How to obtain an ST3 post in general surgery and vascular surgery

Authors: Kapil Sahnan, Jessamy Bagenal, Kaji Sritharan 

Publication date:  26 Feb 2014


Kapil Sahnan, Jessamy Bagenal, and Kaji Sritharan look at the interview process for the third year of specialty training in general surgery and vascular surgery

The national interview selection process for the third year of specialty training (ST3) in general and vascular surgery is coordinated by the London Deanery and overseen by a specialist advisory committee of the Joint Committee on Surgical Training. Candidates can apply for either general surgery or vascular surgery or both, and their overall interview score will determine their placement. In 2013, candidates were asked to complete an online application form and then, depending on their eligibility, they were invited for interview at a single location. In total, 555 candidates were interviewed.

A candidate’s end score is based entirely on his or her performance at interview, which is broken down into six stations (box 1). Throughout the process candidates must display a number of characteristics to maximise the number of points scored. These are outlined in the person specification published on deanery websites. This specification also gives advice on techniques that can aid interview preparation and performance on the day.

Few people can walk into an interview without feeling anxious, and so anything you can do to limit stress ahead of the interview may help your performance on the day. This includes knowing exactly where you are going and having a separate folder with all the information the deanery asks you to bring, such as passport, photos, and original degree copies.

Find a partner or group with whom you can practise your interview techniques. This will help you to formulate structured answers to commonly asked questions and allow you to articulate your responses under pressure. Practising with others will also highlight any problems with your interview technique—it is better to iron these out early. It can also be helpful to join a journal club as your ability to critically appraise an abstract or paper will be assessed in the interview, and journal clubs are an invaluable way of developing this skill.

The interview is a snapshot of what you may have been working toward for several years. Bear in mind that each station is only 10 minutes long and the initial impression you give will make a difference. In general, wear comfortable, smart clothes, and avoid loud colours. During the interview you will be asked to perform surgical skills, so wear clothes that do not restrict your movement (you are allowed to take a jacket off). A smart, professional appearance and structured, well organised manner, in combination with your achievements, will help offset minor blips you may have during the interview process. If you give a good initial impression, interviewers may also be more likely to guide you through difficult aspects of the station or give you some direction if you are stuck.

It is also worth finding consultants who interview candidates regularly and asking them to give you a mock interview. As well as surgeons, ask emergency medicine and anaesthetic consultants, especially with regards to case scenarios that entail resuscitations. Although there are no correct answers, you need to deliver a structured answer that you are ready to defend.

Interview

Candidates are scored equally in all stations apart from the portfolio section (box 2), where they are divided into three groups according to the number of years they have been qualified (fewer than five years, five to seven years, and more than seven years). The further you are from qualification from medical school, the higher the required standards that you are expected to achieve to receive maximum marks. For example, more senior interviewees will need more publications to score full marks. In many of the clinical scenario stations, candidates tend to achieve similar scores, and so you may be able to distinguish yourself more easily in the portfolio and the academic station.

Between each station, there are a few minutes where candidates have the opportunity to move on to the next part of the interview and also to prepare for the upcoming station. This time is invaluable for you to formulate a basic structure to answer your next question. If you have one bad station, it is important to try to put it behind you and remember that stations are marked independently and scoring is based on a set scoring system. In some stations the panel may challenge you, disagree with you, or make you feel uncomfortable. But they may still score you highly, as the station scoring sheet may require the demonstration of attributes such as, “Capacity to operate effectively under pressure and remain objective in highly emotive or pressurised situations.”

Who are they looking for?

The interviewers are not trying to find a finished product. Rather, they are looking for a set of attributes and achievements that suggest an ability to undergo an accelerated learning curve that will allow a smooth transition from senior house officer to registrar to consultant. They want to appoint trainees who are safe and who recognise their limitations—that is, trainees the panel would not be concerned about being on call with. Patient safety is paramount and all candidates, irrespective of experience, need to recognise this and discuss key decisions with their seniors.

Often marks are awarded on the basis of a candidate’s ability to communicate in a team and show appropriate leadership in delegating to juniors and maturity in asking for help from seniors. A common scenario for the interview is to be in a position where all you need to know is the correct ladder of escalation. For example, you have an emergency and your consultant is not answering his or her phone. In that situation, an appropriate answer could include calling the second consultant on call, a more senior trainee who is in or near the hospital, the clinical lead, or the consultant whose team you are in. If none of those options is feasible, you could even ask the switchboard to start at the top of the list and ring all the consultants covering that specialty.

In most cases, the scenarios have been taken from real situations and there is often no right answer. But the panel is looking for aspects of the person specification, such as “capacity to think beyond the obvious, with analytical and flexible mind,” “capacity to bring a range of approaches to problem solving,” or “capacity to monitor and anticipate situations that may change rapidly.”

Box 1: The stations

Before you start the process you will be shown a short video detailing the events of the day and explaining the format of the stations.

Audit and risk management

Candidates are provided with a scenario where a mistake has occurred and then asked to describe the management of such an incident. This may entail developing an audit around the event, such as a foundation year 1 doctor not using aseptic technique to take blood from a central venous pressure line and two patients on the ward developing line infections.

Teaching and clinical skill

In this station you will be asked to teach the panel a skill, as well as showing the panel your ability to perform this skill, such as “open and close an arteriotomy.” The Royal College of Surgeons teaching course “Train the trainers” asks you to follow a set teaching method, and often marks will be awarded for knowledge of this, although you may be asked to speed up the process. You should also ensure you perform basic skills, such as gauging the experience level of your audience and designating time for questions.

Management and academic

Usually you will be given an operating list to order and asked to start the first case alone before a problem arises requiring you to call your boss. In the second part of the station, you will be asked to review and discuss an abstract, which will often be a randomised controlled trial. Higher scoring candidates may be pushed on statistical tests and the basics of study design.

Portfolio

A two person panel will go through your portfolio and ask for evidence of essential and desirable criteria—for example, evidence of engaging in teaching. See box 2 for more advice on how to prepare your portfolio.

Clinical scenario

There will be two basic emergency scenarios with multiple sick patients, thus testing medical knowledge and management ability. Questions are similar to those asked on advanced trauma life support courses but with a greater focus on delegation of resources. Here it is important to establish where you are (for example, do you have vascular/paediatric surgery on site) and which colleagues you have available (foundation year 1, core trainee year 2, associate specialist, and so on).

Communication skills

You will be given a list of the on-call take and asked to ring your consultant to update him or her and to justify management decisions, as some patients will need operations or to be transferred to an intensive care unit. Here it is important to use the time before you go in to the interview to structure your answer. For instance, you might want to say, “There are 12 patients, and I am concerned about seven of them, three are worrying but I have stabilised them, one has been taken over by another team.” Here you can show your initiative and pre-empt the interviewers’ questions by saying that you have already discussed the preoperatives’ cases with the anaesthetic team and the theatre staff and that the patients’ family members are on their way in. Try to summarise if time permits, and if you think at the start of the interview that you are going to need the consultant to come in, then open with that before you give the summary.

Box 2: Portfolio

How you present a portfolio is a reflection of your personality and is your opportunity to sell your attributes to the interview panel. Candidates who present a well structured, easily interpretable portfolio generally succeed. Time invested in developing a robust portfolio is therefore essential. The deanery will send clear instructions on how you should organise your portfolio, and it’s important to follow these meticulously. Additional features, such as coloured index cards and dividers, can make a portfolio more visually appealing and easier to navigate. Such features will also save the panel from having to shuffle through each page when they could be listening to you telling them how great you are.

Giving your portfolio to a non-medical friend or family member is often a useful way to ascertain how easy your portfolio is to read. After a day of looking at dozens of candidates, the panel develops sharp eyes, and it therefore helps if you are slick about the detail. So ensure you print using the same quality and colour paper throughout, and use the same type and make of plastic wallets.

A range of candidates apply for specialty year 3 posts. Some come directly from the second year of core training, while others will have completed higher degrees, such as a masters degree or doctorate of philosophy. Whatever stage of career you are at, it is important to consolidate your account of your experiences and achievements so they are targeted either toward surgery or the criteria on the person specification. For example, there is normally a section of the portfolio in which the deanery wants you to put Intercollegiate Surgical Curriculum Programme workplace based assessments. In this section, try highlighting two or three pairs that show progression. For instance, if you initially attained a level 1 outcome on a procedure based assessment for a hernia repair but then received a level 3 as you built your operative competency, this demonstrates qualities such as trainability, thereby making the most of the required documentation.

Competing interests: The authors are running an interview preparation course for specialty training year 3 interviews entitled “Get your first choice, first time.” Further information about the course is available by emailing  kapil.sahnan@imperial.nhs.uk.

Kapil Sahnan ST3 in general surgery  St Mary’s Hospital, London, UK
Jessamy Bagenal ST3 in general surgery   Chelsea and Westminster Hospital, London, UK
Kaji Sritharan vascular consultant   St Mary’s Hospital, London, UK

 ks303@doctors.org.uk

Cite this as BMJ Careers ; doi: