Interview questions

Question 1

Explain why you would want to do clinical oncology as a career?

Answer 1

Interest in oncology
- MRes
- Clinical attachements
- Work as registrar

Quickly evolving field with many new treatments coming through

Ability to help and impact patients and make meaningful treatments

Follow patients through their treatment and help support them

Team working

Question 2

Please outline a difficult case you have had to manage

Answer 2

GRI case

50 year old admitted with worsening neuropathic right arm pain

Previous visit to ED which on retrospect showed lesion at apex of right lung - awaiting CT thorax

On Ct thorax reported Friday afternoon - showed probable lung malignancy with erosion into T4 body with probably MSCC

Discussions with neurosurgery and oncology

Discussions with husband and wife and breaking bad news

Starting treatment

Question 3

Please give an example of an mistake you have made and your actions following this

Answer 3

During receiving shift on a medical assessment ward a woman was referred in with a history of abdominal pain with a family history of AAA rupture from the rheumatology clinic

I was handed over to chase the report of the CT scan which in the conclusion did not show any evidence of acute coronary syndrome. However in the body for eh report it was noted that the Aorta was enlarged at around 6cm

The following day, the report was amended by the radiology consultant regarding this and advised urgent referral to the vascular service

Question 4

Please describe a weakness of yours

Answer 4

Over critical

Self-confidence

Question 5

Please give an example showing how you are a team player

Answer 5

While working in radiation oncology in NZ, we had a patient undergoing curative chemoradiotherapy for a HNSCC.

In the centre we treated patients for across a wide geographic area, and so some patients stayed in temporary accommodation while completed longer courses of radiotherapy

This patient did not have much family support with her and struggled through treatment with a number of side effects to be expected. She unfortunately did miss a number of fractions because of this.

We would see her regularly to evaluate her symptoms, and worked closely with the nurse specialists, radiotherapy technicians, nurses on the ward, cultural liaison for Maori people in the hospital as well as involving her family with her consent

Question 6

Please give an example where you showed team leadership

Answer 6

Undertaking a respiratory QIP in the inhaler management of COPD to ensure up titration of inhaler therapy to triple therapy inhalers for COPD patients admitted to hospital

Working with pharmacists and more junior staff

Delegating jobs

Question 7

Please give an example where you showed empathy

Answer 7

While covering medical HDU, there were a number of seriously ill patients, often at the ceiling of their care

A 55 year old man, very comorbid with servere LVSD and COPD was admitted from home with necrotising fasciitis, felt that would not be a surgical candidate due to comorbidities and had been having IV antibiotic treatment

Unfortunately was worsening despite this. His wife was with him

Spoke to her of his deterioration with nursing staff present

Offered support and to call his extended family

Offered chaplain

Would check on her throughout the evening

Organised room in the hospital for her to have a bed

Question 8

Please explain a situation where you had to consent a patient in a vulnerable situation

Answer 8

Schizophrenia patient with fungating tumour

Patient in NZ with history of schizophrenia attended with CPN

Not sought medical treatment earlier, had been encouraged by CPN, but had been mistrustful and did not wish to seek advice

At point of referral had a large fumigating breast tumour, for which he had been prescribed a palliative dose of radiotherapy

Explained process and involved CPN
Invited questions
Tried to build rapport

Question 9

Tell us what you know of the training programme in clinical oncology

Answer 9

Enter into ST3 oncology common stem year
- Development of CiPs related to areas of overlap between medical and clinical oncology

Requiring to enrol with the Royal College of Radiologists

Clinical oncology specific ST4-7
- Clinical oncology specific CiPs

Four exams to obtain FRCR (oncology):
- FRCR Part 1 - Oncology - investigation and management of cancer patients, tumour biology, mechanism of cytotoxic drugs, statistics and physics - usually done in ST4
- FRCR Part 2A - radiotherapy and drug therapy - Usually done in ST5-6
- FRCR Part 2B - Usually done in ST5-6

Question 10

Tell us of your teaching experience

Answer 10

During university:
- SSC with university - anatomy demonstrator for medical/Dental and biomedical students, and clinical skills

Teach the teacher course online

Teaching at hospital:
- ICI with case study of triple M syndrome

Teaching medical students in hospital and online e.g. Haematology and oncology SBAs for medical finals - universities throughout the UK

Question 11

Tell us the qualities of a good teacher

Answer 11

Sets specific and challenging goals
Able to give good quality feedback
Encouraging
Enthusiasm and shows enjoyment in their topic
Adapts the teaching for the students
Involving

Question 12

Please describe your experiences with QIP/audits

Answer 12

QIP in F2:
- Immunisation in <5 year olds

Audit in radiation oncology:
- Treatment with RAI in thyroid cancer - presented at national meeting

Audit of ophthalmology reviews with hydroxychloroquine in a rheumatology department

QIP in resp:
- COPD

Question 13

Difference between audit and research

Answer 13

Audit - Process comparing clinical practice against set standards

Research - Aimed to create new knowledge that can be used to develop new standards of car

Question 14

Please outline your research experience

Answer 14

MRes
Attendance at journal clubs

Question 15

Please outline why research is important in oncology

Answer 15

Evolving medical field, with many new treatments and technologies becoming available

New treatments help with patient survival and outcomes

Example in the ICIs

Question 16

Please outline your interest in research

Answer 16

Know that it is important

Outline reasons you wouldn’t necessarily be involved in research
- Prefer to be patient facing

Question 17

What is research governance

Answer 17

A framework setting out principles of good practice in the management and conduct of health and social care research in the UK

Full guidelines set out in the Health Research Authority document

Principles include safety, competence of the staff undertaking the trial, scientific and ethical conduct, patient, service user and public involvement and integrity quality and transparency

Question 18

What is evidence based medicine

Answer 18

The use of best evidence in making decisions about the care of individual patients, alongside your own clinical expertise and judgement

This is applied to a specific case, taking into account patient values

Question 19

What are the different levels of evidence available

Answer 19

1a. Systematic review or meta-analysis of RCTs

1b. At least one RCT

IIa. At least one well-designed controlled study without randomisation

IIb. At least one well designed quasi-experimental study e.g. cohort study

III Well designed non experimental descriptive studies e.g. comparative studies, correlation studies, case-control studies and case series

IV. expert committee reports, opinions and/or clinical experience of respected authorities

Question 20

Please outline types of clinical trials

Answer 20

Randomised controlled study:
- Two or more study groups followed up over time which differ in interventions. Usually introduction of new therapy in one group with standard of care in other
- Can be blinded with use of placebo and double-blinded in which clinicians do not know where patients have been allocated

Cohort study:
- Follows a group of people over a period of time
- e.g. identifying risk factors over time in a population in who develops cancer

Case-controlled study:
- Looks at people who have a disease and assess against a control group over risk factors developing the disease. Opposite of cohort study
- Quicker and cheaper than cohort studies but often less reliable

Cross-sectional study:
- Carried out at one point in time, or over a short period of time. They find out who has been exposed to a risk factor and who has developed cancer, and see if there is a link.

Question 21

What is clinical governance

Answer 21

Quality assurance process, in which clinicians should be involved to maintain and improve the quality of care that patients receive and ensure that the NHS is accountable to the public

Question 22

Outline the ethical principles

Answer 22

Beneficence - act in patient’s best interest

Non-maleficence - do no harm to patients

Justice

Autonomy

Question 23

Outline the different stages of clinical trials

Answer 23

Pre-clincial trials:
- animal models/ex-vivo/in-vivo/AI assisted

Phase I;
- Tests small number of people with trial drug to ensure safety and identify side effects, and identify dose

Phase II:
- Given to medium size group to identify effectiveness an for safety profiles

Phase III:
- Large groups comparing to gold standard treatment to identify effectiveness

Phase IV:
- Following approval of medication, long term study of side effects

Question 24

How can you assess capacity

Answer 24

Understand

Weigh up risks

Retain

Communicate

Question 25

What are the seven pillars of clinical governance

Answer 25

Clinical effectiveness and research - Evidence based approach - adopting new guidelines Audit Risk management - Complying with protocols e.g. hand washing - Learning from mistakes M&M - Reporting significant adverse events e.g. Datix Education and training - CPD - Exams - Appraisal Patient and public involvement Using information and IT Staffing and staff management CARE mnemonic for the top four PIRATES for all

Question 26

Difference between competence and capacity

Answer 26

Competence is a legal judgement Capacity is a medical judgement

Question 27

Five principles of the Medical Capacity Act

Answer 27

1. Presumption of capacity 2. Individuals should be supported to make their own decisions 3. Patients have the right to make what may be deemed as 'unwise decisions' 4. Anything done for a patin lacking capacity should be done in their best interests 5. The less restrictive option should also be used in a patient lacking capacity

Question 28

What is your biggest achievement

Answer 28

Presenting at the RANZCR conference in Queenstown NZ

Question 29

Tell me of a recent research article you have read

Answer 29

ARANOTE trial - Darolutamide in combination with androgen deprivation in patients with metastatic hormone sensitive prostate cancer Phase III trial Darolutamide plus ADT significantly improved rPFS, reducing risk of progression or death by 46% versus placebo

Question 30

What makes you a good team player?

Answer 30

Conscientious Will catch up with team mates regularly Diligent

Question 31

What makes you a good leader?

Answer 31

Able to delegate Try to take account of team members strengths Supportive

Question 32

Describe a situation where you showed professional integrity

Answer 32

Death certificate on ward 10 Came back from leave and death certificate had not been completed as had to be reported to the procurator fiscal Cleared in the afternoon prior. The morning in question family rang up multiple times asking for death certificate to be completed, had to deal with a number of sick patients During phone call, patients family showing quite a lot of pent up emotion and dissatisfaction with patients care Apologised for wait, explained wait, and directed towards PALS Discussed with consultant and completed death certificate

Question 33

how do you handle stress

Answer 33

At the time I organise with list and try to prioritise and delegate where possible Try to plan ahead such as exams or with deadlines Support from friends

Question 34

What do you like least about this specialty

Answer 34

Can be emotionally difficult, following many patients for a long time, and unfortunately some will relapse There are also some very unlucky patients e.g. 31 fire-fighter with lung cancer with two young children

Question 35

Please explain the clinical oncology curriculum

Answer 35

Number of generic and oncology Capabilities in Practise (CIPS) Generic CIPS can be covered in OCS Specific oncology in St4-7 years such as brachytherapy, radiotherapy planning, SACT The scientific basis of cancer and its treatments Acute oncology presentations Tumour types - rotation through these in St4-7 years Emerging technologies e.g. genomics and AI

Question 36

What have you done to demonstrate commitment to specialty

Answer 36

Placements throughout the years Audits in RAI in Palmy Year as work as a radiation oncology reg - experience of the department and clinics

Question 37

Take me through your CV

Answer 37

Oncology experience: - F2 experience - SHO and registrar experience in radiation oncology in NZ - working on oncology wards and in outpatient settings, treatment reviews with radiotherapy patients, consenting to radiotherapy, radiotherapy planning Academic achievements: - Distinction in MRes in oncology - research project looking at radioresistance in medulloblastoma Audits and QIPs: - RAI audit in NZ, presented at national conference - Immunisation QIP - two full PDSA cycles, led audit, worked with CSWs, clinical support staff, RNs, GPs, updated practice guidelines, presented locally - Audit in retinopathy screening in rheumatology - presented locally Achieved MRCP Teaching: - Teaching experience in Uni with SSC in anatomy - Teaching session - grand round teaching on ICI and with medical students - teaching the teacher course

Question 38

What have you done to prepare for clinical oncology

Answer 38

Oncology experience - IP and OP - Experience with oncology clinics - with consenting patients - Talking to oncology MDT staff e.g. RTs and nursing staff - Radiotherapy experience including planning Discussing with local registrars and consultants Attended local MDTs and clinics Audits in thyroid cancer Looking at the curriculum and exams needed

Question 39

What is involved in clinical oncology training

Answer 39

First year in OCS - same training with medical oncology ST3s 4 month rotations in first two years and then repeat in next 2 years

Question 40

Talk me through some part of your CV that you are proud of

Answer 40

RAI audit in PN Audit for patients receiving radioactive iodine for thyroid cancer - comparing to standard set out in the ATA guidelines, identifying that patients have been correctly stratified, received correct dose for RAI, and have been correctly rest ratified following treatment with appropriate post treatment investigations Identified opportunities to improve on post stratification of patients with investigations as laid out in the ATA guidelines This was presented at a local multidisciplinary meetings as well as an oral presentation at a national conference in New Zealand to an audience of radiation oncology consultants, registrars and associated specialties Associated skills: - Teamwork - working with specialist nursing staff, ward staff, consultant and registrars - Presentation skills - Analytical skills

Question 41

A woman with history of breast cancer with recent chemotherapy calls from home through the cancer specialist nurses presenting generally unwell with a temperature

Answer 41

Ask for her to come to hospital unit or assessment unit for urgent bloods and assessment Let staff know that she has had recent chemotherapy and at risk of neutropenia A-E assessment Bloods inc FBC and lactate Blood cultures CXR Urine culture Sputum culture Flu swab Start treatment for neutropenic sepsis while awaiting blood results Escalation status Alert parent team Discuss and highlight to senior

Question 42

Patient in chemo unit receiving 5U infusion for a colon cancer has been alerted to you due to SOB, what would you do?

Answer 42

Assess in person, abs to check stable Review notes, PMHx, oncological history, medications, allergies, is this first cycle?, recent oncology clinic letter Assess A-E Differentials: - Allergic reaction - Infection - Chemo reaction - coronary vasospasm - Anaemia - Progression of disease Bloods inc FBC and CRP, trop if concerns with chest pain Blood cultures if pyrexic Urgent treatment if anaphylaxis as per ALS Chemo reaction - can slow rates/antihistamine Alert parent team

Question 43

ON call first week - consent to radical treatment to prostate

Answer 43

Seek more information - clarify with nursing/RT staff Find more information - recent clinic letters, or if staff from the parent team are still present Discuss with patient and family, find understanding of situation, check not confused As not able to consent patient to a treatment that I yet do not know, apologise to patient Notify parent team Try to arrange appropriate consenting Postpone start to treatment prior to consenting

Question 44

What do you understand by informed consent

Answer 44

Consent given by a patient or proxy for a treatment, for which the intended outcomes, alternatives and potential side effects, especially common or serious side effects have been relayed to the patient

Question 45

Asked to speak to the family of an advanced met HNSCC patient, concerned that he is not getting nutrition and ask about alternative feeding such as PEG

Answer 45

Seek more information - read patient notes and recent clinic letters Discuss with nursing staff and other staff that may know patient e.g. MDT Check patient's capacity e.g. check if AWI is in place Check if ok to discuss with family with patient - whether they would like to discuss in private or together Check understanding of situation and discuss what they know of alternative feeding methods and what benefits this may gain Discuss whether this is appropriate - may cause patient harm or distress If not moving forward - discuss with senior/treating consultant

Question 46

You have been asked to ask patient if they would wish to be consented for a clinical trial

Answer 46

Check patient meets the specified basic requirements for the trial Check patents understanding fo the trial Information on the trial - what this may involve e.g. treatment, follow up, investigations If RCT - explain that patient may either receive the trial treatment or placebo, explain that they will also get standard of care so will have some cancer treatment. Clinicians may not know if the patient receives this treatment if double blinded Explain this is absolutely up to the patient, and if patient does not wish to enter trial will still get cancer treatment. Explain that they can drop out of the trial at any time Involve trial nurses and give trial patient information

Question 47

You are approached by a family of the patient in the corridor, they have asked you not to give bad news if there shows signs of progression on a recent CT

Answer 47

Question of autonomy Explain to family in general terms that for any scan results if the patient wishes to know and has capacity then they have the right to know but ask if there were any specific reasons that they did not want the patient to know e.g. low mood Read patient notes and overview of history and acquaint myself with scan results Have patient in consultation, and ask whether they would prefer for this to be by themselves or with family present Go over understanding of treatment so far Ask whether patient would like to know results of scans - warning shot if wishes to know and negative results Ideally have specialist nurse present - identify how patient feels and discuss next options in treatment

Question 48

Call from 17.30 with signs of cord compression

Answer 48

Gain patient information, read notes scans Contact patient and arrange urgent assessment Identify if having any pain Discuss with neurosurgery if surgical route an option - particularly if new diagnosis, no prior biopsy sample, good PS If any signs of instability ensure log rolling patient Start high dose steroids and PPI QDS BMs May need titration of diabetic meds if has underlying DM Discuss with on call consultant re urgent radiotherapy Alert parent team - may need discussion on current treatments and discuss next line treatments

Question 49

You are called to review a patient that has arrived at chemotherapy treatment and is very confused

Answer 49

Get information from nurses Information on patient - clinic notes, previous admissions, GP summary and recent medications History and A-E assessment: - May need collateral - Assess for baseline - PMHx - Meds and allergies - Recent oncological history Bloods: - Na, Ca, CRP, FBC - Urine dip - Blood cultures if spiking Explain will need to delay chemotherapy as cannot give consent and may be unwell Dx: - Hyponatraemia - Hypercalcaemia - Drugs e.g. opioids - Delirium - Infection - Disease progression e.g. brain mets

Question 50

Tell me about the curriculum and exams

Answer 50

New curriculum implemented in 2021, updated 2023 ST4-5 will do 4 month rotations in a number of different tumour types, will then repeat these in ST6-7 Within the Royal College of Radiologists Competency based Generic CiPs - develop in OCS in ST3 year Then further 4 years of training with ST4-7 years - will focus on development of clinical oncology specific CiPs 3 exams: - Part one, needed to progress to St5 level - usually sat in St4 - - Comprised of 4 parts, clinical pharmacology, cancer biology and radiobiology, medical statistics and physics - Part 2A and B - written paper and practical exams respectively - - Usually sat in St5-6 year

Question 51

What is needed for curriculum

Answer 51

Number of different methods to show competency CBD, Mini-CEx, DORPS, ACAT, MCR, MSF, Teaching observation 2x QIPATs expected to be done within ST4-7

Question 52

Tell me about developments in clinical oncology

Answer 52

Exciting research driven specialty - Many new treatment in oncology - Immunotherapy - Mutation based treatment e.g. TKI Arc based models - complex 3D treatment +/- nodes with various doses of radiotherapy VMAT (volume modulated arc therapy) and IMRT SABR - Gamma knife Proton beam radiotherapy

Question 53

Can you tell me of any trials that have made a difference in the treatment of clinical oncology patients

Answer 53

FAST-Forward trial Published in the Lancet Showed non-inferiority with hypo-fractionation in adjuvant radiotherapy for breast cancer with 26Gy in 5# vs 40Gy in 15# in early breast cancer with similar side effect profile Benefit for patients - not needing extensive longer treatments, which they may have to traveller or spend time away from family Reduced time for machines and so allows increased slots for other patients

Question 54

Underperforming colleague

Question 55

Chemo prescribing error

Question 56

Patient with brain mets that are still driving