How to prepare for the ST3 general surgery applicationBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i352 (Published 28 January 2016) Cite this as: BMJ 2016;352:i352
- Rikesh Patel, year 3 specialty trainee in upper gastrointestinal and general surgery, Aintree University Hospital, Liverpool,
- Adele Sayers, year 4 specialty trainee in vascular and general surgery, Hull Royal Infirmary,
- Amar Deshpande, consultant breast surgeon, Royal Albert Edward Infirmary, Wigan
Candidates must start preparing early to win a place in this competitive field, say Rikesh Patel and colleagues
Competition for surgical posts at specialty training level 3 is fierce, with roughly five candidates for every general and vascular surgery place.1 To maximise your chances you must prepare well in advance. Numerous articles have been written to aid preparation, and it is important to review these.23
Candidates should read the previous year’s application guidance to identify the most recent format of the interview.4 In 2015, the interview was divided into five stations:
2) Clinical management/clinical scenarios
3) Professional communication
4) Leadership, team working, and academic
5) Patient communication scenario, technical skills, and teaching.
Candidates must work on their portfolio for at least a year before the interview. Marks awarded are based on your achievements in relation to the number of years since completion of your primary medical qualification (table⇓).
The portfolio should be set out as described in the application guidance, ensuring that each section includes a consolidation sheet and also your CV as an overall summary. As examiners have limited time at interview, most of the marks will be awarded beforehand. The purpose of this station is clarification, so it is important that you know your portfolio well.
Marking has previously been carried out according to 10 domains (see table).
Surgical experience, which is divided into two sections:
—Workplace based assessments
Clinical management/clinical scenarios station
Ask colleagues who have done the interview for tips. As the interviews have been running for several years now, a large number of scenarios are in circulation to practise.
Maximum marks are awarded based on recognition of all clinical issues, prioritisation, utilising all available resources, and delegation of tasks. Marks will be deducted if prompting is required.
Professional communication skills station
Here, candidates telephone a consultant to hand over roughly 10 patients. This tests not only communication skills but also the ability to devise an appropriate management plan and prioritisation.
Leadership, team working, and academic station
Leadership and team working
This station tests candidates’ ability to come up with and implement an action plan after an adverse incident. Ensure you are familiar with the audit process and route cause analysis.
Candidates will be asked to appraise a piece of research and find the mistakes or areas for improvement in the abstracts presented. After summarising the abstract, you will be asked research related questions. Two useful books are Medical Statistics Made Easy5 and Medical Statistics at a Glance.6
Prepare by joining or setting up a journal club. The British Journal of Surgery also runs a workshop on critical appraisal at the annual meeting of the Association of Surgeons of Great Britain and Ireland.
Patient communication scenario and technical skills and teaching station
Patient communication scenario
This ran for the first time in 2015 and involved consent and breaking bad news. Practise communication skills on the ward and ask colleagues for feedback (see boxes 1 and 2).
Technical skills and teaching station
The station is designed to test not only your technical ability but also your teaching skills. Watch the Royal College of Surgeons’ Basic Surgical Skills DVD repeatedly and practise each skill as a four stage technique.
At the 2015 interviews, a variety of skills were assessed across different panels and different days (box 3).
Timing—Two stations require advance preparation so keep an eye on the time and wear a watch.
Get advice—Ask colleagues who have done the interview for tips. Ask consultants who have acted as interviewers in previous years to review your portfolio and advise you on certain stations.
Practise—Practise scenarios and teaching technical skills with a colleague.
Preparation courses—Several privately run courses exist, such as the Medicate ST3 General Surgery Interview Skills Course, which are expensive but useful. Your local education and training board may also provide training.
Obtaining feedback—If you don’t succeed, ask for feedback to help identify areas for improvement.
Box 1 Tips for consenting in the patient communication scenario
Review all necessary information and images first
Confirm the patient’s identity
Explain the procedure including postoperative management (high dependency unit/ward/discharge)
Ensure all technical terms are explained in lay terms; consider using diagrams
Ascertain patient’s prior understanding
Mark the site appropriately
Discuss the benefits of the procedure
Discuss the risks of the procedure (know percentage risks for common procedures)
Ask the patient if they have any additional questions and to read through the form before signing
Give the patient a contact should they have any further questions
Give the patient a copy of the consent form and any additional information if necessary
Box 2 Tips for breaking bad news in the patient communication scenario
Use a quiet room
Leave your bleep with a colleague so that you are not disturbed
Ensure that you have the patient’s permission to talk to the family
Take a senior nurse with you (with or without a Jehovah’s Witness elder/hospital legal team/independent mental capacity advocate, as appropriate)
Introduce yourself and explain your role
Ascertain prior understanding
Set out agenda
Empathise and develop a rapport
Apologise if necessary and admit fault
Give patient or relative a contact should they have any further questions
Give patient or relative additional information—for example, support groups
Give patient or relative a contact for Patient Advice and Liaison Services if they have any complaints
Box 3 Skills assessed at 2015 general and vascular surgery interviews
Subcuticular suturing using a suture training pad
Excision of a skin lesion and closure of the defect
Laparoscopic excision of a triangle
Arteriotomy and vein patch
Small bowel anastomosis
Surgical knots—one handed reef knot, surgeon’s knot, and instrument tied knots
Competing interests: We have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.