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Hello to this evening's webinar about preparing for T three interviews. I'm the chair for the webinar this evening. My name is Ginny Brick and I'm a vascular surgeon in East Kent by background, I'm also head of School of Surgery in KSS chair of the vascular sac and have previously been a recruitment lead for national selection for ST Three and Vascular in about 2021. I'm here in my capacity as elected council member for the Royal College of Surgeons of England. Um, could you put the next slide on, please? Um I'm going to let the panelists introduce themselves to you with Lily going first, please. Hi, everyone. I'm Lily. I finished plastics training in pants last year and I'm also a professional coach, so I'm going to talk to you a bit about performance. Hi. Uh, my name is Michael Fox or Smith. I'm one of the, er, ST fours, er, in KSS at East Sur Hospital. Er, and I'm working in trauma and orthopedics. Hi, I'm Holly Wright. I'm an ST three in the Northern Deanery. Um, and I plan to pursue breast surgery. I've actually been through the process twice so I can go into more detail about that. Hi, my name's Michael Tra. I'm ST six and seven. I ranked first in my year so I've got quite a lot of experience. I can tell you about the torture and preparation. I went through to, to get better. Um, and I'm also president of Mohan Academy and we've just done a prepping for ST three. So I got some tips from that as well. So, as you can see, we've got a very experienced panel. Um hopefully hearing their backgrounds, you'll be starting to think some questions which please can you put into the chat and then once we've had the presentation from Lily, we'll start to answer those questions. Thank you. Cool. So, thanks so much for having me. Can you see my slides? Ok, Ginny. Uh Yes, I can. Thank you. Perfect. Great. Ok. So when you sit down for your interview in the old days, when you walked into the room, you've got three things with you on the day, your knowledge. So that's your learning, your experience, everything you've prepared your templates, so your patter and your spies, algorithms and so on and then your ability to deliver it your performance. But the way we tend to prepare for these things is quite different. So we spend a lot of time learning lots of facts and learning our C VS backwards, which is fine. Um We learn our templates and I've also included technical set up here cos it's a remote interview, but we tend to spend very little time looking at the way that we come across and perform. So I'm gonna really focus on that today. I'll talk a bit about the technical stuff, but I think most of us are pretty familiar now with how online interviews work. And then I'm gonna talk a bit about the principles of performance. It's quite a short talk, so feel free to get in touch with me. I'll put my details up at the end. So set up wise, you wanna be mindful of your clothing, obviously appropriate clothing but also nothing glaring like really white shirts or vertical stripes that warp on screen and lighting. That's good. So you don't want to be backlit, cos no one can see your face. Um beware of your whole environment. Often you have to show the whole room to make sure there's no one whispering the answers to you. So don't just tidy behind you and have your documents ready. I do not recommend you wear pajama trousers. But one of my friends er his partner had moved his passport, he actually he was wearing P Js and he had to get up and get his passport. So make sure you have everything there where you think it is, have your camera angle either directly at your level or above you a little bit. No one wants to look up your nose um or see your double chin and you can manage external distractions. So pets, Children deliveries, washing machines, all these things just do not need to intrude on your experience. Make sure you're familiar with the platform that you have a charger available and that you have a phone if you need to hotspot or if you drop out and they need to call you, but that it's on silent. Have water around but not so close that you knock it onto your keyboard and have a wee be on time. Be mindful that a lot of platforms will drown out the questionnaire if you use verbal cues. So get used to nodding but try not to drown them out or you might miss the question. Be aware of your hands. Some people are very animated and it can be quite distracting on a screen. Talk to the camera. Don't look at yourself. It's so annoying and don't read notes. It's very obvious. Ok, so that's that bit. I think everyone knows all that anyway, but obviously just needed to touch on it. Now, mindset, you need to be focused and attentive. You also need to be able to access all of that knowledge that you've spent so long developing and learning and rote learning. If you're panicking, you can't get access to any of that. We're going to talk a bit a bit about that in a minute and you need to be able to recover when you will mess something up because it's just likely to happen, it's fine, it's normal. You just need to be able to recover and you need to be but also appear calm and confident. So how'd you do that? So humans have a limited quantity of attention and people talk about paying attention cos it's like you have a budget of it. You can reduce your budget if your brain is not firing on all cylinders. So if you're dehydrated, if you're tired, if you've eaten a Mars Bar an hour before and you're having a hypo, your brain will not work very well and you can also divide your attention unwittingly. So external distractions, a text message that catches your eye or internal distractions like self criticism will reduce the amount of attention you have available to spend on the question, on listening and thinking through and then delivering your answer. So be mindful, but it's not just the quantity of your attention, it's also the quality. So I'm gonna take you back to med school. We all learnt about the parasympathetic and the sympathetic nervous system and I don't know about you, but I learned that the parasympathetic was rest digest and sympathetics, fight or flight like p you know, pugilistic, but actually they both exist in both secure or safe environments and unsafe or insecure ones. This becomes really relevant when you think about cognitive function. So if you're feeling really secure and you're in a parasympathetic state, this is like gazing at the ocean at sunset on holiday or whatever someone can l can ask you, you know, where do you want to be in 10 years? And you actually have the headspace cos your cognition is so big and sort of lousy, you can go there and develop those answers. You can even think about thinking which is meta cognition. But when you've got a bit of adrenaline and you're feeling safe, so you're maybe working to a deadline or you're operating in front of someone you respect, but you're kind of, that's when you develop this hyperfocused state. So it, it looks a little bit like people talk about tunnel vision. It's like a, a focused state, you lose your peripheral vision and this is actually the optimum state for performance. And it's where flow lives and flow is very interesting because it's slightly hypofrontal. So because you have a bit less blood flow to the frontal lobe, you lose your sense of self and that's when four hours go by in theater and you have no idea. And you've been totally non self conscious, but that goes too far as you start to get worried or feel insecure and whatever your defense behavior is, could be any of these things. They're all linked by a lack of access to the prefrontal cortex. So as the Amygdala fires up through fear or anxiety, the prefrontal cortex reduces in function and you then can't access all that knowledge that you've painstakingly gathered and we all get this right. You go to a cocktail or like a party and you think God, I'm gonna forget their name and then you do and then you do forget their name because you're so anxious about it and then you're on the bus on the way home and you remember it because as you get more stressed, you can't access facts. So the key for performing in interviews is to stay in the top half of the graphic. So how do you do that? Well, you either feel less unsafe or you feel more safe. But why would an interview make you feel unsafe? We're much closer to our ancestors than we think. So, the way we live now has only really affected like the last six generations. We're actually evolved to live in small communities in exposed environmental conditions where our social status really is a matter of life and death. So if you think back to 500 years ago, if you're not in the group, you can keep warm, you can't defend yourself from predators. You can't hunt and gather and cook efficiently. You can't child rear efficiently. You may not be able to procreate with anyone. It's actually a disaster if your social status is threatened and that's how our brain is still wired. We worry about our physical safety. We worry about our social safety and an interview is deeply judgmental. We're being marked literally and we have a special bit of our brain, which in coaching is, is called the in Ari or the saboteur, which essentially is the Amygdala and surrounding limbic system that's constantly gauging how we're doing in comparison to others in the context in which we find ourselves. And that affects our attention because it squanders our attention budget because as we start to worry about what we've said and whether we messed it up and whether someone else would have said it better, it starts to use our available attention and it affects the quality of our attention because we start to move down in the graphic. So how do you maximize your attention? Sounds really simple, but a lot of people don't do it and then you need to spend it carefully. So deal with your external distractions. We've already talked about that, but deal with your internal distractions, know that it's normal to have an in ari you wouldn't be human if you didn't notice it, pause and give yourself a bit of time to just back out of that sense of anxiety and go somewhere else, go somewhere rational and you can give your body calm signals. So there are various things that modulate cortisol. And there are various things that stimulate the vagus nerve, going from a hunch to an open posture, reduces your cortisol, smiling. It's prosocial stimulates Oxytocin modulates cortisol. And there are direct stimulus to the vagus nerve, like breathing slowly deeply and with exhale, emphasized breaths. And we do it. When a patient's panicking, blow into a syringe, blow into a straw, it's just increasing the exhale against resistance. It's a valsalva maneuver. Another really good tip develop a process rather than an outcome. Focus. So stress exists in the gap between where we are and where we think we should be. If you create a, where we should be, that's impossible. Like delivering a perfect answer. It's impossible. You don't actually know what they're looking for. You can't interpret what the interferer is responding because they may be rushing you cos you've actually got it and they're trying to move you on, but you think you haven't got it right. You're basically setting yourself up to be stressed and be in the bottom half the graphic if you change what you're aiming for and instead aim to be in a process that supports you giving your best possible performance. So it might be remaining relaxed for instance, or doing your best, then the gaps much smaller and it's something you can actually achieve regardless of the answer and it, it will set you up to do a lot better and a word on impact. So just like you, your interviewers are closer to their ancestors than they think. So take yourself back 500 years to your small group. You need to be able to pick at 100 paces, someone who's unsafe to be in your group or a threat. We hate people who seem phony stressed out or nervous dysregulate us in some way, it ma it gives us the woolies. So the calmer and more regulated, you are the more calm and regulated, your examiners or interviewers will feel and the more calm and confident they will think you are. Remember a very small amount of how we communicate is the words we use. Most of it is the way we say them and our body language. So consider your physical impact on other people even on screen. And the last tip is when you finish talking, finish. Good luck. And as I said, very happy to answer any questions in the panel or feel free to get in touch. Thanks. It looks like we might have quite a few issues if people are not able to hear us. Hm There's some messages in the chat saying unable to hear, which is a shame if that was the case. Lily cos your presentation was fascinating. II, have you open on a separate screen? So I was watching the live stream and it was perfect. So II it was really good. Um So just moving forward. Well, just to ensure that that's all. OK. I thought because we haven't got any questions yet. I was going to ask you of your own experiences of ST three interviews um that you've all been through and all been successful. Um And just to see how just to tell everyone how it went for you, um I'm going to start with you. Holly, because you did it twice. Um So I going to ask you about your experiences and reflections on it. Um Yeah, so I did it uh first time around in 2012. Um And that was when it was national recruitment and I had to travel down to London. Um And I was Act two. I prepared as much as I thought I could and done all the things that I thought I needed to do performed well, got offered a post in the Northern Deanery, which is what I wanted and flew straight into training. Um And then I did, um, the interview reenter last year. Um I did it online and from Cuba, I was actually on holiday at the time. So I had bikini bottoms on, um, and the Caribbean Sea in the background. So that goes against quite a few of the things that Lily said. Um, but I found it far more easier this time and granted, I've got a lot more experience. I'm a bit older, but I think it was more to do with, it was just, it was nice going in and having three set questions with 10 minutes each. Um And honestly, I could, II would say the biggest tip I can give is for people to, um, know that this is not your only chance. Just try not to put all of the stakes on this 30 minute interview if you, if it goes wrong or you don't get it. Um, a living example that you, you can do absolutely anything. You can leave the program and still come back to it. If you go in with the mindset of this isn't life or death, just try to relax is the best advice I can give. Um, but yeah, it was much easier doing it online. It felt very formal. Um, also I think I've been trying to reflect upon it in the last few days. And if you go in, I was already working as a registrar. But if you can go in for you, those of you who are at maybe CT two as if you already are a registrar. So when they ask questions, say I do this in my practice, I do that rather than what you would do, just behave as if you already are a registrar, um, and be personable. They just want to see someone who is safe, um, who can think things through. They don't expect you to be a robot. Um, as long as you're personable and you make, um, you sure that you're thinking through your decisions and come into reasonable conclusions. That's all I did. And I scored really quite highly. So, um, just keep it simple. Keep cool and calm, detach yourself from the worries of not getting it and just focus on just being you, you already can do the job. You wouldn't even be at this interview if you weren't totally capable. Um So just use it as 30 minutes to totally sell yourself and show a bit of your personality. I had a bit of a laugh with them at some at one point. Um So yeah, that's, I think they're the best bits of advice I can give. Thank you, Holly. Going to ask the same question to Michael O. Ah, so my, my year was a bit different in that we were portfolio scored, a few of us were selected for kind of verification. Um But really, I think the things that I would say were important were kind of knowing your portfolio well, but also knowing which bits of it make you shine in a good light. Um And it doesn't have to be the things that everyone says, you know, I had a level four PBA when I was in F one, I could do a laparotomy. Those kind of things don't really benefit you in interview. Uh things, you know, I highlighted um my MSF um and those kind of things as people have said, make you more personable. Um And the interviewers want to see what you can, can you guys hear me? OK. Yeah, the interviews want to see that you are human and capable. Um So yeah, it's, it's a bit of a in terms of preparation. Um A lot of you would have had part B preparation and some of the clinical scenarios in that are quite similar to what you would get at your individual's interviews. So, prepping that was really useful and uh in terms of kind of uh management stations, everyone knows about the interview book. If not, I will, I will find it and post it in the, in the messages. Um but prepping your stations along there is good. Um I did a few online courses and I asked some bosses to give me a hard time just to see how I'd react under pressure. Lily, your presentation is really spot on about go to stress response. I do a lot of fidgeting, apparently a lot, a lot of fidgeting and, and my voice gets really, really quiet. Um So actually having a couple of mean bosses grill you a little bit is, is quite helpful. Um But the, the, the thing that I think that someone told me at my core interviews and I did well in core and, and, and well an STP and it's the same kind of process. They said that this interview is an opportunity for you to shine, show yourself and also demonstrate why you enjoy your specialty. And I think if you're going with that focus about, I'm actually enjoying this process. I really wanna pursue the specialty because I actually enjoy it the way you answer questions, changes from just being a tick box, you start actually talking about what you do. And I think that's really important. And Holly, absolutely right. That, that's really important. Anyway, thank you Michael, um, and the other Michael Michael Fox Smith, what was your experience, um, at, uh, TN O interviews? So, um, the Tao er interview was to be honest, quite fun to prepare for. I thought it really got me engaged with the specialty and got me thinking about, er, the next level of training. I think we all have a goal to be there but we also need to understand what the role entails. And I think preparing for the interview is the best way to do it. Um in terms of how I prepared it was a lot of um talking through er certain questions, whether that be clinical portfolio with um like peers and colleagues. So people that are also going through the interview with you, your other core trainees are at the same level as that talking to your bosses and getting practice interviews in with them. Many of which usually at a trust you'll find someone that has been in a role of um you know, on, on the boards of these interview panels and you can ask them what they're looking for. Essentially, they can't give you an answer sheet but they can, you know, say, recommend how you answer questions, what the other examiners are looking for. And then the other thing is also um kn knowing that your portfolio a your portfolio back to front, er and B er the, the types of questions I can see in the chat already er, the first question was, you know, due to short time, how do we, er, are expected to answer without, um, a lot of the information going amiss. And I think the, the answer to that is to make sure when you do answer a question, answer it with focus, try not to um, whiffle on a lot. Er, you should, you should theoretically have an answer prepared that you can reach into your memory bank for and provide. Um There's a lot of um practice er books out there, there are a lot of courses you can go on where people will do example, questions that are very similar to those that come up. And I think having an answer ready to fit means that you won't waffle on a lot. Er the same is true of your portfolio. Um and the portfolio is also an opportunity as micro culture says to er to shine, it's an opportunity to sell yourself and say why you're different. And I think the single most important piece of um information I gathered from that was when someone asks you about something in your portfolio, that's not just um you know, listing what it is, that's a chance a chance to say it was this, this is, this was my role in it. This is what I learnt from it and this is how it will affect my practice going forwards. They want to see that you've er not just done something but you've developed a skill and you're going to take that skill forwards as a registrar and a young professional in helping with whether that's research management teaching. They all want to see that you are a surgeon that's willing to expand the role and not just turn up day to day to do operating in clinics. You want to show an example that you are going to be a leader, not just a surgeon. Thank you, Michael. Um Lily, I think you sort of told us a little bit about your experience the way through your presentation. So I'm, I am going to slightly change the question that I wanted to ask you and it relates to um when you're answering the questions, the speed and the pace and getting as much information in as you can have, you got any sort of top tips as to how someone might do that because that's what that relates to that question, Michael was asking about the speed of answer. Yeah. So front load is the golden rule. Same for exams. If you think of a tree, you wanna start with the trunk and then give the branches and then give the twigs and then if you're cut off, it's OK cos you've delivered the, the crux of it. And I really like what Michael Michael M FS said um that, you know, and again, this is like principles of how to survive training, but never get less than three things out of any project, you know, never make less than three points from any example. Um And as he illustrated, you know, around your reflection about your professional practice, you can, you can hang a lot on one example and it's much more powerful to deliver it in a very deliberate and slow and calm way. And I think a lot of that comes from you giving credit to it yourself. Like if you believe it's a really cool thing and you really are passionate about it, you won't rush through it because you won't want to because you want to give it the credit it deserves. And I think, I think a lot of this is about self esteem and self value and it really comes through in the way you answer your questions. Um I also really liked the way Michael O pointed out that everyone who gives their time up to interview is passionate about the specialty. They wouldn't be there otherwise. So those are people who really care who they're appointing and care about the future of their specialty. And again, like you, you giving your answers the weight they deserve, kind of gives over that subcortical message, which I think is very powerful. I think being able to act at the grade for which you're interviewing us is a very good point to raise that when I'm talking and answering questions. Sometimes I run out of breath, I've got so much to say or I get so nervous. Has that happened to anyone else here? And how would they recommend overcoming it? Um, Holly, have you had that? How do you pace yourself in these and, and sort of what techniques do you use? Um, I think I just, I sort of, I've got quite, when I'm in a panic situation, I've got a way of staying calm. So it's the whole swan on the surface and kicking underneath. But, um, I tend to just make mental notes. Yeah, I mean, you've got pen and paper when you're at the interview and just get across the like right down the salient points that you want to make, you know, in your mind that you can talk around those things. And if you get through the bulk of it, like you see the tree trunk of it. Um, really sorry, I got a little bit distracted there because I was looking at one of the questions which said, have we, um, got any examples of feedback? But what I was going to say is the, the parts where I missed any points were real, my eye, like something like I missed the inr of a patient, you know, and that was really the far end of the question. If you, if you really just get the obvious glare and points out first and then you can embellish and they're not gonna, they're just really not there to catch you out. That's the mindset. I went in with these guys who are interviewing you want you to do? Well, it's not, they're not gonna, you know, try and make you screw up. Um, they want to see you do well, and I think just get that out of your mind that anyone's trying to trip you up at all. Um, and it can just be a friendly discussion between professionals. Really. Um Michael Fox Smith, what, what, what, what have you done? Do you write things down? Do you, how do you do this? Yeah. So I um essentially made a list of all the questions that I could find across all the databases and almost like a play kind of learnt my lines, er, for each question, er, I just brought up, I basically learnt a lot of flash cards and for example, one of them was what makes you a good leader and this is, you know, applicable across all specialties, whether you're orthopedics, plastic breast general. Um And I thought I want to answer that with three things, the rule of three, as I was saying, and then I want to use those three things and say the examples of how I did it. So, er, what makes you a good leader? Er, leadership is important um due to er, multiple teams involved. So I want to show that I'm a good communicator organizer and passionate and then I thought, how did this, er, course that put together example those and so it was really about putting bullet points down that I could learn and just write off. And if you do enough of that, you, you begin to learn your portfolio quite well and you can almost bend some questions round to your strengths, which is what you want to do. I wouldn't say go completely off script and just tell them how good you are. You have to make it applicable to the question was answered, that was asked, but the strength will be in how you answer it and making sure it's a good, strong focused answer. Thank you. Um We've got a question about and you sort of touched on that Michael in your, in your answer about resources. Um But because Michael K has had positions in asset and a s GBI wonder if he's got um got any recommendations about resources. And of course, we're thinking about all different specialties, not just general surgery, you know, urology, everyone does something a bit different. Where can we get the information from Michael or is it specialty associations, trainee associations, other trainees? Who would you if I if I so for general surgery? Um there's, there are a couple of websites that I highly recommend. Um I am I allowed to recommend non RC. That is um so the first is something called Medic interview.co.uk. Um And I cannot highly vouch for one I've taught on the course, but also I can highly vouch for the course. It's general surgery theme for ST threes, they have a really high success rate and they take you. So I approached them when I was a core training trainee because I was finding it really difficult uh with kind of performance anxiety and stress at trying to get things across. Um And you know, do a range of courses face to face or online to really help you get through that and help you formalize your answers and give you examples of what to expect. Um, so it's a really good, good course. Um, the other thing was using part the MRC and all the scenarios from that to kind of get an idea of what is a good answer to a good clinical question. Um, and then assets uh, prepare for ST three interviews. And I can also say the A H GBI Mohan Academy fr Weekend had a section on how to apply for ST threes as well. So they're all really good resources a bit tailored towards general surgery apart from asset, but they're really, really useful resources. I think most specialty associations do have them. Do they have something for voter Michael Fox or Smith? Do you know? Er, I couldn't tell you about bota, er, as I didn't use, er, any that they provided, I imagine they would if you went onto their website and they're very good at answering emails. If you had any questions specifically for orthopedics, there was a few websites and if people wanna write them down, er, ST three Ortho Ortho interview and Ortho prep and they all have um, a, they all run courses but they all have a database of questions that are really useful to just go through and learn answers to. Um, I imagine there's some quite generic ones there as well about leadership and some management questions as well. So to, to look at different sites. So that's, that's really useful. Thank you To make it more affordable as well. Is to consider um getting a group of you one of you by, by subscription to one website, the other to another website and just kind of get together and go through them all together I think is which makes it a lot more affordable. And I did that with a colleague of mine. Thank you. Um Holly, as you said, there was a question about feedback and feedback you could expect to receive and I know that you have brought some feedback with you that perhaps, I don't know if you're able to share it or whether you want to talk through it. I'll try and share it a little bit earlier. It's quite small. Can you magnify it up at all? I can on my screen? I don't know if people can, can just magnify it on their own screens, but you talk through different sections and what was good and bad and how, how that was this from what you were successful in this attempt? Weren't you? So there was, yeah, so I was successful both times, but this is the most recent one just last year. Um, so there were three stations. This is for general surgery and the first one was the clinical station and it was just basically a patient who had pancreatitis. Um, and it was about, um, I was on call overnight and at what point would I ring the boss? Um, and what would I do before that? What would I do? What would I say to the boss? And what would the management be thereafter? To be honest, I felt really comfortable with it because I was working as a registrar as I say. But, um, it's just about really putting yourself in the situation and I didn't do a lot of prep, to be honest because I just thought, well, I do it every day so that if, you know, if it's going to be weird if I haven't come across it in my experience, but pancreatitis is quite a bond or one. So as you can, if you can see it, it's quite small. So it's, it was out of 10 and I sort of got 10 out of 10 for, um, sorry, I'm coming really close to the camera recognition of the clinical issues, uh, judgment and prioritization, um, planning and use of investigations. And I did drop a mark there and that was because I missed, um, I think that's the one where I missed an I nr result. I hadn't noticed it, but as I say, that's an example of the minutiae of it. Um not being important. So, so get the real basics in there. Um uh looking at the feedback, um, they basically comment a lot on being um sort of a good, excellent performance. So it really is about putting on a performance for that 10 minutes being the registrar seeing exactly what you would do. Um, and very clear, er, and being calm, they seem to be the overriding them. So, um really just reiterating what I said about acting as if you are a registrar. They don't want to be like when I am a registrar, I just say I do this in my practice. I do that the next one was a management station. Um, and basically they gave you like a theater list for the morning and there was a whole array of problems within it. So it was stuff like from memory. Um, there was a diabetic on there, there was a guy whose inr um wasn't suitable for surgery and would have to be canceled. Um, there was an anesthetist who was being a little bit naughty and saying he didn't want a trainee to do some of the operations because he wanted to be away by 5 p.m. And how would you deal with that? Um, and basically you just, you have to strategize. So you prioritize, I made a little list um the stuff which did need to be canceled if you're going to cancel someone, having the foresight to talk to the patient and say that, you know, obviously apologize but say that we will get you in for another operation as soon as we can. It's kind of thinking around the whole scenario and I kind of got commented upon um the empathy from that side of actually taking the time to talk to the patient and explaining that we would um sort it out and saying that you would make it like your personal responsibility. You can embellish a little bit and say, I'll go to the secretaries and I'll explain what's happened and get you in for the earliest date possible. Um And then with regard to the anesthetist situation, you can make that into whatever you want because it's basically play acting. So you can say like, whilst I understand it's about being really um accommodating of everyone's needs. So whilst I understand the anesthetist would want to get away. I am a trainee and I do um sort of have a bit of priority with regard to training. Um I kind of compromised and said I could maybe discuss with my boss, I could discuss with them parts of the list that I could do. Um And I remember saying if it was just a one off, I might just let it ride because it's likely to be someone that I'm gonna have to work with going forward. Um But if it becomes an ongoing thing, it might be something that we have to raise as, you know, like to highlight an issue with training. Um So yeah, it's just about real, really thinking around all the scenarios, not just saying the most obvious answers, but kind of thinking through the the other side of the coin, the patient who's being canceled, the anesthetist who, you know, you've got to work with in future, like I said, um and then with regard to the Portfolio station, um they basically just asked me to talk through it and that's what I was most proud of. Um And I think I score pretty well there as well, but I did drop a mark for not really clarifying what my individual role was within an audit. So that's one point and maybe that you need to know what your exact role was and what the sort of implication is of that. I think Michael M Fs touched upon that, knowing your role and what you're then going to do from it. Um But yeah, that's, that's, that's probably gonna be recorded now if people want to sort of screenshot the, the feedback and it shows you how to break it down. Um But overall, there's there, there were two examiners in each station um and they're pretty consistent and they give their own little bits of feedback. Um and particularly for the clinical stage. I remember I finished after something like seven minutes you get 10. Um, and the female consultant said, well, we can either sit in silence for three minutes, um, or we ended up chatting about where I was in Cuba. So, you know, they're not there to make it hard for you. If you, if you get, if you've done a good job, you're gonna know about it. So just, I wouldn't undo any of your good work. Just, just leave it at that and um be thankful that the, the stations ended early. Thank you, Holly. Um I just wanted to ask Lily some questions about if, for example, the feedback you received was not as positive as that, that Holly got um or that you felt the interview wasn't going as well as those that Holly had any salvage techniques or when you get the feedback, any, what would you suggest to applicants to do for next time? Yeah. So I think that's two questions. The first is if something goes wrong in the interview, don't drag it around with you. And that's the old train crash scenario where you just allow it to taint everything subsequent. Um And that involves skill around understanding, normalizing why it feels catastrophic that you've messed something up and then labeling it, which reduces our cerebral experience or our cognitive experience. So, OK, that's a thought or that's an emotion, pausing and then going towards a rational place. And if you have time and you want to spend time doing it, you can develop somewhere that you go. So it might be your process. But a really good like quick thing to do is think, ok, if it was my friend who told me this had happened, how would I treat them or how would I judge them? Because we tend to judge ourselves very differently to how we judge other people. And that can often give you a much quicker access to perspective and compassion that allows you to just park it for now and move on. So that's what I'd recommend. Like practicing, you can practice that just in daily life between now and the interview. Like if someone cuts you up in the traffic or try takes your case off you or is rude to you on call, all of those things that dysregulate you are chances to practice. Ok, I notice that I'm feeling worried or anxious or angry or whatever it is, label it, pause and go somewhere else and that will just practicing that skill will stand you in good stead for the interview if something happens in the middle of it and then if you get bad feedback or the result that you don't want afterwards, this really goes back to the concept of using it as like information. So trying to learn, learn from it. The old Nelson Mandela, you know, I never, I either win or I learn either way I succeed and it is really hard I think in a profession like ours where your whole sense of self and a huge amount of sacrifice is tied up in that judgment. It is really difficult to do. But you know, as Holly said, you can always do it again and if you can separate that thing that didn't go so well from your sense of yourself, so you're not a failure. It's just something happened that didn't go the way you wanted. Then you can be a lot more rational about it and really just like pretend you're a scientist collecting data. What went well, what can you improve? What's the opportunity here and how can you change it next time? It can feel a bit artificial and it's definitely helpful to have someone, a friend or a coach or a partner or someone to go through it with you because it's quite hard to discipline yourself to do that. But it's a very good life skill and it's really good practice for being a registrar and managing rumination around feedback from trainers and you know, complications as and when they happen and all the stuff that you will actually have to deal with in your life as a reg and then a consultant. So maybe you look at it as an opportunity. So sort of in the same way that you said to practice with your consultants, when you get this feedback, to go to one of those consultants and go through that feedback and see if that will help. It's sort of like that growth mindset, although easier said than done at the heat at the moment when you're disappointed. Yeah, we've got a question about the nitty gritties of it about how these interviews vary between specialties. I think one of the bits of advice of that is each specialty will have its own handbook online, um, associated you can actually look at but, um, the two Michaels obviously coming in from two different perspectives, one from general and one from TN, perhaps you just want to run through what the interviews are like in those specialties if you're able to, and then we can draw out, um, any differences between, should we do, um, a general surgery first? Maybe to discuss the, um, so clinical stuff is all almost always emergency terminal surgery. So you'll be on call, it'll be a perforation or, uh, uh, anastomotic leak in my ACF interview. I had a anastomotic leak question, um, which was, uh, quite challenging, but just make sure you don't miss out on simple things. So, assessing the sick patient, um, and then, uh, being very clear as to you're the reg, so you're not the sho, so your escalation plan needs to reflect that. Uh, so is this someone who needs to go to CT, is this someone who you need to go to the, to start thinking about those kind of things? Um, ah, in terms of other scenarios that I practiced things like basic consents just because sometimes they do come up. But really, it's a standard kind of leadership and portfolio questions. That would be the other scenarios. So, yeah, thank you. And in orthopedics, what sort of, what's the form like in that? So, the orthopedics is split into three stations of 10 minutes each. You start with the portfolio station usually, er, which, er, often the first question is why do you want to do orthopedics? Um, and as I said, it's an opportunity to not just tell them why, but then how you've gone about doing that. So best way to the ideal portfolio station is also one where you're almost not asked any questions because the examiners kind of let you sell yourself. Um, moving on from that, you then have a clinical stationer. My clinical station was kind of split in half with two cases. The first was, er, what does this X ray show? And I was asked to describe an X ray which showed a neck of feur fracture. We got into the anatomy of um, the hip joint and then they asked me, how would you treat this? Er, I said I'd do uh this procedure and this is my approach to it and you talk through how you, because they're looking for people that are going to hit the ground running when you're in ST three, ready to go knowing how to do some of the more simple operations. Second, half of that, er, station was a clinical emergency in orthopedics. There's generally about five clinical emergencies and we had, uh, a necrotizing fasciitis. So they essentially were like, how would you treat this? Um, and you go through, I would approach the patient using a TL S approach, er, and then the full examination and then what they want you to know is, er, also the boast guidelines. So the British Orthopedic Association, er, guidelines, er, and there's only about 10 or 15 of them, of which they're usually um, straightforward, er, ways of treating cases. So, learning those is a, is a good start. Then finally you have a uh, a station where you're asked to organize, er, the operating list for the day. Um, we want to know that, you know, the priorities uh in terms of the patient. So best practice tariff for neck of femur fractures, we'd ideally get them operated on in 36 hours. However, you need to know the emergencies called a equina, um, necrotizing fasciitis compartment syndrome, whether you'd prioritize them and then also prioritizing elderly, er, patients, Children and diabetics and what, you know, what could wait a couple more days if needs be. And there's, there's never really a right way of doing that. But the, the thing is you have to talk through your thought process just giving them a list and expecting them to understand that, you know, the priority isn't, won't really cut the mustard, you really need to show your internal thinking and why you think it's appropriate and that's the best way of getting that out. You should also start thinking about things like co as well, whether your hostel can do certain operations, whether you operate overnight. Um, it's all that the examiner wants to show that you're thinking through the process. Er, and you can ask them questions because often they may not have given you, you know, cos it's a short station, they may not have given you everything you need to know. So they, they quite like having questions as well to answer. So it seems to boil down to knowing the common emergencies or common conditions in whichever specialty you're applying to and understanding the basic principles as well. Someone's asked if there's any book to study the clinical scenarios, which, because the scenarios are written by the, um, the recruitment board, I doubt there is. But is there any resources in book format that anyone can recommend would be good to look at to get some ideas, orthopedics? Sorry. In terms of orthopedics, I couldn't name one off. I didn't use any books, unfortunately, but these websites that have a similar fee price to a medical textbook have the stations on them. Er, there is also a group on Facebook I can recommend is run by one of the registrars in, er, the seven Deanery, um, called I wrote it down somewhere Ortho revision ST three. And that's by run by a gentleman named Alex Curtis who's got a very comprehensive PDF and he's cheaper than all the courses and puts together if anything a more accurate and more widely spread view of the interview. So he's very good and I'd encourage anyone to get a PDF. Yeah, we knew we were going to have one at some point with two Michael. So I haven't got a book per se but the websites I posted before are pretty useful, Michael Fox or Smith had mentioned a TLS. But also the crisp algorithm is really, really useful in my ACF interview. I definitely fell back on that on that leak question because they started digging, you know, you know, what would make you think a patient was sick and you're like, well, they're sick but having that album in the back of your head kind of guides you on what to say. So yeah, it was quite useful. You went into that other place that Lily was talking about at that time that I can just see that happen. She's not. So there's an important question here and I'm not no one making the assumption. Are any of you I MG here on the panel, international medical graduates. Um There's a question about whether IM GS are advantaged or disadvantaged by the changes. Do any of you have any colleagues who are, who have been through the process and can comment or help me? Put the question in the chart. I posted a reply to, to that question in the chat. Um, we've just done a video of the general surgery sac who will out who've outlined all the changes and if anything, it just makes it more equitable, um, so your experience will be counted as long as it's done in the format, but they've requested it to be. So you shouldn't be disadvantaged. So what inequitable in what way, what considerations? So as long as your evidence matches the required evidence that they put together, they will accept it. So you logbooks need to be verified in the correct manner, you need to have your documents signed by the correct people and those kind of aspects of it are accepted. Um And obviously everyone goes through a verification process in terms of how much clinical time you spent in a specialty. And if someone is disadvantaged as a UK graduate, then an I MG would also be disadvantaged in the same way, but they've tried to make it as equal and as fair as possible. Um So just really, really look at the evidence cos that's, that's where people lose marks. So look at what exactly they've asked you to do to evidence. Things. Of course, there may be the aspects and Lily, I don't know if you know anything about any thoughts about this. If you're answering questions in your second language and any implications for that or any, anything that you could advise or you know, tips for that. I would be, I mean, I would never be shy to ask for a question to be repeated or, or reworded if there's any sort of either syntax or if it's delivered too quickly or there are specific words that you don't know or that you didn't catch. Um, and I would be super careful about the verbal feedback thing that means people fade out cos it's just harder to hear. But yeah, I think no, I don't have any specific advice apart from don't be ashamed to ask. And that goes for everyone actually, because often, you know, if you, if you do slightly lose your train of thought and have a moment, you know, anyone can miss a word or sometimes it is just really hard to hear. Some examiners or interviewers don't enunciate very clearly. Um So I would always ask rather than have a shot and guess what the question was. And yes, that's perfectly, I agree as having been an interview is to be able to ask again. But also when you've asked the same questions 10 times in the same day and you're on the 11th time, sometimes, you know your way of putting it, you need to pick yourself up on that as well. So always ask. So we've nearly reached the end of the hour. How can an hour of fun go by so quickly you ask yourselves? But here we are. So I think we're going to round up with each of you giving your, you know, your top tip to everyone here, you know, to take away message from each of you, please. And if we start with Holly, what's your takeaway message that you hope that the people listening to this webinar will take from what you've said. Um I think it would just be that no matter what your circumstances don't see it as you being at a disadvantage. Um, because on paper, I was an older candidate with time in other specialties and time out and I thought they're gonna divide my score by loads and actually, it's made absolutely no difference to me. Um, whether you're CT two and you're flying straight into it or, you know, I used to worry about my accent being AJ, are they going to understand what I'm saying? Just be yourself. You're unique, you're your own unique selling point. Um, and don't think about other people just focus on performing and giving the best you can in those 30 minutes. You must have had concerns about the waiting that you get from the years in training to, to be problem. So that's a really good point to make. Thank you. Um, we'll go to Michael Foxl Smith next, please. What, what's your sort of round up? My round up would be practice, practice, practice. And that means having an answer ready, having thought it through in your head. Um, but also having said it out loud. Quite often you'll find your pacing and your emphasis changes a lot when you say something out loud that you've been practicing in your head. Er, and it, I, as mentioned a, a second ago, if you're worried that your, your, er, language might not come across correctly, then actually having practiced it a few times can really help deliver the message that you want, er, to say. Absolutely. And we always seem to speak a bit faster if you listen to yourself actually. Do you think, did you record yourself at all to know what you look like or do you think that would be quite good because, you know, body language speaking quickly, it's very different when you watch yourself to what you think you're doing. Yeah, I did actually. And I thought it was absolutely ridiculous at the time and then having done it, I really noticed quite a few things about my facial expressions and how I paced. It helped me slow down a lot, which I think is very important because I think you can rush and then the examiner might not hear you or might not say the right thing. So, yeah, it was good to record yourself. Ok. Great. And then delete it. Yeah, I still have my recordings. Um, I would say that try and reframe the process in your mind, lie and Michael made good points about, you know, thinking that you're not at a disadvantage and Michael about how you practice your answers. But I would also add, you know, this is an opportunity for you to demonstrate the best of yourself and you need to go in there positive and excited for the fact that this is the specialty you in. This is, you know, the next 35 years, 45 years, if NHS England have it its way 60 years of your career. Um So really do try and enjoy um enjoy the process and uh talk to your supervisors. Some of them would have been interviewers, find out if anyone has had an interview recently um and practice with them for my A CFI had about four consultants practicing with me continuously for weeks. And it was really, really good and I learned a lot. Thank you. Um And Lily, um your sort of thoughts and also um the take home message from your presentation as well, just um uh from you, please. Yeah. So I had to echo what Michael just said, like, enjoy it. You've worked so hard and you should be so proud of yourself. And for once someone's actually asking you what you've done, which let's be honest, people rarely do in the hospital. So show off, it's also really infectious when someone's optimistic and has a positive mindset, it will only regulate you and make you come across. Well, um If you've had feedback that you come across arrogantly, then maybe have a little think about that. But for most people they struggle to let their light out from under the bushel. So this is the big moment and just really enjoy it. And I think the, the take home message and Ginny, I think you should listen to this too is breathe. It was like the obvious answer that no one said when you run out of breath, breathe. Um, your breath is with you at all times. It's something you can always anchor yourself to, you can always be mindful within and just get out of your brain if it's having a complete meltdown, just focus on your breath. However you feel it like whether you feel your chest moving or air passing over your top lip or whatever it is, you can literally modulate your auto, your autonomic nervous system by just exhaling for twice as long as you breathe in. So that is such a powerful tool and it's with you and it's inspiring to others. Er, it's amazing how we core each other. So use it, I think. Um, you're quite right about that and I was lucky enough to do a workshop with ra at the, um, it was something wrong with the college and actually we could learn a lot from actors as to how they breathe, how they prepare to talk. Um, and the exercises they do and the mental exercises they do as well. We just say there's a podium go rather than actually the preparation that goes with that. So all the preparation that you can do for your ST three interviews would be really important. So, um thank you very much to our panelists for giving your time and joining us tonight. And thank you to those who listened to the webinar for at telling them for your questions. I've been looking at what's in the chat um As well as your, as your comments. Last thing says, just good luck to you all and thank you very much for coming tonight. Thank you.