Interviews

Question 1

What are your interests outside of medicine?

Answer 1

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Question 2

If you didn’t get fellow job, what job would you do next year?

Answer 2

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Question 3

Have you been offered job opportunity in a particular hospital?

Answer 3

.

Question 4

Tell us about research that you have initiated and completed

Answer 4

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Question 5

Can good quality care be achieved with low costs?

Answer 5

Some interventions, like good communication, cost nothing except time
Costs in care can be reduced by standardisation of procedures, efficient use of resources to eliminate waste, enhanced recovery programs and MIS to expedite recovery and use of evidence based practice to use efficacious treatments and avoid less efficacious ones

Question 6

If you have unlimited resources and you could do a Australia-wide trial, then what would you do?

Answer 6

Combination of Hydrocort and external stents for high risk joins

Radiation preop to reduce panc ca - maybe in context of crt vs ct for NAC

Procalcitonin to detect infected panc necrosis

Question 7

What’s involved as an AANZHPBA fellow?

Answer 7

Typically at least two 12-month placements
Quarterly journal club
Exam (2 papers, 4 vivas) at end
Annual meeting

Question 8

Tell us about yourself and why we should select you?

Answer 8

Myself
Clinically - enthusiatic, keen hard working team member. Motivated to improve both myself and the dept in which I am working - evidenced by my involvement in collaborative activities- trauma mdt, teaching nurses, junior docs, as well as dedicated study, practice
Academic - keen to develop simulation, active in research locally
Education - passionate teacher of juniors as evidenced by teaching program
Personal - good team member, active socially outside of work

Question 9

What are your future career plans? Where do you want to work? What sort of work do you envisage making up your usual practice

Answer 9

Resectional hpb and renal transplant, participation in trauma roster, fte for education and simulation training, time out for army surgical work
Have spoken to Christchurch and Hamilton both of whom would be keen to have me back
Really keen to develop MIS HPB wherever I end up

Question 10

What do you know about the AANZHPBA program/ what are the requirements during training

Answer 10

Two 12 month jobs
Exam (2 papers, 4 vivas)
Quarterly journal club
Annual meeting
Research expectation

Question 11

Are you willing to move around/ be flexible with placements?

Question 12

What issues face AANZHPBA in the next 10-20yr?

Answer 12

Specialty challenges and broader issues

Specialty challenges
- Role of MIS
- Role of multimodality therapy
- Availability of organs as demand increases
- Managing obesity as a comorbidity
- Trainee experience

Broader issues
- Healthcare funding
- Appropriateness of treatments and treatment futility

Question 13

Tell us about a problem you faced and wished you could turn back the clock, and how you addressed this

Answer 13

Pilonidal sinus complaint

Trying to help out with busy short staffed clinic whilst running acute theatre. Saw patient in a rush with med student - slow to heal pilonidal wound. Still smoking and not looking after himself but not happy that wound not yet healed. Told him it would be fine, takes time, needs to stop smoking, then rushed off back to OT. Pt not happy and complained. I was trying to be helpful but actually made things worse. Learnt that you have limits, can only do so much, better to do one thing well than split yourself too many ways. Also patients deserve better, even if their expectations are not totally realistic.

Question 14

Tell us about a problem you have personally solved that had a positive outcome (either clinical or non clinical

Answer 14

Trauma MDT
Naomi MDT
Wanganui chest drains

Question 15

Your Registrar tells you that one of your consultants was intoxicated when he came in to help the Registrar with an Emergency case. You also notice that same consultant has had adverse outcomes in the last few months, much more than others. How would you deal with the situation?

Answer 15

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Question 16

Any questions for us?

Answer 16

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Question 17

Tell us about a time where you had conflict with a patient

Answer 17

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Question 18

Tell us about a time when you felt out of your depth

Answer 18

.

Question 19

Tell us about a time when you demonstrated empathy towards a colleague

Answer 19

Supporting Nat transition to reg
Sit down each week or two and talk things through
Tell her all the mistakes id made along the way etc etc

Question 20

Tell us about a time when you delivered a successful presentation

Answer 20

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Question 21

Tell us about a time when you made a change to practice

Answer 21

VTEPWTR audit
AXR audit
Trauma MDT

Question 22

Tell us about a time when you received a complaint

Answer 22

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Question 23

Tell us about dealing with an underperforming colleague

Answer 23

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Question 24

Tell us about when you lead a team well

Answer 24

Trauma MDT

Question 25

Motivation for the role

Answer 25

Clinical and personal

Question 26

Why hpb?

Answer 26

Technical - difficult organs, mis, Clinical - challenging pathologies, make a big difference, not seen same improvements in panc ca etc Patient - closely involved for long journey, get to know well

Question 27

Why should we choose you?

Answer 27

What I can bring to dept and what dept can do for me What I bring - Personable - Empathic - Dedicated - Passionate advocate for junior staff and patients - Enthusiastic learner and teacher - Broad range of interests - Keen to collaborate on research What I can gain - Bring back high volume, high end experience to NZ - inc MIS, transplant etc - Gain academic experience in centre of excellence - Potential future collaborations - Continue longstanding relationship between Edin and NZ

Question 28

What would your colleagues say about you?

Answer 28

Concientious Advocates for patients Supportive of junior staff Responds well to constructive criticism Hard working A good colleague

Question 29

Where would you like to work on fellowship?

Answer 29

Have been offered job in Edin to do transplant and HPB After than try for high volume MIS liver unit - Pittsburgh, Heidelberg, Royal Marsden, Royal North Shore

Question 30

Tell us about your research

Answer 30

High risk PJ - use of external stents and hydrocort Outcomes of subtotal chole CBD stones SR Previously Spleen MA

Question 31

Tell us about your teaching experience

Answer 31

MRCS course -> book -> Ace The Exam Trauma Forum Chest drains and trauma scenarios in Wanganui Teaching program in Palmy and Hamilton Juniors seek me out for operative experience Travelled to Uganda twice and taught on courses there Invited to become EMST instructor

Question 32

Outline your plan for a patient with a clearly resectable hilar cholangiocarcinoma who is deeply jaundiced with a small left liver remnant. Focus on broad concepts rather than precise technical considerations

Answer 32

Optimise pt inc relieve jaundice Stage Plan for surgery - FLR Discuss - in MDT and with pt and family

Question 33

You see a patient with Bilobar Colorectal Liver Metastases. - What broad principles will you use to decide if this patient is resectable up front?

Answer 33

Optimise pt - nutrition Stage Plan - synchronous/staged, NAC, FLR, adjuncts (ablation, TACE) Discuss - with mdt and pt

Question 34

You see a patient with a head of pancreas lesion involving the Portal Vein. - What broad principles will you use to decide if this patient is resectable up front?

Answer 34

Patient factors - fitness, comorbs, motivation Surgical factors - is it anatomically resectable/borderline - vein involvement, arterial involvement, reconstructability Disease factors - mets, biochemically borderline (CA-19-9)

Question 35

‘Discussion at an MDT is critical”. Argue for or against this statement.

Answer 35

For: Consensus decision of experts Best evidence base Fosters collaboration Enables audit and research Minimises bias Against: One strong voice can overpower others Risks loss of patient ownership May delay intervention - particularly if all cases being discussed, even those not really necessary

Question 36

 ‘Neoadjuvant therapy is important’. Argue for or against this statement.

Answer 36

For: Test of disease biology Downstage, permit resection Reduce systemic failure Enable more delivery when pt still fit Against: If not effective, delays surgery May miss the boat for resection Pt debilitated when reaches surgery

Question 37

Ileal NET with Liver mets - Treatment priorities and options

Answer 37

Optimise pt - nutrition, comorbs, carcinoid syndrome Stage Plan - curative vs palliative. Systemic options. Synchronous vs metachronous surgery (is ileum obstructing) At surgery - nodal resection. Look for synchronous lesions. Debulking >90% provides good palliation. Do cholecystectomy Discuss in MDT and with pt

Question 38

Tell us about something non surgical that you do

Answer 38

Mountain biking Drums Army

Question 39

Why do you wish to be involved with AANZHPBA?

Answer 39

Support of society Build on expertise of members - chance for continuing education and training Opportunities to collaborate Expert help in difficult situations Support network Build profile of the specialty in ANZ

Question 40

How does research change your practice?

Answer 40

Produces the high quality evidence that guides my treatment decisions Helps ensure the equitable and efficacious allocation of resources Develops new technologies and treatments to realise improvements in care Contributes to patient safety and quality improvement Finally for me, it provides an opportunity to influence and improve medical care for a greater number of patients than I could ever do in a purely clinical setting

Question 41

What do you bring to AANZHPBA?

Answer 41

I'm a dilligent and motivated individual who brings great passion and drive to anything I set my mind to. My CV and references attest to my passion for both the clinical and technical aspects of surgery, as well as my active involvement in research and education. I am passionate about mentoring and supporting juniors and improving their training experience. Finally, I care deeply about my patients and place great importance on communication with them and their family members.