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All right, good evening guys. I'm just gonna get started now and this is being recorded. So if you have to drop off at any point, then you can find the recording on youtube. Um Hi, my name is Niraj. I'm a current SFP trainee in Northwest London working at North Park Hospital and I'm presenting on behalf of myself and Jan Vich, who's an SFP trainee in Northeast London, who can't make it here today. Uh You've probably seen her on our previous uh webinars about the SFP, excuse me. So it always just going to start with a quick disclaimer. So all of the information that we've included in our slides today are just based on information that we've passed, you know, that have been, has been passed down from other applicants and also is available in the public domain. Um It goes without saying that obviously, we can't divulge specific information about um particular interviews or marking criteria and of course, any of the medicine um involved in this, in this teaching session is purely for learning purposes rather than anything else. So, um I'm just going to talk to you briefly today about the clinical interview um for the specialized foundation program can be really good to have some interaction. So if you guys make use of the chat, that would be really good. So a lot of um almost all, actually all of the SFPAS will have a clinical interview component as well as the academic interview. And the reason for that is because you have one less uh you have one less clinical block generally. So they need to make sure that you have a good baseline and that you're competent to start off with and that you're going to be a safe F one and aren't going to need all six blocks to complete your foundation training um clinically. So you need to benchmark at a certain point. And that's the, that's the reason behind the clinical interview as well as to provide an extra scoring mechanism. So these interviews can vary quite a lot between different dearies. A lot of them will involve an A two E assessment and clinical prioritization. Uh Some of them may be more of a discussion. So what I would do is if you do get an interview, speak to somebody who has uh gone through the process at the Deaner, you're applying to but also have a look at the applicant guide online because they can be quite useful in telling you what to expect. Uh London, for example, are very transparent on what the interviews contain and they provide example scenarios, I know that not all of the deaneries are the same. But um by speaking to previous applicants, you should be able to get a good idea um as to, as to what to prepare for. But generally speaking, these are the things they test. So normally more than one clinical priority or unwell patient in an out of hours setting. So you might be told that you'll have one at night or on the weekend or in the evening. Um And you might have to prioritize different patients based on their clinical needs. You also uh more often than not need to talk through how you would assess an unwell patient in the A two E approach. Um And that might extend to testing some of your general clinical knowledge as well, which we'll come on to later and then you might also have ethical considerations or discussions uh that arise from the um from the scenarios that you're dealing with. So, um for most of the SFP, pretty much all of the SFP deaneries, you will have prep time before the interview to review a scenario. So again, this is deary specific and you should speak to people who have interviewed and the ones you're applying for. But I know for London, for example, we had about 15 minutes of prep time where we were given both the academic and the clinical scenarios at once. So, um Janie and I have just come up with a couple of do s and don'ts um for your prep time. So it's really important that you read the whole scenario. Some of these can be quite text heavy um because they contain details of multiple patients and make sure that you read the whole thing and that you make brief notes on the scenario because you may or may not have it on the screen when you're in the interview. And even if you do have it on the screen, you don't really want to be reading from the screen uh while you're, while you're trying to answer questions, um you should use a structure. So a two e as I've said, that that's gonna be what everyone uses um and be prepared to prioritize the sickest patient. So you might not have a task when you have the interview. Uh when you have like the interview information, it might just be details of three patients. So patient one who has chest pain and shortness of breath, patient two who is becoming agitated on the ward and patient three who's desaturating. For example, there might not actually be any specific ask of you at that stage, but in your prep time, I would just write a number down like, you know, three, then two, then one or I'm gonna see one, then two, then three and just be prepared to justify your choice. Uh A lot of the clinical interview doesn't have sort of right or wrong answers, but it's more about how you justify things. And obviously in real life, people would see the patients, they give you in different orders anyway. So just be prepared to justify whatever you choose, make sure that you have a drink with you because you can be doing a lot of talking. And in terms of the, don't uh don't feel like you need to write for the whole of the prep time. So that goes for both the academic and the clinical interviews. Like I said, there's a lot of information that you get presented in very, in a very short period of time. So don't feel like you need to spend the entire time writing down the exact scenario on a whole piece of a four paper, that's probably a waste of time because again, if you want to glance down at your paper, it will look bad if you're trying to unpick things from um from, from the volumes that you've written. So write down the most important things and the things that are going to help you um answer the questions and if there's anything in particular that stands out to you or that you think you can say that would set you apart from other candidates, then of course, write that down. So you don't forget it. Don't feel like you need to um allocate 50% of your prep time to clinical and 50% to academic. Um I guess this kind of depends on where your natural comfort lies, but for most of us, we are most comfortable with the clinical scenarios because it's, it's what you're trained to do in medical school. Whereas the academic scenarios generally take a bit more thinking and it's, it's a, it's less easy to sort of wing it in the academic side of the interview. Sorry. In the, yeah, in the academic side of the interview, then the clinical side, it's not the end of the world if you don't get to prep absolutely everything in the clinical interview because again, you're going to fall back on your A P approach anyway, whereas on the academic side, if you haven't fully prepared or read the abstract, then obviously you can, you can get into a bit of trouble there. Uh So you don't feel like you have to allocate 50% to academic, 50% to clinical when you're doing your mock interviews with your friends or with your SFP mentors, then try a few things out and see what works for you in terms of splitting your preparation time, whatever works for you stick to that in your actual interview and obviously don't do anything unsafe. Remember that you are uh being assessed at the level of an F one no more and no less. So make sure that if at any point during the interview, you think that uh OK, if this was me in real life, I'd feel quite uncomfortable, make sure you say that and say, you know, I'd call for help really early. Um Don't go above your sort of level of uh competence and do anything crazy because that just gives a bad impression. Um So yeah, that's our, those are our top tips of preparation time and thinking about things before you go to interview. The other thing that I found was really useful uh When me and my friends were practicing is actually imagining that you're in this scenario, that it's not just an abstract scenario. Um It's something that's happening in real life because then you don't forget to do small things. So for example, if you've got three patients and you go and see the one with the chest pain, picture yourself going to see a patient with chest pain. The first thing you're actually gonna do in reality is, and I know we say it for exams. But what you do in real life is you look at the patient from the end of the bed and then you're gonna go over to them and have a chat with them, take a brief history. You're not gonna launch straight into a to e them without any of that, if they're obviously, unless they're unconscious. So um just small things that show that you can actually be a doctor on the ward come quite naturally when you imagine yourself doing the steps in real life rather than just saying them out loud. Ok? Um And then there are a couple of things that you should do before you go and even see the patient. So I've talked about how to prioritize them. Um Whereas you haven't really talked about how to prioritize them just that you will be prioritizing them. Uh But we'll go through how later on. Um what makes you sound really slick as a candidate is a saying that, you know, uh I can see that there are multiple unwell um patients here and I would like to prioritize patient number one with the chest pain because I think they could be having an acute myocardial infarction. Um On my way to seeing the patient, I would ask the nurses if they could take an up to date set of observations, I would also jot down their most recent observations and any trends in them as well. I would also ask the nursing staff if they can to site a cannula and take some bloods and make sure that all of the um documentation. So the patient's drug charts, et cetera by the bedside, I would also contact back to my registrar or sho and let them know that I'm going to see a potentially very unwell patient and that I might need their help. So that kind of encapsulates what you would do in real life cause imagine picking up a bleep or answering a bleep from a nursing or from a member of the nursing staff about somebody with chest pain. You are going to ask all of those things. What are about obs? Are they on any oxygen? Um Do, do you have any trends in the vital signs? Can you take some bloods, all of that kind of stuff will really help you when you get to the patient in real life and it helps in your interview as well and make sure you're utilizing all members of the team. So if there are like three or four patients verbalizing that you would ask for sho or red if somebody could come and help or even even making mention of the wider people in the MDT. So some hospitals, for example, have a hospital at night team with nurse practitioners who can go do cannula, et cetera. So if one of your tasks is a cannula, then you could say it quite simply. Well, I don't think that's important at the moment. Uh depending on why it's needed, but I would ask the hospital at night team or one of the site practitioners to go and put the cannula in if possible, just um throwing a question out there if you were told. Um So say you answer this bleep and the examiner tells you. So the nursing staff tell you that there's a patient with um a BP that is unrecorded. Their heart rate is 40 their saturations are 80% on 15 liters per minute of oxygen and they want you to go and see them. What would your immediate response be in that scenario. So we wanna show bradycardia and hypoxia. Yeah, exactly. So, I would, um, yeah, I, I would basically put it out straight as a perio arrests or even cardiac arrest call. Um, because it's quite clear that although you can go and see them as the F one you're going to need help and that's obvious from the outset. So there's no harm in saying, well, I'm actually really concerned over those observations and it's quite clear that they're gonna need more help than I can give them. Um And I need more people around me. So I would say to the nursing staff, I come and see them, but please call double two, double two and put out a perio arrests or a cardiac arrest call. That exact situation happened to me on one of my night shifts. I went to a patient who I was just asked to see. Uh and that was the exact scenario and I put out a cardiac arrest call because I needed more people there. So, after you've prioritized the patients, uh I realize I haven't talked about how we would prioritize them yet. So maybe I'll just hold back on this. Uh and ask you guys how you would prioritize patients. What kind of approaches can you use? Yeah, exactly. So I would, I would do exactly that. So I would use the A TV approach again for prioritizing if you've got a patient who is choking. Yeah. News is also a good one actually. Um although remember that news, news is a useful thing and it's, it's um a common reflex to ask in hospital when someone says, you know, what, what do you can you come and see this person, you ask her, what's a new score? What's really helpful is a trend in the new score. If someone's been using seven all day, that's fine. Well, it's not fine but it's, it's probably not as bad as someone who's using a two and is now using a six, for example. So I would go with what, what Bogo has said there in terms of using an A two approach. If you've got someone who's got stridor, somebody who's got uh acute shortness of breath and someone who's got chest pain is a really good example of an airway, a breathing and a circulation problem. I would say, well, there are three critically un potentially critically unwell patients here. And ideally what I would do is contact my registrar and ask if there are other people who can go and see the two patients that I'm not able to see. But at the moment, I'm going to prioritize patient number one because I think they could potentially have an airway problem. In the meantime, I'll also put out a cardiac arrest call. I would then think about seeing patients number two and three. What I would say to the nursing staff though is that if patients two or three deteriorate, then they can escalate that straight to my senior who put out a cardiac arrest call if they need to. So, what you're doing there is you're showing the examiners while you've prioritized one patient over the other. But you've also showed them that you're keeping all of the patients safe because you're giving the nursing staff very clear instructions to escalate above you or to put out a cardiac arrest or perio call, if the patients get any worse or if they're any more concerned. And that way it's not like you're just forgetting about those two patients, you are still doing something for them, you're just not going to them. Um, yourself also asking for things like, can you keep them on a cardiac monitor? Can you keep doing regular observations, et cetera? And yeah, I Christy, I do agree with the news thing. Um, but then if you've got a patient with a new news four news five and News six, it's difficult to say I'm going to see them in order of news. That makes sense, but it's definitely a good thing to know. Uh And that's why a trend in observations is so useful. Ok. So after you've prioritized and you've picked who you're choosing, uh you've, you've chosen who you're seeing, rather you want to do everything you can to maximize patient safety. That's the safety of the person you're gonna see as well as the safety of the people that you're not gonna see. And this is kind of, this kind of builds on what I've just said to you. So, ask for things to be ready before you go and see the patient. So you're not wasting time. Simple things. Can they be a, you know, can they bring a computer by the bedside? So I don't need to look around the ward looking for a computer because I can't tell you the number of times there's been a, a Perio arrests or an emergency call. And I've had to be looking around for a computer I can log into and can you bring the drug chart and the notes by the bedside? You need to know things like the escalation status. Are they DNA R? Are they for ward based ceiling of care or are they gonna go to ITU or HDU if they get more unwell? So all of these things are things you can say to the examiners and that show that you can actually, aside from just talking through an A two E, you're actually thinking about the practicalities of doing this job, um, escalate early if you need to, if they look really unwell, um, if they look like they're gonna arrest, if the observations don't sound good on the phone, put out a perio arrests call, a Met call or a cardiac arrest call, depending on what you want to say. Make sure you're communicating with your registrar, your other seniors as well. And verbalize when you're, when you've reached the maximum of your clinical ability. So for example, if you're stabilizing somebody with acute heart failure and you might go through a two, set them up, give them some oxygen, give them some furosemide, do an A BG, take a chest x-ray. And then at the end of it, you're probably gonna say, and I would reassess everything. But uh at this point, I need some more senior advice um to start having you think about why this has happened and how we can prevent the patient deteriorating again. Um And then when you're doing your A two E, you treat everything as you go along. Don't move on to B or to C or to D or to E without solving a problem in the section before because obviously, you're not gonna get anywhere by doing that and make sure that you reassess. So you say that OK, fine. So the patient has saturations of 85% on air. I'm gonna put on 15 liters per minute of oxygen through a non rebreather mask. And then I'm going to keep an eye on the observations. I'm gonna keep an eye on the, on the oxygen saturations and reassess them continuously. Obviously, it's quite difficult in um an OSI setting or in an interview setting because your timing, you've only got 10 minutes. Um So things do get sped, sped up, but just mention that you would reassess. Uh They'll probably say yeah, 15 minutes later, the oxygen saturations pick up. They're not obviously gonna stare at you for 15 minutes. Any questions so far before I move on because I'm just gonna have a sip of water. Um I've seen your question and anya about the rankings and I'll come back to that at the end. OK? Cool. So no questions so far. So I will move on to the next slide. This is just talking through the A two approach. Um So airway wise, I'm not gonna talk you through this fully because you know this, hopefully and you'll have the, have the slides available via medal and the um the recording available on youtube. But obviously, we're going to assess the airway first. You don't really need to say I would assess the patency of the patient's airway. You can say I'm gonna assess the airway. If they're talking to me, then I'm happy uh if there are added sounds or, or any other concerns. And obviously, I do a more detailed assessment. Um So you're going to look, listen and feel um and you're going to treat so airway type things. Um airway maneuvers, head tilt, chin, lift, jaw, thrust, airway adjuncts. Um If you've got an airway problem because of choking or anaphylaxis, then obviously, you're gonna treat that. Now, what's different for each interview location, but also for each interview panel is whether they interrupt you and give you findings or whether they let you just run through your whole A two E some of you are into, I had two interviews. One at Oxford, one at London, one in London. One of my interviews was very happy with me talking through the entire thing. Not really stopping me and the other one stopped me at each point and gave me findings and asked me how I would treat them. So you just need to read the room, you can actually ask them. Um And I did, I think on both occasions, uh would you like me to just continue from a to e uh would you stop me to give me? Um will you stop me when there are positive findings or would you like me to stop after each section that kind of puts the ball in their court and it avoids this awkwardness where you're like talking over each other when you're trying to do something, trying to do the next thing and then they say, oh, actually, no, let me tell you something about the breathing. So, um I think that was quite a nice thing to do and you just need to find a good way of phrasing it for you. And again, this is where practice comes in. So coming up with your phrases of what you're gonna do before you see the patient, how you're gonna talk to the examiners about your A two approach, all of that kind of stuff really does come with practice um by the way guys stop me at any point by putting uh something in the chat. If you have any questions um in each of these sections or about anything I'm saying, then obviously you move on to breathing. Um again, so your assessment would be your look, listen and feel you're going to do some measurements. So a BG chest x-ray oxygen, saturations, respiratory rate, et cetera. And you're going to intervene as soon as you uh detect a problem. Oxygen is always a good thing. The Resuscitation Council actually advise that all critically unwell patients have oxygen regardless of the oxygen SATS because you can always, you can always turn it off. Um So even at the beginning, if you wanted to be like I put them on some oxygen because they're critically unwell, that's absolutely fine. Um Be aware that you can be asked questions around the topics. So say you've got somebody with an exacerbation of COPD um and you manage them and they say, OK, well, the A BG comes back with a PH of 7.27. What would you do? So they're on 15 m of of oxygen. The PH is 7.27 P CO2 is eight and the PO two is 7.5. What are you gonna do? And they're on 15 liters per minute of oxygen? Yeah. Yeah. Yeah. So definitely senior support. Uh Yeah, maybe refer to it for ventilatory support and maybe just turn the oxygen down a bit and accept a slightly lower po two. and say, you know, you can talk about, you can talk about why you might be doing that because of the carbon dioxide retention. And then a follow up question could be, yeah, if they got cop Yeah. So this is an exacerbation of COPD. The question could be tell me how you would give them oxygen then and you might need to talk to them about not the colors but the fact that you can give vent masks uh to achieve a particular uh fio two or that BIPAP might be required later on. So just be aware, don't be surprised. Rather if you are stopped and asked random questions in the middle, it's not common that it happens, but you should be prepared for it to happen. And that means when you're practicing, please uh push each other and um interrupt and ask questions because it's very easy to talk through an A two E. It's very difficult when you, when your flow is being interrupted, when you're having to actually make management decisions, et cetera. And that's the hard part. So make sure when you are practicing, you're not just running through it, but you're stopping and having the other person ask you questions or challenging you um et cetera. Um and then circulation. So this is probably the easiest one. So again, you're going to do your basic assessment with your observations, your clinical assessment, don't forget things like peripheral edema, which we didn't put on here. Um I guess this is fluid balance, uh pulse JVP, auscultation, et cetera. Um And then your bloods uh making sure that you've got sufficient vascular access. Um If you think that somebody's bleeding, then obviously say things like I, we send off a group and say, if you've got somebody who's bleeding and is shocked, then you can say things like I put out a major hemorrhage call at this point. So again, it's about showing that you know how to do the job of a doctor, not just talk through A two E and then your interventions are gonna be fairly straightforward here. So, fluid resuscitation, blood transfusion specifics. Um If they've got a CS, then obviously, we're gonna think about giving them some aspirin doing an ECG seeing what that shows. And then obviously that will, that will help you decide how you treat them going onwards um to be comfortable with the common immediate management for all of the uh most likely clinical emergencies you'll be faced with. So there are a couple of things that you can almost guarantee a fair game to come up acute. So everything on here. So, sepsis A CS, fluid overload, pulmonary edema, pe fast A F major hemorrhage. Um Yeah, that's probably it for circulation, really airway and breathing wise. Asthma, exacerbations, COPD exacerbations, anaphylaxis. Um You might have diabetic emergencies, hypoglycemia DK A all of that kind of stuff. So the really common clinical emergencies are the ones that will come up. You're not gonna get. I mean, if you look at the people say, look at the Oxford handbook, the emergency section at the back and I think that's good advice, but don't spend your time. I mean, I might come to regret this but I, I wouldn't say spend too much of your time looking through how to treat neurogenic shock, for example, or how to treat an Addisonian crisis because those things are unlikely to come up. They're beyond the scope of what an F one should be able to manage by themselves. So these are things that you should be able to stabilize immediately when you start working and then escalate for further advice. And I've personally in, in 2.5 months of F one had to deal with somebody in, in flash pulmonary edema um after an M I by myself, which was actually my, one of my interview questions. So, um yeah, they, they, they aren't unreasonable. They will give you things that you will be expected to know from medical school and also just generally for life and clinical practice. And then you're gonna go on to your disability um interventions here. Uh hypoglycemia, any airway support, if you haven't called the anesthetics, and then you realize somebody's got a bit of a threatened airway or reduction in level of consciousness, then you might wanna call anesthetics now and get their opinion on whether they need to be intubated and then specific in intervention. So, um, if they have had an overdose of something reversing it, if they've got DK A giving them fluids, insulin, et cetera, if they're having seizures, you should be familiar with what you would give and when, um, and yeah, and, and just not forgetting that again, these are common presentations that you see all the time as a doctor, any questions so far on, on the a to approach or, or anything I've said OK, no questions. Yeah, that's great. Obviously, then you're gonna go go on to exposure. Um Yeah, never, never forget to palpate the abdomen. Never forget to say that you'd have a good look at the patient. Um And you should, you should tailor what you say to what the clinical scenario is. For example, if you've got someone with a fever um and sepsis, um you might say, well, I palpate the abdomen, I want to see if there is any suprapubic tenderness that could suggest a uti I would also wanna have a look at the skin, make sure there are no breaks and that they don't have a cellulitis or anything like that. Um I might even have a feel down the back and check that there's no infection um hiding between the vertebrae. So you want to tailor what you're saying to your clinical scenario and that's how you sound good. And that's also what you do in real life. You're not mindlessly doing your A two E with no differentials in mind. Even though it might feel like that sometimes you do naturally focus more on certain things than others and show that you're doing that in the actual scenario because that's what differentiates you from just doing it from an algorithm. Um Do we need to know specific dose of medications? Eg adrenaline, insulin? I would say for the common, for the common clinical emergencies, I would learn the doses. There's no one, there's nothing anywhere that says you need to know them, but it's the same for medical school as well. But it sounds a lot slicker if you can say I would give half a milligram of one in 1000 adrenaline rather than I would give some adrenaline. Uh I'd have to look up the dose and it just sounds a lot better and, and you can be pushed for doses as well. Obviously, if it's something that's really out there or not used very commonly, then I, I wouldn't, I wouldn't say you would need to know it. You can caveat everything you say with. Of course, I would check with local guidelines and check the dose in the BNF. But um from what I know it's half a milligram of adrenaline im uh the DK A it's 0.1 units per kilogram of insulin. Um Things like furosemide for heart failure. I would also, I would also know um but anything more specialist, I, I would say isn't really like, I wouldn't learn the doses of treatment dose heparin or a do a for a pe, I would just say I put them on treatment dose heparin and get AC TP A if that makes sense. So these are some possible scenarios. I took this from a really good talk from um uh an imperial um SFP uh presentation that's online. I think this is a really good starting place in terms of where to focus your revision. I would start off with the scenarios you're least comfortable with. So you might be really comfortable with anaphylaxis with stemi N stemi tachycardias, et cetera. But I would start off by looking at the things you're not so familiar with. Um because those are the things that you, you really need to drill down and then do the easier ones a bit closer to the time. Um There's also a really good document from the resource council online with uh common drug doses and, and com and a, a summary of the A LS guidelines for things like tachycardias. And I'll see if I can find it and put it in the chat shortly, but I'll just take a picture or screenshot of this page and aim to at least cover these and then have a think about if you want to do anything more than this. But I think this is very, very um, very fair game. Um I don't think you'll get anything, obviously, I can't guarantee, but I don't think you'll get anything Peds related, all s and Gyne related. So, you know, I think it's very unlikely you're gonna have like a postpartum hemorrhage, for example. I think that'd be quite unfair. So this is an example. I'm going to give you all about 34 minutes to read this and I wanna see if I can put up a pole to tell me who you're gonna see first. Get a couple more responses before I talk to you about this scenario. OK, cool. So we've got uh three quarters going for patient two and a quarter going for patient one. Now again, there's no right or wrong answer here, but I would agree with the people who are saying that they would see patient two first. Can you give me? So regardless of how you answered, can you give me a reason why you would see patient one first? Regardless of whether you thought that was the right answer or not? What, what sort of, what goes through your mind that these aren't easy scenarios. So what goes through your mind to think? Let's go and see patient one first. Mhm Yeah. So potassium level is scary. They're acutely unwell now. Ok, great. Um So uh for patient two, drowsy and yeah, yeah, I got that airway compromise risk. That's for patient number two. Patient one has the potential to get unwell soon. So yeah, even, even if you ask the patient to tell me how you can justify seeing patient one first because you can. So yeah, patient one has the potential to get unwell soon. Ideally, you would see all of these patients, right. Patient who is unwell now. Exactly. So, um what I would do is risk of arrhythmias for patient or cardiac risk. Exactly. So there are reasons to see patient one first. Uh There are reasons to see patient two first. I don't think there are really reasons to see patient three first, although I'll come onto that in a minute. So what I would do is I would say I can, I recognize that there are multiple unwell patients here, um who all require my attention. However, I would want to see patient number two first. The reason being that they have become very drowsy, they're unresponsive and therefore they're at risk of losing their airway. That being said, I think patient number one has a potential to become very unwell. Um What I'd like to do is ask the nurses to do an ECG to check for any uh ECG changes of hyperkalemia and also do a repeat set of bloods including a VBG just in case this is a spurious sample because this is just a one off. Uh I would then contact my sho or registrar and let them know what's happening and see if somebody could help me. Uh see all of these patients, I would leave patient number three until last reason being they're not currently acutely unwell. However, there is obviously a risk to staff members and to the patient themselves. I would ask the nursing staff to supervise him on a 1 to 1 basis and also maybe call security if it becomes aggressive. Um And then I go and see him as soon as I can. Does that kind of make sense? So you're saying, oh, sorry for patient number one. You can say that I would tell the nurses if they, if they could put out a peri rests call or an emergency call, if the potassium comes back any higher or if they're concerned for any reason. Now, all three of these um cases are common things to see. So potassium is 6.2 by itself doesn't mean anything. Uh Well, it doesn't not mean anything but, but can be interpreted in a number of ways. Is this a spurious result was the uh sample on the ward for ages before it got to the lab. The person has renal failure. Do they normally run at quite a high potassium anyway? Are they due for dialysis tomorrow? Um and therefore their potassium will come down. So, what you really need to do here is an ECG to check for changes VBG and a repeat set of bloods to check whether 6.2 is real or not. Um Patient number two, you need to see first. Most probably um they could be hypoglycemic. Um because of the insulin, they could be, they could have cerebral edema because of the DK A, they could have hypokalemia because of the amount of insulin they give, you know, they're getting. So there are lots of things that could be wrong with patient number two and hopefully you pick them all up in your A two E and patient number three literally had this. The other day person started hitting somebody with their walking old lady, started hitting nurse with their walking stick, not very pleasant, but again, at least the patient isn't unwell. And for the most part, two nurses can hopefully contain this 82 year old until we can go and see them, assess their capacity. Maybe deescalate things verbally uh before prescribing a sedative. What you need in all of these cases is more information before you go and see the patient. So for patient number two, again, can I have an up to date? Ecg, can I have a VBG on the way? Uh Can you do a blood glucose and ketones again, all of that is gonna give you a lot of information. Any questions about these three patients or why you would prioritize each one over the other? Great. No questions so far. Have you come up with any? Please do let me know and then there are other things that could come up. So we've talked a lot about clinical uh scenarios. It's usually three patients, varies. I think more than three would be me. Um because of the prep time that you have and, and again, like I said, not all of the, not all of the deaneries will give you three patients. Some might just give you one, some might give you one in a different scenario. So you have to speak to people who have done it before. Um In terms of how many they gave you might not always need to prioritize them. They might just ask about one patient and then ask you more detailed uh management of that patient or they might ask you to prioritize three and then do a, a more brief bit on the management of them other things that could come up communication scenarios, dealing with an angry relative, for example, um I don't, I don't think it would be like a, a roleplay sort of scenario, but you know how you would go about talking to somebody about a sensitive topic, ethical dilemmas, capacity, consent. So for example, the last one poses a bit of an ethical dilemma. And this is a dilemma I had on my own call the other day. If you're, if somebody is verbally aggressive, threatening to leave the ward and you don't let them leave the ward, what do you have to do? What do you have to do if you're keeping someone in hospital against their will pretty much you're not letting them out. Uh cessation is not a bad shout. That's more of a, a mental health um thing. But yeah, usually these things come under the deprivation of liberty, safeguards of the dolls. So um if you get time at the end and they ask you, OK, quickly tell me about patient number three, it looks really good to be able to say, well, I need to do a capacity assessment. They don't have capacity and I think they need to stay in hospital. I need to put into place a doles um so that we can keep them in hospital and then deal with things. Um So that's an ethical thing, capacity to stay in hospital or to accept medical treatment um dealing with an error. So, you know, it might be the case that it's like um somebody's received double the amount of insulin they should have, they haven't come to any harm. What would you do? You might need to talk about the duty of candor to tell people uh about things when they go wrong, even if they don't result in harm. Uh You might have to talk about being honest and owning up to errors in clinical practice, less likely discussion surrounding end of life care DNA R and, and treatment escalation and who you need to discuss them with before implementing them and then medical questions related to your scenario. So depending on how your scenarios are going, you might be stretched at the end with a few quick fire questions. I know I was um I had some random things thrown at me at the end of my interview uh that I, I didn't really see coming but they were, they were just random medical questions um loosely related to what I was talking about. Um Do we need to know reference ranges for blood tests? I wouldn't say so. I don't think you'll get a large number of blood tests, but obviously you would need to know the common thing. So potassium, um what would be considered high or very high glucose? Um If I to think about other things, that's it really like I I nothing outside of what you would need to know immediately off by heart to manage the conditions in the other slide. So COPD asthma, you want to know what normal po two PCO two ph is what a normal bicarb is maybe as well. But aside from that, you don't need to know what normal chloride is if that makes sense. So no reference ranges for common things and, and even if you know a ball park and you can say that that, that bicarb sounds high. If it's 32 you don't know that the the normal is under 28 being able to say that that sounds high. I think that a chronic CO2 retainer is fine cause no one's expecting you to know everything off by heart. The other thing I would say is, is when you don't know something in these scenarios, it's quite important to be honest and say, to be honest, I don't actually know, to be honest, I don't actually know too much about the condition. This is how I manage it, but I'd look up guidelines on XY or Z if you've got sepsis then say, well, I prescribe antibiotics. Um according to my local guidelines, I'd look up at what they are on micro guide, for example, which is an app that all NHS hospitals use or on the BNF, for example. So that is, that's a lot of me talking, I'd really appreciate it if you could give us some feedback. Um And I forgot to mention at the beginning a big thank you to previous mind, the believe SFP teams because we've used a lot of material from their slides. So if you could give, give us some feedback, that would be fantastic. It just means that we can try to smooth things out for the future and make sure that we're giving you um education that's genuinely useful. There any other questions? I've got some time now. Um There was a mention about a police officer coming to talk to you about an injured patient. Can you talk about uh your approach to that and preserving confidentiality? Yeah. So this is a very difficult one. Um And it depends on, it depends very much on the scenario. So if the police officer has there. Ok. So there are some circumstances where you have to, uh, where you have to disclose certain information. So for example, gunshot wounds, knife crime, no, maybe not even knife crime, gunshot wounds, for sure. You don't need to tell the police who they are, who the person is or the circumstances just that there's a person in the department with the gunshot wound or whatever. The other thing you have to do is if you are aware that a crime is taking place or could immediately take place, you should let the police know obviously to stop uh further badness happening. Other, more niche things are things like fe female genital mutilation in Children. You need to report that to the police as a duty to do so. And then the police coming to talk to you about an injured patient depends on the scenario. Remember that in terms of confidentiality, generally, there's always this clause of a public interest disclosure. So if someone's broken their leg and you suspect it's because there've been an, there's been an altercation, physical abuse at home and they've got a young kid. I would say that's kind of fair game to disclose to the police because there's a risk of harm to somebody else. Whereas if they've broken their leg because they've done something stupid in the garden and the police come and ask about it. There's no real reason to be disclosing that information. I'd recommend having a look at GMZ. Good medical practice. Um Like the shortened version of it to look at things like confidentiality and just revise those common ethical scenarios because they could come up. Would I mind sharing roughly where I needed to rank to get Northway Park? No, of course not. Um I, um, I ranked, I ranked the North Weick Park Jobs at the top because I it's my local hospital and I really wanted to work there. Um, personally, I ranked um in the top, I want to say top 16 I applicants. But I know people that got North Park who had ranked in the fifties as well. So you have to remember that not, although some hospitals are seen as more competitive than others, not everybody wants the same thing. So you might be 60th and get a job at a Central London Hospital. So for example, I was a fairly highly ranked applicant, but I didn't rank any of the central London teaching hospitals up top because I had different priorities. So, er, it, you can't, you can't really extrapolate from where people rank, just rank as highly as you can and then rank where you want to work in order of where you want to work and hope for the best. Do I know of any good resources to find an example, clinical manage to practice with? Um I struggled this with this, to be honest, when I was, um when I was practicing, there are a handful online if you Google. So for example, this Imperial um if you Google, Imperial SFP, uh Imperial London SFP interviews, there's a really good PDF. Um And that's got, I think two scenarios in it, aside from that, the London applicant guide has a scenario in it. What I found really helpful and we will try and send you out some scenarios as well. Um If we get a chance to, what I found was really helpful was um making up scenarios with friends and that was both for the clinical and the academic interviews. Um And every time I practice with a friend, I would, we would each make up one or two scenarios and that was actually very good revision in itself. Because if you think if you're making up the academic one, you start to think about points and how to appraise the abstract and then you hear your friend do it, that's really useful. And it's the same thing for the clinical. You start to think about what your friend should say or what the priorities should be. And then they might say things that you hadn't thought of before that are really useful to you. You learn off each other like that. So I would say, um better than just reading out scenarios or, or looking at them, making them is, is good, is a good thing to do. And I would also extend that to your osk for final year if you've still got osk left any more questions. Ok. So it looks like there's no more questions at the moment. Thank you very much guys for coming. Um Our email address is up there, so SFP at mind dot com if you think about if you think of anything. Um But good luck with the practice. Hopefully you found this useful. Um And if you do have any um anything that you want to, that you want us to cover in the future with regard to the SFP stuff, please do let us know on the email and we'll try our best to get that sorted for you. So thank you very much again and have a good rest of the evening.