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Careers

How to prepare for the ST3 general surgery application

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i352 (Published 28 January 2016) Cite this as: BMJ 2016;352:i352
  1. Rikesh Patel, year 3 specialty trainee in upper gastrointestinal and general surgery, Aintree University Hospital, Liverpool,
  2. Adele Sayers, year 4 specialty trainee in vascular and general surgery, Hull Royal Infirmary,
  3. Amar Deshpande, consultant breast surgeon, Royal Albert Edward Infirmary, Wigan
  1. rikeshpatel{at}doctors.net.uk

Abstract

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:

  • 1) Portfolio

  • 2) Clinical management/clinical scenarios

  • 3) Professional communication

  • 4) Leadership, team working, and academic

  • 5) Patient communication scenario, technical skills, and teaching.

Portfolio station

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).

  • Additional qualifications

  • Prizes

  • Surgical experience, which is divided into two sections:

    • ­—Workplace based assessments

    • —Logbook

  • Career progression

  • Courses

  • Audit

  • Publications

  • Presentations

  • Teaching

  • Management/leadership/teamwork

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.

Academic station

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).

Additional tips

  • TimingTwo stations require advance preparation so keep an eye on the time and wear a watch.

  • Get adviceAsk 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 coursesSeveral 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 feedbackIf 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

Footnotes

  • Competing interests: We have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.

References

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