessment categories. So think about that and think about, you know, what they want to see in a course, surgical training. So great guys. Thank you for all of that input. Um So I had a little brainstorm about what I'd done. I really wanted a research example, a clinical example and an out of medicine example. And that's kind of how I went for it. I know some people who did all nonmedical examples and did really well. Um And I know some people who did all research. So I think it really doesn't matter, but I just kind of thought that to share a balance, I read the R CS Leadership guidance, which I've linked there. Um And I use buzzwords that they use within their own guidance to help frame my speech, which I think made a real difference and I recommend you do that yourself. Um And then the follow up questions are either specific to you or they can be quite generic. What's the difference between leadership and management? What qualities make an effective leader, how you develop your leadership skills. They asked me this one, I said I would do a le course um or formalize my leadership training because everything that I had spoken about previously was that? So I think, ask that they say how we continue to develop um form I with this is what I've gleaned from online. Um It seems as though your self assessment part will be removed and it will maintain the same scoring system. But instead they'll choose 22 kind of topics to ask you about and you need to speak about your highest scoring experience in those domains. So I guess that's the first thing to say, write down all the domains, write down what your highest scoring example is and it sounds really obvious but make sure that you can talk about it in a logical and structured way. Um I find the a framework quite useful and I also find the camp framework quite useful for personal questions, things like why do you want to do surgery? Talking about clinical academic reasons, management reasons, personal reasons. Another thing I thought you could do is just match your audit proposal. So if they're asking about a quip or an audit proposal match the structure for which you'll present that like an abstract. If you're talking about research, you can do the same thing. I'm sorry that I can't be of more use um for this, but I didn't do it. Um You guys will be absolutely fine I'm sure. Sorry, am I cutting out? Um You're ok to me now? Ok. So some, he said, how do we decide if you could speak about surgical or not? Um I think you should just do choose your three best leadership examples to be honest and use that. I don't think they mind if it's surgical or not. As I said before, my friend did all non surgical and got full marks. So, um it really doesn't matter as long as you've evidenced the underlying parts of the question that show you're a leader working in a team. Um And why this will make you a good CST um trainee. So you need that sentence at the end. This will make me a good CS C trainee because it sounds really stupid, but that is the best way to make sure you've hit all those points. Um I'm happy to take the emails or stuff about the portfolio questions and I can try and do a bit more research, but it's not what I did. Leadership experience needs to have been done after joining medical school, I think. No, but there's some questioning over this. Um I think they prefer it if it's after. I don't know the answer to that. Uh 100%. I'm sorry. Um I would try and get it after but then again, I don't know how they would know when exactly you did it unless they specifically asked you that. So it's up to you. Um I will try and find out for you and let you know whether it needs to be after or not. So you guys are there in the end? Thank you for staying with me. Um Preparation timeline. I think I left it a bit late. I recommend three months to be honest with you because as you can see, there's a lot to get a grasp on and you can't just do this last minute. You need to put in the time speaking to a body, um or yourself in the mirror. I think a study body is almost essential for this. You can't assess yourself really, you can learn things, but you can't assess what you look like and how you frame things clearly. Um I practice with Carl who I think did a talk for you two weeks ago and we only practice together actually. Um And I think it was really helpful but practice current CST S. Um If you see them around the ward, they would have just done it, especially CT ones and they will know, you know exactly what to say. Um I really recommend recording yourself on the camera. I even did this right up to you before my actual interview to check the lighting was good that I looked, OK, you need to speak to the camera. So currently I'm looking at the screen and you notice the difference and then if I look at the camera, which I'm doing now, then you can maintain much more eye contact. Like you're actually speaking to the person makes you seem much more engaged. And that's what's going to help you for your communication skill. So I would say it feels unnatural at first, but practice speaking at your camera, not at your screen, looking at yourself. Um It makes you come across so much better. Um And the speech, you really can't afford to get this out of time or um not recall it. You need to write this well in advance and be able to recite it in your sleep, some practical tips, um talk through your clinical and management answers about stopping if they don't like to prompt you sign post um and use buzzwords when you can um categorize everything you can, as I just said about the camera, it is so important. It takes a little while to practice it and get used to it. So I recommend doing that a couple of weeks before and make sure, you know, where you're gonna do your talk, what the lighting is like and that you have good wifi. Um It's on a little chat kind of like video. Um I think it was called CCOM that they did it. I'd never used it before. It was pretty easy to use. It's just like using teams. Um So yeah, these are the main resources that I used. Um The course interview book is really good to kind of get a handle on things. It's a bit out of date. Um But I read this back to front and did all of the stations in it with Carl and some of my other friends, it was really useful. Um And valuable. Actually, I would definitely get your hands on that one. Um Medi Body is a paid resource, but again, it has the same pretty much stations as in the green book. Um But it has a couple more. It's useful for structuring your answers. Um I shared the subscription with someone and pretty much just learned the answers to each of the questions. This is the surgical leadership PDF, which I linked earlier. Um It's really good to read this that's front for your leadership scenario. Um I watched a couple of things on youtube and I didn't use this medical interviews book, but people told me that it was good. So I'm recommending it to you and that's everything. Um If you want any have any further questions or need help with anything, I'm happy to answer. Um Or if you see me, if you're in Charing Cross and want to talk to me, then that's absolutely fine. Um My email is there just in case you would like to send me anything and um and just have a look at the chat to see if anyone's got any questions. But otherwise, thank you for coming before you guys leave. It would be highly appreciated if you could just do the feedback for us. Um Just to let us know how you think this session went and it was really helpful for Alex's portfolio as she's working towards a qualification. So if you could do that, that would be fantastic. Thank you. Yeah. Thank you everyone. And thank you for giving up your Monday evenings. I hope it was useful. Thank you, everyone. See you next time with our ranking jobs webinar. Thank you, bye-bye. Thank you.