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Hello. Hi, everybody. Uh, welcome to today's talk, which is a kind of overview for the course, medical training interviews. Um Many thanks to those who joined on Tuesday and who provided feedback as well. I've tried to use your feedback for today's session, so hopefully there'll be some improvements. Um Yeah, so we're gonna give I uh in a, in a couple of slides, I'll show the kind of overview of today's talk, but as always, you can pop messages in the chat, um, and I'll answer them at particular points throughout the, throughout the talk. So whenever you've got any questions, just feel free to pop them in, in the chat. So, uh just a bit of background about myself. So I'm act one, working in London. I'm doing a urology themed um post and here's a bit of background of the hospitals I've worked in previously and I'm joined by um, San Sharma, who's Act Two. Do you want to introduce yourself? I'm Act Two in the Midlands. I'm based in Leicester. Um, I'm doing an orthopedic and plastic surgery themed, um, core training and I'll be applying for plastics sc three in coming up in the next few weeks. So, yeah, so we're very lucky to have um Sanje with us here today so he can help out with answering the questions and um chiming in with some of his wisdom and if you've got any more kind of oriented questions, the person to kind of pro so um let's crack on. So hopefully you'll get a kind of general overview of the CST interview process. Uh We're gonna talk through some kind of key strategies for effectively answering the questions. It can be a little bit formulaic. So I would say it's something that you can prepare for. Um And it is worth kind of nailing your technique so that you can kind of score as highly as possible. Um And hopefully, you'll feel a bit more confident about the interview process, having kind of gone through an overview of what to expect and also how best to prepare for it. Um Remember that the interview can pull up your overall points quite a lot. So if you're doing your self assessment or maybe you joined the talk on Tuesday and you're feeling a bit under confident about your number of points from the self assessment, you can definitely pull up your points um at interview. So it is worth putting some energy into your preparation. So just to kind of talk through what we're gonna cover today, uh I'll talk a bit about kind of why we have the interview, a brief application timeline which might be helpful for you to screenshot. We'll go through the interview format, how it's scored. Um There's also kind of two main sections which we'll talk about. So a management section and a clinical section and I'll talk through both of these. Um And then I've got some slides of resources that I found helpful in my preparation for my interviews. So this is kind of aimed at those who are applying for C SS T or those who are kind of thinking of applying for CST. So hopefully it'll be relevant for those from kind of fy A plus plus. Um and then also medical students. Um We're also gonna instead of me answering questions as I go along so that it's less disruptive, I'm gonna put some slides that kind of come up asking if we have any questions. So feel free to put the messages in the chat as we go. But I'll kind of get on to answering them at those like pause points so that I can keep a bit of a flow. So the purpose of the interview is basically to assess your kind of breadth of knowledge of some key surgical con conditions, key surgical presentations, their management. And also knowing about kind of surgery as a career in general, looking at the kind of ethical side of things, the interpersonal skills. Um It's a way for them to kind of differentiate applicant ability because obviously they have the self assessment scoring, but this is a bit more kind of uh first of all, and they can really kind of see what you're like, how you communicate and assess those skills that they can't necessarily assess on your self assessment. And this is an opportunity for you to kind of show off for you to obviously not in a kind of overly confident way, but for you to really display your skills, display your experience um and kind of treat it almost a bit like some of the sections a bit like a blank space. You can talk about things that you weren't given the opportunity to in your self assessment. Um It focuses on the kind of non technical skills, also leadership and management skills. Um And then also we'll be looking at your kind of clinical competence. So here's the application timeline which I've taken from hee. So you can follow that um link or kind of take a screenshot of it. Uh This is the timeline for kind of applying for the course surgical training with the oral screenshot just there. Um So the interview window will be fingers crossed from the 19th of Feb to the 28th of FEB um which is earlier this year than it was last year, I would say take these deadlines with a pinch of salt because from my experience last year, I think almost every single deadline changed, so they're not hard and fast. So just to kind of warn you of that. So in terms of the overall interview format, it's gonna be two main stations which last 10 minutes each. So it will go by very quickly. Um You have a management station which is 10 minutes and then you have a clinical station which is 10 minutes and you don't have any break and you're interviewed by two consultants, you might have two extra people, one or two extra people in the interview who would be a lay representative or a trainee. And all of this is a virtual interview. So it will be via the um I think they're trying out a new system this year. So um via a kind of video link set up with the management station, you'll have one preprepared three minute presentation and you'll be sent the question about a week to two weeks before which you can prepare, but it tends to be very similar every year. So I'd say it's worth having a think about what you want to say and have a go at drafting some um drafting some kind of example presentations. Um You have two minutes questioning on this presentation. I'll go into this in a bit more detail later. Um And you also have a management scenario. So this will be a kind of a kind of non technical skills station I'd say. Um And again, we'll explore this in a bit more detail later on in the session. The clinical session is also 10 minutes and this is kind of two clinical scenarios. They might be based on your kind of trauma patients. So ATLS or they might be a critically unwell surgical patient. So more of a crisp or als type of approach, um the patients vary in kind of how unwell they are. So don't be thrown if the patient is actually quite stable and well, and they just want you to kind of explore a bit more of the, the history um reviewing the notes and that kind of thing. So in terms of how it's scored, um you get a different number of points um for the kind of each section, they look at the amount of evidence you have and kind of the strength of the evidence. And then the interviewers have a lot more kind of guidance than this. This is all that we're allowed to see that the interviewers have a lot more guidance of what constitutes a very poor answer, what constitutes an outstanding answer. And they have guidance for each kind of question that, that they're asking you. Um It's not like a kind of old fashioned Viber everybody doing the same kind of set of interviews will be asked the same questions. Obviously, interviews run over several days. So there will be variety to, to kind of stop people telling each other what it is, but they won't freestyle loads like they would kind of in the olden days, they've got a bit more of a structure of what they have to follow and what they have to actually kind of ask you about um in your presentation, they'll be looking at the content of it, your presenting skills and also how well you answered the questions um in your management station, they're gonna look at your kind of awareness of medical ethics, patient safety, this kind of thing. Um How well you kind of respond to pressure, how well you prioritize and also your communication skills. Um Obviously, you can talk about your communication skills, but a lot of that is conveyed through the way that you answer the question. So always be bearing that in mind. And then with the clinical scenarios, this is more focusing on your kind of clinical judgment and knowledge, but then also some similar themes from the management, looking at your judgment under pressure, your ability to prioritize and also your communication. So in general, you wanna be getting about four out of six in all of the stations to be offered a CST post because it is a competitive process. So you wanna be aiming for good to outstanding. So in terms of kind of general tips for your preparation, I think it's a good idea to have a little group of you or find a partner who you can practice your mock interviews with because this is a kind of an oral exam. So it's really important that you get used to talking aloud and get used to structuring your answers because that is really critical for you to be able to reach those half a marks. Um It's very cringy, but it's definitely worthwhile recording yourself answering the questions, particularly when you're practicing your presentation. Have a go at saying it whilst you're recording and then you can see how well you kind of come across on the screen, whether you're giving good eye contact to the camera. Some people suggest instead of looking at the person on the screen to look actually straight into the camera like I'm doing now, um because it gives a better impression of kind of eye contact and also you can look at your information and that kind of thing. I also think it's helpful to make some flashcards or however you like to revise notes or something like that, talking through the kind of key surgical conditions looking at the presenting complaint, the differential diagnosis, um investigations management, which we'll come onto all in a bit more later. Um I think AKI is quite a good tool for this. It's like a free online flashcard app that you can download. Um and make sure that you've kind of really got your a to e rehearsed in a really slick way. And we will talk about that again in a bit more detail when we come onto the clinical sections. So in terms of the booking of interviews, it's worth bearing in mind, I'll go back to that timeline. So it is worth bearing in mind the kind of the pricing windows um and the kind of interview booking windows when they the the invitation to interview because they'll give you a date of when you can kind of book your interviews and it is first come first serve. So if you're not able to kind of log on when you want to, then you might be less likely to get a date that you'd prefer. So just bear that in mind when you're kind of looking at leave and that kind of thing. Um And yeah, because it's a virtual interview, you want to be thinking about Wi Fi having a quiet space, having a microphone and all of those technical elements um because it can be difficult if your interview is interrupted by one of these kind of issues and some people have found that unable to rearrange it or they weren't given any extra time and that kind of thing. So try to kind of reduce any of that added stress and have it all sorted out beforehand. So we don't have any questions in the chart, but if anybody has any questions, um feel free to add them in. Uh But I'll just carry on since we don't have any questions yet. So the management session, we're gonna focus on this element first. So we're gonna look at this preprepared presentation. So it's a three minute presentation. I'd aim when you're practicing it for it to be about two minutes 45 max because when you're doing it on the day, it's a lot more stressful. You, the last thing you want is to overrun. Um If you do overrun, you will get cut off. So you wanna make sure that you're able to get everything you want to say in there. Um Yeah, you receive it about a week before the interview window opens. Um So set aside some time during that period for you to really kind of fine tune the question and finish it. But I would recommend drafting something along the lines of the question from the last two years because it has been the same question more or less. So it is worth kind of having something in your notes and really do learn off by heart. Um It sounds silly but you want to kind of be able to perform this presentation. So you want to be thinking about your intonation, um whether you're doing hand gestures or not sharing enthusiasm, having eye contact because you've learned it off by heart. It's very easy to sound like a robot. So it's good to kind of really try to say it in, in, in an interesting manner. These interviewers have to sit there through interview after interview. So the more kind of you can interest them by telling them your story, the the more likely you are to get higher marks. So basically, just practice this until you're bored, just say it over and over again. My sister um, does acting. So I asked her for some advice on this and she said, when you're learning the lines, learn it with, with the kind of piece of paper and then to make sure that you properly know it, practice saying it whilst, um, like throwing a ball up and down in the air or whilst you're doing something else so that if you're able to rattle it off whilst you're multitasking, doing something that's also requiring concentration, then you'll know it really well. So I've got the question from 2023 I can see your question in the chat. So we've got the 2023 question here. This is screenshot from the email that I received about a week before the interview window. So reflect on your experience of leadership within the team or organization and how this will be useful as a core trainee. And then they explicitly tell you to give examples of roles you held, describing the scope of the role and the positive impact you are able to achieve. Um And then the 2022 question you can see below which is pretty similar. Um So yeah, I'd say it is worth kind of getting this prepared because as you can see it kind of repeats itself. So yeah, you can use that time to really kind of finesse your answer. So I think it's good when you're doing this to kind of use this star framework, which I'm sure some of you are quite familiar with. So making you sure you briefly explain the situation, don't go into loads of detail because the interviewers don't really care about loads of detail. They just want to know the general situation. Um And you don't want to be wasting word count setting the scene. So the general situation, the ge general kind of task you were doing what you did and then show some kind of reflection and some lessons learned. So what you're able to achieve if you're able to bring about positive change, so we can see here, um we want to look at the positive impact that you achieved. So making sure that you're kind of demonstrating that. And then also reflecting on this process, how this helps you kind of to develop as a person and then reflecting on how that would make you a good core training. So thinking about the values and skills of good leaders, um I personally gave two examples, some people do up to four examples. I think it's best to have like fewer well developed examples than having loads that you're kind of listing off. And you can also whilst giving the example, bring in some of the things in kind of like a a slick way just to kind of add it in, in a way that flows. So you can kind of show off multiple things that you've done whilst explaining one example and try to focus on things that might not necessarily be showcased in your portfolio so that you're really displaying the kind of breadth of character. So this is like a snippet of my management station. So this is like one of my examples. Um If people find it helpful to have a look of, I don't know what I've written. This is only yeah, only half of it. And then I spoke about um another example in my second half. So I kind of brought in that, I'd won some awards for this work to kind of again, showcase a bit more of what I've done. Spoke about patient safety, spoke about the changes that happened, spoke about the kind of impact on the MDT. Um And the time kind of really relate relating it to surgery. It doesn't necessarily have to. But I think it's nice if it can do if it's something relevant. Um And then I spoke about some of the challenges, how I overcame the challenges and what I've learned from that. And I've talked about some skills that are really important for leaders. So communication, skills, negotiation, skills, resilience, and adaptability. And then I've kind of flipped this back onto why I think this would be important as a core trainee showing that kind of insight into the job of a core trainee. Um And then in my second one, I kind of spoke a bit about how I didn work as an anatomy demonstrator. And then how from my anatomy demonstrating? I kind of identified an educational need that was unmet and then developed a teaching program. So I kind of spoke about the anatomy demonstrating isn't my main thing, but I just added that in to kind of show a little bit more of what I've done. So I didn't, hopefully that's somewhat helpful. So I think it's worth kind of just having a look at these. Well, I find them fairly helpful, kind of with buzzwords that you can maybe include um just these guides to kind of surgical leadership um and good surgical practice, which might have some phrases that you might want to kind of lift and add to your um to your presentation. Um Next, we're gonna come on to the questioning you might have on the presentation. Well, a question you will have on the presentation. So you can have questions that might be about your presentation, but they tend to be more generic questions. Um So they might ask you kind of, what's the difference between leadership and management? What are the qualities of a good leader? Um What, what do you think makes a good teacher? What's been the biggest challenge in your life so far? All of these kind of fairly generic questions? I really don't think you could over prepare for things like this. I think the more that you've thought about how you're gonna answer these questions, how you're gonna structure these questions the better, especially the example questions when they say, oh give me an example of a time when you've done this because I don't know about you. But when I'm thinking about something like that on the spot, often I can't think of a very um helpful example that really kind of shows me in a really good light and shows off my skills. So I think the more you can often just think of five things you've done and they can fit into loads of these different example, questions. So think of five things that are like good for you to kind of show off about an interview are relevant to the job. And then think about which example questions that could apply to. So finally, the final kind of part of this management station um which makes up the second five minutes is you get a management scenario question. This is kind of like S JT type of question. So um thinking about good medical practice and that kind of thing again, I really think you should prepare for this. None of these should come as a shock. They should also be, they, they should all be questions that you've thought about and kind of prepared. So they might talk about never events or kind of serious incidents which might be wrong site surgery, that kind of thing. Um You might be thinking about prioritizing patients on the ward or um cpod theater, it might be talking about the who checklist. Um It might be about discrimination towards patients or towards colleagues. You might have angry or upset patients or theater cancellations. Um In, in the instance of theater cancellations, always remember about telling the patient they can eat and drink. That's a little note to just add in there. Um There might be things about colleagues who aren't getting training opportunities or there's um unfair kind of balance of the training opportunities. There might be some ethical dilemmas, think back to kind of the ethical stuff you did at medical school, all of that kind of thing um or stuff that's kind of impacting your work life balance. So a colleague is late to work or they don't attend, attend the shift, what do you do? Um or someone calls in sick really late, all of that kind of thing. So the way that I think is good to kind of structure this is to use the spy framework. Um So I actually kind of amend this slightly for these questions. So I think it's good to just talk about patient safety first because once you've kind of got that out of the way, it's, it's something that you just, yeah, you just want to prioritize and show as being really important. So I normally put patient safety first, then talk about seeking information, then do initiatives. So what things would I do myself and then escalation, um you can put escalation early if it's something that you really think would need escalating because you don't wanna seem hesitant about escalating, you want to seem quite happy to escalate. Um Because that's what's required for patient safety in some circumstances. Um And then support, thinking about what support you can offer. I also add doctor. So like Spy's doctor to remember to say documentation and also reflection. So you can say um so core trainees have to do a portfolio called I SCP. So you can say, oh I'd then reflect on this incident in my I SDP portfolio. And that's showing that you've got some insight into um the kind of requirements of a a core trainee and also um showing that you want to be kind of learning from this practice. But I'll go through a kind of example in a bit. I also think a headline is really important. So you can start off by saying um the the main issue within this scenario is that of probity blah, blah, blah, blah blah or whatever insert relevant thing and then talk through it. So always start with the kind of key headline so that they know that you know what's going on. So an example might be as a canceled surgical case due to equipment issues. So I'll just give you a couple of minutes to kind of think about things that you might say in this situation. If you want to pop it on the chat, feel free to if you just want to think about it in your head, then you can do that also. And then I'll go through what I've suggested as some potential points. So with regards to patient safety, um here, I guess the patient is we don't have much information and often with these questions, you won't be given much information. So you have to kind of explore all possibilities, to be honest. Um They are vague on purpose so that you can kind of show that flexibility of thinking. So it might be patient safety issue because the patient is unable to receive care that they're requiring. Um We also want to ensure that this patient is stable. We don't know what operation they were going to have. We don't know the urgency of it. So it's important to do an A um and to ensure that the patient is stable um and clinically clinically safe. Um seeking further information. So how urgent was the surgery? What was the case? Will it be rearranged? Where um was it their first cancellation? Have there been other cancellations? Have other patients been canceled or has this particular patient being canceled before? Um with initiative. When you find out that they're gonna cancel it, you want to make sure all the the staff, the anesthetist, the surgeon or the ward, everybody knows. Um You want to break the bad news to the patient. Um You want to potentially talk to the next of kin if applicable and reinforce duty of c so make sure in this question you're really thinking aloud, don't just say what you do, like really spell it out, follow it. Um um As per the kind of ensuring that I um I working in line with duty of candor, I would make sure I apologize to the patient. I would take them to a side room, um break the b all of that kind of extra stuff to really show that you're really thinking it through and you know exactly what you do. Um, things like allow the patient to eat and drink and take their medications and then you might want to think about the use of the theater space. So there's this theater that maybe, maybe the equipment was just for that specific case. Are we now able to use a theater case for another patient or an emergency case? So you could talk about that showing that you're aware of kind of how theaters work and how precious that theater time is. Um Yeah, excellent, really good. Someone's written in the chat as well to escalate into Dax. That's really important and to discuss with management team and reps. That's, that's really, really excellent data is something that they um really like to see that you've got an awareness of. So excellent and I actually didn't have that on here. So, thank you. Um So escalating, yeah, your senior team to management, do the data or data all through the reps. Um ensure that there's kind of appropriate care of that patient in the interim. Make sure that the consultant in charge of that patient is aware of what's going on. Um You can support the patient and their family, reassure them with a plan, you can advise them, they can talk to pals if they want to, which is the patient advise, liaison service. Um For people who don't know, it's where patients can go if they've got a complaint, a concern, that kind of thing, you wanna make sure you document the discussions and the cancellation and you could also reflect on this on your IP portfolio. Um and you might consider auditing theater cancellations so that you as a department can learn from this experience, all of that kind of thing for any of these examples. So with that, this is a non exhaustive list, non exhaustive list here, but just think about these kind of things for all different kinds of questions that you can get just so that you're nicely prepared, a lot of the points that you raise, you can kind of bring them up in other other scenarios as well, like s or something that's very frequently relevant. So that's a really nice thing. Really nice point. So top tips, make sure that you always apologize early, always empathize showing that duty of candor you want to escalate appropriately. So if it's like an educational issue, so core trainees are not getting their third time et cetera. Um You can escalate that to your educational supervisor. You could escalate it to the Trust Director of Medical Education. You could then go to the post graduate medical education kind of national portal or the um deanery specific. You could go to your TPD, who's your training program director or your deputy head of school or your head of school. Um If it's a clinical problem, you can go to your reg to your consultant to your clinical supervisor, the head of the department or the clinical lead um or the chief medical officer. So knowing these kind of chain of commands and in my interview, I remember they really kept pushing me. So they said, OK, you've escalated to them. That was no good. Who would you next go to? Who would you next go to? And they kept like pushing me to go up the tree. So make sure that you're kind of aware of these pathways. Um Yeah, remember to document discussions, reflect in IP um and consider your kind of qi or audit that you could do and think about the impact on the patient on yourself, on the department and the trust. So for example, if there's something like, oh, your colleague um hasn't arrived for the shift, you want to think? Ok, let's think about the safety of that colleague. Are they unwell? Do they need help? That kind of thing? You've already worked a 12 hour shift, it might not be safe for you to continue your shift and you need to be at work tomorrow. So it may not be appropriate for you to continue because of your own wellbeing and it might impact your work because of tightness. So thinking about human factors as well and all of those kind of things. So there's often not a right or wrong answer to these questions, you just want to be having that discussion and the more that you can show that you're aware of the kind of two sides of it, I think often the better and that your score because you're considering multiple options, you're not being kind of single track minded when you've got such a vague situation. OK? Any questions or Sanji wants to add anything? No, I think you've been giving really good feedback. Um I think there's one thing to add for the presentation um is it's really important to reflect. Um That's something that they really look at and they want you to give ex examples and experiences, but reflect on how that will help you for your work as a a course, surgical trainee. I think a lot of people do miss that element and they'll reflect on feedback but not explain why and how it will help them. Yeah, really good, really important point. And they often explicitly say you need to kind of talk about how it affects you as a core trainee. So yeah, being affected, that was really essential to get to get the higher marks. Thank you. Ok. So we're gonna move on to the clinical station now. Um So here you have two clinical scenarios and they each last five minutes. So you'll be kind of just described the clinical situation and then it's kind of over to you. So, in general, um whether it's kind of trauma station or a kind of critically unwell surgical station, um these are just generic top tips that are worth bearing in mind to always think about pregnancy test. If it's a woman of childbearing age and in your differentials, think about kind of gyne gynecological issues as well and also kind of medical problems. So for example, if it's um kind of an upper ab abdominal pain like epigastric, think about things like, oh, it could be atypical acs, it could be lower lobe pneumonia, any kind of abdominal pain. It's always worth thinking about a AAA, particularly if it's like a loin pain, don't jump straight to your pyonephritis. You always need to think about a AAA unless kind of proven otherwise. So, keeping your kind of differentials broad and then particularly in women thinking about pregnancy tests, could it be ectopic? Could it be gynecological, that kind of thing? Um It's worth thinking about the setting of the care so often you'll just be given, I mean, they vary in how vague they are, but you'll just often be given a presenting complaint, like you are called to see a patient who has XYZ or these OBS or it might just say you're called to see a patient with back pain might be as simple as that. They might give you a bit more detail. Um So it's important to kind of verbalize the care setting. Like where is the patient? Are they on the ward? Are they in the community? Do they need to go to resource? Like if there's a ward patient and they're really unstable, suggest taking them to moving them toes if appropriate or whether they need to go to HD ICU. Really thinking about where is this care happening and where is the appropriate place for this care to be occurring? Always escalate early as well. I haven't written this on the side, but it's always worth just putting escalation in early, particularly if they're unwell. Um You want to structure answer and signpost, what you're going to say it otherwise it can become quite kind of list. So really try to kind of introduce now I'm gonna move on to investigations. Now, I'm gonna consider the management options just a little kind of line to really show them where you're going. Always think about the sepsis six like that will come up more often than you'd expect. And although you will kind of learn your artery and you'll have it down a, a way that you go through it personally, always make sure you're tailoring the answer to the scenario. So for example, if it's a burns patient, remember that you're going to talk about, oh, I'm gonna see if there's any singing of the nose hairs, um, or shut in the mouth because then I'd be concerned about inhalation or injury and we'd want to intubate early or preventatively, um because of the rapid onset laryngeal swelling and I'd wanna make sure that anesthetics are there from the early stages to facilitate with that. Um You might think about on b whether there's circumferential burns that are restricting expansion of the lungs, you might think about um carbon monoxide poisoning and so do a monitor for that. So really for each kind of issue or presenting complain, think about the kind of specialist a to e things that you want to add in to show that you're really kind of tuned into that specific scenario. If the patient is maybe gonna need to go for a rook or need to go for the theater because of their presenting complaint, you wanna show an awareness of that kind of process. So you'd wanna call the on call anesthetist, you'd wanna make sure they're consented by an appropriate member of staff, whether it's yourself or the registrar. Make sure that they're marked, inform the theater team and complete the booking forms. Um They used to have kind of COVID pathway and everything as an important part. I don't think I mentioned it when I, I did my interviews last year and I think most hospitals, most hospitals are moving away from that. So I wouldn't worry yourselves too much about the whole COVID pathway thing, but there's no harm if you work in a trust that does that if you're kind of used to saying that. Um and also think about POSTOP care. Do they need a bed booked? Um, so to liaise with recovery, is this patient gonna need to go to the HD ICU ward care? Do they have a bed? Um And if there's any kind of cancer involved or concerns about cancer, it's worth mentioning you more kind of multidisciplinary team um malignancy meeting. So this is not an exhaustive list, sorry, it's quite a busy slide. Um But I thought of some examples of scenarios that you might get um which could be a TLS, which is your trauma or your A s or crisp. To be honest, a lot of these TN O fracture things could be the kind of on the trauma side. Um So a lot of them might kind of cross over. So it's worth just thinking about um the kind of mechanism and how they're coming in. Yeah, to be honest, it depends on the situation because it might be like POSTOP care of someone with femur fracture. If they're presenting with a fracture, then I'd go down the ATLS route um particularly if it's like an emergency patient or they've had a fall or whatever. But then a lot of kind of the als or the crisp um scenarios might be a patient who's kind of already on the ward or they've come in, they might not necessarily be really unwell, like sometimes it might be a testicular lump and it just says how, ok, you, you go see a patient who has testicular pain or testicular lump, um always kind of assume the patient is unstable. Uh say that you kind of will make sure that they are stable before you kind of commence. So go in saying, oh, I'd check that the patient is stable. Doing an A you can talk to your examiners and say, would you like me to um expand on my a? Uh because if you have set it for one scenario, um you can just ask them if they want you to go over it again for the second scenario and they'll tell you if they think it will add anything or not depending on kind of what you've covered. But yeah, this is an example of some of the things that might come up, but there are plenty more that are not on this list. Um in terms of preparing in general, I think teach me surgery is a really good resource. So learn for kind of all the conditions present a complain history of presenting, complain a list of appropriate differential diagnoses. What investigations would you do? Which includes kind of your bedside, your imaging um including scoring systems and risk stratification tools, they like this kind of thing. Um And also the management options for that patient. There's a good uh research Council UK video of the kind of very kind of simple normal A but it's worth having a look online and reading through the kind of the key sections in A TLS and crisp at LS is a massive manual. So don't worry about reading through it all, but there are some really helpful sections on the kind of key presentations. So I think it's worth having a look through that. Um And again, I think teach me surgery is like a really nice level of detail for the um CT interview. So for the A S or the crisp one, don't be thrown if the patient is stable, sometimes they are stable. But as I said earlier, say, I'd want to um approach this patient with an A to e to ensure they were clinically stable. Would you like me to go through the A to E and then they'll tell you yes or no, they might say no, they're stable, that's fine. And then you can kind of talk more about the taking a history. You'd ask specifically about XYZ, you'd review their past medical history and then you can talk about all of the relevant stuff. Maybe if it's a POSTOP patient, you'd look at their op note, you'd look at their drain, input, output more of the stuff that you do imagine if you're kind of on the ward and you're asked to see someone who's like a little bit unwell or that you kind of, you're just doing a ward round. Think about all of that kind of thing that you do in real life. Talk about that and if it is somebody who is kind of POSTOP and getting very unwell like a wound dehiscence or something, think about early escalation to senior, think about all of those theater booking things we spoke about before. Um Think about when you're doing the at e reassess after every intervention that's really critical that you do that. Um and also involvement of HD or it, and it's good to look up the criteria for a referral and then you can talk about that in your answer like, oh, I think this patient would require itu because they're likely to need dual organ support and benefit from 1 to 1 nursing just being able to say things like that kind of shows that you've got that awareness and it's nice and slick. Um with your at E assessment, you might be stopped kind of midway through. So don't be thrown by that. Um It might just be because you feel like you've already collected your points. But yeah, there's multiple ways you can do an A to E um and multiple things that you can think of. So it's worth kind of getting your own a to e nailed. Um And yeah, for a TLS, it's slightly different. But yeah, think about all the little phrases you say. So I'd say kind of, I'd expose the patient whilst maintaining dignity and normothermia. Little things like that is just, I don't know, you'll pick up things that you will just say yourself but make sure that you really have your a to down and you're really comfortable saying it with your eyes closed. And also always do a headline whenever you answer any question, I would always do a headline. So I'm concerned that this patient might have anastomotic leak. So I will um go to see them urgently. It might be that you kind of get a, a message on the phone from one of the nurses. So you want to talk about um OK, so I want to ask the nurse to do XY and Z. Um this would be my clinical priority because this patient appears to be very unwell. And I'm concerned they might have an asthmatic leak and they may require a return to theater. I'll need to initiate the sepsis six da da da. So really talk about how you're gonna prioritize this patient. Um So for ATLS, so the trauma things, um you wanna be thinking about your kind of c spine and also the catastrophic hemorrhage. So you start with your catastrophic hemorrhage airway and II say I would sim simultaneously assess the fa and stabilize the C spine um, and then B CDE as normal, again, early escalation to a senior. You want to, even if the patient is on the ward, if they've had trauma, you wanna put out a trauma call. So don't get tricked into thinking that it wouldn't be a trauma call because they're already on the ward. You need to think about who the members of the trauma team are. They might ask you who, who do you want there? So, talking about anesthetic, general surgery, trauma orthopedics, um nursing support, all of that kind of thing, talk about how you want to allocate roles if the patient's coming in. So you know the roles before her arrival again in the ATLS manual, there's a lot more on this. You might have a catastrophic hemorrhage. Um So it's worth knowing the major hemorrhage protocol, knowing what blood products you will receive when you put that major hemor hemorrhage protocol out. Um Tranexamic acid, the use of a fast scan and knowing which areas they look at in a fast scan. Um pelvic blinder splinting fractures and knowing this kind of um blood on the floor and for more the areas that can bleed um or collect blood and then simple things like direct pressure on active bleeding, knowing about kind of cc spine stabilization. So three point in line immobilization with uh collar blocks and tape and then again, this care environment. Do we need to take that patient to research? Will they need to go to HDI T, you need to think about stability. So if the patient is clinically unstable, do not take them for a CT scan because obviously in a lot of these HLS patients, you want to do a trauma series CT. If they are not hemodynamically stable, please do not take them there because they might die in the CT scanner. So before the hemodynamically stable, you wanna be doing bedside interventions like a fast scan, that kind of thing you can say once I've achieved hemodynamic stability, I would um urgently get this patient taken, you might wanna have them taken with a nurse escort, for example, for better safety um for Act Trauma Series, for example, and then if it's a child because you sometimes get Children and you get some Children um presentations, things like supracondylar fracture. Um always consider na I so non accidental injury and safeguarding and be aware of the the kind of presentations that are suggestive of N A in Children and babies. So have a good look into that so that you're comfortable in identifying what is an N A injury and what pattern that would be. And then knowing about things like you do a skeletal survey involve the safeguarding team, involve pediatrics, all of that and you admit the patient, you always admit Children where you're worried about N A and you tell the ped safeguarding lead. So they all will get admitted again lead with your headline, I am concerned that this patient has had this. So I'm gonna XYZ and that just means that they're kind of rest assured, you know what you're talking about. Sometimes they'll tell you the lead in and then you'll start talking about the differentials about the investigations. Don't wait for them to kind of reassure you that you've got it right. You can just keep talking, like, make sure you talk about management because if you don't talk about management, if you don't get to it, you won't get all the points. So even if they haven't said yes, OK, the patient does have that just keep talking. So talk through the differentials and go with what you think is the top differential and talk through the management. If you do pause, it's fine, like they'll just ask you more questions, but make sure that you fill it all in, in that time, make sure you get to management so that you can kind of maximize the number of points you get. Yeah. Somebody told me kind of if you have any gaps and they're asking you questions, that means they're prompting you and then you don't get as high marks. I don't think that is necessarily true. Obviously, it's good if you can all if you can kind of direct it yourself. But don't worry massively if they do ask you questions. So questions they might ask, you might be, what are the risk factors for this? What are the options for managing this. How do you grade injury in this? So you might answer those yourself. If you're talking about scoring systems, you'd use management options. So they might not need to ask you any questions if you're just covering it in your talking. But try not to spend too much time on the A to E because it's very easy to talk about A&E A to E for ages. So really try to be nice and succinct. So again, this is not exhaustive, but here are some scoring systems that I think is worth knowing about. So you've got your well score for your DVT P. So for score, which is used in the IC um lower neck, which is used for neck fash cocker, which is for septic arthritis. Uh your rifle and the aching. II don't know how you say that one. That's like your renal failure one uh Garden and va for your um or we, I never know how, how you're meant to pronounce that one. These ones are your fractures, your kind of neck femur and your ankle and you've got your pancreatitis scores with the Glasgow. You've got your kind of lower gi bleed with Oakland, Rockall Glasgow, Blackford, your upper gi bleed um et cetera. I've got a slide later on shock stages, which is really important thing to know. So I think the key ones, if you decide you're gonna be lazy and you only wanna learn a little bit of this, then just know that at stage three shock, you have your drop in your systolic BP. And at stage two shock, you have an increase in your heart rate because when you're getting the information about the patient, you might be given some vitals, some results. So it's very slick for you to say. Um I'm concerned that this patient is in stage three shock, given the drop in their systolic BP and that would be nice and slick. They might specifically ask you as well, what stage of shock is this patient in? And it's worth knowing the different types of shock as well and whether it's hypovolemic, distributive, et cetera. So extra things to know I've already spoken about the features of II, look at the CT head classification. So who qualifies for CT head if you've learned this two years ago in the last like year, it has changed with regards to anticoagulants in the elderly. So do have a look at it again because like in this last year, it has changed um knowing the indications for HDI TU also knowing like indications for hemodia dialysis that's helpful, knowing about cpod. So what is the kind of elective, what is immediate all of these kind of surgery classifications? It's really important that you know about those um different classes of surgery, if it's clean, clean, contaminated, contaminated and then have a little look into the kind of requirements of a core trainee when you are a core trainee, what stuff you have to do? Um and what's involved in the ACP OK. Any questions, four for questions. So feel free to share some wisdom as well. Um I think you've given me some really good tips. Um some things to be aware of when you're practicing. I feel that this station is very rushed, so be mindful that you're trying to convey a lot of information in a very short period of time, particularly things like your at E assessment. You need to be very, very quick with rattling off your at e very succinct. Um and saying the key features in a very quick way because most people will be saying the same things I don't think at will give much in the way of marks. It will be what you say after that your management plan based after your at E that will give the bulk of the marks. Um So practice, practice, practice that will make you better make you slicker. Yeah, 100%. It can uh you can talk about an A for four or five minutes if you want to. So don't waste all your time. You need to get to the management, you need to get there. Think about that as your finish line, you want to be aiming, getting all the investigations and management now and you can time yourself when doing your A to try and get it down to like 30 seconds, do it as quick as possible. Uh make it really succinct and short. Yeah, I feel like also the interviews do lose a bit of concentration. So, yeah, try to do it as nicely as you can. Um I've put some resources here. Um I've got a few slides of resources and you obviously, if you've used anything extra, please do share. Um This is the I se medical interviews, but this is the older edition to the right? But some of you might recognize that. So I thought I'd put that one up because I recognize that more than the new flashy one. Yeah, yeah, using my T three interviews, but it's really good for CT as well. It's a good investment just for any interview, to be honest, even if you're doing fellowship applications and all of that kind of thing, really good. Um And then the little another one to the right, which is more like surgery oriented, which is really good. Most libraries will like like uh medical school libraries or hospital libraries should have these books or you can ask them to buy them in. So you don't necessarily have to buy them. I'm sure you can find them somewhere online as well. Um This PDF to the right is really, really good. Um You can find it online for free. This is like the out of date version, you can get that for free online or you can pay for the most recent one, but I thought this one did the trick just fine. Um just call surgical interview guide. If you search it, it comes up and you can just download it um ATLS and crisp manuals. This is quite an out of date version of crisp, my apologies of my screenshot there, but worth having these to have a read through. Um teaching me surgery is a really good resource. Obviously, the nice criteria, good to know for some of the conditions. Um a society that I also work for or work for volunteer with um called stars do mock interviews. So we'll run those with current core trainees in the kind of winter period. So it's worth having a look on their socials um for when that's happening and signing up to those because you get um a full mock, a full mock interview. Um and you get to watch three of the mock interviews, which is um I found that very helpful, good practice and it's worth being kind of put under the pressure of being watched by people. Um because you might think that you're all prepared, but actually sometimes nerves can get the better of you. Um And then this kind of non technical skill stuff and the surgical leadership and I found these trauma things. So the British Orthopedic Association, um trauma management guidance, these are really good for the kind of ATLS stuff. So you can say, oh, I'd do this as per the best guidelines, which is quite nice to say. And you can download all of these for free on the um ba website. And then, yeah, some more kind of surgical leadership things that are just online. And yeah, that's that if we have any questions, feel free to ask away. Yes. If you have any other resources that you'd like to, to share pretty extensively, that's one other resource I use was Medi Buddy. Um This is a website which again, I'm using for my ST three applications, but I certainly use it for CST. Um A lot of the stations were covered in other resources, but I found there were some extra ones which had been missed in other things. So that's a useful resource as well as an online website. Thank you. Um And as on Tuesday, we'd really appreciate it. If you guys can complete some feedback, let us know what you found helpful so that we can continually develop and improve this series for future applicants. All of the feedback on Tuesday was really valuable. Um And hopefully you found that some of this had been um taken on board for today's session. Ok. So we have a question about self assessment score. Yeah, that's fine. Um Yeah, so I think I had a similar question on Tuesday. So I think as long as you've done the um second stage, so you've kind of closed the loop of the audit. It doesn't, I don't think the, the criteria specify that it matters whether or not you've shown an improvement or not. It's just that you've done that thing and you've looked to see whether or not there was a change and you've taken the time to close that loop. So just make sure that you're just specifying on the evidence that you did a closed loop order it and you're reading, um, the kind of evidence criteria on that, that PDF is on oral, the CST handbook, making sure that you're showing that you met that criteria. And I wouldn't mention perhaps that you didn't show an improvement because it's not part of their criteria. So I don't think they're necessarily worried about that. So this presentation we're going to, if you follow um NST S on our social media once like a little while now that we finish the series, we're gonna be sharing all of the um slides and all of the recordings, which we'll put onto the website. So so that you can kind of stay up to date with when we do that if you just follow the Instagram or Twitter or whatever, um You'll, you won't miss the post saying when we've done that. But yeah, we're gonna upload them all onto the website. So you can periodically check if you're not one for social media. I posted the page um on the med website where we'll upload all our presentations as well. Just a follow up the chat. Thank you. Yeah, thank you all very much for attending and hopefully you found, found that helpful. Yeah, please please also fill out the feedback. It really is helpful to us um to continue delivering these presentations and there will be another series next year for the next batch of CSC applicants. Um So it really help with them as well. Um in terms of a CF in T mo I'm not entirely sure. I think it's worth Googling to see if there's any organization that does this. Um at the moment stars only does the kind of uh straight CST MO. Um But I wouldn't be surprised if there was some organization that did ACF mock. Um I'm not on an ACF personally, so I'm afraid I'm not the best person to ask. Um But I hope that these will exist somewhere. If not, it's worth finding somebody that, you know, or work with who's doing an A CF and seeing whether they'd be able to support you and maybe do an informal mock into you. I'm sure lots of people are quite happy to do that. Um And happy to support people through these processes because they are a bit of a headache. Thank you. We'll just stay on a minute or so longer in case anybody has any other questions. OK. I think we'll finish up there. Thanks for everybody.
