Intended for healthcare professionals

Career Focus

How to prepare for your first specialist registrar interview

BMJ 2004; 328 doi: (Published 12 June 2004) Cite this as: BMJ 2004;328:s233
  1. James Thaventhiran, specialist registrar in immunology
  1. St Bartholomew's Hospital, London


Mark Scoote, Andrew Elkington, and James Thaventhiran talk you through the most important hurdle that future hospital consultants face and give a list of genuine interview questions on web extra

Entry into a higher specialist training scheme is the most important career hurdle a future hospital consultant faces. The failure rate in competitive specialties is far higher than any postgraduate exam.1 Despite this, most candidates spend only a fraction of the time preparing for specialist training job applications that they spend on preparing for postgraduate exams. As a result, many aspiring specialist registrars (SpRs) are not sufficiently prepared to pass this bottleneck, a situation acknowledged by the emergence of several SpR interview courses increasingly advised in this journal.

In this article, three trainees who have recently passed this career hurdle share their experiences and give advice on how to prepare and plan for the SpR job interview. We discuss the reasons why our earlier attempts were unsuccessful and what lessons we learnt, along with how increasing preparation and planning finally led to a successful outcome.

Various resources on interview preparation are available, and the purpose of this article is not to discuss all aspects of generic medical interviews. Rather, we specifically focus today's cohort of senior house officers (SHOs) on the future SpR career hurdle and alert them to the various issues they will soon be faced with in the search for that ever elusive national training number.

Adopting the “me first” attitude

The SpR application process is one time when you have to put your own interests first. You are competing against your peers for the security of your future career and all that entails. You may be competing with friends and colleagues, and many medics feel uncomfortable about adopting the hard sell or me first attitude. Unfortunately, this is one situation where it is needed. You are effectively being assessed on your suitability to be a consultant and colleague of your interviewers in the long term (as well as their potential registrar in the short term).

A note on the application form

The subject of preparing a curriculum vitae (CV) and getting short listed has previously been discussed.2 We assume that your presence on the interview short list signifies a good application form and CV. Do not exaggerate your credentials on the application form, and under no circumstances be tempted to lie. You must assume that anything written down will be checked beforehand or discussed in detail during the interview—for example, we experienced our publication list being reviewed on PubMed in front of us during the interview. Any departure from the truth, if detected, will be fatal both to this job application and probably future ones as well.

Desired criteria list

Most SpR appointments are made on the basis of assessment from both the application form and interview against a defined set of essential and desirable criteria, which we have considered previously.3 Remember that all shortlisted candidates will be deemed to possess the essential criteria, so everyone will be similar on these points.

What will set you out as a successful candidate and distinguish you from your peers is how many of the desirable criteria you possess. For example, all candidates will be able to say they have competent computer skills, but how many will have passed the European Computer Driving Licence examination? All candidates are likely to have some experience of teaching, but how many have attended formal training on teaching techniques to improve their skills. It is points like these that quickly identify the best candidates. Many deaneries use a standard application form and assessment criteria, which you can often obtain in advance. Review these documents as early as possible and work towards having something of credit to put in every box.

Interview performance

Although you may be the best candidate on paper, this does not guarantee your success because the best candidate may not be the best performer at interview. For many candidates having their first attempt at getting an SpR job it may be the first interview for some time, possibly two or three years if they are coming to the end of a long SHO rotation or finishing a research appointment.

During that time, attention has quite rightly been focused on passing examinations, and other than advice from seniors, little formal interview preparation is available within general professional training schemes. So candidates may be short of practice and unprepared for the process ahead of them. As your desired SpR post may be advertised only once a year it is vital that you begin preparation as soon as the euphoria of passing postgraduate exams has subsided.

The interview panel

In general, the SpR interview is likely to be more formal than any you have encountered previously. There may be 10 or more interviewers on the panel, who may themselves be split up over several tables. The interview may be carried out in an OSCE (objective structure clinical exam) format, each station designated to ask specific questions. This is particularly true in some of the bigger specialties, where there may be several national training numbers available and a large number of shortlisted candidates.

The panel typically comprises the chairman and programme director of the specialty training scheme, along with a variable number of consultants in the specialty. A representative from the postgraduate deanery and possibly a member of senior management will be present. There may also be a lay member, who may be responsible for introducing the interview panel and starting proceedings.

Answering the questions

Members of the interview panel will all have your CV or application form in front of them and take it in turns to ask questions on various subjects. Such questioning is not random. It is carefully designed to touch on all aspects of the selection criteria. Therefore, the general subject areas and first question in each subject will be the same for everyone, allowing a direct comparison of performance between candidates.

Question organisation may be structured so that each interviewer has a number of set questions to ask within an allotted time span. Your answers to all of these questions will gain credit, so it is essential that you don't spend too much time answering the first question.

You are likely to score more highly by delivering several concise answers over a range of subject areas rather than spending all your time answering just one question, even if it is delivered well. The ability to know when to stop talking is one interview skill that may be difficult to master. Although monosyllabic answers are rarely called for, if you believe you have answered a question fully do not be tempted to keep talking further, even if there is a brief period of silence which you feel a compulsion to fill by extending your answer.

It is helpful to view your interviewers as examiners: they will be polite and try to put you at ease, but do not expect them specifically to help you with your answers or give verbal and non-verbal feedback on your performance as you progress. A smile and a nod may greet an appalling answer as well as one that was answered perfectly. If you feel your last answer was poor, put it behind you and focus on the remaining time you have; it may well be possible to overcome a setback and redeem yourself with subsequent questions.

The questions

One thing is almost certain: many of the questions will be difficult and searching and they will test to the limit your ability to think and respond under pressure. We have assembled a list of questions which we have been asked at SpR interviews attended over the past 12-24 months (see web extra).

The common question categories are listed in the box. For example, you can expect to be asked about your understanding of clinical governance and your experience of audit, but the difficulty lies in how these subject areas can be expanded. We can all learn and recite a definition on clinical governance, but what will be tested is your understanding of the issue. For example, after giving your definition you may be asked how the European Working Time Directive is relevant to clinical governance or whether there are any problems relating to how clinical governance is being implemented. Your answer to these follow on questions will be the time you can shine and put yourself into contention.

The interview is not the time to express controversial views on a particular subject. You need to strike a balance between demonstrating independent thought and opinion but at the same time showing you are someone who can fit in to the training scheme and conform to the required standard of conduct.

Under no circumstances argue a point with the interview panel, even if you feel you are correct. You may be asked quite detailed questions concerning clinical knowledge in your specialty. This is not limited to discussing an ethical dilemma or problem patient. You may well be asked to discuss how you would manage a particular condition as a SpR or be asked to discuss the latest evidence based treatment advances in your specialty.


Although we all know people who seem to sail confidently through interviews, most of us find them difficult and stressful. This will be true for most of your competitors as well. Your success depends on adequate preparation and practice, so you can identify your weak areas and address them.

Some question subjects asked at SpR interview

  • Academic achievement and career progression (often opening “ice breaker” question)

  • Teaching and audit experience

  • Information technology skills

  • Clinical governance and risk management issues

  • Specialty knowledge base—for example, latest treatment advances

  • Clinical experience—for example, practical procedures (and their associated complications)

  • Seeking advice versus acting independently

  • Dealing with ethical dilemmas

  • Use of communication skills

  • An interesting or difficult case

  • Experience of multidisciplinary teams

  • Research experience

  • Current NHS or healthcare politics

Make a question list, prepare your answers, and rehearse them over and again. Get colleagues to interview you critically under pressure and try to arrange a practice interview with a senior doctor you are not too familiar with as this will help simulate the pressure of the interview.

If possible, video yourself being interviewed and observe your posture, mannerisms, and clarity of speech. It may be helpful to obtain additional professional coaching and advice on interview technique. Several courses are now available, including some which are tailored specifically for the SpR interview. Some courses have a distance learning facility.


In our experience, the SpR interview is probably the most objectively assessed interview you are likely to experience. Your CV credentials and performance on the day should be the deciding factors on whether you are appointed.

You should have some knowledge and information about the training scheme and the hospitals you are hoping to work in. This may come from previous SHO posts within these hospitals or by visiting one or more of them and talking informally with SpRs currently in post.

Contacting and arranging meetings with more senior staff, such as the training scheme programme director, may or may not be possible. Often the individuals' secretaries or current SpRs will know. In general, such people react positively to any interest shown in their region and training scheme. They may be able to give advice on the current content of your CV, your realistic chances, and potential areas that you need to improve. After all, they are the people who know the current standard of candidates obtaining national training numbers.

We suggest that unless informal visiting arrangements are specifically offered for shortlisted candidates before the interview, it is best to carry out such groundwork well before the time of the job application.


Unless you are an exceptional candidate, it is likely that your first attempt will not be successful, especially in the more popular, over subscribed specialties. This can be a shock and be difficult to come to terms with, as it may well be the first time you have failed to get the job you applied for.

Despite the immediate disappointment you should use the failure as an important learning experience. After coming out of the interview, immediately write down as many questions as you can remember so that you gradually build up your own question bank to practise with (see web extra).

Inquire whether feedback will be available, possibly by arranging a meeting with specific interview panel members on another day (the interview organiser may know if this is possible). Alternatively, your referees may be able to ring up on your behalf and ask a panel member why you were unsuccessful.

Your goal will be to find out the standard of those who did get the post(s) and to identify areas that you need to improve. This may relate to gaps in your CV or a weakness in your interview performance, or both. For example, in competitive specialties it may well be that all the successful candidates had higher research degrees, a string of top journal publications, and additional locum appointment for training SpR experience.

Focus on any weakness identified by subsequent practice so that you will not make the same mistake next time. Make a decision before the interview about whether you would be prepared to accept a locum appoinment for training post, as this may well be offered and can catch you out.

Making a wrong split second decision on such an important career move can have important consequences for your future. The advantages and disadvantages of such posts have been discussed previously.”


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