How to get a specialty training post: the insider’s guide success in medicine series How to get a specialty training post: the insider’s guide written by Danny C.G Lim, MBBS, BSc, MRCP Cardiology Specialty Trainee, Northern Deanery, Queen Elizabeth Hospital, Gateshead, UK 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2011 The moral rights of the author have been asserted Database right Oxford University Press (maker) All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Data available Typeset in Charter by Glyph International, Bangalore, India Printed in Great Britain on acid-free paper by CPI Antony Rowe, Chippenham, Wiltshire ISBN 978–0–19–959080–3 10 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations The authors and the publishers not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding To my dad for teaching me the importance of working hard and smart To my mum for encouraging me to always strive further To my wife for her unwavering love and support Acknowledgements Thanks to Fiona Goodgame for taking the time to listen to a new, untested author I must also thank Katy Loftus and Christopher Reid for their indispensable advice in writing this book Philippa Hendry and her team have brought this book to life My gratitude to contributors Christopher Lamb, Anthony Jesurasa, Benjamin Morton, and Simon Wan for their suggestions vi Acknowledgements Contents Specialty advisors x The ‘secret’ to getting into specialty training Introduction The selection process 1 2 Career development: the secret of success Key points about career development Which specialty? Your development score Prizes Presentations Publications Professional examinations Commitment to the specialty Audit Research Teaching Portfolio Practical procedures Courses Management 5 10 11 12 15 15 17 18 18 20 20 21 21 Being prepared Forewarned is forearmed Applications: you snooze, you lose Get kitted out Preparing your portfolio 23 23 24 25 25 The application form Introduction Get the short-list protocol Presentation matters Don’t be late like Cinderella Essential criteria Additional undergraduate degrees Postgraduate degrees and diplomas Royal college examinations Training courses Prizes Publications Presentations 29 29 29 30 32 33 33 34 34 35 36 37 38 Contents vii Audit Teaching Clinical and practical skills relevant to the specialty Commitment to the specialty Achievements and extracurricular activities Leadership and teamwork Management Information technology (IT) Selection exams In summary Interview and assessment stations: how to excel Introduction Three golden rules Prepare strategically: don’t just work hard, work smart Answering well Practice makes perfect Approaching interview day: it’s almost time! Practical skills assessment OSCE: history or examination Presentation station Clinical scenario—resuscitation Role-playing scenario Group discussion Prioritization exercise (written) Telephone consultation 39 39 40 41 42 44 44 44 45 48 51 51 53 58 60 62 64 66 67 68 69 69 75 76 78 Interview: practice questions and answers How to use this chapter Background question Portfolio station Clinical scenarios Commitment to specialty Audit and clinical governance Research and academic Teaching Leadership and teamwork Problem solving and decision making Coping with pressure Empathy and sensitivity Professional integrity 81 81 82 84 88 89 91 93 95 96 99 101 102 104 The specialties General Practice (GP) Core Medical Training (CMT) Acute Common Care Stem (ACCS) Surgery in General (CT1 and CT2) 107 107 109 114 116 viii Contents Anaesthesia Emergency Medicine (ST4) Obstetrics and Gynaecology Radiology Paediatrics and Child Health Psychiatry Public Health General Surgery (ST3) Trauma and Orthopaedics Otolaryngology (ENT) Ophthalmology Neurosurgery Plastic Surgery Acute Medicine Cardiology Care of the Elderly (Geriatrics) Endocrinology Gastroenterology Infectious Disease Renal Respiratory 121 126 131 134 138 140 144 147 150 154 157 159 162 165 167 169 171 173 175 177 178 If at first you don’t succeed, try, try again Back to the drawing board Try, try again Get feedback Improving yourself 181 181 182 182 182 Appendix 1: Deaneries 185 Appendix 2: Royal college websites 186 Appendix 3: Interview practice feedback form 187 Appendix 4: Interview question feedback form 188 Index 189 Contents ix question An 18-year-old woman presents with acute breathlessness She is tachypnoeic and her arterial blood gas shows hypoxia with respiratory alkalosis Your consultant suspects a pulmonary embolus and wants her to be admitted for treatment and a ventilation perfusion scan The nurses report she is refusing treatment and admission Speak to her Suggestion: Explore her concerns in a non-confrontational manner, explain the dangers of pulmonary embolus without treatment There may be multiple concerns, e.g undisclosed pregnancy, illicit drug use, fear of needles Clinical scenarios question You are seeing a 70-year-old man with COPD in the Chest Clinic He is asking if he can have oxygen at home How would you asses if long-term oxygen therapy is suitable? Suggestion: Be aware of the clinical indications question A 68-year-old patient with an exacerbation of COPD on the ward has been increasingly breathless On examination he has poor air entry and is wheezy with a prolonged expiratory phase An arterial blood gas shows he is hypoxic with a marked respiratory acidosis He is already on high-dose steroids and regular nebulizers How would you proceed? Suggestion: Consider intravenous theophyllines and critical care, know the indications for non-invasive ventilation question A 20-year-old man, previously well, presents with pleuritic chest pain and breathlessness His oxygen saturations are 96% and he has a respiratory rate of 16 breaths/min His blood pressure and heart rate are normal He has reduced air entry and hyperresonance in the right chest His trachea is central A chest X-ray confirms a pneumothorax with almost complete collapse of his right lung What you do? Suggestion: Read up the BTS guidelines for managing primary pneumothorax Highflow oxygen, analgesia and aspiration Repeat chest X-ray A chest drain is indicated only if repeated aspiration fails Topical questions • What you think of the growing role of respiratory nurse practitioners? • Recent BTS or NICE guidelines, e.g asthma, pneumonia, non-invasive ventilation 180 How to get a specialty training post chapter If at first you don’t succeed, try, try again I f you don’t get a job offer, don’t be too disheartened You are not alone Many doctors don’t succeed in getting a training job on their first, second, or even third attempt This is particularly true if it is a competitive specialty Instead, see this is an opportunity to build your experience and improve yourself for the next round The most important thing is to learn from your mistakes and move forward Back to the drawing board Use this opportunity to take stock and ask yourself some important questions There are no correct answers and ultimately it is for you to decide what to Think hard and choose carefully • For how many years are you willing to keep reapplying (bearing in mind that you have about 30 working years ahead)? • Would you be willing to commit additional years in research, e.g PhD, MD? • Is there another specialty which interests you but is less competitive? • If recruitment is organized locally, are you able to apply to more deaneries? This can improve your chances of success • Is this the right time to try new experiences, e.g career change, working abroad, travelling? If at first you don’t succeed, try, try again 181 Try, try again Persistence and dedication are essential for getting into specialty training Many specialty trainees I know had applied to the specialty repeatedly In between applications, they dedicate their spare time working on their CV If at first you don’t succeed, try, try again and improve yourself with each attempt Get feedback You can only improve if you know your weaknesses Request feedback on your interview from the deanery Some deaneries give out minimal information That’s no good You need a detailed breakdown of your short-listing and interview scores The Data Protection Act of 1998 allows you to see information held about you If the feedback you receive is unhelpful, e-mail a formal request ‘subject access request’ to the deanery Your e-mail should start with the sentence ‘Please send me the information which I am entitled to under the Section 7(1) of the Data Protection Act 1998’ Then describe the information you require in detail By law, the deanery has 40 calendar days to comply If you get no response, contact the Information Commissioner’s Office at casework@ico.gsi.gov.uk Visit their website if you need more information (www.ico.gov.uk) Improving yourself Use the feedback from the deanery and the career development tool in chapter (page 9) to help identify your weak areas If you were not short-listed, it means that you need to work on your application form If you made it to the interview, it means your interview skills need polishing, though it wouldn’t hurt to spend time improving your CV as well Seek the advice of trainees and consultants in the specialty Ask them to review your CV and to give you suggestions on how you can improve for the next round Write down their advice so you don’t forget it—this advice is worth its weight in gold Set goals and plan Set long-term and mid-term goals which are specific and realistic Plan how you are going to achieve your goals For example, if your goal is to have a publication, break it down into a few different steps You would have to browse different journals, read the instructions to authors, think of cases you could submit, request patient notes, 182 How to get a specialty training post and approach the patient for consent etc Specify how you intend to achieve those goals Commit your plan to paper Do it and stick to your plans Keep the momentum going and don’t lose your enthusiasm Last but not least, review the advice in this book Don’t forget to read the section on your specialty of interest I wish you luck on your journey to specialty training Work hard, work smart, and remember to enjoy the journey If at first you don’t succeed, try, try again 183 Appendices Appendix 1: Deaneries Publicly available short-list and interview protocols from the following deanery and royal college websites were used as reference material for Chapters 4, 5, 6, and The competition ratios for the specialties quoted in Chapter are from Modernising Medical Careers (www.mmc.nhs.uk) Deanery websites East Midlands Healthcare Workforce Deanery www.eastmidlandsdeanery.nhs.uk Kent, Surrey and Sussex (KSS) Deanery www.kssdeanery.org London Deanery www.londondeanery.ac.uk Mersey Deanery www.merseydeanery.nhs.uk NHS East of England Multi Professional Deanery www.eoedeanery.nhs.uk NHS West Midlands Workforce Deanery www.westmidlandsdeanery.nhs.uk North Western Deanery www.nwpgmd.nhs.uk Northern Deanery www.northerndeanery.org Northern Ireland Medical and Dental Training Agency www.nimdta.gov.uk Oxford Deanery www.oxforddeanery.nhs.uk Scottish Medical Training www.scotmt.scot.nhs.uk Appendices 185 Severn Deanery www.severndeanery.nhs.uk South West Peninsula Deanery www.peninsuladeanery.nhs.uk Wessex Deanery www.wessexdeanery.nhs.uk Yorkshire and the Humber Postgraduate Deanery www.yorksandhumberdeanery.nhs.uk Appendix 2: Royal college websites College of Emergency Medicine www.collemergencymed.ac.uk Royal College of Anaesthetists www.rcoa.ac.uk Royal College of General Practitioners www.rcgp.org.uk Royal College of Obstetricians and Gynaecologists www.rcog.org.uk Royal College of Ophthalmologists www.rcophth.ac.uk Royal College of Paediatrics and Child Health www.rcpch.ac.uk Royal College of Physicians www.rcplondon.ac.uk www.cmtrecruitment.org.uk www.st3recruitment.org.uk Royal College of Psychiatrists www.rcpsych.ac.uk Royal College of Radiologists www.rcr.ac.uk The Royal College of Surgeons of England www.rcseng.ac.uk The UK’s Faculty of Public Health www.fph.org.uk 186 Appendices Appendix Interview practice feedback form Interviewee name: Interview question asked: What was good: What could have been better: Suggestions for improvement: Please score answer: Poor Below average Average Good Outstanding Appendices 187 Appendix Interview question feedback form Interviewee name: Interview question asked: What was good (i.e positive indicators demonstrated): What needs improvement (i.e positive indicators not demonstrated): Other suggestions for improvement: Please score answer: Poor point 188 Appendices Below average points Average points Good points Outstanding points Index achievements 42–4 Acute Care Common Stem 3, 114–16 acute medicine 165–7 Adrian Tanner Prize 117 Alan Edwards prize 110 anaesthesia 121–6 Anaesthesia History Prize 122 application form 29–49 achievements and extracurricular activities 42–4 additional undergraduate degrees 33 audit 39 commitment to specialty 41–2 essential criteria 33 information technology 44–5 leadership and teamwork 44 management 44 postgraduate degrees/diplomas 34 presentation 30–2 prizes 36–7 publications 37 relevant clinical/practical skills 40–1 Royal College examinations 34–5 short-list protocol 29–30 submitting on time 32 teaching 39–40 training courses 35 applications 24–5 submission assessment stations 51–80 audit application form 39 career development 17 practice questions 91–3 body language 60–1 bursaries 11 cardiology 167–9 care of the elderly 169–71 career development 5–21 audit 17 commitment to specialty 15–17 courses 16, 21 development score 7–10 key points management 21 portfolio 20 practical procedures 20–1 presentations 11–12 prizes 10–11 professional examinations 15 publications 12–15 research 18 teaching 18–20 clinical experience 15–16 clinical governance, practice questions 91–3 clinical problem solving test 46–7 clinical scenarios 67–8 Acute Care Common Stem 115–16 acute medicine 166–7 anaesthesia 123–4 cardiology 168–9 care of the elderly 170 core medical training 111–13 emergency medicine 128 endocrinology 172–3 gastroenterology 174–5 general surgery 149 infectious disease 176 neurosurgery 160–1 obstetrics and gynaecology 132–3 ophthalmology 158 otolaryngology 155–6 paediatrics and child health 139–40 plastic surgery 163–4 practice questions 88–9 psychiatry 142–3 radiology 136–7 renal medicine 178 respiratory medicine 180 resuscitation 69 Index 189 clinical scenarios (cont.) role-playing 69–75 surgery in general 119–20 trauma and orthopaedics 152–3 Cochrane Prize 144 commitment to specialty application form 41–2 career development 15–17 practice questions 89–91 communication skills 76 competitiveness computers 25 conciseness 61–2 conferences 11, 16 coping with pressure 101–2 core medical training 109–14 course direction 19–20 courses 16, 21 curriculum vitae review 59 Dame Josephine Barnes Award 131 deaneries 185–6 decision making, practice questions 99–101 development score 7–10 Direct Observation of Procedural Skills 20 Duke-Elder Exam 157 earnings emergency medicine 126–30 empathy 75 practice questions 102–3 endocrinology 171–3 English language 31–2 essay prizes 11 European Working Time Directive 59 examinations preparation for 15 professional 15 Royal College 34–5 selection 24, 45–8 extracurricular activities 42–4 feedback 182 fellowships 18 gastroenterology 173–5 GAT Audit Prize 122 general practice 107–9 190 Index general surgery 147–9 geriatrics 169–71 group discussion 75–6 Herbert Erik Reiss Memorial Case History Prize 131 Herbert Reiss Trainees Prize 131 infectious disease 175–6 information technology 44–5 interests of candidate internet access 25 interview likeability 61 practice questions 81–105 interview courses 63–4 interview practice groups 62–3 interview score 55 maximizing 53–4 interviews 3, 24, 51–80 answering well 60–2 being concise 61–2 checklist 65 getting there 65 keeping calm 65–6 paperwork 64–5 person specifications 58–9 personal appearance 65 practice 62–4 preparation for 54–7 research for 58 selection 24, 52–3 selling yourself 53, 60 structured 51–2 journals core medical training 110 endocrinology 172 forget-me-not 14 non-clinical 14–15 ophthalmology 157 otolaryngology 155 see also publications keeping calm 65–6 keeping up to date 17 leadership 44 practice questions 96–9 lifestyle considerations likeability 61 local presentations 11 long-listing management 21, 44 Maurice P Hudson Prize 122 MDs 18 mock interviews 62 Modernising Medical Careers 16 neurosurgery 159–62 non-verbal cues 60–1 Objective Structured Assessment of Technical Skills 66 obstetrics and gynaecology 131–4 ophthalmology 157–9 otolaryngology 154–6 paediatrics and child health 138–40 paperwork 27 Patrick Trevor-Roper Undergraduate Travel Award 157 persistence 182 person specifications 58–9 personal appearance 65 personal integrity 76 PhDs 18 plastic surgery 162–4 portfolio 20 preparation of 25–6 review 59 portfolio station general surgery 148 plastic surgery 163 practice questions 84–8 surgery in general 118 postgraduate degrees/diplomas 34 practical assessment 52–3, 66–7 surgery in general 120 practice for interviews 62–4 practice questions 81–105 audit and clinical governance 91–3 clinical scenarios 88–9 commitment to specialty 89–91 coping with pressure 101–2 empathy and sensitivity 102–3 leadership and teamwork 96–9 portfolio station 84–8 problem solving and decision making 99–101 professional integrity 104–5 research and academic 93–5 teaching 95–6 training and portfolio 82–4 Preiskel Elective Prize 117 preparation 23–7 presentation of application 30–2 copying and pasting 32 English language 31–2 presentation prizes 11 presentation stations 68 presentations 11–12 acute medicine 165 anaesthesia 122–3 cardiology 167 care of the elderly 169 endocrinology 171–2 gastroenterology 174 infectious disease 175–6 neurosurgery 159 obstetrics and gynaecology 131 ophthalmology 157 otolaryngology 154–5 plastic surgery 162–3 public health 144 radiology 135 renal medicine 177 respiratory medicine 179 trauma and orthopaedics 150–1 pressure, coping with 101–2 prioritization exercise 76–8 prizes 10–11 acute medicine 165 anaesthesia 122 cardiology 167 care of the elderly 169 core medical training 110 emergency medicine 127 endocrinology 171–2 gastroenterology 174 infectious disease 175–6 listing on application form 36–7 neurosurgery 159 obstetrics and gynaecology 131 ophthalmology 157 otolaryngology 154–5 Index 191 prizes (Cont.) plastic surgery 162–3 public health 144 radiology 135 renal medicine 177 respiratory medicine 179 surgery in general 117 trauma and orthopaedics 150–1 problem solving 76 core medical training 113–14 ophthalmology 158–9 otolaryngology 156 practice questions 99–101 public health 145–6 professional examinations 15 professional integrity 104–5 Professor Harold Ellis Prize 117 psychiatry 140–4 public health 144–7 publications 12–15 anaesthesia 123 cardiology 167 care of the elderly 170 case reports 13–14 forget-me-not journals 14 gastroenterology 174 infectious disease 176 letters to the editor 13 listing on application form 38 neurosurgery 159 newsletters, local newspapers and magazines 13 non-clinical journals 14–15 public health 145 radiology 135 renal medicine 177 respiratory medicine 179 review papers 14 surgery in general 118 trauma and orthopaedics 151 see also journals radiology 134–7 reapplication 181–3 reflective practice 26–7, 87 regional presentations 11 renal medicine 177–8 research 18 practice questions 93–5 192 Index research prizes 11 respiratory medicine 178–80 resuscitation scenario 69 Richard Johanson Obstetric Prize 131 Roderick Little Prize 127 role-playing scenarios 69–75 Acute Care Common Stem 116 acute medicine 166 anaesthesia 124–5 cardiology 168 care of the elderly 170 emergency medicine 130 gastroenterology 174 general surgery 118–119, 148 infectious disease 176 marking scheme 70 neurosurgery 161 otolaryngology 156 paediatrics and child health 139 radiology 136 renal medicine 178 respiratory medicine 179–80 trauma and orthopaedics 152 Royal College examinations 34–5 Royal College websites 186 scenarios see clinical scenarios selection centre interview and practical assessment 52–3 selection exams 24, 45–8 clinical problem solving test 46–7 situational judgement test 47–8 strategy 45–6 timing 46 selection process 2–3 exams 24 interviews 24 learning about 23 where to apply 25 self-improvement 182–3 self-practice 62 selling yourself 53, 60 seminars 16 sensitivity 75 practice questions 102–3 short-list protocol 29–30 short-listing Sir John Brotherston Prize 144 situational judgement test 47–8 society membership 16 specialty choice of 6–7 commitment to 15–17, 41–2, 89–91 knowledge of 59–60 research into 16 State of the Art Prize 122 structured interviews 51–2 success in job applications surgery in general 116–21 teamwork 44 practice questions 96–9 telephone consultation 78–9 Tim Chard Case History Prize 131 training courses 35 trauma and orthopaedics 150–4 UK Comprehensive Clinical Research Network 18 undergraduate degrees 33 vocal tone 60–1 tasters 16 teaching, practice questions 95–6 teaching posts 18–20 listing on application form 39–40 working smart 2, Index 193 ... Mortin anaesthetics Catherine Houlihan infectious disease Akash Patel tr auma & orthopaedics Aisha Janjua obstetrics & gynaecology Preethi Rao diabetes and endocrinology Amrita Jesurasa public health... societies award bursaries to students organizing an elective or project related to the relevant specialty The awards are made annually and they are always worth trying for—plus the spare cash will.. .How to get a specialty training post: the insider’s guide success in medicine series How to get a specialty training post: the insider’s guide written by Danny C.G Lim, MBBS, BSc, MRCP Cardiology