General interview Flashcards
1
Q
what to do if patient is peri-arrest/severe circulatory shock?
A
get crash trolley and put defib pads on
2
Q
what to do if you think the patient may need to go to theatre?
A
clotting
G&S
keep NBM
hold any blood thinners
3
Q
what to remember about teamwork
A
- be specific when task you assign individuals and ensure appropriate for the tole
- if you think pt will need cannula/ECG, ask nurse before you do your spiel
- closed loop communication
- check tasks are completed
4
Q
key structures to use in answers
A
- A-E when assessing/managing patient
- SBAR when handing over
- SPIES structure with difficult patient/relative/colleagues
5
Q
how to list differentials?
A
systematic approach
- highlight most likely and most dangerous
6
Q
how to list investigations
A
- examination
- bedside
- labaratory
- radiology
7
Q
why anaesthetics?
A
- wide variety of clinical exposure and therefore MDT working (link to my experiences in F1 anaesthetics/ITU/DSU –> spinal project, pre-op importance and course)
- ability to be involved in teaching and simulation (recently completed GIC ALS, working with senior trainee on restart a heart campaign)
- very procedure orientated (F1 job –> bronchoscopy, CVC, art lines, even vascath now on renal)
8
Q
what is your experience in the speciality?
A
- started with BSc in anaesthetics and ITU (effect of vasopressin and hydrocortisone on cytokine trajectories, poster presentation)
- self selected module, elective in VIetnam in anaesthetics/ED
- hand selected jobs that had anaesthetics/ITU and complementary specialisites (renal/ED)
- Courses (ALS, airway matters, perioperative anaesthesia, TIVA)
- QIP (ganapentinoids, ambulatory spinal)
- research (genomic)
9
Q
what are the difficulties are anaesthesia?
A
discussion with anaesthetists reinforced aspects of career I enjoy but helped me identify challenges
- difficult exams (safe anaesthesia is utmost importance and takes lots of knowledge –> worked hard for exams in past, earned awards, London Gold medal)
- bottle neck at ST4 (aware of self assessment portfolio and ehnace my career throughout core training, one aspect is POCUS)
10
Q
tell us about your career to date…
what model to follow
A
CAMP
Clinical
Achievement
Management
Personal
11
Q
key clinical achievements of career to date
A
12
Q
key academic aspects of my career to date
A
- QIP and writing local guidelines for ambulatory spinal pathway in DSU patients (questionnarie found lack of confidence in doing it without local guidelines, lack of knowledge in nurses)
- Published and International confrerence
- GIC ALS course
- Gabapentinoid QIP
13
Q
management achievements of career to date
A
- F1 representative
- F1 leadership award
- LEEP
14
Q
personal achievements of career to date
A
- sports (triathlon, hyrox)
- St john ambulance cadet help (values my time as cadet growing up)
- GP to London refugees
15
Q
what makes a good anaesthetist?
A
- good communication skills (recent GP placement, patient feedback/TAB on my rapport
- strong leadership and teamworking (F1 leadership prize, F1 rep working with MDT/PGME/clinicians, anesthetists work seemlessly with surgeons, nurses, operating theatre)
- remaining composed under pressure. Anaesthetists make quick decisions and adapat to rapidly changing conditions while clear focused mind. Recently while away, OOCA, limited resources
16
Q
where do you see yourself in 5/10 years time?
A
- complete primary FRCA
- ST4 number
- involved in research
- POCUS skills
17
Q
what are the challenges facing anaesthesia?
A
- increasingly frail co-morbid patients
( NAP7 highlighted co-morbid patients inc risk of experiencing perioperative cardiac arrest, I did pre-assessment clinics with senior anaesthestics, complete future learn) - Sustainability
- 3% of carbon emissions
- TIVA more sustainable, but plastic waste (re-use synringes)
- less nitrous oxide
18
Q
what are some aspects you find difficult about anaesthesia?
A
- exams (over the years I have developed my study skills successfully which has allowed me to win exam prizes, distinctions and even represent Imperial medical school in London gold medal)
- steep learning curve (I felt a similar way doing my anaesthetic job in F1. I found so many valbule courses on e-LFH, future learn and asking questions from colleagues/ gaining as much exposure as I physically could)
19
Q
what are the 4 key non-technical skills?
A
task management
team working
situational awareness
decision making
20
Q
example when you showed all of the technical skills
A
- only SHO Renal weekend ward cover
- nurse alerted me to an acutely deteriorating patient which I reviewed as a priority over other ward jobs
- new drop in GCS with a right pupil that was smaller and not reacting
- liaised with the radiologist, CT radiographer, nurses and the porters to get an urgent CT Head
- I accompanied the patient to CT, anticipating further deterioration that may need urgent action (situational awareness). - new brain haemorrhage so along with the consultant and the family we made a decision to palliate the patient.
21
Q
what is clinical governance?
A
- systematic approach to maintaining and improving quality of patient care within health system.
- Framework through which healthcare organisations are accountable for continuously improving their services and safeguarding high standards of care
22
Q
how have you been involved in clinical governance?
A
- developing local hospital guidelines for ambulatory spinal anaesthesia in DSU
- involved the pillars of clinical audit, education and training
- Using a survey, I identified a lack of experience in day case spinals, despite a national guideline
- I provided education to anaesthetists and nursing staff
- created an infographic and presented these to the clinical effectiveness committee to get the local guidelines approved
- have gained valuable insights into importance of clinical governance and importance of a structure, collaborative approach.
23
Q
how would you improve your CV intro?
A
whilst I have built a robust CV underscoring my readiness for anaesthetic training
I believe my CV can be enhanced to ensure I am the best anaesthetist I aspire to be
24
Q
clinically how do you want to improve your CV?
A
- focus on US skills
- gain proficiency in POCUS to help guide management for emergency scenarios
- also help develop my ability to do neuroaxial blocks in future allowing me to deal with more complex comorbid patients (i saw in my time in perioperative clinics)
25
how would you like to improve your CV academically
Undertake more research
- enjoyed my BSc looking at effect of vasopressin and hydrocortisone on cytokine trajectories
- also helped collect data for Genomic and more recently Vitdalize
- passionate about doing more research around pharmacology
26
how do you plan to improve your CV through teaching?
- already involved with ALS teaching and restart a heart day
- want to develop teaching programme for final year/F1 re unwell patients/NIV. More recently, I've been F2 overnight dealing with patients on high BiPap pressures without formal teaching
27
how do you manage stress?
- stress guaranteed part of job
- being anaesthetist can result in lots of mental/emotional stress (dealing with sickest patient of hospital and need to assimilate information quickly and make decisions)
- learnt to recognise signs of chronic stress (sleep disturbance, irritability)
- exercise outdoors, challenges with that
- travel and plans outside of work (resolution)
- ensuring mental and physical resilience allows for better patient care
28
what is professionalism?
- outlined by GMC encompasses set of values, behaviours, relationships that underpin trust that public has in doctors
- important in anaesthetics due to high stakes work
29
important aspects of professionalism
- patient centered care
- clinical competence
- follow appropriate ethical and legal standards
- inter-professional collaboration and professional development
30
example when I showed professionalism
- patient on ward that developed sudden onset SOB/pleuritic chest pain
- not on VTE prophylaxis as admitted with UGI bleed and not restarted
- carried out appropriate investigations
- worked with MDT and added section on live board which details if assessment done to prevent future errors
31
what is your biggest weakness?
32
what makes a good communicator?
1. active listening
- different members of MDT and patients
- from GP and consultation skills tutorial
- give people space to talk, can address concerns first couple of minutes
- positive feedback from pt/TAB with comms skills
2. Adaptability and knowing audience: communication styles need to be addressed. Colleagues vs patietns
33
explain how you have been involved in quality improvement
PLAN-DO-STUDY-ACT
- lead ambulatory spinal project
- identified issue through staff survey, looked at data, made inforgraphic, discussed at clinical goverence, taught nurses, CEC meeting
- needed teamwork and stakeholder engagemetn
- broader patient impact = more complex comorbid patients can have day surgery, less NHS money
34
how do you do reflection?
- I reflect daily on patient encounter. Some brief and just take some self notes
- Some larger reflections, I do on my portfolio and use Gibbs reflective cycle to guide process
- Also have been reflection representative this year to help guide my fellow colleagues through group reflection to enhance and share relfection and learning process
- example syringe driver
35
describe significant event involved in
- Accidental syringe driver dose prescription for dying patient. Busy weekend ward cover over Xmas
- Thankfully they had PRN written up
- Palliative care came to find me to discuss situation, reflected with them
- Reflected, duty of candour, did script module and datix
- Now I do cancel re order
- Ensure constant professional development and organisational development (incidents are learnt from as a whole)
36
give a time you worked in a dysfunctional team
- Geriatric rotation, we had 6 locum consultants
- was no effective trust or team working amongst the MDT on the ward
- deteriorating patient, was clear the consultant was not going to step up and help lead the team
- break down in communication and trust; however, patient is top priority
- peri arrest call in order to get an effective team to help
- Stark contrast between how effectively the resus team worked (having only huddled that morning but by having defined roles and responsibilities/ a leader)
- following stabilisation, escalated to medical director, we sat down to discuss
