CAREER IN PLASTIC SURGERY 

Surgical Training

      Interviews

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Obtaining the job will depend mostly on your interview score, therefore preparing for your interivew is absolutely essential. It is worth doing a few sessions of mock interviews (or viva style) with your colleagues or supervisors (a consultant or a registrar) to practice the common clinical scenarios and common interview questions abour audits, management, leadership and teaching. Try to keep your answer succint and comprehensive.

 

Preparing for your interview

This is an example format of how you should practice for your interview: 

 

• 3-4 months before interview 

  • Find out about the interview format from previous years

  • Research the training programmes in the appropriate deaneries 

  • Organise your portfolio

  • Form an interview practice group

  • Book an interview preparation course

  • Research issues specific to the specialty

  • Read the latest research and clinical topics in the specialty 

• 1-2 months before interview

  • ​Arrange a mock interview with consultants 

  • Interview practice group: organise a few sessions

  • Practice answering questions in different areas of the person specifications 

  • Review your CV and application forms

  • Revise resuscitation manuals and clinical manuals

  • Prepare for the selection stations (if relevant)

• Less than 1 month before interview

  • Make practical arrangement, eg. travel, accommodation

  • Final interivew question practices

  • Review CV and portfolio for a final time 

 

 

THE INTERVIEW DAY

It will take place in London - so it is advisable to go the day before to settle down and calm yourself. The interviews usually take place over two days so check the dates and times carefully. It will last for about 75 minutes and will divided into the following structure according to the Joint Committee on Surgical Training (JCST):

 

• Structured interview, eg. audit, teaching, and research (15 minutes)

• Oral presentation (5 minutes)

• Objective Structured Clinical Examinations (OSCEs) (two stations of 5 minutes each)

• Clinical scenario (15 minutes)

  • Telephone consultant 

  • Role-playing scenario

  • Paper review exercise

• Portfolio interview (30 minutes)

 

Structured Interview

This station asks candidates about audit, research, management, leadership, and teaching experience. The first question (“Why do you want to do plastic surgery?”) is an icebreaker and is not marked. After this, the panel, made up of two markers and possibly a third observer, will have four questions or requests, such as “Describe an audit you’ve done.” The aim is to give well rehearsed but real and excellent examples in response to each of these questions.

 

They may also ask you a few questions like:

• Do you have a specialist interest in any area of plastic surgery and why?

• What have you learned from your case-based discussions?

 

Oral Presentation

This station allows candidates five minutes to prepare an answer to a plastic surgery “hot topic,” that is, something important to current training, or an issue recently topical in the press. Candidates then deliver a five minute oral presentation. Marks are allocated for organisation of the presentation, delivery, content, and concluding remarks. Candidates are then asked questions by the panel and marked on their answers. In this station maximum marks can be awarded only if candidates are able to incorporate specialty specific material by quoting a recent study or article. The key to preparing for this station is to know about current issues within plastic surgery by reading news features on the British Association of Plastic, Reconstructive and Aesthetic Surgery’s website, reading the Journal of Plastic, Reconstructive and Aesthetic Surgery, and generally knowing about the shape and direction of training.

 

OSCE Stations
In this station candidates are asked to take part in a role play during which one of the panel members will act as a patient, and the candidate will have five minutes to obtain consent on a plastic surgery procedure. To get good marks for this task, you should discuss the type of anaesthesia, the operative environment, and the postoperative care of the patient. In the other five minutes you will be asked to “call the boss” about an acute scenario, such as amputation of digits or a major burn. You will be given a page of basic history and examination findings and asked to relay this to the consultant on the phone. Marks are deducted for being prompted for information and lack of a coherent assessment and plan. Here you are tested on safety and appropriate management of an emergency, including investigations and communication skills. The key is to be methodical, clear, and to have an excellent understanding of how to investigate and manage these scenarios by what you tell the boss over the phone.

 

Role-playing Scenario (as adapted from Reference 2, you can read the full details from this book)

Role-playing scenarios are used to assess the candidate's communication skills. The topic for it may include:

• Breaking bad news

• Explaining a diagnosis or results

• Dealing with complaints or disgruntled relatives

• Explaining procedures or treatment options

• Patient education

 

Scenario 1 

Candidate instructions 

       You are the orthopaedic ST1 and Mr Bean, a 79-year-old man, was admitted for an elective hip replacement. The procedure itself was uncomplicated, but a few days later Mr Bean developed diarrhoea. A stool specimen has confirmed Clostridium difficile toxin. Mr Bean has been on metronidazole for 2 days as advised by the microbiologist. He is slightly delirious and the diarrhoea is still present.

       Mr Bean's daughter has just arrived from Australia. She is on the ward and demands to speak to the doctor. Your task is to speak to the daughter and update her on her father's condition. You are expected to respond appropriately to any questions or conserns raised.

You have a total of 10 minutes, including 2 minutes of readign time.  

 

Clinical scenarios (as adapted from Reference 2)

This station tests the candidates’ clinical knowledge and safety. There are usually four scenarios to cover in 15 minutes and candidates are asked specific questions about each one. This station will go well if you have learnt common plastic surgery clinical scenarios with others beforehand. Examples include a flexor tendon injury, a minor burn, and skin lesion.

 

Question 1

You are called to the high-dependencey unit to see a persistently hypotensive 73-year-pld man who is 2 hours post-op (intra-oral free flap reconstruction for tumour excision. How would you proceed? How do you assess a free flap?

 

Question 2

You are the plastics registrar asked to review a 57-year-old man involved in a road traffic accident. He has a significant degloving injury with cold and pale digits. There is no radial pulse palpable. What are your next steps? How long is the critical ischaemia period?

 

Question 3

You are called to the ward to see a 47-year-old woman who is 5 hours post-op. She had undergone a bilateral breast reduction. She now has increasing pain and swelling in her right breast. How would you proceed?

 

Question 4 

How would you manage a 60-year-old man with full-thickness burn? How do you estimate the percentage of skin involved? Calculate the fluid resuscitation requirements.

 

Telephone Scenario 

This scenario is an imaginary telephone call scenario that you have been asked to discuss to your consultant about. The topics may cover: making a referral, requesting an urgent scan, or talking to a GP. This will aim to assess your time-management skills (you will have about 10-15minutes), communication skills, decision-making (prioritization) and organizational skills (involving other professioanls). 

 

Question 1

You are the plastics ST3 on-call and it is midnight. A 45-year-old patient has necrotizing faciatis in her right lower limb. You have 5 minutes to read the notes and formulate a plan. You are then to call your consultant Mr Gruff with your plan. [Note: Do not expect Mr Gruff to be friendly. He may be off-putting on purpose.]

 

Positive indicators:

• Clear communication

• Resuscitation and sensible plan 

• Teamwork, ie. anaesthetist, theatres, juniors

• Be firm with a 'difficult' consultant

 

Question 2 

Speak to the consultant for Neuro-ITU and ask for a bed for one of your patients. The consultant could challenge you on your apporpriateness of your referral or that he woudl like to 'reserve' his remaining ITU bed. 

 

Question 3

Speak to the neurosurgical consultant on-call (a locum) to come in to help you with an operation that you are not competent with. The procedure is urgent but the consultant may try to persuade you to postphone it. 

 

Paper-Review Exercise

You could be given a paper to critically appraise. Revise your evidence-based medicine and ensure that the evidence is applicable to your patinet's circumstances. 

 

Topical Questions

General surgery (CT1): 

• The European Working Time Directive (EWTD): do you think it is good for surgical trainees?

• How would you determine if a patient is comeptent to consent?

• Do you think whistle-blowing should be encouraged? Explain. 

Similar to surgery in General plus: 

• Face transplantation: the ethics involved

• Cosmetic versus reconstructive surgery

• Should plastics surgeons be performing primary section for breast cancer

 

Portfolio Station

This station acts as a verification of evidence. Before you meet the panel, two members of it will go over your online application and check your hard copy portfolio for evidence to see if they agree with your self ratings for all the competences as well as to check evidence for your listed publications, posters, and presentations. You are then invited into the room and given the opportunity to discuss any areas where the panellists disagree with your score. Your scores may go up or down based on the evidence in front of them, which is why it is crucial to have all printed evidence of any claims you have made on the form. If after discussion you don’t agree with the panel members on the final score you will be allowed to appeal the station and go through the process with another panel. You will not be penalised for doing this and you can choose to sign the form to say you want to appeal outside of the station. Unlike other portfolio stations you do not get marks for describing your poster or talking about your research. The scoring of portfolio station is often based on: 

1. Presentation and organisation of portfolio 

2. Quality of the evidence provided

3. Qestions on training and achievements

4. Knowledge of work-based assessments 

 

 

More interview question examples available in the book: Success in medicine. How to get a specialty training post: the insider's guide by Lim DCG.