Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, guys. Thanks for joining. Um, if you guys are able to hear us, then can you just pop something in the chat? Um, we're just going to keep our cameras off tonight so that we can make sure that this runs smoothly without as many technical difficulties as yesterday. But do pop in the chat just yes or something to let us know if you can hear us. Great. Thank you. Cool. So if Dan's ready, then we can make a start. 701. welcome back to the last webinar of our series today. We're going to be focusing on the clinical station. So this form is usually the other half of the London interview. We'll run through kind of the approach that we took two preparing how to prepare the best, um, the HPV framework, which is super important not only for these interviews, but also, um, when you start work, and then we'll run through an example of how we would go about presenting or talking to one of these cases as if it were a real interview. So it just gives you an idea of what kind of things you should You should be saying or how to kind of keep the good structure so that the interviewers know exactly what you're talking about. So I'm Alice and Dan, um is here as well. We're going to do this session together as we've been doing all of the other previous ones. Any questions? Pop them in the chat and we'll do our best to answer them. And we'll also leave all of our contact details at the end of this presentation so you can get in touch if needed. Cool. So just a quick overview. We're going to talk about the interview format again, just a quick run through of that. We'll talk through some clinical scenarios, and finally we'll finish off with a Q and A if you have any questions, as we mentioned yesterday, um, everything that we talk about is based on our personal experiences and also what others have told us from previous application cycles. We're not endorsed by any official body, and everything that we discussed is freely available on the on the Internet and our website mind believe sfp on mindedly. We also have a page which covers academic and clinical um stations. So do take a look at those blog articles, Um, as they'll cover a lot. A lot of things also in detail as well. Um, just to answer your question, Yes, this is being recorded. Great. So just a quick overview as we spoke as we spoke about yesterday. The interview, at least for London, gives you the 1st 15 minutes of preparation time during which will have both the clinical and the academic abstract on your screen so you can take a You can spend as much time as you want on either, um section, but total in total. You have 15 minutes to read a note down, um, the details or whatever you need, um, in order to jog your memory for when you actually go on to present and have the interview. The time gap between preparing and then doing the actual interview varies like Dad was saying yesterday, he waited, you know, like two hours before he was able to go into his interview. I waited like, now as well. And there's some technical difficulties, so it really does vary from students to student. But I would just say make the most out of those 15 minutes, write down everything you want. And the key thing? The key, um notes that you drop down and they should just be important points. Don't try and write down the whole critique or the whole clinical scenario. You just need a few key points. Um, and then you have 10 minutes for first the academic station, and then it will move on quite quickly, and it will pass very quickly as well to 10 minutes of the clinical station as we mentioned yesterday. Um, the clinical station everyone generally does well in. So I do try and spend kind of like quite a bit of time finessing or improving your critical appraisal skills, because that is what I can set you apart from from another candidate. But I think the bottom line is that you have to be very clinically excellent, um, in order to get an SFP to do academic medicine because it's difficult juggling both academia and clinical medicine. So you do need to show off your clinical skills and show that you're absolutely, clinically, clinically competent. The panel is made up of one academic lied. He will He will talk through and question you about the abstract. One clinical lied, he will take over when they ask you about the clinical scenarios and then possibly an additional observer. Yeah. So the session is being recorded? Um, no, I do not think you should take a screenshot of the abstract. Exactly what stands said they'll make things very clear when you go into the interview room. But no cool in the waiting room. Um, there will be quite a few asthma checks. So when they invite you to interview, they will have a whole list of things that they want you to hold up to Webcam and show them, like, you know, just the normal i D checks. And then you have 15 minutes for the clinical scenario and academic abstract to read through and make notes. And yeah, you can see everybody else also, because you'll have your Web cams on. Um, so, yeah, don't panic. Keep calm and just do your own thing. Just take as many or as few notes as you need. Cool over to day. Thanks dot Yeah. So I think we've really If you attended yesterday's, um kind of talk, that much of the things we're talking about prep time are basically the same. So I would definitely encourage you to read through the clinical scenario and the and the academic abstract in whole. Before you do anything else, make brief points and we'll talk more about how you may want to make points and notes around prioritizing this evening for the clinical station. And then, as we both talked about being prepared for the weight between preparing and going in and having an interview, um, ultimately for the clinical station, if you are going to go about prioritizing a very simple way that you can't go wrong by just seeing the sickest patient always and justifying who you think is this preparing to justify why you think that person is the sickest patient and I would always just prioritize them in an 80 fashion. So people with the airway problems go in front of people with breathing problems to go in front of people with circulation problems who go in front of people with neurological disability problems with some caveats, we can talk about it a bit, and then finally kind of everything else behind that, um, I think it goes without saying, even though it's slightly repetitive, don't attempt to write down all of the abstract and all of the clinical scenario off of the screen straight on paper. It's a waste of your time, Um, and it will make your hand tired, and it just you will gain nothing from doing that. You need to be more succinct when you're making the notes. Um, if you prepare and you've still got plenty of time left, then that's also not a bad thing. It doesn't mean you've under prepared. It probably just means you're very, you know, you've done enough preparation. You're very kind of ready for the interview in your head, and you don't have to succinctly make notes on the things you've been given. So I don't think you should feel bad if that does happen. And, um, you know your strength and allocate your time accordingly. So if you're very good at the clinical station, I think you could probably spend easily only 3 to 4 minutes on that, um, knowing that you talk about almost the same things for most patients in that scenario, um, and then you have the rest of your time to dedicate the academic station, which, as we talked about yesterday, is probably the more challenging of the two stations. I think it's probably everything for that side, so really briefly on the clinical scenario. So as you probably know by now, it's 10 minutes long. Normally, essentially, you have more than one competing clinical priority, then normally I/O of our setting or in a setting about to go out of our so an inpatient medical order five minutes for the past five or something similar to that. There's normally more than one hour unwell patient, but there isn't normally more than one critically unwell patient. Um, you won't be expected to manage anything that's beyond the realms of a, I guess, first day F one, Um, and there's normally more than one or one opportunity to talk through a broad 80 approach. So, uh, an approach of clinical assessment on an unwell patient. There's normally a distracter or a red herring in there as well, and then the whole scenario is certainly parts of the scenario act as springboards to discuss ethical or clinical questions. If you have time at the end, and hopefully, if you're prepared and you know how to present things succinctly, you'll have plenty of time at the end next night. So things to think about before you even found out what the scenario is or seen the patient or any of that stuff. So the first thing you're always going to ask for is an esmarch handover of the key observation. So s bar, for those who may be unfamiliar with it stands for situation, background, actions and recommendations. So you want to certainly know the key observations. So that would be heart rate, BP, temperature, oxygen saturation, respiratory rate. And you want to know the trends and those observations. So you want to know? Sure, their BP is 90/60. But is that just changed in the last half an hour or if they've been 90/60 all week? All the patients you don't see and you you know you're not going to get around to seeing you need to talk about how your safety net them or the other steps you might do. And I would I would talk about doing that up front. So if there's three patients to see, but you're going to see the sickest one first, I think you could get away by saying things like I would call back Patient X. Um, I'd call back there. The nursing team and I asked them to repeat the the observations in 25 minutes time. And if they get any worse to call me back And if they did here, um, significantly in that time, they could put out a 222 or a medical emergency call if they were concerned. And then you're just highlighting the fact that you know, you're one person. You can't be everywhere at once. But you would also like to kind of start the ball rolling on a few other people. You can also ask for things like an E c G. If you're concerned about, you know, cardiac causes and stuff. And then the nursing thing could go and do that before you see that patient. Um, you can also talk about because these are hypothetical made up scenarios. You can make up people in your own call team, so you're obviously applying to become an F one. But in most teams, if you're lucky, there is an F two or an S H o. There's a registrar. There is a consultant. There are out of ours. Often there are other members of staff. So maybe critical care outreach or other people who may be appropriate to call on and you could ask them to do things. Or you can ask the nursing team to contact them, so I don't It's a made up scenario. Obviously, you can't be completely wildly out of, um, you know, unrealistic and say, Well, there's obviously normally 10 s H. O s on my team, so I'd get them to go and do whatever. But you can certainly make references to people, and it makes it sound like you've got more experience working in a hospital if you're aware of all the people who work with and not just in isolation. And then I think the other thing that's really important to do before you even talked to 80 and stuff is if anything, in the clinical scenario primer jumps out at you is something that's really concerning, then you would be doing yourself a disservice if you didn't just say that out loud. So if there was a person, for instance, you were concerned about something like anaphylaxis, you were concerned about an imminent airway compromise. Um, or you were concerned about someone with an extremely low BP. Those are all things that I would actually say as an f one. You you would not be expected. It would be inappropriate to try and manage. I see our slides have disappeared or they have a my screen. But I keep talking about So, um, I think essentially what I'm saying is, if there is something you can read that seems scary and you think Oh, my goodness, I don't know how I would manage that. Then I would just say that out loud. Um, because again, you're just highlighting your competence and your awareness of the boundaries of your competence. Um, and you can talk about how you would escalate those patients and who would escalate them, too. So those are just things that you're going to keep in your back pocket or up your sleeve. You're gonna say, almost regardless as to whatever you're presented with. The most important thing of this entire scenario is demonstrating that you know, that patient safety Trump's all it's, I think, and I said this yesterday. But the academic station is the station where, if you really XL, you'll get yourself a job. The clinical station is the one that if you mess up, you'll lose yourself the job. If you do things that are not safe and you do things that seem bizarre or like you have not worked around sick patients before, they have not worked in the hospital before. That is how you'll highlight your inappropriate as a candidate. If you're safe and you're sensible and your logical, you have nothing to worry about in the station. So a few more tricks of the trade so you can. And if you were to ask me or you go ask Alice, do we do these things in our jobs? Usually would say, Yeah, absolutely. So you can always ask for things that you travel. So if the patient who is on well as an award you're not done, you can always ask for things to be done. So they're ready for when you get there. So things like observations. You've already talked about simple bedside investigations like an E c G. Dependent on the competencies of the nurses on the hypothetical ward that you're visiting. You could always ask them to take this if they're able to do that, and you can ask them to set the patient up, for instance, you could ask them to put some oxygen on. If you're worried about them being being the saturated, um, and you can ask them to get equipment ready so you could ask them to if they're not able to put a candida and you can ask them to get all the things that you need to put a candida in or to get an ABG so in ready, Um and that just shows that you're aware that when you're going to see this patient, you're kind of aware that you want things to be ready for when you get um, I'd also encourage people to talk about escalating early. Definitely you're going to talk through your 80 approach, But I think if you're concerned about patients, then it's always good to. As I've already said, Highlight, you're aware of the boundaries, your competence. And if someone did semen, well, you could also talk about calling your registrar or calling us Hoho, letting them know. And that is genuinely something that I still do. Um, you know, as an F two, I still regularly call the registrar sometimes and let them know that I'm going to go and see someone to run. Well, um, and I'll call them back if I have any other problems. And that just shows that you are aware that you work in a team. Um, and it shouldn't be seen asking for help or escalating. Things shouldn't be seen as weakness. It should be seen as the strength. Um, and I think I've just sort of touched on that about communicating with your actions of your team. I think something that's definitely were thinking about more, um, in medicine now And that can only be a good thing. Is thinking about treatment, escalation, protocol or treatment, escalation status. And by that I mean, whether patients are for resuscitation or not and whether patients are, um whether they have previously had discussions around going to I t u or going to a HD you to 11 2 or a level three bed because, actually, if someone is becoming very unwell, but it actually looks like, uh, they are quite conceivably, you could be asked to go. You know, patient has deteriorated, but they have terminal cancer. They are 96 years old. They're incredibly frail. They have a poor prognosis anyway, rushing in and saying We'll do an A to assessment on that person and I put two wide call cannulas in them, and I give them a bag of fluid shows that you're not really aware of. Perhaps a holistic care of patients. Um, and perhaps there is a different, more, well, patient who would benefit from imminent resuscitation. And this patient would actually benefit from a more holistic care plan. Um, uh, and and and palliative care input, for instance. So, um, it can't be repeated enough. So I repeated again. You need to maximize patient safety or clinical scenarios. You need to make sure, um, that you're not just doing that inside your own head, but you're saying that out loud and making sure that people who are assessing you are aware that patient safety is your number one priority. And I'd say probably after patient safety should be your safety, so I wouldn't do things to protect patients. But I would also be really aware that you wouldn't do anything that perhaps would put you at home or any members of staff at home, Um, and again verbalizing when you're aware of you're competencies and utilizing um DT. As you can see, there's very similar themes that are quite repetitive, but they clearly very important. Um, I think if you're calling all of these things, you can't really go wrong next slide. So instead of just listening to me bang on about it, let's do an example. So what I want you to do is I want you to read through this example, and then I'd like you to post in the chat. Who are you going to see first or what order are you going to see these patients and why any of you that are brave enough Feel free to pop in the chat the order in, Which would be these patients, or or who you would. Oh, thanks, Dan, for a pole. Yeah. Who would you go and see first? Okay, so very kindly someone tripped in and said that they go and see a patient to first because they have the lowest GCS. And then they would say, patient one for a high potassium. Can anyone else think of any other just looking at the primary? Any other reasons that you might want to see patients to first? Do you have a possible, like framework or something. You think about what you think about when you go and see. Yep. So, respirator, it sound septic. So I think you're alluding to the fact that it's a breathing problem here, and you use the A TUI approach like an airway. Problem is always the most urgent problem. That's the first thing. And then in order, Yeah, exactly. Issue to be. It's a problem with breathing. Absolutely. And I would. It sounds, really, I think sounds really simplistic. But that's the beauty of the 80 e kind of assessment. And I I don't know about you, but when I when I see people, when I get handovers about people now out of hours, I do in my head think, Do I think this is a problem with the problem, the problem with the problem, the problem, and actually that when I'm really busy, I have other things to be doing that does really clearly, you know, delineate. Do I need to see this person right now? Five minutes, 10 minutes or half an hour. Great. So you guys have put in really good suggestions here. We will talk through, um, in a few slides time how we would go about presenting this if this were an exam, if this were what you got in your interview, so hold on to your thoughts and we will come back to this slide in a bit. So a few things. So we've told you what we think you definitely should be doing. Um, and I think there's a few things. Just a caveat, Um, that we don't think you do or don't don't expect you to do so. Don't get to see all the patients. There's four people there. We just we just put on the list. Realistically, in 10 minutes, it's going to be impossible to succinctly or with any sort of logic, talk your way through for patients. Uh, that you're not gonna be able to do that, and you're not going to do that and answer questions and stuff. So I think you're really only talking about how you prioritize those four people, and then probably more in depth 80 assessment of the first person you'd say you'd go and see and maybe a push the second. You obviously never gonna state that you do things independently without support from, um DT remembering that you're an F one. So there's lots of invasive investigations and management and and definitely medications that you wouldn't give right off the bat. And one, for instance, anything that might need continuous monitoring, uh, stuff like that. And I even now wouldn't do those things without at least calling a registrar. So I think things I can think of as obvious examples is like if I saw someone having an asthma attack, I definitely wouldn't get all the way down to, like magnesium infusions and stuff unless I had already called my registrar. Let them know. And ideally, the registrar had come to see that person. Because if you're if you're down to like a, I guess third or fourth line management and you're just by yourself still, then you know you screwed up because that shouldn't be happening. Um, at least in most hospitals, um, you know, as I said, not going to do anything you're not competent to do. You're never going to leave a patient with a safety net in every single patient. If you get pulled a way to go and do something else, you need to safety net them. You need to talk about how you come back and go and see them again. Um and then you're never going to prescribe anything apart from a very few emergency drugs like I am adrenaline, oxygen and maybe a fluid bolus with at least without at least mentioning that you look at the past medical history, the allergies and the current medications Giving people the heart failure 500 meal bolus is a fluid when they're on furosemide is gonna make you look silly. So don't put yourself in a situation. Anything else you'd add that Alice? Um, not just yeah. Highlighting the fact that, um, yeah, I recognize your limits very early. We're just friends. And, um, yeah, I always speak to seniors at the earliest opportunity. There's always plenty of help around, even on nights, you know, So there's no excuse to not escalate it. So the next few slides are going to talk about the eight we approach. Um, so I think it's super important in this clinical station to talk through exactly what you're thinking. I think by talking through your rationale, the interviews are gonna be able to follow what you're thinking a lot easier and you'll pick up marks along along the way, which you wouldn't have even realized so justify and verbalize every step. Don't be afraid to ask interviewers for key information, any examination findings, and if they have anything to report back then do kind of modify and just adapt to what they say. I think for some people they go into the interview and just kind of monologue, the entire clinical scenario. But my personal experience was that when I asked, Is the airway patent? Yes. And then kind of. They gave me all of the observations for breathin like the respirator SATs, etcetera. So they do expect you to be able to interpret as you go. So I do try and get into the habit of forming a clinical picture as you go through the 80 um exactly. And also always reassess after you intervene or done something new. And once you've completed one part of the A to be, then you would always say I would go back and re assess from a again, Um, and it's really important that you stay by the bedside and just continue continuously monitor the patient whilst there acutely ill, and it's really important. Also to remember that there's almost never one single diagnosis or correct answer. I think there's always so many possibilities, and it might be very obvious to you that this might be, um X, a diagnosis of X. But there's almost always going to be at least two or three differentials that you should try and verbalize. Um, just to show the Examiner that you're not narrow minded, that you're thinking about all of the possible options because I think if you just think of one potential diagnosis and kind of forget about all the other things that could be, then that's that can sometimes be a bit dangerous and just keep an open mind. But obviously the exceptions are cardiac arrest anaphylaxis, where you need to know kind of the emergency treatment. So I would say for the interview for the clinical station, try and know some of them very common drug doses. So for anaphylaxis, you know you can just real off the one. The 1.5 gigs of one in 1000 I Am, and she's given 9.9% saline bolus 500 mils. Um, I think recently there was some changes with the chlorpheniramine and the hydrocortisone, um, in the ls algorithm. But just try and keep up to date with all of the drug doses. Um, And I think Oxford Handbook for Foundation Program is super useful for that has all of the common emergencies. Um, so try and learn those, if you can. I mean, learning doses is like cherry on top of the cake. But if you can remember a few, then that would be that would definitely work in your favor. So for a to assist assessment, I always follow the look, listen and feel approach. Um, so I do this for every single component. So you're always looking first having to feel and then having a listen. So if we just briefly run through this because we talk about it when I present the clinical scenario, um, Airways, always the most important. So if GCS drops kind of, you're going to lose your airway. Um, and so you need to call help very, very early. If there's something if there's a problem with the airway, um, you can try and give to do your airway maneuvers first of all, so head talked to lift your thrust and then use your kind of adjunct. Anything more than that. Probably definitely. I think in the hospital setting help would have arrived and and anesthetist hopefully would have arrived by now. Um, for breathing again. Look, listen and feel looking to check for any cyanosis accessory muscles used the respirator having a feel on the chest and percussion expansion trickle, deviation, and then take a listen. And then once you've done this, you want to kind of investigate. So you want your 02 sat and ABG, possibly a portable chest X ray, And then you would treat so possibly with nebulizers of COPD or asthma exacerbation oxygen therapy, and then you would reassess kind of airway is still okay. Okay, great snack and move on to see, um So again, it's following the look, listen and feel approach investigate and then intervene so that if if a patient's, um federal, then you might consider sepsis. Six. So any patient who's taking fevers has any signs of strep sepsis, then always remember to start the sepsis six and definitely make this very clear to the examiner that I'm worried about sepsis. Um, so that's three in and three out and and then we move on to the for disability. Um, usually you can kind of if you just want a rough measure you can use of poo or with GCS. It can be a little bit. You can take a bit of time to calculate, but it's really useful. You can also check the pupils to see if people are equally reactive to light and accommodation. Um and then just check him for next stiffness. Any signs of meninges, Um, and glucose is really, really important as well, especially in diabetic patients who might be kind of in hospital. Quite unwell, Um, not really consuming anything orally, but still take it in the very high diabetes meds. And then suddenly they become very drowsy and unresponsive. Um, and then the nurse kind of like what's going on? And you check the glucose and it's like two or three. And in that case, you would give 20% glucose 100 miles. Probably bolus um, over 10, 15 minutes, Um, and then as long as kind of your airways still patent breathing and circulation is okay, you can then move onto exposure. So you're taking a look at the tummy, um, and focusing your examination on to kind of what what you think might be going on. And at this point, once you finish your to assessment, hopefully help would have arrived from seniors and you would still stay at the bedside. Continue to monitor um, and then you can briefly try and take a history. If that's possible from the patient, um, and you would document any findings and just go from there in terms of further investigations? Cool. Anything to add? That done? I don't think so. I think it's important that the only two things that actually are that the the more time to talk through this, the more natural it will sound and the more comfortable be and the less you have to think about what's going to come next. And the other thing I'd be aware of is just when you're talking through, obviously going to do a bedside assessment. But you might be asking for things like chest X rays, E C gs and stuff ABG s and just I'm getting used to knowing you're going to ask for them. But the results for those things won't be available immediately, Um, and that you probably won't simultaneously be able to do an 80 and order a chest x ray. So you just say something like, uh, it's part of my assessment of the I'd order a chest X ray once I finish my assessment. And that just shows the Examiner that you're aware of your limitations as a, you know, as a as a clinician. Yeah, absolutely. I think in these scenarios, or at least that med school when you kind of ask for an EKG and, um at some or something, just bring up the BCG. But in real life, you know, it sometimes takes like a good 15 minutes, and then the leads are in the right place, and then things take a long time in hospital. So just if you can verbalize that, then it just does show that you've been in the clinical environment that you've been around in the wards, and that's always a good sign. Great. So in terms of a few more tips and tricks, so you know all of your life threatening causes of common disease presentations. Um, so in that kind of you must know sepsis and phylaxis Cardiac arrest off the back of your hand. Very important. Other differences kind of the shortness of breath. So you're thinking about the pneumothorax? Asthma, exacerbation, COPD, um, pneumonia, acute pulmonary edema. So what are kind of the acute treatments for all of those conditions? How did you manage? Another important presentation is chest pain. So your a c s your aortic dissection? Pericarditis, ps, um, upper GI bleeds. So by that, we refer to kind of viruses. Peptic ulcer disease. Um, what, you're doing what you would do differently. And your management plan for those, um, and then a key abdomen and headache as well, I think headaches, possibly a little bit. Kind of, um, less common in terms of interview compared to like, shortness of breath, chest pain, but still important emergencies that you should be aware of, Like sch meningitis. A bleed, um, space occupying lesions, for example. Always start with the basics. So you hit a tree assessment history. Um, if possible to do your bedside tests besides investigations, um, blood gases and then further would be kind of imaging and more specific investigations for particular diagnoses like I already mentioned before, know the first time management and some very common drug doses. Um, but if you're pressed for time, then don't stress about it. But it's just something that's which kind of set you apart from others. Um, I remember that all of this is real world. I mean, in a d d h, You wouldn't be requesting, like a nuclear medicine scan at two AM in the morning. Just be realistic with what you can order. Kind of chest X rays are available I/O of hours. So that's something that would be commonly requested for kind of most emergencies. Just be aware of kind of the resources around you and what you can and can't order I/O of hours. Cool call over to you, Dad. Yeah. So once we've talked through your prioritization and you talked to your 80 and you smashed all of that and the example just kind of sat there thinking, you know, this person thinks they're pretty good at this. Um, they'll probably throw you some sort of ethical legal question. And often these are around very common areas. Things that definitely you'll be familiar with will have learned about the med school. Probably come across before replacement to be fair as well, potentially so things like capacity and consent. So you may be asked, what is capacity? What? What are the things that make up a capacity assessment? Um, around consenting for things, For a procedure, for instance. And, you know, you would know as an F one you would unlikely to be, uh, consenting someone for a procedure. Given that you're not going to be performing that procedure or most likely unable to do that. Things that get it competence, um, dealing with violence and aggression on the ward or angry relatives. How would you do that? What? What would be a safe thing? What is a safe thing to do? How can you protect yourself and the other members of the team? Um, uh, I think probably this is a little bit mean, but things like Jehovah's Witnesses have people with very religious, uh, specific religious views and around things like blood transfusion. Um, and then, uh, definitely something you need to know about. So mental mental capacity act and mental health act different types of section and the you know, things like, Can you treat physical illness against the ones will who is under section you can. It can only be for their psychiatric illness things. That declaration of liberty and stuff. Yeah, You don't need to know the ins and outs of all of these things. They're not expecting you to know. You know, you're not. You're not done a law degree. You've done a medical degree, but they are expecting you to know where you look, who you'd ask and how you go about dealing with this problem if confronted with it out of hours. And I think that's a bit that people find perhaps a little bit intimidating. Um, but, uh, you know, by being clear and even saying things like, I'm not sure the person I would ask is or I think this is a I think this is a decision that would be inappropriate for me to take. I would like to speak to my registrar. Just highlights that you're again aware of your competency. Most decisions out of ours, the really big ones. So things like best interest decisions and stuff can definitely wait. They shouldn't be taken undertaken by an F one out of hours that should be made as part of, like, best interest meetings, family meetings, um, buy consultants or registrars in daytime hours. Unless they're really pressing. If they're really pressing, you should always be treating a patient in the best interest. Um, involving other members of the team. And, um, if you're going to give an answer, be really confident about the answer you're going to give. Don't give half an answer and then let the panel kind of beat you around to the to the other answer. I think if you're gonna say something like, I don't think this person has capacity, I would, uh, I think, submit deprivation of liberties safeguarding for Morris, a nursing team to do that. And I would treat them as if they don't have capacity. Don't. Then let the panel sway you into thinking this person might have capacity or something. Stick to your guns and be confident. Absolutely. And I just remembered as well. I think some other common areas which can sometimes come up is like patients wish to self discharge. And, um, first of all, like patients are totally able to self discharge. But we need to first ensure that they have the capacity to make that decision. I e. They're able to understand both kind of risk and benefits of themself dark discharging without without completing the course of treatment. Are they able to retain that information kind of way up those pros and cons and then communicate their decision back to you? Um, so they do need to fill out a form if they want to self discharge. But you need to highlight that. Even though they're self discharge and declined our inpatient efforts, I still need to make sure that they followed up in the community. And I'm still going to do the discharge summary and inform the GP of of what's happened in in hospital and that they still need to be followed up, et cetera. So I think self discharge in patients can, um, sometimes be an area which is asked about. And like I said, with the safeguarding things, um, and mental health acts will always have senior support to help us. Um, and always make sure that you have a red a consultant on hand to help you with those kind of things. So, like we were saying before, um, Oxford Handbook of Clinical Medicine and also Oxford Hamburg of Foundation program really useful in terms of management of emergencies? Um, the common, the most common drug doses that you need to know as well. Also referred to a less resource council, Um, and like British society of like thoracics for kind of, um for lung conditions, just the kind of various websites which a specialty catered towards. And if you want to have a look at GMC as well, they have quite good documents on ethical guidance and what we should and shouldn't be doing as doctors. And so just give a rid of those before your interview as well. So essentially, practice practice practice as much as you can. Um, I think after a while, these clinical scenarios do follow very similar structure because you're always using a TUI. Um, and then you need to modify in terms of what the presentation is. Vary your practice with your colleagues, um, others that are applying to sfp non sfp friends. Um, if possible, on your placements, just ask to talk to a patient with with any of the foundation doctors. You're s h O s. I'm sure they'll be able to give you lots of good feedback and always be really harsh critics of each other. I think the more you criticize each other and, um kind of able to recognize your limitations from an early stage, the faster you'll improve, and you'll definitely be able to get to a really good standard once you reach that interview date and super important to shadow. I know it's difficult having to balance med school and exams and UK fbo. But do spend time, if you can, to shadow an F one F two out of hours to really understand how things happen. I think out of ours you do a lot more kind of doctor in, as it were, as opposed to in ours, where there's a lot of paperwork that should be done like discharge summaries. But out of hours, you can see a lot more acute presentations. Um and yeah, so I would recommend them like maybe one or two as a med student, I think would be very useful. Anything like that done? No, I don't think so. I do think that I can't understate how useful it is. Um, as you said to go and shadow and if one of ours just go and go and shadow one don't need to do lots of evenings of it. Probably don't even need to go over night or anything crazy like that. But going to one and uh, perhaps watch them do an assessment of a patient and then perhaps volunteered to do one yourself. I think having done lots of mock exams last year for people who are applying to SFP, it was really, really clear obvious who done an A to the assessment before. And kind of you could Yeah, I think you could probably tell people have done an A to assessment in real life people who are just talking through it but don't quite know actually what they're talking about asking for, um and the more real life experience you get not only will help you for this interview would also help you for finals. And then actually, life is never one, um, which, although that's a little bit further away than these interviews, is something to be aware of that, actually, the most harrowing and difficult bit of being an F one is the out of our stuff going and seeing sick people. Um, preparation for this, uh, interview is really helpful for that. But also going and seeing people and shadowing If one is equally as important. I think um, someone else with the Oxford Hamburger Foundation for Oxford Hamburger for foundation Be sufficient alone. I've just had a quick flip through it. It, um it does cover the same so of emergencies to the exact same kind of level of detail and has similar diagrams. So definitely I use that, and it's got this right sort of stuff in it. I think the only reason that I prefer the Oxford Handbook of Clinical Medicine is all the emergencies in one section at the back of the book. So you don't have to leave through the book to look forward to look for, um, fine. I think it's probably enough resources and stuff. Absolutely great. I think you're now going to talk through how you would do this in the interview. Yeah, so I'll kind of give a pill of how I would go about tackling scenario. Um, I'll try and set a timer for, like, five minutes, so I don't bore you guys too much. Okay, So I probably would have written down a few things just to jog my memory about each of these patients and then kind of in the interview, I would always start off kind of saying, um so patient safety is always my top priority. So I want to take an SVR hand over for each of these patients and get the most recent set of observations as well. From the nurse having them over. Clearly, there are four competing priorities. Um, personally, I would choose to see the second patient first because I think that they're at the greatest risk of deterioration. It's a breathing problem there, de saturating on 10 liters of oxygen and the panic. So before I even start to go to the ward, I'm going to I would like to ask the nurses to put on 15 liters. Um, then we breathe. If the patient desaturates, then they need to please put out a med call. Um, and that might include the critical care outreach team as well. In terms of the other patients, Um, patient one. I would ask for an e c g to be performed in the interim, um, to put into can, really in case we need this later. And to repeat the potassium as well, using a BBg as this comes back a lot for us compared to lab, um, I would also communicate this to my seniors to let them know that there is a patient with high potassium on the ward patient for, um, I would kind of ask the nurse for a recent set of observations and any advice about, um, general nursing Kind of if they're able to reorient eight the patient and address any underlying causes that might be causing the delirium and then patient three. I'd just like to clarify she's POSTOP And what, um, what the pain nature is like. I'll let them know that I'm currently attending a medical emergency, but that I would try and speak to them. Hopefully a little bit later on my shift. Cool. So whilst I'm on my way to see patient to, I'd let my S h o already know. Um and I asked the nurse for two IV access is an ABG if possible, and then to repeat the obs. Also, ask the nurse to be at the bedside with the notes and drug chart ready for when I'm there. So, on approaching the second patient, I'd introduce myself from the end of the bed and generally inspect the patient ID, then assess and resuscitate the patient is using a structured activity approach, and I would then investigate and treat, um, in line with the local and national guidelines. So first of all, I'd like to see if the Airways Patton if the patient verbalized and then I can assume that the Airways patent And if you could interrupt me at any point if there's anything to report, um, if not, then I would just continue my A to assessment. So moving onto breathing, I'd like to look for any evidence of respiratory distress, so this might include accessible use of muscles of respiration. Um, I'd like to listen to see if there's equal air entry bilaterally and listen for any wheeze. And I'd like to feel for central trachea, um, and briefly check for symmetrical chest expansion. I now recheck the 02 saturations whilst on 15 liters and measure the respiratory rate. I'd also like to perform an ABG um, in view of the low oxygen SATs per, um, request, a coated swab and portable chest X ray might be something which would need to be done later. So I would now like to, um, continue to go back and reassess. So if the airways still patent Then I'd move onto assessing circulation. So here I'm just seeing if the patient checking that they have moist mucous membranes Check the JVP I'd auscultate the heart sounds and listen for any basal palpitations And I would have a feel for the apex Be the pulse. Um measured the central and capillary refill time I'd like for BP to be checked as well again and e c g to be done If this has not been performed already, I would make sure that there's two IV access present in both anti cubital fossa. Um, this would be using two large ball can really? And I'd make sure blood were sent for routine blood. So fbc using these lft um potentially d dimer cotton. And you can kind of cater this to whatever your differential are. The patient here is not hypertensive. But if they were, then I would consider a 2 50 or 500 mil bolus, um, depending on any history of heart failure. So I would now go back and re assess a A and B and if I'm still happy that these are okay, then I would move on to assess and disability so to assess neurological function, I'd briefly check the GCS. Um, I would also ask for a copy of your blood glucose level and treat accordingly. If hypoglycemics, um, I'd also check that the people are equally reactive to light and accommodation, and I would ask for a temperature as well. Um, finally, I would expose the patient's abdomen and check, especially for any skin changes, any rashes and any injuries. And then I would perform a brief abdominal exam. If indicated, I'd like to check the cars for any evidence of DVT, and at this point I would go back and re assess. I would have hoped that members of my team would have arrived by now. But in the meantime, I'll stay at the bedside and continue reassess. Um, if possible, I would try to take a brief history from the patient as well and document my 80 findings and hand over to the nurse. Um, just what's been done and what what needs to be done. Still, So that's just I think I went over. I think it was like 5.5 6 minutes, so that's briefly how I would kind of run through that example, it can be done, I think. Yeah. Within 56 minutes, I made it quite clear from the beginning, um, that I would see patient to first. And I could go on to tell, say, my differential. So I would be worried about the ambulance and potentially keep home. I had, um, a a pneumonia, a lower respiratory tract infection. Um, and then I've also, in the meantime, kind of explained kind of given, um, instructions of what I think each patient should have in the meantime, while I'm attending to patient to, um And I think it's really important always to kind of say that if over the phone, if the nurses really worried and you're not able to make it there in time, then put out a med call or, um, I think in some trust they call it a perirectal school. But never be afraid to escalate. And to put out one of these calls. I think the first time I did it was quite scary, but, um, but you'll get used to it, and it just means that at least the patient is safe, and that is the most important thing to keep patients safe cool. So I hope that was useful going through that example. Um, any questions then do pop them in the chat, I think. Okay, so you just have a few more slides. So this is taken from your handbook, Your u K f your SFP handbook. Um and you can just have a read through and then your free time. Just have a think through what what you would do and how you would manage this scenario. I think the more scenarios you can practice and definitely talk out loud, um, that makes a really big difference compared to just thinking things through. So do speak out loud what you would do and compare with colleagues. Or, you know, when you're on placement, just discuss with any of the F one f two say chose. I'm sure they'll be happy to help. Cool. So that takes us to the end of today's session. We have kind of six minutes before to take any questions that you have, whether it's clinical or academic, and we'll be more than happy to answer them. But if not in the meantime, um, join the Facebook group, you can email us at SFP at minor bleed dot com, and we're also hoping to run some mock interviews in the coming weeks. Um, I do make sure to sign up by the Google form in Sorry. Here. I can post a link in the chat box as well. Um, and please do fill out the feedback as well to our code is here. And also a link in the chat box. It really helps us kind of, um, improve sessions for the future. And also evidence this that we've provided teaching. So really grateful for you guys attending and also filling out feedback. So I think we'll give it a minute or so. In case anyone wants to drop anymore questions. Yet we've posted a link for the sign up. I just Yeah, I just posted it below, and yeah, I mean, that's what we We can float around here for a minute or a couple of minutes and see, if not. Thank you so much for coming along. Please do Leave us some feedback and hope it was useful. Alice, do you remember what your things you asked? You can't. Yeah, I wish I could. You know, it just passed so quickly. Um, I remember it was. I think it was four. It was four scenarios, and there was, like, an angry relative. Um, I can't believe it was just one year ago, but I honestly can't remember. Do you? Yeah. Relative. Someone with the low BP who's POSTOP and someone in pain or something like that. Someone in pain with, I think, with an a k I. Or with chronic kidney disease? Uh, no. I had all different ones. Quite quite different. Um, I feel with these clinical ones, like the first read through of the scenario, it's just very obvious. Like the order, I think personally compared to abstract I found, like, abstract. I could just take ages on it, and I wouldn't know what it's really going on, But with clinical, it's more of a gut instinct. What? I just like blind, I just, uh, like just applying the 80 and just knowing that, like, you're probably not going to get anyone with an a problem. Realistically, that would be to give to a to an F one manage this airway like you're not gonna be able to do that. So it's like a big problem goes first. Uh, well, It's probably a big problem first, um, we've actually got some questions. So was the Cambridge clinical interview you did similar to London one? Um, uh, Yeah, I guess so. Mine was I wasn't I don't remember giving being given, like, a sheet of paper to read. I think they just said it out loud. It was something crazy like that. It was maybe a memory. It feels like they just said Okay, well, let's tell you about a case, and you can make some and you can make notes. We talk and then tell us what you do next. And it was like you're doing this and this person has It was a drug reaction or an anaphylaxis or something. But they didn't I didn't get to read anything. I think they just said it out loud for memory. I don't know whether you remember, but it was the same. Yeah, they're still expecting you to do the same things which is basically recognize the sick patient. Given emergency treatment escalate is appropriate and prioritize or safety net things that you can't deal with because there's an emergency going on. And that's essentially the function of an F one which is two. See who the sick people are in the hospital out of ours, and either fix it really quickly or escalate it to someone who can fix it. Um, and yes, it has been recorded. Yeah. Um, how did we split? Or 15 minutes between stations. So I spent three or four minutes preparing, like, writing my notes from my clinical station, and then about 10 or 11 minutes doing academic, um, station stuff. Yeah, Same. I think I spent, like, first 7 to 10 minutes, 8 to 10 minutes, kind of getting my head around, um, the abstract and taking notes from there. And then the clinical was a lot quicker. So I just read through it, once, made the appropriate notes and then kind of rank them, wrote down a few differentials for each patient. And then that was done. And then I think I had, like, one or two more minutes to go back to the academic abstract and just process it. Yeah, I would highly encourage. I mean, as you've definitely heard, as Alice expertly kind of went through when she was talking through the clinical station. For many for many unwell patients, you're going to do the same things. You're going to examine them in the same way. That's the beauty of the data assessment. It's an objective, thorough assessment that shouldn't change dramatically between patients. Especially undifferentiated. Unwell. Patients don't want to miss things. So you're gonna do the same thing for your patients are going to say the same things for every patient. Um, and it's not about At least I don't think so. It's not about spitting out diagnosis like midway through. This isn't the house you're not doing like a spot diagnosis from the end of the bed. So you don't have to worry about doing any clever like mental acrobatics. You're just going to talk through the clinical station. So once you've got comfortable talking to anything, actually, station is pretty easy to do, I think, um, fine. Anything else you wanted to say, Alice? If not, I think it's eight PM and we can probably bring it. Yeah, I think so. Yeah. If no more questions, then thanks, guys, For joining. Please do fill in the feedback. Be super grateful if you do Good luck for preparation and, um, reading and things just enjoy the process. Remember that you're learning a lot right now, but it's also going to be super useful for finals and even more useful for when you start work. All of this will become second nature to you. And yeah, you'll just find a fun life, um, finals a lot easier compared to peers. So do take this as a really good opportunity to get really sharp and all your clinical skills. Um, but yeah, Any questions? Feel free to message us or email us sfp a minor bleed dot com and, yeah, just good luck from from me and from down as well. Good luck. Uh, I think important to say the fact that you've got to this position and you're preparing for these these assessments means that you you know, a testament how far you've come and all your hard work through medical school. So best of luck with your applications. Um and, uh, yeah, you should be really proud that you're in this position. Absolutely. Bye, guys. Have a good evening.