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All right. So should be going live for short. Oh, ok. So I think we're live now. Um If you can't hear us, please write in the comments section. Um But my name is Freya, I'm the surgical career lead of mind. The Bleak. Uh Thank you all very much for coming to the webinar today. This is our third webinar. Um And it's on the clinical interview uh station for CST. I'm very lucky to have re here today. He is a plastic surgery themed core surgical trainee too. Um He presented last year as well. Um And we obviously want him here because he scored phenomenally well, in his interview, um scored 96% and was therefore in the top 1% nationally of all applicants. So he's going to share his wisdom with us today. We'll have a short Q and A session at the end. Um So please prepare any questions you have and we'll get to them at the end. Um And any questions after that, you can always contact my the as well. So I'll leave it up to you. Sweet. Um Hi, everyone very busy time. Um Obviously my, my name is Gary Kay as Frey has just mentioned. Um, well, I think before I begin, can everyone see the slides and can they hear me? Is that all? Ok? Just put a thumbs up in the chat if, if everything's ok, I can see them from my end at least. Ok, fine. So I'm, I'm guessing we're good to go. Uh, so today I'll be going through, um, the clinical part of the CST interview. Um It feels like it's been well, I mean, it's only been a year and a half for me since I last had the interview. But um I'm hoping most of those sort of key points should still be fairly familiar. Um I understand you all should have had your interview slots released today. So I imagine most of you will now be starting to properly prepare for the interview. So I'll try and go through as much as I can uh regarding the clinical uh station uh for the interview process as well. And then if you have any questions at the end, uh feel free to ask them in the chat and we can keep that fairly interactive. Um Obviously permitting whatever resources we have. Uh So to begin, let's have a look. How do I navigate through this? OK. Just click on it. So the outline of the session, um I'll go through the format for 2024. Um I imagine it hasn't really changed much since last year. However, if there's anything that I mentioned that you think it might maybe be outdated. I did try and have a look and sort of make sure everything was up to scratch. But if, if something uh doesn't sound quite right, just uh mention it in the chat and I'll, I'll try and rectify that. Uh So we'll go through the format for the interview. We'll go through of how best to prepare when to start preparing. Um I'll focus specifically on the Crisp algorithm for today. Um as that's sort of part of your clinical uh station. So your clinical station will be divided into a Crisp station and an A TLS station. And I'll focus specifically on the Crisp Station. Um They're fairly similar in how you approach them. Um But I think just it's, there's still quite a lot you need to, to know uh just for that part as well. Uh I'll go through how I structured my answers and how I think is a good way to structure uh your responses when you're um answering questions, uh any complications with an example scenario um and any curveball scenarios as well. OK. So next, so the format for this year's interview, I imagine is still all online. Um So you'll have a 20 minute interview divided into two stations. Uh One management, one clinical uh both. Uh the clinical station will be further subdivided into a five minute ATL S and a five minute crest uh station usually I think it's usually two interviewers. I had two interviewers when I sat it, um, the year before last. Um, and I, I'd like to think they, they usually keep the same number. Uh, the maximum number of points I believe is still uh 144 with 72 points for each station. Obviously, the overall number of points will take into account your, um, you know, you know, your portfolio and your M SRA as well. Now, in terms of preparation, um Well, I suppose for me, it's, I find it quite difficult to prepare until I've got sort of an interview date. And I know exactly, um you know, how much time I need to sort of devote to preparing. But um what I would recommend and obviously now you've, you've got roughly 10 days I think until the interview cycle starts is that it, it takes roughly 2 to 3 months to prepare um appropriately for, for surgical training interviews. Uh And what I mean by that and the way I sort of approached it was to initially build a knowledge base. So using resources like me, uh the interview CST interview book, which I think now is probably a little bit outdated. Um but just use those resources just to build your knowledge base and then try as early as possible to then either find a partner or practice your interview, uh responses verbally with other people. Um The more you can get into a verbal practice, you know, the better because ultimately your interview is a performance and it's, it's no use knowing all the knowledge if you can't really deliver it or relay it uh verbally on the day. And what I highly recommend as well is to try and practice yes, with people at the same level, but also equally with people that are a bit more senior to you. So, registrars, co surgical trainees and consultants. I know, I know it can be a little bit scary, but I think you sometimes need that. I suppose that, that anxiety to, you know, help you approach it a bit more formally. Um And you know, when you're practicing with someone who's also sitting with CST interviews, it, it's very tempting to approach it fairly casually. So maybe closer to the time, uh maybe start to ask your registrars or your course, surgical trainees um to give you interview practice as I, I've personally found that quite useful. Uh So next, so as I mentioned, we'll be going through the crisp algorithm. Um And there is a structure to this. Now, if I remember correctly, if you're applying straight from F two, I don't think you will have, you will have sort of, you'll have attended a crisp uh course or a crisp session. Um I think much like ATL S the Royal College, um often runs crisp sessions throughout the year, but I think these are only eligible for uh CT ones and CT twos. But essentially um you don't need to have sat the CRISPR course to, to do well at the interview, you just need to know the algorithm and just roughly how it's structured. So similar to your A TLS, you would begin um with your immediate management of the patients. So you would go through your at E um as you've done, you know, through medical school uh during your ay, then once you've done your at E assessment, you then conduct a full patient assessment, which includes having a look at the um patients review charts, um do performing a history and systemic examination and also looking at the patient's uh results as well. So bloods other investigations, imaging, once you've gone through that entire uh patient assessment, you then need to sort of make a decision about what to do next. If you, if the patient is stable, then you just uh continue a daily management plan. So usually what they'll do in the interviews, they'll provide you a POSTOP patient who's on the ward and has suddenly becoming well. So you would just approach them, conduct your at E as you would do um review their charts, charts, uh imaging and then make a plan about whether they are stable or unstable. If, if they're stable, that's good. You, you just sort of continue what you would do on the ward round. So uh bloods the next day, um any further imaging specialist, opinion, um nutrition, fluid balance, and all these other things that you would consider on the ward round. If you're worried that the patient is unstable, then you would need to escalate. So don't be afraid to escalate early. Usually, what I would do is as soon as I'm so as soon as I've finished my at E uh in the initial assessment, if I'm concerned that the patient is unstable, I would then mention that I would escalate uh urgently to the registrar or the consultant on the ward. Um And then continue my assessment. Uh Once you've sort of uh once you have a rough idea about what's going on, um you then initiate your definitive management as well and we'll, we'll go through this using an example um crisp scenario just to help you consolidate it a bit more. OK? So structuring your answer, OK. We've, we've just gone through uh once you've had your scenario, you basically start off with an opening opening statement. Uh It's very tempting in the interview to sort of start off reading off your, your a to E assessment um without providing any context. And you, I think I found it quite useful to set the scene, get your buzzwords out, make sure that you, you demonstrate that you recognize that this is a crisp scenario. Um And what that does for the interviewer is it, it sort of primes them, it, it sort of puts them at ease and they can be confident that you know what you're talking about and usually you'll find after your opening statement and as soon as they relax, they won't be as they, I don't know, they'll technically fall asleep a little bit and they won't be as critical when they're marking you. So I think, you know, those first impressions count and having an opening statement that is, that is impactful and structured, really does help And then that allows you to just go through your at e uh conduct your full patient assessment investigations and definitive management. Uh So just go through your your algorithm. OK. So if we go through an initial scenario, um so in this scenario, you're asked to review a POSTOP patient on the ward who's had a small bowel anastomosis. Um and the nurse informs you that the patient has a low BP. Um So this would be a pretty bar or um type question and most of the crisp scenarios you would get would probably nine out of 10 times be a POSTOP patient um who has something wrong with them, either they're Pyrexic, they have a high, high heart rate or you know, they're in a lot of pain or they're hypertensive. Um and then you're asked to go and review them. So as we mentioned earlier on, you begin with your opening statement, um so you want to try and signpost um as early as possible. And this provides you an opportunity to, as I mentioned earlier on to state that this is a critically unwell patient and you recognize that and you want to go and review them as immediately as possible. So emphasizing urgency once again, um that signposting is, is quite crucial to demonstrate that, you know, obviously, you're recognizing that this is a a fairly unwell patient. Um to demonstrate some forward thinking or forward planning, you would, you may wish to also state that you want to ask the nurse to prepare the drug chart, fluid chart and notes as well so that you can review these as soon as you get there. And you may also want to request a fresh set of observations because this may potentially be the first time you see the patient. And it's always good to have up to date information when you get to the bedside, so you can take all of this into account. And then once, once you've sort of reeled off your spiel, uh you've said cri protocol and you would just begin your immediate assessment following an A to eat e fashion. Now, your opening statement can, can be tailored to your own um as opposed to your own style. It doesn't have to be exactly the same as this. I think what I feel are probably the most important things uh or themes within your opening statement is sort of emphasizing urgency. I think if you can mention that this is a critically and well patient that you want to see straight away. Um I think that that ticks the, the urgency uh marks for that um forward planning. So, you know, if you can vocalize that you want to try and get some information prepared before you arrive at the bedside, that also shows that you're thinking about what you're going to do when you get to the bedside and then stating explicitly that you would perform an at E examination following the cris protocol uh of this patient also further uh solidifies this in your, in the, in the interviewer's mind as well. OK. So when you get to the patient, uh you would then begin your, your at E and I'd like to think most of you should be fairly familiar with how um an at E uh assessment runs. Uh the structure that I tried to sort of keep in mind when I was answering these questions was um as you go through each stage of your at E, you want to uh review obs first and then examine and then intervene. So at a you would obs examine, intervene at B obs, examine and intervene. And what that does is it just keeps it fairly standardized, it can be easy to sound fairly robotic. But I think the more you practice, the more natural it comes off. Um and it demonstrates to the interviewer that you're structured in how you approach these answers as well. So for A um you would obviously speak to the patient. Um And this is fairly straightforward. I think if they're vocalizing, you move on to B and the other thing I'd like to mention as well is that don't lay, don't spend a lot of time at each stage. I think, try and only mention the most salient points at each stage of your eight E assessment. Um So for B uh you would obviously check for the respirate uh and saturation uh and then examine the patients. So palpate CS and auscultate and then intervene by providing them with some oxygen as well. And he is an example of, you know what I would probably say um further to him. So uh check your patients respirator and oxygen saturations palpate because and auscultate and then start them on high flow oxygen. Um You can request a chest X ray and ABG here as well. It's, it's appropriate and they're both fairly appropriate investigations for, for breathing, for circulation. Once again, oops examine and intervene. So you would um check the patient's heart rate, BP, CRT um examine them. So you want to start uh in a systematic manner. So you can start from sort of peripheral to central, which I in my head, I think that that works uh fairly logically. So you examine them for cap refill, you examine them for um are they, are they sort of pale? Are they cold? Are they clammy? Um move up the arm, uh examine the BP if you can uh and then um move more centrally. So I take the patient and then once you've finished your examination, you then intervene. So you get all your circulation related uh interventions. So an ECG um get IV access as well. Um Try and mention of roughly how much fluid do you want to start. So, in this patient, um who's hypotensive, you could give them an initial fluid challenge um of maybe 500 mils uh crystalloid or even Harman solution. I know surgeons love to use heart solution. Um And fil should be sufficient for a fairly youngish patient if you're worried that um they may be slightly older. Um you can drop that down to 250 but either of those volumes should be, should be fine. Um But before you even start giving them fluids, you obviously need to take bloods. Um So make mention your context uh appropriate bloods that you would take at this point. Uh and then start the money on fluids. Let's just go back and then start them on fluids. If you're worried they might be bleeding. Um So this patient could equally have an intraabdominal bleed. Uh They are POSTOP and then you would uh start them on, on some blood products as well. Um But I wouldn't jump straight for this. I think I would give them a fluid challenge initially if they are not responding. Um Then you would escalate before you do anything else. But then maybe start to consider w whether maybe a transfusion might be appropriate and don't forget a catheter. This is something II always used to forget. Like just drill it into your minds that at sea, the patient needs a catheter because you need to monitor uh urine output. If you're worried that they're, they're hypertensive. Now, I'm not, I'm not going to read all of this, but this is uh an example um sort of a response that I would give. Uh and I'll, I'll share these slides. So hopefully you should be able to get, have access to them. So you can read the example answers in uh in your own time. But essentially, it just goes through everything that, that I mentioned. Um So you assess um fluid status by sort of palpating and uh looking at the patient from peripheral to central. Um And then you get your uh interventions, you get your context appropriate bloods. Um And then you, you can consider a transfusion if the patient is a uh not a fluid responder, if what, what I would sort of do in this specific scenario as well is um provide sort of elaborate on your answer. So, um you could say that I would give them a fluid challenge and if I'm concerned that they are not responding, um my suspicion of a potential hemorrhage uh would be high. And if this was the case, I would initiate a massive hemorrhage protocol. Um This doesn't harm you to, to sort of include in your response. But considering this might be potentially low on your um list of potential diagnoses, um I wouldn't jump at it straight away, but it, it may be worth mentioning you regardless. OK. So moving on to d uh once again, observations, examine and intervene uh at this stage, obviously, you would check your uh blood glucose pupils, G CS. Um If you prefer to use um AF PU, you can, but G CS works just fine. Um I always used to get a little, a little bit anxious using G CS because um I've heard in some cases, they can ask you uh to calculate G CS on the spot. And it's, I don't know, for me personally, it's just one of those things I find quite difficult to sort of work through when you're anxious and then having to work through each of the various stages of G CS. So you can use AF pu instead. Um if you find that a bit more comfortable and then you would then request your uh your intervention for this stage. So if you're worried about an anastomotic leak, um I think probably a, a, an, an X abdomen, an X ray abdomen would probably be a bit more appropriate than a, than a CT straight away. Uh But act would be uh probably the most definitive uh scan you could request at this stage. And then once you're done with d uh you would obviously expose the patient uh to look for any other signs um of uh bleeding or fluid loss. So, um it's important to mention that you'd be examining the wound site as well. So this is a surgical patient who's likely got a laparotomy wound. Um You would examine uh probably perform APR in this patient as well. They could have APR bleed. Um just, just to make sure that you've not really missed anything else. Um Check for rashes, maybe a postoperative medication they've been started on, could be causing an anaptic reaction that can cause you to be, to be hypertensive and to be in shock as well. So anything else that you think would be relevant to mention uh for this clinical case is worth mentioning at the exposure, the stage of your ae assessment. Um I think I always had a er, list of just bond or things I would mention at every E stage and I think those were sort of calf tenderness and uh the wound sight in a POSTOP patient. It's always important to mention as well that you would try and maintain normothermia for this patient and dignity as well. It's quite easy to forget that, you know, this patient is on a ward likely with other patients as well. So you would close the curtains and make sure that they are as comfortable as possible and they're warm as well. So this patient is in shock. So you don't want them to go into hypothermia. Uh And I think that's it for your A. So once you've gone through your at E um you want to then review, gather as much information as possible um by reviewing the drug chart, uh fluid chart, the not the anesthetic chart as well. Uh All these documents provide you with very valuable information that would allow you to more appropriately, more comprehensively assess your patient and arrive at a uh differential diagnosis. So at this stage, you would mention that you would review um And this is only sorry, I forgot to mention this. This is only once you feel the patient is stable enough to do. So if you, if you're worried that after your at e assessment, the patient is unstable, then you would escalate before you move to the stage. Um But then start to review your documentation or if they're stable, you can take a focused history as well. Um Once you've, you've reviewed all the information you would move on to the next section. Um which is, oh I think they should say interventions. Oh sorry. No, hang on. Yeah, interventions. So at each stage, you should always try and structure your answer. Um your interventions when you request them, uh how I used to structure them was sort of your all your bedside tests, uh your hematological hematological tests and your radiological tests. So your bedside tests would include uh the things that you've probably been doing um during your, at e uh you've already taken your bloods as well. And then radiological tests would be anything else that you feel might be appropriate to mention at this stage. So maybe a CT abdomen or um an abdominal X ray. Um you should now have an appropriate sort of differential or list of differentials in mind and it's always worth mentioning these. Um some people prefer to sort of reel them off right at the start. Um sort of during your opening statement, but I think you run the risk of um maybe jumping the gun if you haven't examined the patient first. So I would leave um sort of mentioning your differential diagnosis until after this, this section. If you've already hang on one question, if you've already mentioned a to e would you repeat this? No. So if you've, if you've mentioned your investigations whilst going through them and your at e, there's no need to repeat them because you've already, you've already mentioned them. I think this section is only if you either forget to mention something or if there's something that you think would be good to have for completion. Um So for example, if in this case, you could say chest and abdominal x ray uh would be your primary initial investigation, but a ct abdomen would be good for completion. So you probably mention a ct abdomen at this stage. Do the examiners tell you any more info, info during A to E like in S um? OK, good question. So usually you just get the question. Um, and now I think this is examiner dependent. So when I was preparing I found it easier and probably better to just reel off the whole, the whole thing a to e um full patient assessment and just finish your answer. And reason being is that, um I think there was one person in the cycle before, er, I applied who um, in his feedback, one of the examiners had said, um they had to ask him a few things or sort of prompt him. Well, they considered that to be prompting. So if you, if the examiner gives you more information, it's likely they could consider it prompting, but I'm, I'm not sure whether that's, that's a standardized thing or whether that's, that was just based on that one particular examiner. So, what I would recommend is try and get your A to e assessment, uh your full patient assessment, um, all done slickly without being sort of, uh you know, without any uh examiner intervention or if without them stopping you or intervening or, er, giving you prompts because I think you can get down marked if they are seen to be prompting you was the advice that I had from one of the, er, from one of the reads from the year before. Well, they give you the patient's OMs exclamation findings. Uh hypotheticals. Uh Let me try and think from mine. Yes, they should give you the observations at the start in the, in, in the sort of initial spiel. Um So they could say, uh this patient is hypotensive with a BP of 90/60 a heart rate of 100 and 20. Um They won't give you much, but I think from that they expect you to sort of just work through it. Um And that's usually enough information to figure out that this patient is hypertensive, likely septic and in shock, will the examiners stop you after the A to e assessment? Ask you for investigations etc, or should you continue to talk through them? I would probably just continue to talk through them. So I think as long as you're structured, so you'll go through your uh opening statement, then you'll go through your uh initial assessment, which is your at e, then you would go through your full patient assessment, which is your, all your charts. And then, um I think after that, now that would be a good point to which to mention your, your differentials. Um or you could mention your um your interventions first and then mention your differentials afterwards. But I think it's probably better to just run through it independently uh rather than waiting for them to prompt you. Cos I think within your answer, there will be points where it feels natural to stop and then wait for them to, to ask you the next question. But I think it's better to just run through it. And II wasn't penalized for that as well. I think it just shows that you are structured in your approach and you've got pretty much the whole, the whole answer considered if you don't know something and you feel you've arrived at a natural stop, that's OK as well. If, if they ask you another question, that's, that's also OK. But I think that's examiner dependence. Some examiners may consider that to be prompting. Um and they mark, they may mark you down for that, which I think is a little bit unfair burn. Yeah, I prefer to just run through the whole thing. Uh s So at this point, think about your differentials. So after your interventions, you can then think about your differentials afterwards. OK, then definitive management. So once you've got your differentials, you would then consider how you would um you would manage them. So initially, if you're worried that OK, I suppose in this, in this specific case, um your main differential would be an anastomotic leak. Um It could be septic maybe following an anastomotic leak. Um They could be bleeding intraabdominally um and therefore could be in hemorrhagic shock. So you, this patient would likely need to go back to theater. So you would want to first optimize the patient. Um And to do that, you would mention that you would keep them, you by mouth, you would have already taken a group and safe. Uh You would note their last oral intake, you would consent them, you would mark them and you would book them for theater. Um You would then escalate this to the wider MDT. So if appropriate, you could speak to your er registrar or consultant. Um It's good to mention that you would have done this earlier on anyway, um but you would probably formally mention it now because you think this patient may need to go to the theater. You would also involve um other members of the um MDT and the surgical team as well. So the Anissa test, uh the theater coordinator, um HD or ITU if you think this patient might need to go to itu postoperatively, um and the C A team as well as this um likely might end up being an emergency case. Ok. And obviously this, uh this is a fairly long response that I'm not going to, I'm not going to read out, but I'll share these slides uh at the end of the session. So you can have a look at them as well. Ok. Um So usually, so let's have a think your crisp station should be roughly five minutes, um three minutes of which you should probably spend just answering the first question because they usually have follow up questions. So how I sort of tried to arbitrarily split it in my mind was 3 to 3.5 minutes answering the first part which leaves you one and sort of 1 to 1.5 minutes uh for any follow up questions, and they usually have one or two follow up questions related to the, to the initial case. Uh So my follow up question was uh despite fluid bonuses, this patient's BP does not improve. How would you manage this patient? So, in this patient, you've already given them a fluid challenge. Um You probably give them two fluid challenges. If they're not responding, then they are a fluid responder. So you would then start to think about a potential internal bleed or a hemorrhage. Um You would um obviously escalate this immediately. Uh and then also initiate uh the massive hemorrhage protocol. Uh double two, double two. I think this this sort of response is fairly buzz word, heavy. So, fluid nonresponder, internal bleed or massive hemorrhage massive hemorrhage protocol, double two, double 20 negative blood urgently, that's essentially what they are looking for. Um But also equally uh the internal bleed needs to be stopped as well. So you would want to make sure that you optimize this patient for CPOD theater. So you would do all the things that you mentioned initially. So make sure they are near by mouth and make sure they have a group and save available. Um And then discuss it with the wider team as well. OK. So general tips. Um I think the main thing with this session is uh your answers need to be structured. I don't think there's a, there's a right or wrong way to approach um these interview questions. I think as long as you can show that you're logical, you're structured in how you're responding. Um And as long as your structure is consistent, I think that you will score very highly. Um This was, this was the structure that I found to be most useful. Um And this is of that's based on um advice that I'd had and feedback that I'd had from consultants and registrars. Um And that, that worked fairly well for me. Um You may take this structure on board and maybe tailor it to your own um sort of personal liking. Um And that, that works as well, but just as long as you can demonstrate that you're, you're approaching it in a, in a logical step wise manner. So your interview, as I said, at your on, um the initial part should be roughly three minutes to 3.5 minutes. Um Yeah. And you know, as I mentioned earlier on try and sort of run through your response uh without stopping, obviously, pace yourself, don't rush through it. Um But as long as you're sort of uh going through each stage, uh logically and sequentially, you should be OK. Um And obviously, once again, keep your answers structured and as structured as possible and try and throw in any, any useful buzzwords uh where you can, I've tried to highlight all the sort of essential buzzwords in green. How would you defer your approach if unstable? Obviously, Esalen wouldn't want to go back to me again. Ok. So if, if, after you finish your ae and you're concerned that the patient is unstable, then, yeah, exactly. Escalate, escalate straight away. Um, I wouldn't run your A, I wouldn't run through your ae again. Um I would say that I would, obviously, you've, you've been intervening at each time. So I would say that I would repeat the A to E but most importantly, I would want to escalate uh urgently to my registrar and to my consultant um because I feel this patient needs to go to theater. Um And as long as you can justify that, um obviously, if the patient is unstable, then they need something a bit more definitive that you're not going to provide on the ward. So this patient needs to go to the theater basically. Um So you would do the same thing. So you would uh keep them, keep them know by mouth. Um You would get a history for a sort of last recorded meal. Um Then you would discuss it with the theater team, cr team and you suggest itu so it's still, it's all still the same stuff. Uh But you would probably do it a bit more sooner or mention it a bit more sooner. Um If, whereas if the patient is stable, um let's have a look. Um I think that's one of my other scenarios. Oh I didn't run through it. So if we go back to the flow chart, I say to if your patient is stable and this has come up in the past as well. So, um if your patient is stable, then this sometimes can throw candidates off because you, you're sat there wondering like, why, why, why the hell have they asked me this if the patient is gonna be stable? Uh But essentially what they're trying to see is that you can then initiate your daily management plan. So as you would do for any postoperative patient who's fine on the ward round, um you would want to review their investigations um depending on how many days POSTOP, you can review the, you can refer them to physio uh occupational health, uh the dieticians as well. Make sure that they have a good fluid balance, documented oral intake. Make sure the analgesia is optimized, uh check any drains or tubes and then deescalate if maybe they're on itu and they need to go, go back to the ward. Uh then you can uh deescalate the patient as well. So if your patient is unstable, then escalate and maybe transfer to theater if they need to go back to theater. But escalation is the most important thing. Don't then run back and do your A to e mention that you would but don't run through the whole thing again, just continue moving forward. Um And I think that would it be worth mentioning POSTOP protocols like es Yeah, yeah, definitely. Uh If you can talk about them comfortably, um er, s would definitely be worth mentioning in the DA Daily Management plan and that's a good shout. Um And much of these are involved in, er, s anyway as well. So if you can use that as a buzzword, yeah, why not? Definitely, it just shows that you've got a broader understanding of um how to manage a patient who's stable uh postoperatively. But I think the risk with that is sometimes if you mention something uh that could be your follow up question. So when you mention something that you're comfortable to talk about, uh I think that should be the end of the session. Um But I think I've finished slightly early. So if, if you guys have questions, yeah, feel free to ask as many questions as you want on the top of that. Thank you. Thank you so much that really comprehensive run through. Um and really appreciate it from everyone setting the interview. I'm sure. So if anyone wants to put their questions that haven't already been answered in the chat will allow some time for questions and answers. Um And yeah, they can, they can have the slides as well. Um I'm not sure how you share them on here, but just, just, oh, ok. Amazing. We'll, we'll figure out a way to share them. Thank you. Very kind. So anyone have any questions, please just pop them in the chart? I think you've answered the ones that are already here. Can you get scenarios in all subspecialties like ent um theoretically? Yeah, you can. Um I think they try and stay away from anything that could be super niche. Um, plastics probably is probably a little bit too niche. Um, but II don't see any reason why not. You could have maybe a flap that has become dusky and is be almost becoming necrotic. Um, that could be a fairly reasonable, uh, plastics question. Ent wise, I've not come across any, uh, oh, actually, no, to be fair, you could get a, uh, POSTOP hematoma following a neck neck dissection. I think that has come up once before. But it, it, it wouldn't change how you manage them. I think they would only give you scenarios that they would expect you to know at the level of an F two. So sort of most, mostly lifethreatening things. So, if it's ent it would most likely be a, um, POSTOP hematoma following a neck dissection. If it's plastics. Probably a, I think for plastics, I'll probably save that for the ATL S scenario. Um, and that would probably be a burns case or a lower limb trauma which sort of falls in the orthoplastic realm. I think compartment syndrome as well syndrome as well. Yeah, tends to come up, but it will be, I think the important thing to remember is if you go through your structure um like the the structure you explained, then you can tackle most questions without knowing the exact management. Obviously, knowing exact management is beneficial for those extra last points that having your structure will answer most of it. Even if you don't know the pathology. Let's have a look. So see, for the leadership uh station does a three minute presentation include the question they ask you. Uh So for the leadership station is a three minute. OK. Oh, I think I understand that. So for the Leadership station, um how they did it for me was you give off your three minute presentation um and then you usually have two minutes for follow up questions. Now those follow up questions can be related to the presentation you've given. So some interviewers are just curious about how you manage to um maybe lead a conference or uh any challenges that you faced. Um But equally, they could ask you fairly generic leadership questions so they could ask you what makes a good leader, um what makes a bad leader, what makes a good team, team worker um things along those lines. But generally, it's questions that are related to the theme of the leadership presentation. So if it's, if it's a leadership presentation that you've even asked to give, then I would expect to get questions related to leadership. I think the questions that I had, I'm not sure if II share them uh were what makes a bad leader, which I think is a, is a fairly tricky question to approach. Uh I think the way I approached it was, I sort of tried to mention what makes a good leader and then just said that a bad leader doesn't do all of those things, which is a roundabout way of answering the question. And there definitely is a better way of answering it. And then I think I had another question about the surgical team. So try and obviously know who's involved in the surgical team other than, than just the surgeon themselves. Um So they need to test uh obviously the CPO staff, er porters everyone else basically. And what are the questions we did cover um management in our la the management station in our last um session last week. So if you go on to mind the bleep on medal, you'll be able to find last week's session while we do run through a few more of that, those classic questions that come up as well and the leadership um presentation that you'll have. Let's have a look, a few other questions, received a question about you. Has anyone received a question for you? I think they're starting to discuss amongst themselves. Um II II think they, they released the question. A few days after the interviews come out. If unstable, I take it, I should consider it per risk. Uh Yeah, definitely. Yeah. If, if you, if you're worried that the patient is unstable, then you can mention at that stage that you would consider it a per risk. Definitely. I think that, that w uh I don't, I don't think I said that when I was answering mine. So that's a good show. Uh I mean, at the beginning of gestation. Yeah. Uh Let's have a look. When does the timer start? The timer starts as soon as they've introduced themselves and they, as soon as they ask you the first question, that's when the timer starts, essentially any other tips on how to prepare resources. Um So I think now interviews, I think you guys are 10 days away from sort of the first interview date, aren't you? So now would be a good time to be practicing with other people. Um I think over the last few weeks, you probably should have been building up your knowledge base or going through me because I think they've got some really good uh scenarios on that, but you should now be refining your answers and getting used to talking about them with other people, preferably registrars and people that are a bit more senior to you. So that, and that sort of encourages you to get into a more formal mindset as well. Personally, I, I prefer sort of watching videos and um going through audio visual resources uh to prepare because many anybody is good, but it doesn't, I think it's good for building knowledge, but it doesn't really, really help you understand how you deliver your answer and how best to structure your answer. Um So if you can find any interview resources that are sort of video based, then that's, that's a good, good approach too. And I think now is probably a good time for me to plug in my own resource as well. Um And I've created a resource as well which has videos uh on there. So if you like the structure that I provided today, uh there are loads of other examples and videos with example presentations that you can look through uh on the website as well and the website is uh things smart cst.com. Yeah, I echo that. So I think it's really important to have um scenarios that you can practice out loud. And I think resources such as this one are just really, really useful. So um use them if you haven't already see if your friend has, you know, access and practice together. I think that's a really good idea. I can't see the questions um For some reason they're not coming up. So I'm trusting you need to keep track of that hasn't. Oh Right. OK. Yeah. No, I think the last question was by uh mesh asking if there are any other tips. Uh I think that should be it, to be honest, no one else has lost any questions. Good. Any last minute questions from anyone speak now forever. Hold your peace. All right. So if nothing else pops up, I think we'll conclude that final session there. Thank you so much again. Gay for presenting your um tips and tricks. It was really, really useful for everyone. So best of luck everyone with your interviews. Um Any questions at all, as mentioned, just uh pop us an email, we will upload this video onto meal. Um As well as the other videos that we've had in the last couple of weeks, you can access them on this website. Um Yeah. Best of luck. Cool. Good luck guys. T