Home > Flashcards > Print Preview
The flashcards below were created by user
on FreezingBlue Flashcards. What would you like to do?
What is CAMP?
- For background and motivation questions:
What is STAR?
- For 'give an example' questions:
What is SPIES?
- For questions on difficult colleagues:
- Seek info
- Patient Safety
Take me through your CV?
- Viraj, currently doing locum work.
- C - Graduated from UoS in 2012. foundation years in GRH - experience in GP, ED, Acute Medicine, Colorectal surgery, Obs and Gynae and Neurology.
- Foundation years- became confident in the basic competencies of the curriculum but also with clinical skills beyond the curriculum such as LP and Chest drains.
- A - As well as developing clinically i have taken opportunities to continue teaching. Undergrad course, Grand round, journal clubs. Fit to teach
- During my Intercalated degree into biomedical sciences i undertook a research project into the neuroinflam of AD. Good grounding in lit review, lab techniques, data analysis and scientific writing. Research is something i plan to pursue.
- M - I completed an audit looking at the management on encephalitis have implemented a change to clinical practice by way of lp sticker.
- Medicine, and specifically neurology, brings together a combination of clinical and communication challenges and creates an environment which I enjoy and thrive in. This is why i am applying to CMT.
- My 10 year career plan is to become a consultant neurologist who is involved in teaching and in clinical or basic science research.
- I have enjoyed neurology since i was introduced to it at medical school and have become ever more interested since. I find the diagnostic aspects of neurology most attractive especially the range from spot diagnoses that require clinical acumen to diagnostic quandries that require good knowledge and application of investigations. I experienced these when sitting in on clinics during my neurology attachment in india as well as during my foundation years. I enjoyed learning the thought processes and diagnostic rationale that the consultants were using and jumped on any opportunity to apply these.
- -Poor prognoses- demands strong communication skills with patients as well as MDT in order to manage expectations and have support structures in place for the progressing physical and psychosocial issues.
- Field with strong academic vein and encourages teaching and research, both of which i have experience in and am eager to do more of as well as the opportunity to develop a special interest which i have begun to do specifically in neuroimmunology.
- The london CMT training program is very upfront about its eagerness for trainees to get involved with research and teaching. I am passionate about both of these and feel that London offers far more opportunites than other deaneries.
- London institutions are renowned for neurosciences research. Both clinical and basic science
- The 5 major teaching hospitals provide plenty of opportunity for teaching activity
- Career focus to stay for registrar years and do PG in london.
- Broad demographic and variety of pts,
Why not train somewhere else?
Other regions also look interesting but none are quite as upfront about supporting and encouraging academic pursuits.
What is your Biggest Achievement?
- Charity bike ride through india.
- Proud of how I executed each stage of this bike ride from the planning through to completion.
- Planning - Routes, mechanics
- Cycle - Motivation, initiative, problem-solving
- Money- still coming in, over 3000 pounds so far + raised awareness.
What do you like least about medicine?
- I welcome all the challenges that patients, their pathology, their relatives and their behaviour present...
- System is stretched. Bed pressures. Pressure to discharge complex patients early and risk patient safety.
- Pressure comes from senior nurses and i often find that it is easily dealt with by communicating early and effectively with the ward team to create clear plans with thresholds and avoiding the same topic over and over again.
What have you done outside scheduled activities to show interest?
- MRCP 1 - furthered knowledge and increased clinical confidence.
- Website for AAN - translating research and communicating it to a wide audience.
- Audit - Insights into how malleable hospital systems are and the effects different interventions can have on them.
- Courses - Enhance knowledge
Where do you see yourself in 10 years?
- Consultant post
- Unsure of DGHtertiary preference
- Special interest in neuroimmunoneuropsych and hope to be able to lead clinical research.
- Still very keen to continue teaching and develop abilities by taking courses.
- In addition, this year out has been about starting a project in india that aims to change health education policy in order to address the vast health inequalities. Its at a very young stage at the moment but hopefully in 10 years i will still be able to oversee this project as it develops.
What skills do you need to improve?
- Training good so far, broad based from a clinical point of view.
- Academically - involved in audit and teaching over F12 but didnt have the chance to get involved in research. Would very much like to get involved in a project from the beginning and learn more about the process.
- Managment - few opportunities in F12, something i will address early upon starting a training programme hopefully with advice from supervisors.
Give an example of a situation where you showed empathy?
Husband and Father of 2 recovering from encephalitis and family were worried because after a period of good recovery he was no communicating less with wife than before. We as the staff looking after him had noticed that he was brighter when fam not around. Gently raised this topic after doing a routine cognitive assessment.
Give an example of when you had to defend your own beliefs regarding the treatment of a patient?
- Patient known to have vascular risk factors presented with acute vertigo, heard about it at handover,
- Consultant pushing for MRI and wanting to keep patient in hospital for 3 days and on high dose oral anticoag.
- I had recently read about HiNTS
- After handover Discussed the possibility of preventing a prolonged hospital stay with a bedside test in 15 mins.
- Consultant said it wouldnt make a difference as he would not be happy discharging the patient until he had MR confirmation.
- I explained that the study found that the bedside test was more sensitive than MR in the early stages of a PCI and i would be happy to find the paper so he could confirm my interpretation.
- Soon the cons was very interested in doing the exam and allowed me to do it with his supervision and we confirmed that the patient did infact have peripheral vertigo.
- Having seen this work so well i was keen to share the information with the rest of the department and presented at the next journal club.
A situation where you failed to communicate appropriately?
- Busy surgical Take in my first placement
- Lady in her late twenties.
- Clerked her and told her that she would most likely need surgery and that the registrar would be up to confirm.
- Kept her NBM
- Approached evening and she hadnt been given any food and not told why it was that she wasnt given any food. Very upset, felt like she was being tortured, pain wasnt well controlled, she was starving. I realised i had not conveyed to her parts of the management plan that i assumed to be obvious and explained the reasoning behind them. I apologised profusley and asked if she would let me just explain why all those thing had happened.
- R - Explain the entirety of the management plan and its rationale at all times. Good practice for you and pt is kept in the loop.
Informed consent from a patient in a vulnerable situation?
- Surgical management of miscarriage in a lady who was very distressed and more worried about her husband's response. Presented with her sister.
- Slow down, give time, offered that we could delay the conversation. Diagrams
What makes you a good team player?
Approachable and supportive - During set of nights, a fellow junior doc was unable to manage workload, approached me to say she was struggling to concentrate due to problems at home, i suggested that id be happy to share the workload but that it would be prudent to discuss with reg which we did and it resulted in far more efficiency.
Adaptable and Take initiative to try and solve problems - On GP placement found that clinics were overbooked and if i was getting through my list at a good pace would offer to share the workload and take patients
Ability to motivateenthuse other team members, especially when things arent going too well. I found during my ED and ACU rotations that taking the time to learn the names of all the staff led to easy conversation and especially during a busy night it made it easier to keep morale high and bust some of the stress.
Recent example of when you played an important role in a team?
Example where you failed to act as a good team player?
Do you work better on your own or as part of a team?
- I enjoy working as part of a team. Interacting with people, forming relationships and supporting each other is a far more convivial environment in which to learn and work.
- I work better when im enjoying my work and for that reason i would say i work better in a team. But a lot of the jobs that i carry out within teams are individual tasks. Such as running a GP clinic list or organising the ward round. Teams i have worked with have given me lots of positive feedback on the initiative i take to do these individual tasks whilst being a team player and making sure that everybody is in the loop and informed of any developments.
What makes you a good leader?
An example where you showed leadership?
- Busy surgical attachment lot of our workload was taking bloods due to an understaffed phlebotomy service.
- Nurses all said they wanted to help but didnt have appropriate training.
- I discussed with senior nurses how to go about getting training they kindly agreed to organise a formallly taught clinical skills session for the junior nurses.
- After the formal teaching i encouraged the other junior doctors on the firm to delegate blood taking to the nurses so that they could get more experience under their supervision.
- Resulted in substantial decrease of our workload by evening it out across appropriately trained staff. Aided in team cohesion.
- I saw an area in which our ward was not working efficiently and communicated with various people to encourage our staff to increase its skill set. By setting aims and delegating appropriately i was able to help our team work more effectively.
Difference between mangement and leadership?
- Leadership is having a vision and leading a team towards that vision with good communication and enthusiasm.
- Management is directing the people and resources in a group to achieve the vision that has been set.
An example where a new and different approach to a patient of yours proved beneficial?
27 year old lady ex-alcoholic with recently diagnosed cardiomyopathy presented with incidental hypokalemia. 3 admission for this in the past 6 months and she was fed up that the doctors couldnt find the cause. Took a full history, voluntereed no new information. After looking at notes + bloods again i went back to discuss the diagnostic difficulty and involved her in the process. Pt now volunteered that she was bulimic but had not been able to tell anyone and really wanted help. K+ corrected, we referred her to the eating disorders clinic and the patient was. On discharge,, the lady me for not judging and being open and approachable.
Creative thinking to solve a problem at work?
- NK case from OBGYN:
- Situation - Atypical pneumonia, prolonged hosp stay post Csection. Resp advised to move her onto their ward. Obs didnt want anything to do with her. Mother and baby were going to be separated
- Task - I had to do a job, read through her notes and on speaking to her found that she was very anxious and depressed about the whole thing. Separating mother and baby = very poor idea.
- Action - I spoke to my obs cons to hear her thoughts and communicated that this was the only ward mother and baby could be together could we keep her here and convince resp to keep her as an outlier with regular review. Also spoke to resp team and they were happy to.
- Result - For the next 2 weeks mom and son got to stay together and maintain a bond. She got regular reviews and was well on discharge. I had to demonstrate initiative and confidence in going against the plans of 2 consultants but by providing an alternative and highlighting the minor disadvantages with my plan we managed to keep all parties happy.
A mistake you have made?
- Distressed 45 year man who presented with abdo pain and one episode of melaena.
- Well when i clerked him with no abnorms.
- His main concern was getting back home and being ready for work on monday morning.
- I reassured him that we would get him home by the evening.
- When cons reviewed he insisted that pt stay overnight.
- I had misled this gentlman and he was distraught. after the consultant left i sat down, apologised and explained why i had wrongly promised him and it was my presumption. The consultant was far more experienced and was keeping him in for his own safety.
- He understood agreed to stay in for OGD.
- Since then, i have learnt to be more diplomatic when patients ask about managment decisions that do not reside with me and convey that i will endeavour to find out from the person whose responsibility it is.
A situation where you showed professional integrity?
Telling UGI bleed man that he could go home. Could not. Apologising. Telling him the reasons for your actions and admiting your mistake.
What are the advsdisadvs of admitting when mistakes are made?
- Gets sorted quicker
- You know your area of weakness and can work towards fixing it
- People trust you because you are honest
- Matters are generally resolved with less conflict due to the honety
- Suedstruck offfired
- Patients + colleagues lose trust in you
How do you organise your workload?
Out of work
How do you handle stress?
- Acute stress
- Busier you are the more you have to stop
Outside of work
- Longer term stress of many hours or persistently busy take
- Sharing burdens is very important and i insist on team breaks and team lunches whenever possible
Squash, Cycling, drums and band. Cooking
How do you recognise that you are stressed?
Flit and think about all the jobs i have to do rather than doing any one of them. Which is why i always bear in mind that the busier you are the more you have to stop. Assess which job is most important to do next. Do that one and then reasssess.
Example of a stressfull situation?
2 locum docs on over weekend nights and i had to take a leading role.
Holistic approach in managing a patient?
83 year old previously fit, presenting with #humerus. Son at home with parkinsons for whom she was carer and very worried.
Describe a time you had to deal with a sceptical patient?
- S - GP placement, man in 60s presenting with headache. Sounded like a neuralgiform headache and had no red flags. Offered appropriate treatment and onward referral to neuro. Man very concerned that it was a brain tumor, wanted a scan.
- i went through signs and symptoms one would expect using a leafelt from a validated website to support my points.
- He had read about how doctors miss tumors when they present with strange symptoms. Still wasnt happy with my answer.
- Wanted a scan, i said i would discuss it with seniors and call him by the end of the day.
- Seniors felt it warranted onward referral and a CT so i called him back and told him i had done all the following.
- He got his CT which was clear and a diagnosis of neuralgiform headache along with appropriate treatment.
- The benefit of allaying anxiety outweighed the risk of radiation and whether it was an aproprate use of resources is an interesting point of debate but in this situation of a man who was skeptical it was useful to delay the decision and get a second opinion from seniors to inform management.
Explain a time when you had to support a colleague with a work-related problem.
A close friend and housemate who was finding clinical work very difficult for many reasons. Although she enjoyed being a medical student, the decision-making and risk-management that clinical work entails was very difficult for her. She was exquisitely stressed and even when she did her psych attachment which was her long term career goal, she despised it.
I outlined to her that her reasons for not enjoying work were going to be present in every clinical job and she should either consider non-clinical work such as public health, research or a more drastic career change and leave medicine altogether.
Reassured her that her degree was very valuable and would get her interviews in most places.
Many long conversations and exploring options she has decided to take a year away from clinical work and explore other career opportunites. Currently applying to ...
What skills or personal attribute do you possess that will make you a good trainee?
Communicate well, work well with others, and use team appropriately to get work done. tabs show this
Empathic and supportive not only towards patients but colleagues too and eager to volunteer to help.
Interested and enthusiastic about science and the way hospitals work. Always asking questions and making time to answer them through audits and reviews.
Very capable of dealing with stressful and difficult situations whilst being very honest about my limitations and calling for assistance when necessary.
- Communicate well
- Empathic and supportive
- Interested and enthusisatic
- Very able to work under pressure
Interested, enthusisatic therefore take on too much.
Tell us about your teaching experience?
- What groups you have taught: Undergrads, FYs and STs, Senior clinicians.
- Delivered these as informal bedside teaching, small group interactive sessions, journal clubs and slide presentation.
- I have organised all the teaching material myself, making sure i have addressed the learning needs of the audience and doing my utmost to deliver the important aspects in an interesting and memorable way.
- I have tried to further my knowledge about teaching styles and organisation by attending Fit-2-teach.
- I'm aware that i am not the perfect teacher for every learning style and ensure i get feedback from teaching sessions to learn what work well and what doesnt and adapt accordingly.
Why do you enjoy teaching?
- I like getting excited about interesting things and get personal satisfaction when others 'get' some thing and get excited too.
- Reinforces knowledge.
Which methods of teaching do you know?
- Small groups
- See1 Do1 Teach1
- Powerpoint slideslectures
What is PBL?
Maastricht 7 step process:
- 1. A scenario is presented that the group goes through and works out the unfamilar terms in it.
- 2. Define the problems
- 3.Brainstorming to discuss the problems
- 4. Arrange possible solutions
- 5. Define learning objectives (which the facilitator ticks off on)
- 6. Private study (everyone goes away and works out answers to all the objectives)
- 7. Group shares results of private study.
The tutor is a facilitator
What is clinical audit?
A process of reviewing the current practice against set standards. Analyzing whether we meet it. If not, then exploring why not. Knowing why not, attempting to achieve standards by changing the way we practice. Then checking the change has achieved set standards.
Why are audits important?
- We work in systems that have incessant pressures to become more and more efficient, Audit is a rigorous and reliable way to search for areas where those efficiency savings can be made and then do something about it.
- Mantain quality of care, as any concientious practioner should want to
- They are good way to learn how hospitals work outside of the immediate clinical arena and how those working systems are malleable if you have the evidence.
What are the problems assoc with audits?
- Problems with carrying out an audit:
- Selecting patients
- Clunky old systems
- Coding issues
- Retrospective so some data missing.
- Problems with audits as hospital do them:
- Audits docs wanna do over audits the hospital needs doing.
Difference between audit and research?
- Audit = comparing current practice against set standards
- Research = Finding out new knowledge
Why is research important?
- Important to who?
- Patients = New therapies, increased qualityquantity of life
- Trusts = Reputation
- Doctors = EBM is everything we do. Research helps understand this evidence and how to apply it.
Do you think that all trainees should do research?
- Don't do something that is expensive in both time and money if there are other who are more eager and more enthusiastic about it than you are.
- Doing research does teach you the principles of research and how to tell the good from the bad. But it doesn't need everyone to take time out and do research.
What is research governance?
A set of rules set out by a DoH document that set boundaries on how research should be carried out. Much like clinical governance dictates how patient care should be carried out.
- Sets out ethical boundaries:
- getting approval, maintaining patient dignity, getting their consent, risk benefit analyses.
Scientific boundaries: Not duplicating work,
Information boundaries: maintain anonimity, Make publicly available whether published or not, open to critical review by publishers.
Health and safety bpundaries
Financial boundaries: To pay people damaged by research (i.e. researchers).
What is EBM?
Using the best available evidence along with your clinical judgement to inform clinical actions and decisions, bearing in mind the patients values.
What are the different levels of evidence available?
- I Systematic Review of RCTs
- Ib One or more RCT
- IIa One well designed study without randomisation
- IIb Cohort studies
III Descriptive studies, case-control, correlation studies, case series.
IV Expert opinon
Why does a clinician need to take account of their own clinical expertise in EBM?
The evidence needs to be applied correctly. Age group, race, comorbidities,. If they apply great. If they dont you need to take into account the risks and communicate your thinking with the patient and come to a decision together.
What is clinical governance?
A quality assurance process that maintains and improves standards of care and holds the NHS accountable to the public.
- Clinical effectiveness - EBM approach, implementing guidelines, changing practice as necessary.
- Audit -
- Risk management - learning from mistakes, report incidents, blame free culture.
- Education and training - Courses, exams, WBAs, Appraisals
- IT systems - keep updated and confidential
- Staff manangement
- Patient involvment - satisfaction questionairres
How do you critically analyse a paper?
- I - Introduction
- Suddenly - Sample selection
- Realised - Randomisation
- I - Intervention
- Orally - outcomes
- Fucked - Follow up
- Saddams - Stats 1 - chance and power
- Son - Stats 2 - precision analysis
- Randy - Results
- Cunt - Conclusion
Who is responisble for clinical governance in your trust?
The trust board + execs - put systems inplace to make sure the culture at work is focused on the 7 pillars of clinical governance.
All of the staff are responsible in making sure the ethos of clinical governance permeates everyday work. From junior doctors, to ward clerks, to cleaners and the Pals service.
Whats the difference between a standard, a guideline and a protocol?
Standard = a defined level of quality
Guideline = a framework that assists clinicians in making decisions. To be applied with clinical judgement.
Protocol = step-by-step approach to dealing with a certain situation that must be followed exactly. Sepsis6 for example.
Consultant comes on ward drunk?
- P - get consultant away from patient areas quickly and sensitively. If that doesnt work, use another senior (nurse\reg\cons) if that doesnt work then last resort = security.
- I - Needs to go home, could help organise transportation, make sure he doesnt drive. Speak to other cons colleagues and organise cover in the short term.
- E - will need to inform his senior consultant colleague\clinical director and ask whether this will be escalated.
- S - Support team until matter is resolved. Volunteer to take on extra duties etc.
What will the clinical director do once you tell him about drunk cons.?
- S - Info from you and his other colleagues
- P - Will need to decide whether cons is suspended for a while or its a one off event with a clear trigger and has been sorted.
- I - Provide cover if not coming back to work. Look into reasons for behaviour
- E - WIll discuss it with medical director + cheif execs and decide whether to just warn or suspend and report to GMC
- S - There are underlying causes and clinical director should work with the cons to address these either changing working schedules or insisting on getting outside help.