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is Mind the believe we're definitely events that that is saying, You know, I wonder, can you see on my account that says, verify your account to join the conversation? Uh, I can't hear anything. Just seeing the events starting soon. Bit, uh, we have started. It says it's live working now. All right. Okay. Can everyone hear us now, can you guys message? Can we see more messages that people can hear us And if you can see my slides fucking now, All right? Okay. I wonder where that was. Okay. Sorry about that. Brilliant. Okay, that was That's really odd, but do you think I don't know why that happened? To be honest? Um OK, should we just start from the beginning? Yes. It's a good rehearse rehearsal, but yeah, I don't think anyone had that except for us. Then, uh, Jake, just let me know when you want me to start again. Yeah. Good. You're good. Okay. Uh, so hi, everyone. Thank you so much for coming to this webinar about internal medicine training this evening. Um, my name is Anna. I'm in I m t three based in Liverpool. So I've been through this process just like you three years ago. So I know. Um, you know how anxiety provoking it can be. Um, but I hope that this webinar allay some of your fears around the interview process. Um, I'm not going to be talking much about what internal medicine training actually involves. Because if you come to the stage, you probably already have a good awareness of what the program is is going to entail. I'm just gonna let my colleagues from minded people so introduce themselves now. So Hi, everyone. I'm Jake. I'm an f Y one based in Edinburgh at the moment, and I'm sort of under the mind the bleak medicine team. Uh, diminution one of the F two s. I'm in Liverpool at the moment. I I run the medicine subsection of mindedly. Thank you. Okay. So, um, the first thing I want to say is, you know, if you come to this webinar, I I presume that you've got an interview. So congratulations on on this incredible achievement, because I m t has suddenly become incredibly competitive compared to when I applied three years ago. And the fact that you've got an interview means that you've probably got quite a lot on your CV or, you know, you you've got plenty to talk about. So hopefully the interview should actually be quite a good you know, a good way for you to show off everything that you've done. Um, you know, the You know now, now the interviews are online. It is quite different experience. Um, you know, back in the I don't want to sound like someone who's archaic. But when I had my interviews, we would go to a center and have to have our big heavy binders and go around different stations. But the online interviews feel a bit more like a conversation. Um, and you'll be talking to the same people throughout. Um, and, you know, it's only, you know, its entire interview last less than half an hour, so it's gonna go by incredibly quickly. Um, so I think the important thing to remember is no matter how you feel, the interview went, uh, retrospectively, you probably be criticizing yourself about lots of things. Just remember that, you know, it's it's not a reflection of you as a person. Um, it's a very artificial setting, and, you know, it's there's no way anyone can get a full picture of you as a trainee from you know, this kind of interview length. So you just have to learn to play the game. And today we will talk about the structure of East station and how you might want to structure your answers. So the first station is about your about you and about your portfolio and just you as a person. So to some extent, you do have the most, um, control over the station, and it is also worth the majority of the points for the interview. So I would suggest that you probably want to spend the most time preparing, um, and practicing answers for the station if you haven't found someone to practice with, um, I would highly recommend that you do before the interview. It doesn't have to be a medic. Um, it can just be, you know, family member or a friend. Um, but you do need to at least practicing, um, talking about yourself, um, and and and it is it is awkward, but you have that. It will make you know it will make things sound a lot more natural when it comes to the actual interview. If it's come out of your mouth at least a few times, so it's going to start with a two minute narrative. Um, by the way, sorry. If anyone has any questions, Jake is gonna let me know. Um, so feel free to ask questions throughout this, and you know, I do want this to be interactive. I know it's difficult when it's online, but feel free to ask questions throughout. So the first two minutes are going to be a narrative about about yourself. So it's it's it's it's time you don't have any props or AIDS. Um, you should prepare, like a few key points I wouldn't necessarily memorize. Um, what you want to savor bottom because that that you risk sounding a bit unnatural. But you should have a few like a very select, um, number of things that you want to mention, ideally, that are internal medicine focused. There's no way. In two minutes you can discuss your entire portfolio. It's it's not possible. This will then be followed by a four minutes of questions about you know that might be lifted from your application. So anything that you've mentioned on any of the sections, your application you should be able to discuss, um, at more length, and you should prepare for that. So it's really important. Uh, the score ng is actually really crucial because basically, your entire I'm the application, um, is scored on your interview. Um, Station one is scored by the to interviewers interviewers after five possible marks. So if you look at the mark scheme one mark is, um, so in the very middle, if you score three, you're performing at the level expected of an F two. Um, and five is, you know, exemplary performance well above that level. And and one would be, you know, not, you know, performing well below um, So there's gonna be to people scoring out to five on two different domains. So each interview will score you, uh, out of 10. Um, and this will then be weighted at times 1.6. So 16 marks each. So account you for 32 points out of 60 points from the entire interview. So this station really is half your entire interview, even though it's only one. So it really is where you should be putting a lot of your focus, and it'll probably be where um, you know, now that the it's all online, you will start, you will have your stations in order. So you know, if this interview go if this station goes well, it does set the rest of your interview up to go quite smoothly, I would say, And it it gives a good impression to be into yours. Although I wouldn't panic if you feel it doesn't go well. Um, and you also get some points for communication across all stations. So in terms of planning, it's entirely up to you How you want to do it. You can either talk about your achievements in a chronological fashion. You know, undergraduate, as a foundation doctor, as a fellow, or, you know, whatever you've been doing or you can divide it by, um, your academic achievements or your clinical achievements. Um, Q I and research and that kind of thing. Um, there is a person specification for the i m. T. Application. So, um, that has some of the qualities that they're looking for in candidates. You probably want to lift from that and talk about. So now you know, um, experiences. You had that show that you, um, can manage an acutely unwell patient. You can prioritize. You can delegate if you work well in the team. Um, you know, and, you know, do research on top of that or quality improvement. I mean, to be honest in my in my opinion, I do think they expect a lot of trainees, because it's not enough just to do a good job in a full time job. But you do all these other things, But, you know, I'm sure you will all have, um, things you can talk about. More than so possible. Um, way infrastructure included. Talking about exams, MRCPI something you probably is worth mentioning if you've started doing that. Um, research and publications, any leadership roles you've had, you know, as an undergraduate or postgraduate, Um, you know, ideally, medicine linked, but not necessarily. And you want to make it into how it's affected you as a person and what kind of skills you've taken from that, um, quips I'm teaching. So hopefully you've all had opportunity to do at least some of these things. Not necessarily. All, um, two minutes is quite short, so I'd probably max pick four things, um, to talk about with half a minute on each. So here are some examples just gonna go through them. So I'm just gonna allow you to read these examples, so as mentioned before, you might want to start to them by domain. So this is just a very common interview technique that is used, and you might want to, um, have many four things you want to discuss, and you can You can use the staff framework. So you might say, you know, I was you know, um, has to do you know, um, to manage the the acute medicine row to and this was, you know. Then you want to explain your role in that and how you did it. You know how you contacted people, maintained a spreadsheet or whatever you did and what the result was in terms of, um, you know, any organizational skills you got out of that and then the questions after that are pretty variable, but are usually about the same kind of themes. So what can your evidence has commitment to I m t training? You know, l r c p. And the conferences you've been to you probably will get asked about quips and orders any any academic presentations and you might get asked, You know what your future career aspirations are as well. It might not necessarily have an idea of what specialty you want to do. And I think that's completely reasonable to say. And yeah, I mean, how you decompress is really important as well. Um, because, you know, it's medicine is just getting It's incredibly stressful. And, you know, uh, the workload has significantly increased in recent years. So So I guess here you want. So this this is a question about what qualities can you demonstrate are essential to being an intelligence in trainee. So these are really about your soft skills and generic skills, which are really important. And communication, which there's growing up throughout your interview, is probably one of the most important, um, like, attributes to the medical trainee equip and audit. Does anyone have any questions so far? Uh, no. Nobody's placed it so far. Okay, Okay. So just some key takeaways is you want to be quite, um, concise with what you select in the two minute period. It it is really short. So you should time yourself and make sure that you can finish it within two minutes and you're not having to cut you off. And if you haven't seen the person's specification, do I have it saved up here? Probably don't actually don't think I left it up. Just continue, Okay, so the second station is the clinical scenario. It's not going to be something that's already out there. It's gonna be something fairly standard, and you you will be fine. Um, you know, keep it simple. It's, you know, it's just basic management, basic initial management and showing that you're a safe, uh, a safe doctor. So it's going to be three minutes of preparation time. So you might want to think about, you know, so that you will get a bit of a short vignette. You might want to think about your, uh, any questions you want to ask, um, any investigations, your differential and your management, and you might want to also consider which other specialists you want to involve. Then it's going to be eight minutes of questions about the clinical scenario, followed by a one minute S bar handover, which is also something that was introduced last year. So the way it's forward is again out of five marks and your score down investigations, diagnosis management and then your hand over separately. So that accounts for 20 points out of the 60. I don't know if it's Is it a quarter of the whole interview then? Or is it a third? I think we need to double check that. So the Vanessa vanessa tend to be quite short. So a few sentences it's not going to give you all the information in this scenario. And you, you need to kind of structure and method pair yourself at this time. So think about what further information you would like to gather. And what next steps would you take your differentials? Um, possible interventions and treatments, particularly initial management And, um, any any kind of wider aspects of the scenario which might involve a communication with the patient. You know, d really kind of, um, guidelines or, um, you know, end of life care discussion's or that kind of thing. Uh, I know we've just got a few questions, actually, and, uh, this is quite good. Uh, during this, um, station, obviously. What? You have three minutes to prepare. Do you know if we're if the sort of individuals able to drop down sort of notes on paper as it all mental preparation. I in my time. Yeah, we did have. I mean, I think the difficulty is the sole, which we online, but I'm fairly sure don't notice. Okay. Yeah, I I just know it's the presentation bit in the station. One. You can't have any sort of notes or or any kind of power point. That all has to be verbal, but yeah, this one this three minutes, you've got to read the, uh, so clinical scenario, you can jot down some notes. Yeah. Yeah. Thank you. Okay, so this is, um, an example we've we've we've come up with, um, just to go through what a potential scenario might look like. So this is quite, you know, straightforward 19 year old guy, you know, uh, gentleman with the background for epilepsy, who's brought into 80 with, uh, having coming with a seizure that was witnessed by his family. So the first question is, how will you assess this patient? Um I don't know if we can make this interactive at all, or if anyone wants to just kind of draw anything down. About what? What? What does that mean, what? What does What does, um, your interviewer definitely want to hear you say in this kind of scenario? A Yeah, 100%. And I think certainly if if if your your scenario might not necessarily be this acute. For example, I had a patient in my in my in my interview, Um, it was a patient coming in with infective endocarditis, and I think he was relatively stable. So I had you have a bit more time. Um, but this guy is like, actively seizing, So you do have to just dump and then do an A T V assessment. Um, so you know, you I think it's really important when you're doing a two e to say that, um, if you're taking the lead in this scenario, you want to get delegate responsibilities to other other members of staff. So you make sure someone is looking after the airway. Um, you know, you you'd call for help. You get someone to ensure that patient has IV access. Um, and someone checks, you know, blood glucose. Um, so general a to eat is fine, but anesthesia. The most important thing is you want to make sure the patient is safe. Um, the airways preserved. You check the glucose. And also, um, you know, make sure you have, um, some emergency treatment on board. So even if the patient doesn't require benzodiazepine is, um it's still worth asking nurse to go and get some, just in case it's required going through the A t e. You might say to the in clearer. I would start by doing a TV assessment. I'd make sure the airway was patent and use airway adjunctive required. I would then move onto breathing, make sure he is an option, um, and perform a blood gas as well. Um, I'd ask a college to examine this patient circulation. I would ask another member of staff to gain IV access Blood's for electrolytes, inflammatory markers, um, and and and a gas as well. Um, check, uh, spacious G. C s and pupils. Um, and then again, you know, do exam examination. Anna, uh, we just got a couple of questions, so just with you know, you're talking through a t E. Is it possible that you could be handed some kind of results to interpret? Um, I was during my scenario, so yeah, you go on. Go on. Sorry. No, I I did get further results. Um, like blood tests and that kind of thing during my first scenario? Um, yeah. I mean, certainly in this kind of situation, you might you might get perhaps, like, a CT head report or something like that, or they might. But I think in this situation, what what's more likely is they'll ask you what? What are you going to do next if it continues to seize, um, and maybe testing management and then how you might want to investigate? Why? You know why it's happened? Sure. Thank you. And just, uh, sort of on that note of management, somebody's asked about sort of covering clinical scenarios in preparation for this station. Um, would you say it's predominantly sort of medical emergencies that you would find in So, like the Oxford handbook, you know, the emergency chapter or kind of how how thorough do you think people need to be for this station? So, yeah, I I used the Oxford Handbook in my preparation, but I don't think in fact, um, endocarditis was in that, and I had I had a friend who had, um, management of hypertension. okay and talking through primary secondary causes. So unfortunately, I don't think you can prepare for every every eventuality I think it is. You know, it's so broad, Like medicine is extremely broad. Should be prepared for, you know, you know, if it's not going to be something that you know nothing about. And if if you really don't know anything about it, I think just showing that you are sick, you're safe acting safely and seeking advice from seniors is fine. Perfect. Thank you. And somebody is just so just to clarify. So because it is an interactive scenario in your obviously speaking to the Examiner and they're giving you information, so you say, like you'd say, I'm going to do an 80 and you get to the B section and with the Examiner, then give you, like, their observations, like the respirator and their oxygen SATs. So they'll give you that Sort of as you work through it, they may. Well, as soon as you say a to eat, they may well interrupt you and say, Fine, you've done You've done this A to yourself. This is what happens next because there might. There might be, uh, specific things. They want to get out of you. Sure. But I think if you mentioned that you would do a to IV and they said, That's fine. Move on. You know, be prepared to, you know, get your Your feel might be cut off at that point. Great. Thank you. Might not necessarily get to discuss exactly what you want. Yeah, but you're just demonstrating that which is obviously the important thing, but yeah. Thank you. Um, So, um, this is a question you might get asked. So what are the possible cause of this man's seizures? So he's 19 year old, 19 years old. He has a background of epilepsy that's diagnosed for which his own treatment. So I think, um, one of the first questions you wanna ask is is he actually taking it? Um, is there a metabolic cause, um, that's, you know, predisposing to seizures, um, such as, you know, infection or alcohol or sleep deprivation whatnot. Um, so that's that's your Those are the kind of primary courses, but when it comes to secondary causes, you won't go wrong. And this, you know, aside from seizures, I think generally in in most areas of medicine you won't go wrong if you mention vascular inflammatory, neuro plastic or infectious, um, as broad categories in your differential. Um, yeah. So, um, certainly if if this had been, um, you know, a a six year old who had no background of epilepsy, you'd be more worried about a CMS infection. Or, you know, an S O. L, um, that's causing your seizures or vascular that, like, an acute bleed. Um, but, you know, it's really, really the context is really important. But I don't want to get obviously where we're talking about how you want to structure your answers. So I would say, if you're talking about differentials, um, you know, use the surgical serve, it is useful. So how would you further investigate this patient? Um, So does anyone want to maybe pop some suggestions from the chat box? Oh, I can let you know if Yeah, yeah, yeah. That's probably for the best. Yeah. What would you be able to? Oh, uh uh, if you you see the box at the bottom, if you just click hide covers some of your perfect Thank you. Uh, so blood. So you would want to do as you said rule out electrolyte abnormalities. Infection? Um, CT head. Somebody said an e e g and an LP. Okay, so, um yeah. So I think bloods is definitely key. Uh, would you necessarily do a CT head? Yeah. Say, say, Say it's a 19 year old and he's just not taking his medication. And, you know, after, uh, following the seizure, you know, you examine him and he's, you know, he's g C s 15. And you know, there's turns out that he just wasn't taking his tablets. A CT head might not necessarily add anything. Um, certainly if he showed other signs and manages him or he's confused or there's something atypical in the history and he's not recovering as he should. You like they're a CT head. Um, if he's banging his head, had some kind of injury, you might want to consider that as well. Yeah. Good. Somebody said if this is the first seizure, So you could say that to the Examiner. Yeah. You want to know if this is if this person has a background of epilepsy? Because that I know if it's the first presentation of a seizure that can change things, can't it? Yes, Exactly. So it was the first presentation. I would want to do a CT head to rule out an organic cause for his seizures. It may be that this is first presentation of epilepsy, but I would want to exclude alternative courses. Um, e g I think is, um probably not something that you'll be able to access on the acute take. Um, it can be useful, like in the outpatient setting. Um, and I would say I would refer this patient to a neurologist. Um, for consideration of further investigations such as an e G. I don't think it would. It would be in your initial kind of steps. And somebody just said an A B G and a chest X ray, which I suppose for completeness. Yeah. And what would you expect to find on the arterial like gas? Mhm. Uh, somebody said hi. Lactate. Yeah. Hypo. Timothy. Mick, that's actually yeah. Yeah, absolutely. So a B G is very useful. Can show you a lot of other information, but typically with the seizure, you have a metabolic acidosis for the high lactate that actually typically resolves quite quickly. Um, following the event. Great. Yeah. Everyone's saying Get lactic also has a glucose from the gas as well. But you should just check a glucose anyway, but yeah. Yeah, it's good to know. Great. Thank you. But certainly this is procedure. In terms of examination, I don't think you'll be able to examine the patient if they have to be seizing. Um, although it is important to document what the seizure looks like, lung puncture is quite important. Now, that's That's an investigation you will be able to access acutely. So your management is really going to be depending on what the information they give you. Who might you call if this patient is seizing? Um, you know uncontrollably. Double two, double two. Yeah, but you're getting the scenario. So would you call double two Double to I t u the med Reds? Yeah. A niece. The test? Yeah. Yeah. Who? Anesthetics is pretty cute here for just for a re management. And But we'll go through some of the treatment procedures as well. So yeah, I mean, gathering information has this patient. So when you gather information, you want to know justice patient? How about her on the previous seizures and what treatment he takes for that um and has he been conclusion with that? And has he had any treatment in the community prior to arrival? And yeah. So, basically, if it doesn't turn the after five minutes, you want to give IV lorazepam, or but I am midazolam is another option, or you can get back on midazolam, and I think rectal diazepam. But in practice, um, you should be able to get access. Um, and yeah, in my in my area, the second line is usually I am midazolam, but I would probably mention I would go by the status epilepticus guidelines you have locally. The first I imagine it is a is a benzo. So you normally give lorazepam 4 mg and then wait for five minutes. And if it still hasn't self terminated, give a second bolus and then wait for five minutes at that point, you want to think about loading the patient with an alternative agent such as phenytoin, Evaporate or Capra. Um, I have to say that if the patient is really seizing for more than five minutes and it's not self terminating, I think anesthetic should be there already, because it might be that they need airway. Um protection and also, um, potentially sedation as well. So just to clarify. And it just because a few people would put double two. Double too. So if you're getting to, you know, someone started the timer and it's getting to say four minutes and this person is still seizing. Would you then think? Could you then say about a medical emergency? Double two, double two. And we need an underneath the test there as well, like would would that be? You can. It doesn't happen often to any, but all right, basically any you've got consultants, but you should fastly be niece tests. Any that should be registering consultants around. Sure. Yeah, yeah. But I think to say that you will seek senior advice. Yeah, possibly be honest. This is good, but obviously this might be a patient on the ward because I already had been admitted is then seizing. Then it's a different scenario. If they're on the ward, then you should put double two, double two out, and that would be entirely appropriate. So we've talked about this. This is kind of beyond the realms of, um, of of what you will be able to achieve, but an East should hopefully be able to sedate the patient at this stage if you're getting to this point, and here I just talking about some complications of status. Yeah, So it's really important because just when your protection to terminate the seizure as as quickly as possible. So this is kind of like, you know, exploring your different knowledge of your different, um, areas of knowledge in terms of long term management of patient's with epilepsy and seizures, so develop guidance is is pretty important. So don't forget those kind of wider aspects of care. Anyone have any idea about about how you might respond to this question? Someone said no. So So what would you do first fit clinic after the second seizure discussed with the patient? I suppose it goes back to you. You know, you would say, if you are unsure, Neurologist, you would refer to a neurologist or seek advice. Maybe. Yeah, people are saying the first would have a generic kind of fall back raises like I will seek advice in this situation. And yeah, um, but yeah, first foot clinic is entirely appropriate. And, um, you know, kind of treat any provocative factors. So you know, if they took like, a bunch of cattlemen and had a seizure, then, you know, you know, you just that's a very different scenario. Um, yeah, sure. Answer is no. So, in terms of handing over this patient, we just wrote like, an s bar example. So I'd like to make you aware of this 19 year old male. So let's say, for example, sorry you're handing this patient over, You've seen them in resource, and then you go into medical handover and you want to let your night colleagues know about them. I'd like to make your way of this. 19 year old male Karen In Resource, admitted with the seizure. He has a background of epilepsy diagnosed two years ago, for which he takes sodium valproate. He was recently even unwell with a flu like illness and has been noncompliant with his medication so on. The first seizure was reported to have lasted two minutes and was self terminating. The second seizure lasted 90 seconds and was also self terminating, um, and was witnessed by staff and any and with chronic chronic in nature on examination. Currently he's postictal. He asked DCs of 14. However, he's maintaining his airway without support. He's tacky, hypertensive and saturating. 93% on oxygen. Um, gas shows a metabolic acidosis with a raise lactate, and he's normal glass Emmick. We've sent blood's for, uh, fbc electrolytes and inflammatory markers and also request their chest X ray. And he has had a stat of his evening anti seizure medication. So I'd be grateful that you can review this patient and also keeping our eye out for his bloods and chest X ray. Um, if he has another seizure, he may. He may well need, um, discussing with neurology and loading with an anti epileptic agent or IV lorazepam. So sorry. This I think we written here putting out a 222. But if he's still in resource, that that might not be appropriate. Um, so I mean, you know, you can. The clinical scenario really could be anything. Um, but this is just an example of what an s by handover might look like. Um, do we have any more questions at all about this or nobody's put in just to clarify you? You have a minute for that, don't you? Handover is just 60 seconds as all your allocated for Yes, I think I think I think that was the case of just double check. Yeah, it was Yeah. Yeah. So you've got, I suppose it's about just trying to remember as much as you can and then being, you know, sink and concise, but yeah. And I think, you know, I don't know if anyone is using resources to look for particular like, um, um, examples. But I think, you know, there are resources out there. Certainly more than there were a few years ago to help you prepare for the interview. And, you know, I think, you know, I think many buddy is something that I think I know quite a few people using. And certainly if I had access to that, I would have used that. But there are quite a few resources out there, and someone's just ask, will you be given time to prepare for the handover? So I from what we read, I believe it's just you finish your scenario, and then you go straight into the minute of Yeah. Yeah. Are we allowed to take notes during the interview scenarios? I'm sure. I'm sure you can, but I think it might uh, interfere with your flow? Potentially because you probably expected to answer questions alongside that, isn't it? Like an off ski, but not examining. There's no one physically there like a dummy to examine, But you're kind of talking through things, aren't you? So you want to keep focused and can you tell us the reason I mentioned it's probably gonna be quite difficult to take notes during, uh, during the actual interview process? Yeah. Um, so you just go in touching the resources. So you you were saying you would have found a kind of bank of, um scenarios useful to prepare with. And you said medi bodies because somebody said, Can you tell us the resources? You I mean, did you use anything when you were preparing for your time? Not not. Not really. Like, I think I just used the Oxford handbook, and I went through everything in that. And I wish I I wish I had more to do. Use the time, to be honest, I mean, I I I haven't really used anybody myself, but I used it when helping someone prepare for her surgical interviews. Okay, that was quite good. Fine. And the thing is, I think please suggest the resources I think at work and things. People will be doing a spot handovers, your you know, referring to different specialties and things all the time. So I think it's just from what you've said here, it's just making sure that your handover is really focused and it's addressed in the pertinent details because the examiners can't expect you to remember everything. But as long as you're as you were saying, always need to you know, a good espada you're going to start out with an actual request you don't want to be going through. Um, you know, all this stuff and your colleague is just thinking, Like, what? What? What do you want me to do with this you want to start out with? You know, I need you to do this And this is the situation, the assessment and what what we need to do in next, like it has to be quite, um, you need to make it quite actionable. I would say that's that's That's what a good s far is. So you would say, You know, I'm calling to ask for a review, please of and then you go into, say, a 19 year old male, and you know you want to grab their attention, Especially if you've only got that minute. You want to get that across? Yeah. You want to be like, you know, I'd like to seek some further advice regarding this 19 year old male who's coming with a seizure. Uh, you know, just, um What? What, like, what are you asking? Like, Are you asking for advice about about management, or do you want them to come and review some some tests? Like, are you handing over to a different shift? Um, yeah. I don't actually know, Um, like, whether they're gonna make it clearer, like who you're handing over to, because that does have quite a big impact on how you go to frame it. But, um, I love you guys know or how I think like they'll give you, They'll tell you who you're handing over too. So it's like a senior colleague. Okay. Oh, it could be like, say, for example, I t u right. So if if the scenario could have gone and, you know, gone south, you know, he may not have had his health to an aging seizure um, he may have, you know, continuous ease despite treatment and has just been loaded on keppra. And you, you might be on the phone to I t u. So now that that's a very like, specific conversation about, you know, I'd like to, um, uh, discuss potentially. Um, you know, I'd like to refer this patient with potential potential intubation ventilation and sedation. Um, you know, this 19 year old gentleman with a background of epilepsy who is currently presented with refractory status epilepticus. Um, and that that immediately is going to make you know I to be, you know, take notice because you've asked them, um, for specific organ support. Obviously, your scenario might not be something this acute. It might be something that's, you know, um, it might be that, you know, if someone would endocarditis and you were talking to microbiology about about the case and you want some advice regarding antibiotics? Um, but I I haven't actually had experience from about the s bar. I don't know. And you guys know Has anyone told you, like, what kind of examples of who who you might be handing over to, uh, from having to look around it. It's often to like the medical registrar. All right. Okay. So it's often to the senior colleague within this, okay? And they also don't stipulate they just say handover. So I think it's a bit up to you and how you do that. But certainly as far you know, from medical school, you're taught, you know, it hits the points. Um, but I think what you were just saying it's really important that you are almost having that headline statement at the beginning. I'm calling for this or even if it is just microbiology and you're asking for antibiotic advice, like stating that because then it gets it across. Yeah, yeah, exactly. Yeah. If it is often going to be the medical registrar, I think even just saying that, you know, there's really a cute young, well, a patient, but I think you should be aware of and I think would benefit from a review is fine, even if you you know the red is not going to add anything to your management plan because you may well have done everything that they would have done. Um, yeah, great. Thank you. I don't think there's any or this patient is deteriorating actively. And I'm worried. And I think, you know, I need some advice regarding management or something like that. And I suppose you Anna, as a med Reg, you know, if in fy one is calling you or an f y to you when you're busy on the and you're rushing around and yeah, you've got, like, a list that's just ever growing you just you want the important things, don't you? Yeah. When somebody's on you here. Like what? Like what? I you know, I would like, you know, if someone says I want you to review this patient, Yeah, that automatically, you know, I'm gonna I'm gonna come review them, and I just want the key points. But it's hard when someone you know goes through something, you know, a big pre ample. And it turns out to be about, like, a question about, say, their medication. Or and, you know, you could have just got to that in the first place. I think it's helpful listening to someone who has, you know, a specific question. Thank you. No worries. Um, so the last station is about ethics. I think it's really short. Actually, it's, uh is it up to five minutes. Just kind of double check. That's correct. It's up to five minutes in total. That's what the I M T website says. Yeah, so I'm guessing it will be pretty much five minutes, but yeah, it's a single question. Right. OK, so is it So? So in my time, it was actually a scenario, but I'm guessing it's not going to be a scenario anymore. Uh, so I think it can be presented as a kind of situate. I think there's an example that we've put in the slides, actually, Yeah. So, um, this is again scored out of five, um, on one domain. So, um, that's going to be 10 and then wait till I get up at one times 1.6. So a total of 16 points. So probably the least important stations, but also again should be quite, um, it is incredibly important to have, like, some idea overview of the main ethical principles. And, you know, it should be hope, hopefully quite straightforward for most of you. So yeah, good advice is, you know, just going through the g m. C. Good medical practice, and, you know, knowing your five ethical principles, you know, autonomy, beneficence know maleficent and justice. I'm not sure what the fifth one is. I think there is 1/5 1. But, you know, just knowing those inside out so patient safety is always going to be the priority. Um, you want to think about what other kind of secondary issues are raised? It's a confidentiality or consent, for example, um, applying the medical ethics principles. And you know how you would, you know, potentially resolve the issue in the in the most in the least kind of invasive way and the most kind of, you know, direct way before you escalate it to hire channels. And you know, what extra information would you want to gather to clarify some of the the ethical issues? So I've just kind of picked a few things that I think you know. It's just good to have revision about. So capacity is one. So always assume a patient has capacity. So I think unless there's some something obvious that makes you think, Oh, I need I need to assess the patient's capacity as a zoom it and take all the steps you can to ensure that, um, you're you're optimizing that decision that that assessment just because the patient is making a bad decision doesn't mean there that capacity. Um, so if you're struggling to ascertain a patient's capacity, you might want to involve other professionals, such as a speech and language therapist, because they might be just raising, for example, you might want to seek advice from their relatives or from the mental health team. Um, you also want to know if they lack capacity where they have made any, um, advanced directives or if they have someone they've they've allocated as they're lasting, um, power for 20. Um, And if there is no one to represent the patient, know friend or relative, you may want to involve an independent mental capacity advocate to represent the patient. Um, and ultimately, you always want to act in the patient's best interest if they do lack capacity. So, um, just remember that a patient has to be able to do four things to show that they have capacity. And that said they can understand the information that you're giving them. They can communicate it back to you. Um, and they can They can retain that information. So, you know, memory is not an issue and that they can also weigh the risks and benefits so often in clinical practice. Um, it's not before that patient's, um, might not be able to demonstrate, and it should always be with regard to a specific decision. So for a patient to consent to something, they have to have capacity. The consent process should be informed, Um, so it has to be started early. They should be prevent, presented with adequate information, including, um, what the alternative is of not having the treatment of procedure, and it should be free from coercion. Um, this shouldn't hopefully for I m t interviews. I don't think you you have you. I doubt you will have a scenario involving Gillick competence, because obviously you're applying to do adult medicine. But if they're under 16 years old, they can consent a procedure. And that's called Gillick competence. But if But if they refuse a procedure, this can be overruled if the procedure is in their best interests. And confidentiality is another big topic. So you know it's implicit that most patient's will will understand that the information is gonna be shared with other members of the clinical team. But I think in this scenario you just need to be aware that there are certain situations where you might breach confidentiality, and that might be where there's a risk of harm to others. Um, for example, you know, if you know, risk of, uh, tuberculosis exposure, um, or HIV exposure. Um, other communicable disease, Um, particularly those that are high consequence. Um, And also, um, if disclosure is required by law, Um, And of course, if a patient consents for their confidentiality to be breached for other purposes of then direct care, you may have a situation that where they talk about end of life care. Um and I think just having an awareness that, um if someone has, like an underlying physiological process that is not reversible, Sometimes the kind thing to do is is to not not continue treatments that are going to cause some unnecessary just for us, um, and savings of care are really important to discuss, but But again, I doubt this is going to be something that comes up for a five minute station because that's quite a lot shorter compared to previous, um, stations we had. So again, you know, just being basically a sensible safe, you know, ethical doctor, and not nothing again. No rocket science here, but these are just some examples. So another seizure case, actually. So you're an f y two n g p. And a patient previously admitted to a knee last week with the seizure tends for follow up, and you suspect the patient they have driven themselves. So, you know, you want to, um, gather information first and, you know, you know, I ask the patient, you know, you know, is this what's, you know, potential? What's going on? And do they understand? Firstly, what the G b L. A guidance is because it may well be that they don't. They're not aware of that. If they actually actively refuse to stop driving, then this is a situation where you do need to breach confident confidentiality. Um, inebriated colleague. Um, so, yeah, I mean, you're f y one in general medicine. Probably not in the scenario, because you probably be the i O. T. And the I m. T two has arrived on the ward in slurring the speech and making inappropriate remarks to his nursing staff. So I think in this situation, you would, um, have a direct conversation with the i m. T two. I think I don't think they would be safe to continue working. Um, and you know, if it was a recurrent issue, you may want to escalate it to supervisors, but I think the immediate immediate issue is patient safety. And, um yep, you're the F F one on Jerry's and notice a fellow colleagues as opposed to there on Twitter, or joke about a patient who's been delirious during your shift. So again, I think again you want to directly raise this with your colleague, um, and give them an opportunity to rectify their actions, especially when there's a patient, identifiable information being shared online. Here are some other like potential scenarios or issues that might come up. So when when it comes to mistakes, um, don't forget duty of candor. So you should always, um, like that you have a duty to actually tell the patient about the error, regardless of whether it had any consequence or not. Okay, so that brings us to the end of the presentation. So if anyone has anything they want to ask about any aspect of interview, um, or I m t like feel free to and thank you all for coming. We appreciate you taking time out of your evenings, and I I'm sure you'll do really well. So good luck, everyone. I'll just end this presentation. Yeah, uh, no problem. Um, I don't think you have to bring any evidence of your achievements the interview anymore. So I, you know, it's it's really, really, really brief. Like it's, um it's actually it's actually crazy how quickly it goes by. And I think it's It's not all very like because it's, like, a bit like an Noski. It's the very pre specified questions they have to go through. It's very unlikely to ask you to bring any further evidence, but you should be prepared to talk about things in your portfolio. Yeah, Michelle, no problem. We're going to send out a pedia for the whole, um, presentation. Someone said, please. Could you go through the scoring for the first station? Oh, yeah. Shall I bring up the slides? I've got it up if you want. All right. Um and you know, what's really interesting is that I know the so you have to get a good enough application score to get an interview, but your actual I M t ranking is 100% interview. But it's almost a bit of the more you have in your portfolio, the more you can talk about in Station one, which constitutes, like 50% or so of it like it. It all kind of feeds in, doesn't it? So you have a good portfolio. You probably will do quite well in the station. So a lot of it, like, depends on how you sell yourself, so you have to have good communication as well. So even if you have a great portfolio, but you can't communicate that well or if you don't have a great portfolio, but you can really sell yourself, I think you know it's But the the chances are if you have things to talk about you, it will reflect in your score. Yeah, and somebody said, um, there's no daft questions. Don't worry if my portfolio is lacking, I m t content. Radiology slash sur surgery Heavy. Do you have any advice for the first station? Um, I think, um, well, I think everything is relevant and medicine isn't it because like having skills in different areas you know, is is really useful. But I think what? First, I have to ask you if if I m t Is is there a reason that your your portfolio is is having these other areas? And like, is there is there a reason why you have applied to I m t and you? You probably they probably will want you to justify that. And, you know, was there a change of heart? And what was that? Because, you know, people do change their career path. Um, would would you say Anna, You know, you mentioned before about of the i m. T. S a relatively broad. Um, Step two. Then go on to sort of a physician based specialty. You know, this person saying radiology surgery, But you don't necessarily have to know or I want to become a dermatologist or I want to become a cardiologist. They just want to see that you're, you know, interested in a commit a career towards medicine, right? Exactly. I'm sure anything that you've done that is where the old your surgery related can have a medicines land how broad it is. Um, And anyway, you know, if it's made me to just see mostly portfolio stuff is just to see, like, have you engaged with Q I processes? Um, Okay, good. So I would I would talk about how you really enjoy cardiology. And actually, um, you know, you you came to quite late, but actually, radiology is potentially really, if you have good radiology related stuff, I mean, a lot of cardiology, I mean argues involves involves, you know, interventional procedures. That and also, you know, imaging is now another subspecialty. And, uh, but I think even saying that, yeah, you realize you wanted to apply to medicine a bit later is actually really nice. Um, and it's fine. Like, you know, I I think to be honest, I don't know why I think we need as many internal medicine trainees as possible. Um, and we do. We need more all of you. All of you should get a job, and the chances are all of you will get a job in in the region you want. Um, I think the interview is just a way to maximize the chances of you getting your top choice. Really? And would you say I know that you know? You know, you said that I m t has become more competitive. I think you know, I looked and there was about 4000 applicants for last year's round. But that's, you know, not the people aren't just applying to I m t like surely there'll be Some people do find a GP or other specialties. So it's you shouldn't be kind of phased by that, right? Yeah. Some people do spread their eggs and lots of baskets. Sure. And that that number alone doesn't really reflect, like the numbers that to say. I mean, if you're in London, then you know it's going to be competitive wherever you like. Whatever you apply too. But generally outside London, um, you know, you probably get a job in in in the dignity you want. Um, even if your interview score is not the best like it's even if you're you know, in the 50th percentile or whatever like you, you probably will get a job. Um, yeah, because the competition ratios were very, quite dramatically with the region. Okay, But having said that, I think now, um, like I think cream I m t is pretty much filled up in round one. I can't remember if they had around two last year, so I don't think they did. A round one is that it's around two is if they don't fill all the national training numbers, right? Yeah, but they did. They filled all of them. Traditionally, I anti never filled national training numbers. I think in the past it used to be, like, 60%. Really? I think you know, it's a multiple factors. Uh, okay. And somebody said, I think you mentioned so medical school performance within the first station. So what do they look at within that? And I think the reason why we put that in was because when you, um, do your short listing score, I think it asks if you've had sort of a distinction in one of your exams or if you graduated with honors. And I suppose you could say that as part of one of your achievements and that, you know, this demonstrates that I am a hard worker and that I've achieved academic you could really sell yourself as you have achieved academic excellence, which is what I think. Yeah, I know. It's it's, um it's not right way of doing this, but I think just back yourself. But you've got an interview back yourself to sell it. Sell yourself. You'll be fine. And is it better to have an end specialty in mind? I suppose. Dermatology. Your respiratory. You know, some people go into, uh, mt knowing exactly what they want to do. And I suppose the fact that you're saying, you know, I'm really committed to achieving this goal in terms of my career would be fine, But you wouldn't be a disadvantage, right? If you didn't know. Absolutely not. Absolutely not. Um, yeah. I mean, a lot of I MPs actually don't know what they want to do. Both CIMT, but they're just interested in medicine as a whole. Um, I wouldn't say it's better either way. I think if you do have an interest, then mention it. Um um, somebody said, How do they have access to our portfolio? Can they access my J r. C P. This is nothing. So the interview is purely based on, like, you know, it's just that it's just all all the scoring for the interviews based on the conversation they have with you or that time period, so they're not going to be looking at anything else. Anything that you say. Like if you've said I've done a 12 week teaching program and you know, you Max out on the teaching points, can they ask for like, And then you mention that in station one, Can they ask, Do you have to provide sort of a certificate or a letter confirming that? Or so they're just trusting you that you're being honest. I suppose they could ask you, right? Yeah, I think I think basically, like in the past, they actually did look through the portfolio they marked. Like how? Like how? How? Fidel, I guess you were to whatever you said you self assessed on. Yeah, well, I don't think they can do that now, given the volume of applications, Okay, I don't think there's any kind of I think they there's they said that they will randomly pick some Chinese, um, to that portfolio. Um, but yeah, I mean, it's relying on your honesty, but it will come out in the interview if if they ask you about something that you've written in your application and you, you can't, you know, justify it or explain what you've done, then it's going to come out and I mean, you know, it's, I hope that most trainees are not going to lie about what they've done. No and anything that you have done. As you were saying before Anna, it's just about making sure you can demonstrate how that's transferable to an I M. T. You know, and it's very broad, like anything you've done like you said, whether it's in medicine or outside. If you were, I don't know, volunteered through a charity or something. It's all transferrable, you know, Teamwork, leadership, good communication. They want to look that So you just got a couple of soft skills. I think they want to think that you're not just someone who's got a great TV, but you're someone who, like is someone who has, like those, you know, softer and more emotional, you know, emotional intelligence, because you do have to have part. A lot of fun as a medical trainee. Um, yeah, really good calm skills I was gonna say I was also just going to say so. Also for evidence. Like if they wanted you to provide evidence for anything, they would have contacted you already to upload it onto Oriole like like it's very few people that ever get asked to do that. Um, it's like one out of every, like, 200. I I imagine that the people that are probably asking to the contacting for evidence of those who have, like, potentially very high scores maybe, you know, I don't know what the cut off was for the interview this year. Yeah, I I mean, I don't know anyone that's been contacted to upload things, but it I think somewhere it says that you might be contacted ahead of time, but that that window has also passed, so they won't ask you now. But I think that the prospect of being potentially asked means that people have. You know, they you can't just put anything on the on the application. Yeah, I think you just randomly like check, you know, like a quota. Because I I reckon if they did, they did. If you were selected and you didn't have the evidence to back it up, I think that would disqualify you from the whole process. Yeah, yeah, yeah. No, Everyone will be good. You'll get your I m t. You guys, you guys are here at, like, eight o'clock on your You're going to be fine. This shows commitment you've attended to mind the bleak and and honestly we want. We want I m t twenties. Yeah, like it's Yeah. I mean, you've already expressed an interesting one to do medicine. So, like, already, you're you're doing really well. I mean, you know, kudos to you. It's It's one of the toughest, uh, training programs. I think so, um, you know, it's Yeah, it should. It should be the other way around. They should be, um, you know, you should be interviewing them. Why? You know, why should I, um, join your greenery? But, you know, this is how the situation we're in and somebody said about neurology being my endpoint. And the thing is, if you're passionate about a specialty, and you know that will shine through and I think you know, that's what we need different specialists, don't we? Everyone finds what they enjoy. And I think, yeah, that's great, if you know, but yeah, definitely a stepping stone. Remember that neurology has now become a group one specialty. So, you know there is, um, you know, G I m They want to see that you can do G I m as well. Unfortunately, I think, for for a neurologist, but yeah, you know I'm not No, nothing else to comment. Really? No, I think, Yeah. Most specialties. I think dermatology is still holding out to not be jen med, but I wonder. Yeah, I I think I I doubt I don't think I don't know how many times soon. I love the anthology. Cool, right? I don't think we've got any more questions. They need more med Reg is we do well and yeah, yeah, yeah, no words. I mean, they need a lot more people in medicine, to be honest, and yeah, you know. Yeah, you guys will get a job. Don't worry. What we can do is we'll send out the PDS. I don't know, Anish. How the best way to do that? Is there a way of just sending it out to all the emails registered? Or I think the best way to do is probably put it on the event page on on the on Facebook. All right. Yeah, we can do that. Fine. Derm Reg. Hoping for SGS than the take. Yeah, happen? Yeah. There's definitely a lot of acute dermatology I've seen as an F one already. Yeah, cool, right? I hope everyone enjoyed that. Do you recommend any study material as my interviews in two weeks, then one resources. Um, so if you just, you know, Google I m t. And to be a prep. But unfortunately, a lot of them do like you have to pay for them, which is a potential barrier barrier for some people. And I would study the slides that we've sent out as well and practice with other people. Um, and there's one book that traditionally a lot of people used What was for interviews for Oh, is it the interviews for healthcare professionals or something? Yeah, the one that's black and white and medical interviews. Yeah. Sorry, I So I did use that when I was preparing. I think it's probably a bit too much detail to be honest for I m t interviews. Um, I'd say I am to interview is actually a lot more straightforward than that book presents. Um, so you you will end up, like, over preparing for it. Potentially. If you go through every question in that book and the study material, just I know we've mentioned about the clinical cases. I suppose you could think back to, like, what are the core things that you would see in medicine? So, like, I suppose, shortness of breath, it could be a scenario or chest pain or really common things they're not going to put in like some really like. It's not gonna be a Pacers scenario, is it? It's going to be It's not going to be paces. It's going to be like it's going to be like like, Final Czarsky. Two point. Oh, yeah. Just think of it as like, how did you care for that? I think that's probably And it's going to be all very pragmatic stuff. And you know you know it. Yeah, so but what? 11 other way you might be able to just look through potential things that might come up is maybe research the I m t curriculum. They actually have a list of, like presentations within that that they expect, like all I M. T s Will will encounter during the training years. Um, so if you don't just scroll through it, um, if I I really want to stress about the clinical station, uh, I would really focus your preparation on Station one, which is, like more than half your your entire score. Um, your your baseline critical knowledge is is probably already very good and definitely good enough for the interview. You know, remember that they're not expecting you to act at, like, the level of, you know, a registrar. You know, you have to just have a good basic approach. Um, yeah. And they just wanted to make sure you're safe, right? You know, they're thinking if this person was my i m t. One and they've recognized that this person is acutely unwell and they're escalating, you know what more you know, as long as you're safe and you're you're seeking support. Where you know where needed? Exactly 100%. Yeah. Any other questions for anyone? And yeah, I'll put the pdf on the group on the event page now, and we can upload this recording. Yeah. Be awkward watching myself back, but no get thank you all so much for coming and letting us really appreciated. Good luck, everyone. You'll be great. So you're going to be great. Have faith. You be good. Honestly, the interview will be so much more straightforward than you you imagine. And so much more like So it'll go by so fast, and it's just it's just so, um they're not going to try and trick you, like, catch you out or anything like that. Perfect. Great. Nice to meet everyone. Right to have a nice evening, everyone. And I'll upload that P D f now. Thanks, guys. Thank you. You're free to email any questions or like to I don't know if you we've got a contact detail. If anyone has anything they want to ask afterwards, I think people can message There's a, uh, mind oblique messenger group. Like, certainly there was a question about what? How to access this live event. And I answered it. So I think anyone that's part of mind, oblique, we all get access to it. So we can always just make sure the right person is, um yeah, answering that. Cool. Great. Thanks, guys. Great. Thank you. Cheers. Bye.