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Good evening, everyone can everyone hear me okay so yes, I've got one yes and can you see my slides up on the screen, sorry, it's the first time I'm using medal, so there might be a little bit of you know it hiccups, but I've got yes is that's good cool. I've not got any nose yet so that's good um what maybe one or two more minutes um before we start just so people who are joining slightly later are able to log in, but do you let me know if there are any um you know hiccups, you can't hear my voice you can't see my face. I mean that's not that part's not really important, but you know you can't see the slides that sort of thing well. We've got people slowly trickling in, but I think that might be the majority yeah. I think people are slowly trickling in um so I'll start I'll start um the introductions so good evening. Everyone Thank you for taking um the time out of your evening to join us for the first n. S. T. S. Presentation on court, surgical interview preparation, My name is innocent, I'm a course surgical trainee and academic clinical fellow in trauma, orthopedic surgery, um I'm currently based at the Northern General Hospital and the University of Sheffield, and today, I'll be taking you through um course surgical interview preparation and more specifically preparation for the management um Station, so what we've done is we've tried to spit up the interview preparation into two stages firstly management and then secondly clinical, just because it allows us to do each of the different stations, the justice it deserves and it prevents you from you know, sitting here for two hours listening to one of us ramble on so let's get started and if you have any questions feel free to put them in the chat, and I'll try and answer them to the best of my ability. If I don't know the answer, I can sort of sign post you to some resources or anyone else who might know the answer, so a brief introduction to the aims of the session today essentially, um we're going to do a brief explanation of the format of the interviews, but I think the main area of benefit would be explaining everything and explaining areas that are worth practicing over and common pitfalls so that you can take that forward and into your interview preparation and practice because the reality of the reality of preparing for the court surgical training interview um is that the majority of the preparation will be work, that you undertake yourself rather than things that I am able to tell you in an hour um The second aim is simply improve familiarity and preparedness with the structure of the interview. Um Someone's popular question will the slides be available for us to view later. Um Yeah I can put this, I can put this. I can send the slides over. I'm not entirely sure how medal works, but there should be a way to facilitate that um right, so the structure of the structure of today's presentation um is that I'll go through an overview of the interview structure, so the general structure of the court surgical training interview. Um General tips and preparation strategies um on the day tips um run through of my experience of sitting the court surgical training interview which I sat last year um Will quickly talk through the, we'll talk through the management presentation, and I've got a couple of examples, which we can go through um and discuss about some of the things in which they have done and then we can talk through management questions and how to approach management questions, um which you can then use to direct your preparation, so how are the interviews structured, so over the last maybe two or three years, they've moved away from the format way you traditionally had in person interviews where you had to shop to the interview center in london with your portfolio and do a round robin of interviews at a couple of tables, where it's now a single online interview, which is 20 minutes in structure and is um over microsoft teams um from what I've been told the interviews come out on the interview. I think you find out if you've gotten an interview today, but correct me if I'm wrong um and you're able to book a slot for an interview later this week, but that's that's only what I've sort of read up online up that structure could might not be entirely correct, however, the the general overview of the interview is that it's 20 minutes and when I say 20 minutes, it is 20 minutes bang on the dot um and that's going to be recurring theme throughout these two sessions, um where you have a management station, which is 10 minutes in structure and have clinical scenarios, which is 10 minutes instructions as well, the normal interview process will have to consultants and one layperson and the consultants will be um they won't they shouldn't be consultants that you personally know and work with um there'll be two different consultants normally from two different hospitals and one administrative person, so that's a layperson that is there simply for logistical reasons, so if your internet connection is um dodgy um or your you disconnect for whatever reason, they're able to check any errors and rectify them, so essentially um jumping straight into some very basic tips for the online structure into use the thing that alabama home is it's all practice you need to practice practice some more and then practice a little bit more as well um and when I say practice, um I'm talking about effective practice, so practicing under interview scenarios with, with colleagues and with senior colleagues as well, that's what I found to be really really valuable in my interview preparation. Um In terms of booking the interview, try and get onto that really early set an alarm for Wendy interviews um come out and then before the interviews come out think about a time and a date that suits you, so you don't want to be booking interviews um You know just coming off a night shift unless that's the only option that you have um certain people work better at certain times of the day, so for example, I know that if I book the first interview slot in the morning, I'm done because like I don't really wake up until mentally until 10 am or something like that, however, some people by the afternoon, they're flagging already, so book an interview time that suits you um A lot of people talk about when to book an interview and when might give you a little bit more of an advantage. Some people recommend that being the first person to be interviewed um is more advantageous because you set a lasting impression in the interviewers minds, um some people say that you should avoid being you know the first or second interviewee after lunch break, For example because people um you know have postprandial um tiredness and fatigue, and as the day goes on, people get more fatigue. I'm not sure about the amount of truth in that um it's more important to book an interview time that you're confident with because one of the things that interviews will do throughout the day is that they will um they can adjust interview schools post talk, which means that once they've had a batch of interviewees, what they count as a good score or a excellent score might change depending on the subsequent interviewees, um so one of the things you should do is you should try and position um your camera um in a way that gives you the maximum amount of eye contact as well, so essentially, I'm not I'm not doing it now because I'm presenting a slide off a second screen, but in the interview, you want to you want to send to your camera in a good field of you, so you can look directly at it, um try not to get flustered as well. They're not trying to catch you out and they won't ask you any questions which wouldn't be expected of someone who's coming to call surgical training just after um f. Y. Too and remember to you know smell and act presentable and show your motivation and enthusiasm because by getting it to an interview by getting to the interview stage, you've already achieved quite a lot, so how do you prepare, so I would prepare online for this interview structure, so use microsoft teams, and you get a group of maybe 34 different colleagues that you can um prepare regularly, and you can look at their interview styles and structures rather than getting just one person to prepare with and the really the real thing um that helped um me and a lot of other people that got court surgical training jobs was preparing with different um course surgical trainees, registrars, and consultants. So if you have any bosses on your jobs, just ask them if you can spend you know 10 15 minutes going through an interview scenario with them, and that's really important for the presentation part of the management station, which we'll get to in a bit um I know of some people that did I know that some people that even did um like real um real interviews for jobs, you don't really want to be doing that. If you did like you know, I don't want to be burning bridges to do an interview for a job you might not take perhaps in the spot you're going to be doing your interview in, prepare your interview spot, so have a neutral background don't have anything exciting in the background, which might distract interviewers from what you're saying um be in a comfortable chair um in the reach of a power outlet, just in case your laptop battery somehow decides to give up the ghost on the day of the interview and have a good stable internet connection. One thing I'm I'm a bit paranoid about like internet connections and things like that so one thing I did is had my phone semi nearby, so I could hot spot myself, just in case um just in case there was an issue, um ensure no one enters the room that's really important because at the start of the interview, um the administrative team will ask you to essentially show them the room and make sure that no one else is in the room um and if you, if people do enter the room that can avoid the interview, so be really careful about that and then also just ensure that your room is quiet um As well. Um on the day of the interview, these are basically common sense things get as much rest as possible, stick to regular routine, try not to cram, um and log on to interview invitation link early. They say five minutes before the um before the interview time, try not to log in. You know like an hour, two hours before because they might have interviews going on at that time, So this is just an overview of the interview process. Um You'll be you'll click on the link you'll be let into a room. They'll firstly be an administrator, um and they will ask to view room to ensure that no one's there, they don't have piece of paper with you know, uh secret or a TLS guidelines or your presentation on a sheet of paper. Next to you um they'll talk you through the interview process to answer any questions you have um you'll then be let in um the interview don't be alarmed if the interviewers don't introduce themselves and go straight into um starting the interview. Um That's because of the pressures of time in the interview, 20 minutes is 20 minutes and they will stop you and move on at the end of that time, I've had it, I had it in my interview, where I waffled on a bit, and then they were like no that that's it you're done. Those are just more tips and here are some good study guides. Um I really recommended I really recommend um the the Green Course surgical interview uh book that I think I have it like here um course our recording interview. I also used the the Yellow Masterclass um Course surgical training interview booklet. It's a little bit more outdated. I think than the Green one um for the management questions, I think um the picard book is really is a really good by um or you can borrow off your local library um Medi body is really good as well and um one of the things one of the other resources I used is a Pdf called course surgical interview guide. If you google it, it is available online um for free um I'm not sure if it's actually free, but you should be able to find it. Um If you search hard enough, I think my advice for preparing for the interview stations based on the amount of time from now until when they are is pick one or two resources and um stick with them. As long as you're able to, as long as you're able to encounter the majority of the subjects which will be encountered in the interview. The majority of how you're scored is based on how you sell what you're saying. Rather than trying to develop an understanding of very specific and very niche things, it's about getting the bread and butter really um really spot on, so just an overview of the management station um It's 10 minutes um it's 10 minutes and it split into 25 minute halves. There is a five minute presentation, so it's one pre prepared three minute presentation on an aspect of leadership and management, which they will send you a question for beforehand and there's two minutes of questioning on the presentation. The management scenario is one management scenario question and you have five minutes allowed to answer question and any follow up questions now. When I sat the interview, I did the presentation, and they stopped me at three minutes and then they asked me questions until the five minutes were up um the same with the the same with the scenario. They just kept on asking me questions um until the time was up um So that's not something to get flustered by. If you feel like you've answered something quite well and they ask for your follow up question. It means that they're trying to stretch you to get some of the higher level marks. The management station is commonly the least prepared for because it requires a lot of it compared to the clinical stations where preparation is quite easy relatively, This is a little bit more less straightforward um to prepare for, but it's equally important you get the same art of marks for the management station as you do for the clinical station and it's arguably slightly easier to prepare for because a high proportion of your marks come from the presentation, so here's how the management station is um scored, so it's split into the presentation and the management question. This is when I um sat the interview, so you're so your ranks globally from a scale of 0 to 6 and the free domains in which they look at for the presentation is the content of your presentation, the presentation skills, so how you deliver the presentation and your ability to answer the questions that they present to you. Um The management question has the domain on property and professional integrity basically the aware your awareness of the pertinent issues to the management question how are you able to understand what is going on your judgment under pressure and prioritization, which is essentially how are you able to judge what is going on and judge what is more important than what is more important and what is less important and communication how do you convey that to um the examiners or the interviews, so one of the main things that is one of the things that is really important is to have a really clear structure and I know that no matter what interview um talk or presentation you go to, they'll say the same thing have a structure, have a structure, have a structure. It's really important because it allows for clearer communication think about. When you do your s bar, when you're in a hospital, or you receive a handover when you're in a hospital, someone who has a clear s bar structure of handing over. It's much more easier for you to understand the clinical question and what the refers trying to say than someone who just spouts out a lot of knowledge. So going into the presentation specifically, three minutes, it's pre prepared, but you're not allowed to use any visual aids or prompts, you're not allowed to have a sheet of paper with you or use a power point presentation. It's normally received prior to the interview. Um I'm not sure if it's been received if you've got on the interview question already, but it normally relates to the person specification have a different questions. The question I got when I sat, interview last year and it's the question which people have gotten for the last couple of years is reflect on your experience of leadership when working as a team member, and how this will be useful as a corps trainee. Other questions which might come up less relevant now, but this is a question that I've seen used as an example is how do you think the Covid 19 pandemic is likely to affect your surgical training, how might call surgical trainees overcome the challenges posed by the situation and as you can see, there's a multi part, these are multi part questions, which linked to several aspects of the person specification for course surgical training um and have a lot of scope for you to answer in many different ways so the presentation, it will be personal to each of you because each of you have different experiences that you bring to the table, um so in making your presentation or thinking about what to um right, it's really important to have that personal spark because the interviews will be listening to presentations for from from maybe nine AM to four PM with a couple of breaks in between and they will they will hear about how everyone was the captain of their football team, how everyone did dance how everyone did x. Y. And z, but if you have any personal experiences, it helps to convey something a little bit different to the, to the interviewers, um One of the other things which I want to highlight is um the principles of leadership which you may or may not have heard of, so there are three principles which you should try and utilize within your presentation, so that's initiating an implementing change, developing people and delivering results. So an example is an example of change is identifying a problem and if you're stuck, for examples, you can use pretty much anything everyone everyone would have done some work to address a problem, which they've seen in their clinical practice wherever that's audit work, so data collection for an audit which looks at best practice, which looks at best practice and comparison of standard practice to best practice, attendance at morbidity and mortality meetings, so looking at what was done wrong and looking at ways in which that can be improved, quality improvement, even raising issues with training. If you've sat on a junior Doctor Forum, not even as a member just sat in one raised issues with your t p. D. Or um your educational supervisor about training that is all identifying a problem um and also holding positions of responsibility so if you've been on a committee if you've been a team member that's where you're sort of traditional, you know sporting um or charity work comes into play. It shows that you're initiating a change um people is more to do with managing different opinions, So one of the examples I used in my presentation was um in basketball, where you can only You have you know 15 people on a team and 55 people, only five people can start yet. You know, 14 15 people think they deserve to start it's managing those different opinions and coming towards a common goal is what I used in my um presentation um as one of the examples that also links to dealing with conflict, so if you've ever had to deal with conflict, so a difficult patient, for example, a difficult um family member, difficult colleague that's all dealing with conflict, and the third point is about supporting junior so if you've been in if you're an f. Y too, that might be supporting fy, one doctors on the wards or on call and also um and also medical students as well and then the third step in that solution as results, so if you ever manage difficult situations such as assessing unwell patient's if you've ever spoken to you know difficult colleagues made a difficult referral, had to refer to a senior, then that is all determining results so what I'm going to do what I'm gonna do now is I'm actually gonna get a slight drink of water, just cause my throat is parched, but I've got two different examples of two different presentations, the excerpts from the presentations, and these presentations all scored um scored four marks for the presentation station. I just want you to have a look have a look through them and identify common points within the structure of the presentation um that you that you could apply to any presentation, you might want to make yeah, so I'll give that I'll give that about a minute and then we can break it down and look at look at how these presentations are structured, and why they scored particularly highly yeah and the reason why I've highlighted two different presentations is because I feel like these presentation um struck, are structured quite differently um and the point that I'm trying to make is that there are many different roads to rome to use the saying it's not that you need to structure your presentation in a certain way, it's about having a structure which is clear and easy to communicate, cool, so what I've done what I've done here is. I've highlighted different parts of both presentations um and what I've highlighted in um what I've what I've what I've noticed from reading these two presentations that they both are different in the way in which they're structured, so for example, the presentation on the left reads more as a more as a speech or statement of prose where they do sort of they do list out there different experiences, but they're more sort of free flowing with it, whereas the second point on the right states out the free you know states out quite intently um At the start of the presentation, what the key points they're trying to make are and that they will be discussing three key points um on what I've highlighted in Yellow is um essentially um be what of their presentation, so what they did um what the situation um what the situation was. Um you know on the left hand side, It's as presidente of ex ex, ex, I did this in my role of captain. As of this, I did this, yeah the second part, the part in Green is the so what so what sort of skills did they use and it's really what I would recommend doing is in your is following a similar structure, of course make it original to yourself, but have a brief statement about what you did and then have a second statement about the skills it demonstrated and then link those statements too. Some of the common buzzwords which you would see um in um in a in a job application for course surgical training, or, and all the persons specification so inspired like on the left hand side, you can see words such as inspiring, motivating, dedicating, organizing, supporting, nurturing a caring environment, demonstrating adaptability, um same thing on the right hand side, um My job was to motivate people make them believe the goal was possible. These are all key buzzwords, which they if you remember going back, it's really it's about reflecting on your experience while working as a team member and how this will be useful as a corps trainee and then within the within the the purple sash magenta part, it's reflecting and focusing on how that experience will translate to being a court surgical trainee and as a surgeon, so um one of the, I know one of the positive, they don't necessarily use positive indicators actually um in um in the market criteria but one of the things which in my feedback the examiners really liked is where is the fact that I used my experiences and related it to, to court surgical training, um So one of the things I did um is none of these. None of these presentations on mine by the way, um but one of the things I did is I linked. Um I said you know I made an analogy of my situation with a situation you might encounter as a court surgical trainee or as a surgeon, So you know having 15 members of a basketball team, who only want five places um Is all is very um similar to having different members of an m. D. T, who have different opinions on the best course of treatment for a patient and your job as a surgeon is to bring bring together the different views of the m. D. T. And the different evidence and combine it to make the best possible treatment option for the patient. Something along those lines um So that's one of the tips which I can give you about the presentation, some general tips be concise and do not waffle you only have three minutes, and although three minutes seems like a long time when you when you actually think about it, it's not at all have a very clear structure. So if we go back to um if we go back to these two presentations, they both reading them, aren't you know exactly what is being talked about at what point and it makes it very easy for the examiners to follow, especially the one on the right, the first point I'll talk about is number one. This secondly, this, thirdly, this not really a structure that works for me personally, but it's easy to see if you're listening to it, how it works, you can spend a minute um talking on each point practice practice practice um That's going to be true for everything within the station, it's really easy to score really highly on this station because it's something that is within within your control. Um You'll find that when you make the presentation, you'll start and the way I my experience with it and this might be true for a lot of people is that you start and it's quite long and you're trying to get within that three minutes and then as you practice it under exam and time conditions, you'll find that you actually finish a little bit earlier because you're basically on the day you're like trying to rush and just throw everything out of your mouth as quickly as possible um So, it's a case of practicing to the point where you're able to say what you want to say in a common, controlled and structured fashion. Another good point is relating it back to court, surgical training, and your future as a surgeon. That is something that will always sit well with the interviewers, avoid lengthy introductions, conclusions, and definitions, the interview is not what leadership is, you know what leadership is just leave it out of your presentation. Um It's about your personal reflections and your personal experiences. If you spend 30 seconds defining some rand, like you know some concept, it's 30 seconds which you could have been reflecting on something else and one of the key tips is get critique from senior colleagues, especially people that have gone through the process before like really like get your present like one of the things which I found quite useful, was going through it with a reg, um that I you know had had a placement with and you get the perspective of someone who knows what who is a surgeon and has been a surgeon for several years, and it's similar to you know, reading med school student, personal statements, some of the things they say about being a medical or a doctor as someone who is a doctor, isn't um is a little bit different, so they're able to you know bring a bit of reality to that and it also allows for a um for understanding of, for them to give to give you follow up questions, which would be useful for the actual interview. Um Other things, um is don't make it to clinical try and talk about rolls outside of medicine a little bit shows your rail, rounded person and it gives you that little bit of originality um as well in terms of how you memorize, memorize it, people either memorized the script, the disadvantage of that is that you can sound quite robotic. If you're just reading off you know a sheet of pros, if you mess up, then you might not have the adaptability to sort of work your way back into it versus a bullet point of topics, the disadvantage of that is that you might miss something quite critical, um but the advantage of that it's it sounds a little bit more natural do what works for you, so follow up questions. These are actually quite important as well because everyone will prepare presentation, and if we go all the way back, um some of some of what you are mocked on is your response to the questioning, so these will be the marks that you know propel you from a score four, which is a good kind of that to score six, which is you know an excellent candidate candidate and you get four marks. This is from my experience and my experience of talking to other course surgical trainees. Follow up questions will be either, will be split into either too general broadchurch, is there will be follow up questions based on your interview presentation, so the interviewer might be genuinely interested about your presentation and what you have to say so they might say tell me more about ex experience of leadership or tell me how you how you applied ex principals to this situation. You've described or tell me more about you know x. Y. And z. That's normally quite good um because it shows that they've listened to what you've had to say and it puts the power back into your court's because you're able to relate the answers more easily back to um your personal experience as well, however, if you get generic follow up questions, then that's not something to be disheartened by um it just could be what the interview fills to feel to arc's, so I got questions, I got question on oh what is what is leadership and what or what is what is what does leadership mean to you describe or describe you know a situation where um describe a difficult situation where you had to show leadership. It's really good to think of a pall of appall, of those generic follow up questions and just have um just have a response to it, and I'll go through some structures that you can use just in just a little bit mhm, um Here are some good um some good links um for surgical leadership. I can um make the slides available, but medal I think this session will be available and catch up as well, which goes over different aspects of surgical leadership. One thing that I would also add to this is the person specification for course surgical training, so falls over filling the presentation and going over the three minutes um that will that will impact you negatively because they will they will stop you at the three minutes or they'll stop you at the five minutes, I'm pretty sure they will stop you at the three minutes because that's what I had, but if you overfill the presentation and they stop you halfway through, you can feel a bit flustered, um which will then impact you negatively for the questioning. The second pitfall is fairly to prepare two little practice in actually delivering the presentation, Will make you sound quite robotic and um if you have no feedback on the presentation, you don't know whether it's good or bad and also not thinking about potential follow up questions, so have a look for your presentation and think about oh if I was you know picking this up and reading it, what questions would I want to know about the person and what would I want to know about the understanding of the question posted them, So just to summarize about the leadership presentation, I would say the best way to prepare for it would be to think of two or three examples of leadership within your clinical or personal academic life, Then within that, think about think about the way the way the structure in which I would like to use is um what, so what now what, which is quite similar to different structures such as Star Camp, we'll go through those in a second have to have 2 to 3 of those and then at the start at the end, have a brief sentence or two explaining um outlining the scope of the question now for the, are you allowed to have a watch or clock um you can have a you can obviously have a, an analog clock um You can have an analog clock or digital clock with you um I had a clock you know just a normal clock which was on my wall um. Or you can also use um the sort of clock function on your screen um but I don't think you're allowed to have like a smartwatch or your phone um with you if that's what you're trying to if that's the question, so um the management question moving on to that, That's one question and it's five minutes, five minutes long as opposed to the clinical scenario, it's a problem solving question, so from my experience, it's either likely to be a scenario, so you are the ct one on x one, said you are x one said, ex, why this happens, how do you deal with it or it will be a question oh what what is your knowledge on topic x one. Z The most common scenarios these are sort of the unholy, is it pent, had. I don't know the unholy five um This will be your bread and butter the banker. This will be what everyone will prepare for your late colleague, a drunk colleague, unavailable, seniors cancel operation aggressive patient's, and this this is just a reminder of how it's scored, so it's awareness of the situation and the issues at hand your judgment of the issues so which issues are um more important and which issues are less important and your communication of those issues and you're scored from 0 to 6. So here are several frameworks that are useful um for answering management questions. Um One of the one of the frameworks um yeah which everyone will use is something called spies, that's useful for your difficult colleagues um situation, or ethical situation, what I would what I would recommend um in terms of just generally uh prepared for management type um questions is preparing, preparing using some of the resources, which I highlighted earlier, so your medi bodies. Your you know your green course surgical interview, but and then trying to subdivide where a specific question or scenario will lie on in terms of which structure you'll use because what I'm gonna do is, I'm going to go over several structures, and I think that each structure is slightly better for a specific type of question um So spies is more useful for your situations with difficult colleagues. You know someone shows up drunk at work and it's about to operate what do you do someone's an hour late, what do you do and one of the things one of the yeah, one of the things that I would do is I would state the immediate concerns because going back to the score ng system. Part of what you're marked on is your awareness of safety and ethics, so showing that awareness straightaway just gives you some marx say saying, look I understand this is important, then it's your standard things which you may have encountered before, and I'll go through them, so seeking information, it's essentially understanding the nature of the problem, so talking to people what has happened about this problem. Why has this happened. What's going on talking to the person in question or other colleagues, then patient safety, which is so it's important likely be a concern for most if not all questions that you receive, but more specifically instead of just saying oh you know, I will prioritize patient safety, think about the actual risk of harm to patient's and how those might occur in the immediate short, medium, and long term um that's a good way to sort to demonstrate that you have a bit of a more um developed understanding of patient safety concerns, so it's assessing the risk in the immediate short, medium and long time and then acting on the risk, which lease on to the point of initiative, so what can you do to help the situation. Yeah there are some things which you can't do to help the situation, So you know your boss shows up drunk, you can't just you can't grab another colleague and you know do the operation, doesn't really work like that, but is there anything you can do within the realms of being a court surgical trainee that you could do to help the situation is anyone you can speak to is there anyone. You can um talk to is there any ways in which she can problem solve and come out of the situation in a better way escalate, which leads to the point of escalation, so this is involving your senior colleagues, so it's thinking about the immediate surgical, your immediate seniors within the surgical team, say registrars, consultants, clinical medical directors, etcetera, thinking about people outside um of the immediate surgical team, so other colleagues from other specialties, If appropriate, depending on the situation, but also think about external factors and external bodies, which might need to be informed, however, that would likely be a later resort, so your union, the Gm see um your Defense Defense Union, um and then support how are you able to um in that support in this situation um the person in question and to the wider team, so here's another framework which is camp, which is useful for your broad based general questions or motivational questions, so what made you apply for CST. I know this is a little bit more related to the follow up questions for the presentation, but I've generally just grouped in frameworks here, so you can understand the different types of very much um so was made you apply for CST then you can talk about you know um or you can talk about the clinical aspects of course surgical training, academic aspects, management, and personal aspects um also similar for what what what what makes you x one z. O. I've done this clinical thing this academic thing, this management thing in this personal thing and all of these relate to making me a better candidate for course surgical training, another another another framework to use as um star and that's more useful for your sort of broad based situation on skill type questions, so when have you shown leadership or have you been part of a team, that's functioned well or when have you done x. Y. And z. And then it's highlighting a situation so this was the situation that play this is a specific task which needed doing this was the axion I took and this is the result, so going back to my example of basketball. The situation is oh I was you know in ex basketball team, we needed to um construct a roster, which was able to compete and win x one z competition. The difficulty in that is that it required difficult conversations as to who would get playing time and who wouldn't get as much playing time. One of the things we did is um i I constructed a way for people to voice their feedback about changes within their playing time in a constructive manner by having discussion forums. The result was that people felt more valued and it's translated to greater by into the system, which translated to more winds so on and so forth. Um That's not actually that, that's not even the uh the actual scenario that I used with that specific scenario wasn't the actual scenario that used, but having that structure makes it very easy for you to fall back on if you're arcs that question, um so just some general tips for the management station um It's answer the question which is axed of you, not the question which you find easy to answer, um That's something that applies to sort of every exam or every interview that you do um be specific and personal uh practice with colleagues, think about common questions which might come up within management station, so as I said you're on holi, five well come up quite a bit, but there are other topics which will come up so that includes topics like dna cpr or consent, so my the topic which I got an interview was wasn't actually about you know a difficult colleague, it was about a um a lady with delirium um and you know what sort of issues what sort of issues would be at play um oh She's you know due for a hemi, tomorrow, what do you do um and then that leads to discussions about resuscitation, which, which members of the team should be involved in discussing discussing resuscitation um so thinking about your immediate surgical team um the wider members of the m. D. T. Within the hospital, and also thinking about the wider members of the MDT within the community such as the g. P. Um consent um knowing about different um consent forms um w. H. O checklist, so knowing about what is in which stage which part of the w. H. O. Checklist um see pod, knowing your see pod classifications, um the difference between management and leadership um knowing some basic pub uh concepts related to public health and surgery, so for example about covid 19, um and so um and how it's affected um surgery or how it might affect prioritization of two different patient's um never events, so you know wrong site, wrong surgery. How would you approach a never event, what sort of things need to be done talking about things such as duty of candor um How would you how would you approach a situation where a patient has had a never event um is a question that they could act as well. One of the questions I got as a follow up question is what makes a good, what makes a good um or makes a good surgeon. Um I don't think I actually got time to answer that question, um but thinking about these things really important issues such as capacity, critical incidents and then your difficult colleagues um You're struggling colleagues and managing stress as well, so I think we're got about 5 to 10 minutes left, so I've got a I've got a example, so, I've just got a question, a colleague of mine got scenario about a surgical patient with some mental health concerns, which sounded tricky not sure how to best prepare for that. What would you what would be your approach be. If you've got a very atypical sort of scenario, so my scenarios actually my my management scenarios and one of my clinical scenarios, but I can talk about that. At the end, one weren't ones which were your standard textbook one, so they want your drunk colleague, your difficult colleague. Whatever so my my my scenario was about, as I said it was someone, it was a patient who had delirium and one of the things you should be aware about is the, the topic of capacity should probably expand that to include um the concept of um talking about the Mental health Act as well as well as the mental capacity Act and when you might apply um which act um so the way in which I would the way in which I would prepare for that scenario is by going through some of the topics which I've mentioned so capacity, when someone is deemed too lack capacity and when someone is not deemed to lack capacity, so um and then also dealing and also preparing in regards to the mental health Act, and when someone might be when it might be applicable, supply the mental health Act um as well, and then in regards to answering the scenario, depending on what the information is presented, I'm not sure what what the um what the what how your colleague received the question, but in terms of following the structure, it would be stating the concerns or staying the relevant issues so going back to our structure, it would be staying the concerns stating the relevant um issues, so this is an issue which could concern the mental health act. It could also concern mental capacity as well. I'd like to seek more information so um take some more information and ensure patient safety, so um go and see the patient. Um If it's for example about consent, see see the patient and treat any um life or limb threatening injuries as they arrive, um and then I'll take a focus history and determine the patient's mental state um and I'll take a focus history and determine the patient's mental state including any past medical history of any um mental health issues for with within, that I would determine their capacity for the specific decision at play. Remember that capacity is time specific and decision specific. Um Some of the things I would potentially do to take initiative is um one of the things I talked about in my um interview question is uh if the patient doesn't have capacity now, is there another time in which the patient could have capacity later on and it actually happened to me today at work. There was a patient who had enough and was had a consent form for filled out and then we saw them in the morning and they were completely lucid, slightly that they had a fluctuating delirium, um but it shows that capacity can fluctuate and you recognizing that is a really good sign to um to the interviewers um. Hopefully, that's yeah, hopefully that answers your question a little bit um so just just to end the session I've got, I've got an example, I've got an example question um in the interest of time, will probably probably just do the first bit so how would you proceed, um but just take a minute to um think about the question, so your ct one had a 12 hour shift on, called the person you're meant to hand over to so the senior house officer um the other doctor 30 minutes late and our to patient's awaiting review in a and e how would you proceed exactly uh. Huh so, using the framework, using the framework, spies remember that part of the part of what you're gained by practicing is recognizing the type of question and which framework would be best suited to answering that question, so you can proceed, take the immediate concerns, so patient safety professionalism and also the concern about your colleague seek information so why is it that the colleague is late or absent, um So there's information that is not present in the question which you need to know to make a decision so that could be calling your colleague texting them trying to get in contact with them in order to find out what's going on and then the clinical urgency of the two patient's awaiting review in a and e. If there are two patient's you know who are medically stable patient's who are admitted for physiotherapy and pain relief, then that leads you to a different um that leads you to a different set of actions than it that might be the case that there are two trauma calls with polytrauma and um vascular compromise um So they will guide your actions um. Then that links into patient safety is their immediate action needed um in terms of escalating in terms of either escalating this or in terms of prioritizing the patient's so if there are any, for example hemodynamically unstable patient's that will influence your decisions um that might call that might you know cause you to act a bit differently or it might influence you to go and stabilize the patient and ensure that any critical patient's are stabilized and also think about your own actions as well, anyone that's what 12 hours in any sort of capacity knows that by the end of it, you're flagging quite a lot and the decisions that you make might be quite impaired um. Especially if this is a night, if this, if the roles were flipped and this was a night shift and the day, s. H. O. Is someone that you're waiting waiting for um In these scenarios, could be interviews, interject, and provide more information in the interview book. These sorts of questions have multiple parts, so in terms of interjecting um yes, they can interject, in the sense they can interject, and one of the reasons why they might interject. It's not as common here as it is in the clinical station, but when they feel like you answer the point they might just move on and oxy something differently. Um So you're right about in the interview book, this question would have multiple parts, and in this scenario, it does have multiple parts as well. So you know if they've seen, if they've seen that your you scored all the marks, then they might just move on, especially if it's very time pressured um going back to going back to um the structure of the answer for this question. After thinking about patient safety um and immediate concerns, short term, medium term long term concerns aren't really medium and long term concerns aren't really applicable in this situation, but for example going back to here, If your colleague does this several times over the course of replacement, then it starts to become a medium and maybe long term issue, take the initiative after you've considered patient safety, so try and contact your colleague if they are unavailable and you know they're unavailable, you can try and arrange cover so that can either be through your through your site manager um through arcs ing. If there's a you know emergency locum that could be put out um through boxing if a colleague could um swap swap shifts, um. If none of those options are available, then it might be the case that the registrar and call um if that if the register and call could step down, and then the consultant, the registrar can step down to be the s. H. O. And the concern can step down to be the registrar. Most also have a policy in place for those sorts of, for these sorts of events um Another question, will there always be follow up questions for scenarios. I'm just wondering how to time what we will be saying in order to have time to be arts, follow up questions, so your interview score isn't wholly dependent on your ability to get through everything, remember that the domains in which you're scored against is your understanding of the issues, you're prioritization of the issues and communication, so it's not to say that you need to sort of blast for everything, and then you'll get 66 out of six that's not really how it should work, and from my experience, they're just so time pressured, they would they can just keep on up to your questions just to see how far you will get um in order to how to time what you're you'll be saying, try and be concise, don't waffle on and then but try to give everything try to give them all the information, so it's not just the summer, it's not a case of chasing and follow up questions um. So that's escalation, so the first step of escalation would be talking to your uncle registrar your consultant, one of the things classically in this question, they could ask you um is about the chain of escalation, so you call your registrar they're not available, you call your consultant, they're not available. Pre do you call necks um so there is a chain of there is a chain of escalation within hospitals um So it might go to you know like your registrar consultant, trying to contact another consultant on called, contacting the clinical director, contacting the assistant, medical director, medical director, um, and all the way up to chief executive officer. Um So is this, in this scenario is a ct one uh to be considered senior to the s. H. O. It's a bit of an anachronism. It's a bit of a funny naming system in which u k um grades are right, so s. H. O. Is any can be anything from an f. Y, too, so a doctor who's in their second year post graduation all the way up to a c t two um so as a c t one, f two, s h show locum ct, ct one, c t two but is all of the, that's all of the sort of grade of s. H. O. So no um their their equivalent grades, um So knowing the chain of escalation of who you would escalate to is really is something that is quite useful to learn and then support the colleague might have personal issues. They might have had a car crash like who knows why they are and there, but part of being a good colleague would be supporting your colleagues, which may have you may have personal issues um. So highlights one of the things I think um when I was practicing, I mentioned is you know, highlighting different support groups or charities, which might be able to you know help colleagues, which are struggling um things of that nature and then reflect and redirect so how could you have managed it better, you could have called earlier. Um you could have how could you have been more proactive in the future, so you can always say I would reflect on the situation and think about how I'd manage it better. Maybe I could have called at 10 minutes. Um Instead of you know 30 minutes, maybe I could have given my colleague you know after my colleague, you know a different time all of these different things and the reflection and redirect the redirection redirection, which I didn't which I felt to talk about is how you know you can apply it to court sergent your your personal course surgical training um job, um but yeah, I think that is all that we have time for at the moment. I think we've run over by quite a bit um what I'll do is. I'll send, I'll send the feedback form out um Has anyone managed to get get that um. And I'll I can also answer questions for about you know another like 10, 10, or so minutes, so I've got a question here is what happens after cst um after csc you can work as a locum, doctor increasing your publications, is there a limit how many years you can do this like 23 years. Otherwise, it looks bad so after you finish course surgical training. Um You can work as a locum. You can you know, apply to gpu, comply to radiology, do whatever you want. In terms of is their limit for how many years you can do, it depends on the specialty, A lot of specialties, will start to progressively penalize people who have been in your s. H. O. Grade. Um posts over you know free, free, or 43 years or so um That's to avoid a situation where it takes you five or 10 years to get a red job, um but it's quite clear it's very dependent on the specialty you're applying to um so I know orthopedics, they use a multiplier, where let's say you've had two years of experience. If you have four years of experience, you have a multiply, which is lower than if you had two years, so you can loken but low comming for too long, off staying as an s. H. O. For too long, isn't great uh um Are there any other questions what stations do I have um so the stations that I had I had a question to my management question. My management's question was I can't remember the specifics, but it was a lady who had she had that delirium or dementia or something along those lines and what they wanted to talk about was d. N. A. C. P. R. Um um and consent, um which was unusual in the sense that it's not talking about your difficult colleague. My clinical stations. I can talk about more in the talk on the 20th, but I had one lady who had pulled that essential line um which was which was my first clinical station, which you know sort of throws you off a little bit because if you've not done an i. T. U. Job, it can be quite a weird one to approach that was my c crisp question and then no that was my, I didn't really have an 80 less question that was that was it um uh to see chris questions. There was one about central and, and the second one was compartment syndrome, which you know is more bog standard um is appropriate to reflect on most issues in in, in the management, so I would say it's always good to mention reflection um the amount of detail that you want to put in does it need to be that much so. Um you know in a scenario like this. For example, you might just say I'd like to reflect on how I could do it better. If it's a critical incident you could say oh I would like to you know do an audit on the processes which went wrong and see how we can improve. It doesn't need to be substantial, but I would say it's appropriate to reflect in most cases how much does the interview um score contribute to your final score rank relative to the self scoring criteria, and the m s sorry, um I'll be honest and say that it's changed since last year, um So I'm not exactly sure um I'm not exactly sure you would need to you would need to look at the applicant handbook or um the application website, um but I think the m. R. Sorry is maybe 10 10% and then 30% portfolio 60% interview. Great, thank you. Um It's method of interviewing and giving management case questions are synonymous with most hospitals in the uk uh I presume yes so um the cases and the case and questions would be what you're expected to be able to deal with at the end of your foundation training, so you know 1 to 2 years post graduation um and um and at the start of ct one um as a fresh graduate. I would probably if if I got like uh it's more more related to the clinical questions because they're similar to what you get in when you graduate, the basics are the same. Um It's just the level of fluency in conveying um those concepts so you're a to ease and things like that, um but I think most hospital like you know, um junior clinical fellow interviews follow a similar structure sure, are there. Any other questions do you have any experience of having slightly unusual questions um how is your experience of safety um in surgery um So in terms of answering unusual questions, the reason why the reason why I gave the different frameworks before is that you can apply those frameworks to pretty much any any question um and part of doing the practices gaining enough experience with with practicing under interview pressures so that when you receive a question which sort of blindsides your little, you can sort of recognize um which structure would fall under so um For example, um how was your experience of safety and surgery, looking at the different frameworks, I think that Star would be an appropriate framework, so you could say I had x I had X experience of uh safety and surgery, where a patient came to harm because of x. Y. Um and said uh what what happened was did I did uh the result of this is that we had to do x. Y. And z. Uh do we had to perform duty of kind of, so you know uh there was a case the other week where someone had a eliza raw frame, so basically a circular frame um to lower limb, and one of the pins for the eliza of, went into the, went into the femur instead of the tibia um so they had to have a revision surgery. Um What happened is that we filled in a clinical Internet form and we explained to the patient what had gone on. We tried, we were open and honest and we had a duty of candle to explain everything to the patient as a result of that, she really appreciate the honesty. Um She did have to have a further operation um and we um we assured her that off we assure, turned double checked after the operation that that had um the necessary adjustment was made. Um One reflection that could happen for that from that is checking the on table um image intensify x rays for correct pin placement um and ensuring that in future, um surgeons do that when doing a lizard of frames, so it's not it's not about the scenarios about it's not about the question, it's about recognizing which scenario fits which question and then from then you're pretty much good to go because once you have a structure you've earned most of the marks. Hopefully that answer your question, so um I think I think we'll um call it a day here thank you for um coming hopefully that was quite useful um in terms of your preparation, um as I said practice practice practice. Um If you want to have a look at the size they should be available and catch up, um please fill in the feedback that's really useful for myself, and next week, we will be doing um the clinical um station, so I will see you then enjoy your evening.