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1
Q

Why did you become a doctor?

A

There were many things that led me to choose medicine, but I think a few key factors stand out…

I was 16 years old, living in India

  1. Diverse backgrounds - from race, social class and religion
  2. Growing up abroad - education and healthcare community
  3. Needed a practical job - direct impact of my work on people and community.
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2
Q

What is your plan if you are unsuccessful in securing this post?

A

Ask for feedback and review this with my supervisor.

Make a plan and timeline for how to enhance and grow from this experience - including clinical skills, research, teaching and presentations.

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3
Q

How important is teaching to you and how does this relate to this role?

A

Teaching and education is pivotal to this position and Gynae-oncology in general. There are two sides to this -

Teaching I can provide - day to day on the shop floor, Mentorship,
(helps to solidify your knowledge by being to explain it on a basic level)

I like to regular teaching sessions, anatomy with juniors

Teaching - public health. Patients.
clinic
red flags
Below the belt

Share ideas on regional, national and international level - presentations and conferences - all stay up to date in the Gynae Onc community and transfer our wealth of knowledge.

Teaching can receive - Up to date, international and national conferences. BGCS webinars, Grand round, mentorship and constructive feedback. OSATs

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4
Q

How important are research and development opportunities to you and how does this relate to this role?

A

Research and development is intrinsic to Gynae Oncology. It moves at a pace and it is important to always be up to date and moving the practice of the department along with it.

Exciting!
New ways of doing things - new equipment, new pathways. increasing efficiency.
identifying issues. Collaborating - getting ideas from our colleagues - both in the unit and discussing with surrounding units.

Critical analysis - heightens your understanding of
Being a part of research projects enhances your understanding of critically appraising other research.
Doing the cochrane review has given me the tools to do this and I would like to use these to help others

National trials. Excites patients and staff - boosts morale
Gain more experience in PI or running a multicentre trial.

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5
Q

What other specific challenges do you expect to experience in this role?

A

TIME - organised
plan: other specialities, courses, discuss with SST for tips

MEETINGS - SMART objectives, holding myself accountable

TECHNICAL and NON TECHNICAL
acquiring the skills and maturity required for complex decision making - MDT, intra-operatively,

Paperwork

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6
Q

How good a doctor are you?

A

I’d like to think that I show many of the qualities described by the GMC denoting a ‘good doctor’ but specifically I’d like to think that people say I am :

  1. Teamwork
  2. Teaching, staying up to date, research
  3. Communicating - advanced comms course
  4. Staying up to date
    Management research and teaching
  5. Holistic care
  6. MDT for best possible care
  7. Documentation
  8. Quality assurance and quality improvement
  9. Raise risks to patient safety and make steps to rectify
  10. Communication with patients
  11. Work collaboratively with colleague
  12. Teaching and training juniors
  13. Continuity and coordination of care
  14. Partnership with patients
  15. No discrimination
  16. Honesty and integrity – clinical and research
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7
Q

Best example of working as a proactive team member to achieve something

A

Sentinel node - coordinating the rep

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8
Q

What is your best example of having a positive impact on your team’s morale

A

team morale is sustained behaviour

inspiration from my bosses - ensuring I know the name of people, what they do and helping them do their job when

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9
Q

what is your best example of contributing to the improvement of a team’s efficiency

A

anaemia -

group and saves prior to the day

recognising and creating a pathway

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10
Q

Weaknesses

A

attention to detail
control
delegation
support

pressure on myself, passion frustration,
mentor - reassure and constructively criticise

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11
Q

Tell me about your surgical skill

A

40+ staging laparotomies for pelvic masses
40+ laparoscopic hysterectomies, with or without sentinel lymph node sampling
15 vulval excision

6 laparoscopic pelvic lymphadenectomy
3 radical vulval
7 cytoreductive

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12
Q

Strengths

A

There are some key strengths I think are important to being a Gynae-Oncologist. One of these is

enthusiastic, dedicated

organised, conscientious

caring holistic

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13
Q

Why do you want to do Gynae Oncology?

A

I love operating and first and foremost Gynae-Oncologists are surgeons.

I love working as a part of a team! We have such a wide

I love the immense pleasure that comes from managing patients who are going through what is one of their worst experiences in their life and

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14
Q

Tell me about your research

A
  1. MD
  2. Associate PI for UHS for ROCkeTS trial
  3. Cochrane
    - Dedication and how to critically analyse papers, assess the risk of bias and synthesize them in to a meta-analysis answering a specific clinical question
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15
Q

If you thought you needed an ultrasound machine for the unit, how would you go about it?

A 
Speak to colleagues, service manager. 
Ultimately "cash-strapped" environment
pre-existing alternative solutions? 
If not - build a business case 
benefits to patients, staff and organisation
improve outcomes, indicate the demand
value for money
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16
Q

Do you think that all exenterations should be centralised

A

2 sides to the argument
1. Centralisation to create centre for clinical excellence

  1. Retain the procedures in regional tertiary units.

Benefits: care as local as possible to patients - in keeping with the NHS long term plan
How you ensure the patients receive gold standard care is through close collaboration with colleagues from colorectal, urological and plastic specialities, as well as the wide allied health care professionals required to support the peri and post operative period.

Time and planning to organise joint procedures

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17
Q

LACC trial

A

2018

MIS vs open
Mostly IB1
3 year disease free survival 91 vs 97%
4.5 year DFS 87% vs 97%

Robotics 15% laparoscopic 85%

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18
Q

Tell me about your teaching experience

A

Diverse experience of teaching.

  1. One which might seem unusual is that, alongside a beauty therapist, I have set up a virtual educational programme for beauty therapists for recognition of red flag symptoms for gynaecologial and breast cancers, as well as vulval lesions. More confident to signpost towards medical care.
    Under the supervision of SK - run RTD for KSS in Principles of
  2. More conventionally - teaching on the shop floor in wards, clinics, theatres, departmental teaching to medical students, nurses, F1s , SHOs and registrars.
  3. I am also pleased to have had more formal teaching and examination experience - having 4 years of OSCE which has taught me more needs and level required.
    Also lecturing the undergrad pharmacology students
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19
Q

Will the NHS survive this winter

A

Another enormous challenge ahead of us
We have done it before
Not an endless pot
prioritisation of healthcare on a level never previously imaginable

LTP - enhancing social care
Relationship with the IS has changed

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20
Q

Should we centralise the treatment of cervical cancer

A

Varied by stage.

  1. Stage 1 cancers - LLETZ/simple hysterectomy, closer to home
  2. Advanced cervix cancer, chemo rad, close to home.

Leaves a debate as to whether the treatment of IB1 and IB2 Cx cancers should be centralised.
Some would say yes, - centre of excellence
Others, and my view point:
That this is not currently necessary and that they should be treated at regional tertiary centres.
Benefit to patient: in keeping with NHS LTP, close to home
Benefit to surgeon: techniques used to perform a radical hysterectomy are natural to a gynae oncologist and transferrable to other radical procedures. We do not want to risk deskilling our gynae-oncologists.
One way to ensure continued exposure is to have joint consultant operating on these cases.

More contentious - whether exenteration for recurrent cervical cancer should be centralised

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21
Q

Mistake

A

COVID pandemic, like many moved to IS
elderly lady, TLH for endometrial cancer

As I was used to our standardised procedure 
Ax
Duty of candour 
incident form
reviewed with IS leads
Presented at MDM
Created proforma for IS
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22
Q

DESKTOP

A

DESKTOP OVAR - which patients with recurrent ovarian cancer to operate on and which not to

Q1. what should the surgical goal be
2. Who should be operated on.

Ans: complete cytoreduction.
How can we predict a complete cytoreduction
AGO score (PS0, ascites less than 500mls and previous complete cytoreduction).
Plus: platinum sensitive disease, first recurrence

Validated by DESKTOP 2 as a 75% success rate for AGO score

DESKTOP 3 - RCT

  1. same AGO score success for cytoreduction
  2. OS: 60m for CCR, 45 months for just chemo, 30m for ICCR

confirming - patient selection and centre for expertise in achieving high rate of cytoreduction.

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23
Q

Alternatives to DESKTOP?

A

GOG-0213 showed no benefit but patients were randomised and chosen to be ‘resectable’ by investigator - with lower rate of CCR of 67%

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24
Q

Tell us about your CV

A

Lucky

Clinical
Research
Teaching

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25
Why do you want to do this job
I love operating. technical aspect of learning the huge variation of skills required collaborative operating with so many different specialities intellectual intra-operative challenge - considering morbidity vs potential benefit. ``` TEAM - Mentioned cross speciality Team can have a narrow or broad definition in GO Core gynae onc team - strong hospital regionally - strong BGCS ``` Personal level - immense privilege to manage patients at a time of crisis in their lives. Going through difficult time in their lives - support them and their families through, best of my ability is incredibly rewarding.
26
Why should we choose you for this job
I'm lucky... 6 years O&G, almost 2 with GO in Brighton - giving me the solid foundation in tertiary level gynae-oncology that I needed to now accelerate in to SST. Honed my clinical skills, meaning that I am... I have been involved with different types of research and teaching and I know that units in KSS have a focus on these areas with some fantastic opportunities
27
Tell us about a time .. probity issue.
check everyone involved is safe communicate escalate
28
Cancer alliance principles
1. Diagnosing cancer faster - Rapid diagnostic services 2. Ensuring the best treatment and care - Dx, RXT, genomics, waiting times 3. Involving patients and the public 4. Personalised care - holistic needs and follow up plans 5. Preventing and diagnosing cancer earlier - increasing uptake of screening
29
What are the challenges facing gynae oncology
worse stage specific outcomes delays to presentation and diagnosis increasing obesity and ovarian cancer reducing uptake to screening Delays to presentation - public heath awareness campaign. - risk factors, red flag symptoms literacy rate, changing this to video forms Staffing, staff retention. - names, roles and helping, encouraging ideas and empowering to help with changing interventions.
30
How do you deal with stress
organised, lists, staying up to date, making sure I feel on top of things. Supervisors - pressure of learning, constructive feedback on performance and areas to improve Seeing my sister, taking time out, cycling, walking, supportive husband
31
Tell us about a difficult scenario you have been involved with and how you dealt with it
storm derrick Uterine rupture - gynae onc
32
Tell us how you would deal with .. probity issue.
check everyone involved is safe communicate escalate
33
Why do you want to do SST and not be a gynae onc unit lead
Huge respect for unit leads, different job surgical challenge, when to when not to, how to safely get them through and when to involve other specialities. heart of their treatment and follow up Communication - most vulnerable times, using those skills to support patients and their relatives.
34
Cancer alliance principles
1. Diagnosing cancer faster - Rapid diagnostic services 2. Ensuring the best treatment and care - Dx, RXT, genomics, waiting times 3. Involving patients and the public 4. Personalised care - holistic needs and follow up plans 5. Preventing and diagnosing cancer earlier - increasing uptake of screening Bring centres togethre to make uniform practice optimise pathways Diagnostics - regional diagnostic hubs Support organisations struggling with their patient load
35
Explain an RCT
Phase 1 trials - looking for safety (side effects, best dose and timing, ?route) Phase II trials - side effects, how well does it work Phase III - compares new to standard of care looking for rare complications/toxicities needing larger numbers ``` steps: What team? Design the study - question, inclusion/exclusion criteria, numbers required. intervention vs control recruitment strategy - randomisation blinding Ethical considerations what are the outcomes I want to measure collecting the data statistical analysis reporting of results. ```
36
International Cancer Benchmarking Partnership
International multidisciplinary collaboration founded to facilitate mutual learning about factors that may help to improve outcomes for cancer Characteristics relating to countries with higher stage-specific survival included higher reported rates of: primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.
37
International Cancer Benchmarking Partnership
Characteristics relating to countries with higher stage-specific survival included higher reported rates of: primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.
38
NHS long term plan
improving social care integrate primary and secondary care health promotion and targeting health inequalities cancer - 3/4 early stage 1/2 train and retain staff Digitalisation
39
Waiting time targets
14 days - referral until seen by specialist 28 days - referral until told whether has cancer or not 31 days - decision to treat to first treatment commenced 62 days - referral until first treatment commenced cancer target performance and quality indicators
40
Lynch syndrome management
CONS - health promotion - weight, diet, smoking MED - colorectal - aspirin Surveillance vs surgery - colorectal every 1-2 years colonoscopy - gynae - CA125, scan and sampling annually from 30-35 or 5-10 prior to earliest TLH BSO when ready
41
PORTEC studies 1+2
Intermediate: G1 1B, G2, G3 1A PORTEC 1 - ERBT in intermediate risk of recurrence EC improves locoregional control but not OS 14% to 4% PORTEC 2 - ERBT vs VBT OS and DFS the same, toxicity much more with EBRT 53% vs 12%
42
PORTEC 3
High risk: G3 1B, or G3 1A with LVSI endometrioid stage II or III clear cell or serous stage I-III PORTEC 3 - High risk disease ERBT vs Chemorad improvement in OS and DFS for stage III or serous disease with chemorad.
43
GROINSS-V
Pts: primary SCC vulva, tumour <4cm, unifocal, no suspicious groin nodes. 1. Is it safe to omit inguinofemoral lymphadenectomy in patients with negative SLN Groin recurrence after negative SLN: 2.3% ITC “isolated tumour cells" in SLN led to 4.2% risk of other mets, up to 60+% with SLN pos node over 1cm. Poor prognosis with SLN met >2mm. All mets in the groin need further treatment
44
GROINSS-V II
2. Is radiotherapy a safe alternative for IF lymphadenectomy in patients with positive SLN? If micromets: - With RXT, risk of groin recurrence 1.6% in two years, without RXT FU 11.8% after two years. With macrometastases: - With just RXT – 22% recurrence rate - If had IFL after SLN pos - 6.9% recurrence rate With neg SLN: Recurrence: 2.7%
45
GROINSS-V III
3. Is chemoradiotherapy a safe alternative for IFL in patients with macromets (or multiple micromets) in their SLN? Recruiting
46
Key points of your career
ST1 - told I should consider a surgically oriented job ST4+5 - able to work alongside inspirational gynae onc leads and signposted towards working with gynae onc in Brighton. Gladly thrown in to research and teaching opportunities, embraced the Gynae Onc team and enjoyed every minute of it.
47
Which job most enjoyed and why
Firm based - Brighton, Gynae Onc. Mentorship, investment.
48
which job least enjoyed and why
ST4? surgery disrupted my training and then experienced some bullying which I found difficult.
49
what has surprised you most about being a doctor
I think I felt that my seniors knew it all. Realistically, the more senior I have got, the more I realised that medicine is not straight out of a textbook, that in ways it is more of an art, which is navigated through experience. The more you know the more you know you don't know. Disconcerting but exciting and alleviated through having a great team and the humility to ask for help.
50
what do you find most frustrating about working in this subspeciality
At the moment? I think it can be easy to be frustrated at the impact that COVID is having on the patients, staff and organisation. Inspirational to see the way that this is not translated on to those around them - if someone cancelled because of a lack of beds, or staffing - team still congratulated for their effort. Important not to cause any more undermining
51
what are the most important qualities required to fulfil this role?
Enthusiasm and dedication Organisation and sticking to deadlines Compassion, care and treating each patient to their individual needs.
52
what is the one achievement from your career you are most proud of
Getting through medical school - found it really tough, difficult time in my life. Showed resilience and built support networks required.
53
best friends describe you
Fun I prioritize helping people - will go ridiculously out of my way. Dependable Always at work
54
biggest career disappointment
Applying for GO clinical fellowship but actually in retrospect wasn't ready for.. Taught me a lot, more resolve
55
Time when you disagreed with a junior colleague
Competence and confidence. | Changing the way that you mentor them - different approach
56
Time when you disagreed with a member of another team
Anaesthetics and
57
leadership responsibilities in this role
Increasing opportunities Presenting my cases at MDT Coordinating care pre-operatively - interspeciality, anaesthetics, colorectal, stoma nurses etc. Teaching with F1s/department Supervising research projects by juniors
58
how did you make sure you quickly became an effective member of the most recent team when you joined?
Observation - learning about procedures. Learning everyones names, Rapport, Identifying jobs I can do, asking for help where needed. Being approachable and open in case feedback required. Considering opportunities for development and gently broaching them.
59
time when you supported a new colleague to join your team
F1s - rotate around and recently brand new doctors. Each have their own insecurities and challenges. Listening to them, helping them practice with what concerns them. Being approachable, providing advice.
60
Identify a team you improved your teams communication
WHO
61
Taken the lead in a crisis
Lady with ascites and difficulty - coordinating admission, histopath, theatre the next day, communication with husband
62
What is your opinion on the current standard of handover
so varied. Best: - written and verbal - everyone is there - clear and concise - on time and efficient - no judgement
63
Most challenging shift/handover situation
Twins CS.
64
Most challenging patient/shift handover situation
Twins CS. - bad for patient - continuity, feeling they might have to repeat themselves. - dangerous - clinically not completely up to scratch with a potentially complex case - could be a difficult delivery. - anxious, unsure about what I was going to find. Spoke to supervisor about it
65
Most challenging patient/shift handover situation
Twins CS. - bad for patient - continuity, feeling they might have to repeat themselves. - dangerous - clinically not completely up to scratch with a potentially complex case - could be a difficult delivery. - anxious, unsure about what I was going to find. Spoke to supervisor about it who dealt with it internally
66
Tell us about a time when you failed to communicate well with your colleagues
maybe my post op plan being suboptimal
67
Pass a difficult message to a colleague
Complication from a procedure Went back to theatre Wanted them to hear it from me, not someone else and reassure them it wasn't an issue. went with them when they came in to review and debrief.
68
What makes a good leader
Calm under pressure Communicates well Supports and encourages team
69
Recognised that a colleague was stressed at work
maguire?
70
What makes a good leader
Calmly listen, absorb information and then create clear management plan Goes towards a crisis, not away from it. Communication. Honest. Empower juniors, listen to frustrations, promote thinking about and carrying out solutions.
71
Best act of leadership
uterine rupture and gynae oncology. clear plan communicated non judgemental cared about staff
72
Great team member
Shares ideas Participates Follows team plans Positivity diligent motivated committed pay attention to detail
73
What have I done to improve my leadership skills
Done the leadership course - role model - focus on following a vision - empower followers/encourage collaboration - being positive Have taken on leadership roles - rota ST1, ST2, ST4 - LFG for last two years - voted back in Look for opportunities at work to lead projects such as SNL coordination
74
What have I done to improve my team interaction skills
``` Communication. - advanced communication course Effective teamwork. Time management. Problem-solving. Listening. Critical thinking. Collaboration. Leadership. ```
75
How did you prepare for todays interview
I read the job descriptions for the jobs, as well as the training programme SST GO I had tutoring from colleagues and mentors Practicing and considering
76
What would be your priorities in the first month
Look at the SST
77
How can you achieve the requirements of SST
``` CBD Surgical Logbook MDTs GCP OSATs Learning directly from trainers Personal study BGCS webinars, ESGO surgical courses - anatomy SuPROC NOTSS Reflection TO2s clinics - oncology, palliative, chemo, radiotherapy, IR, radiology, tissue viability, stoma nurses, dietician, CNS ```
78
How can you achieve the requirements of SST
``` CBD Surgical Logbook MDTs GCP OSATs Learning directly from trainers Personal study BGCS webinars, ESGO surgical courses - anatomy SuPROC NOTSS Reflection TO2s clinics - oncology, palliative, chemo, radiotherapy, IR, radiology, tissue viability, stoma nurses, dietician, CNS ```
79
What is duty of candour
``` Legal obligation must inform the people affected by the incident offer reasonable support provide truthful information timely apology ```
80
Define harassment
aggressive pressure or intimidation. sexual, racial, disability, sexual orientation, ageism
81
What challenges are doctors in training facing at the moment
COVID - | affecting surgical training but can be mitigated to a degree with some careful planning -
82
Tell me about your experience of clinical governance
Research - associate PI application for ethical approval Audit - cappuccini audit Protocols Risk management meetings Sodium story
83
Role of the principal investigator
s responsible for the management and integrity of the design, conduct, and reporting of the research project and for managing, monitoring, and ensuring the integrity of any collaborative relationships.
84
5 year goals
As a new consultant in Gynae Onc 1. Encouraging a teaching programme within the department as well as regional training days - looking at current research in GO, principles of gynae oncology and facilitating teaching from the wider MDT with respect to GO 2. Specific mentoring - junior doctor with a special interest in Gynae Oncology, 3. Leading research opportunities within the department - surgical trials PI, collaboration with the university, using data from the units in the south east to inform decision for future research.
85
Struggling colleague
Nithya
86
work place based assessments
identify strengths and weaknesses. accurate picture of your abilities miniCEX CBD OSATs
87
side effects of chemo rads for cervix cancer
``` sexuality/sexual morbidity psychosocial concerns menopause lymphoedema effects on gastrointestinal and urinary systems ```
88
Considerations for fertility sparing surgery
- efficacy of treatment - effectiveness of preserving fertility - potential for complications - obstetric outcomes - PTL, neonatal morbidity and mortality
89
fertility sparing IA1
repeat LLETZ or cold knife cone
90
fertility sparing IA2
Consideration of pelvic lymph node dissection, especially with LVSI
91
complications of a radical trachelectomy
fistula sexual dysfunction isthmic stenosis
92
Challenges facing gynae oncology
COVID 1. Public health - obesity, delayed diagnosis, delayed screening 2. Personalised medicine - 3. Robotics - ensure training and opportunities maximised on
93
Leadership
delegation support thanking communication
94
Risks of virtual clinics
- information governance - valuing the consultation - when is it not appropriate - which patients, BBN - identifying vulnerabilities - risk of not examining the patient - guidance for patients re: environment - choosing our patients - personalised FU plans (Cancer alliance) - FU support - Macmillan
95
Why are you the best candidate for this job?
Lots of reasons why I want to do Gynae Oncology 1. Solid foundation and working relationship with wider MDT in Brighton, maximise opportunities and hit the ground running with respect to SST - - collaborate - robotics 2. Research project with UHS and forged links with the university 3. Public heath -
96
Tell me about your papers
1. Cochrane assimilate 2. MD review
97
Where do you see yourself in 5 years
- robotics - public health campaigns - collaborative research
98
Poor communication story
Patient in fast track clinic | Lap BSO
99
What qualities do you look for in a mentor
Open and honest - feedback Communication - within the team, with the patients Encourages me to get involved with research, quality improvement and audits

Interview Qs (3 decks)

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