How to prepare for your first specialist registrar interview

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

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Introduction

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.

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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.

Practice

 
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.

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.

Visiting

 
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.

Feedback

 
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."

Here is a selection of questions the three authors were asked at specialist registrar interviews they attended over the past 12-24 months. It is by no means an exhaustive list but will hopefully give an impression of the type of questions asked.

• Take me through your clinical posts and career progression since qualification?

• Take me through your academic achievements since arriving at medical school?

• Are there any gaps in your training to date?

• If you were to start your career again what would you change?

• What specific skills have you learnt which make you a good teacher?

• What one technique has had the biggest impact on your teaching methods?

• What is your experience of teaching?

• What do you understand by the term clinical governance?

• Are there any problems with the implementation of clinical governance?

• Tell me about an audit project you¡¯ve carried out?

• What problems are there in the way senior house officer audit projects are carried out?

• What do you understand by the term clinical risk management?

• What is a near miss situation?

• What is the role of the National Patient Safety Agency?

• What complications of procedure X should you be aware of?

• Tell me about the evidence base for the treatment of condition X.

• Tell me about the most recent paper you¡¯ve read which will change your day to day clinical practice?

• Tell me about an interesting paper you¡¯ve read in the past three months?

• Tell me about a memorable case where you¡¯ve learnt something new?

• What is the worse case you have managed?

• What is the most interesting case you¡¯ve managed?

• What invasive procedures have you performed and what complications have you encountered?

• What measures do you use to obtain informed consent for the procedures you do?

• Tell me about a clinical situation where you¡¯ve needed to seek advice; what lessons did you learn from it?

• When was the last time you rang your consultant?

• Tell me about a situation where your communication skills did not succeed in getting something done?

• If you could improve the specialty training scheme in one way, what would you do?

• You¡¯ve done a locum appointment in training post¡ªwhat was the most important step up you had to deal with compared with being a senior house officer?

• What could you do to improve the organisation and running of your current workplace environment?

• Would you be happy being an average consultant?

• What characteristics make a good consultant?

• Why do you want to train in this specialty?

• What are your aims for your time on the training scheme?

• Why do you want to train in this region?

• What do you understand by the term "research governance"?

• Should research be carried out at tertiary centres or do district general hospitals have a role?

• Should every trainee in this specialty undertake research?

• Summarise your research as briefly as possible?

• Tell me about your research¡ªassume you are talking to a group of charity workers from your funding organisation?

• How much of your research is your own design and how much is guided by your supervisor?

• How did you organise your research project; did your supervisor write your grant application?

• How have you kept your clinical skills and knowledge up to date during your research?

• Give an example of where you¡¯ve had to work as a member of a multidisciplinary team?

• Is the expanding role of nurses a benefit or a danger to the medical profession?

• How has the recent national service framework affected your hospital¡¯s practice; how is its implementation being measured?

• What are your ultimate career intentions?

• Where do you see yourself in five years?time?

• What information technology skills do you possess?

• How would you deal with a problem doctor¡ªfor example, if you suspected your consultant had a drink problem?

• How would you cope with criticism and a complaint against you?

• Describe yourself in as few sentences as possible?

• Why should you be given the job over another candidate?

• What are your interests outside of medicine; do they have any impact on how you practise medicine?

• What are your weaknesses?

• What are your views on NHS recruitment drives in the developing world?

• Would you rather work in a shift pattern or a traditional 24 hour on-call pattern?

• I f you were able to do one thing that could improve the wellbeing of the world/mankind, what would you do?

• Give an example of where you¡¯ve prioritised clinical need?

• What was the most important event in your life?

• Do you ever loose your temper?

References

1. Poole A. The implications of Modernising Medical Careers for specialist registrars. BMJ Career focus 2003; 326:194.

2. Burnett S. How to get shortlisted. BMJ Career focus 2002;324:3.

3. Scoote M, Thaventhiran J, Elkington A. Progress towards higher specialist training. BMJ Career focus 2002; 325:49-5.

4. McKevitt F. Locum appointments in the specialist registrar grade. BMJ Career focus 1999;319:2.

Mark Scoote, research fellow Imperial College, London SW3 6LY mark.scoote{at}imperial.ac.uk

Andrew Elkington, specialist registrar in cardiology Taunton and Somerset Hospital

James Thaventhiran, specialist registrar in immunology St Bartholomew's Hospital, London