UK Core Surgical Training(CST) interview - what to expect at each station

The clinical scenarios station

In this station you will be expected to discuss the management of two commonly encountered clinical scenarios. The first scenario will be written out on a card outside the station which you can read and you can decide on how to manage the condition. The second scenario will be given to your by one of the interviewers during the station. Remember the ABC management principles when answering these questions. Come up with as many logical differentials as possible. Remember common things are common. Each scenario will be 5mins in length. Keep your answers structured, logical and precise. Do not hesitate to ask questions, e.g. what were the observations, past medical history, social history if you think is relevant to scenario.

  • Post operative complication - post operatively short of breath patient, post op confused patient, post op patient with low BP

  • Paediatric patient - fractures (remember NAI, green stick fractures), torsion, appendicitis

  • Patient with LIF pain - don't forget AAA as differential for any patient with acute abdomen, abdo pain, back pain

  • Patient with RIF pain - features you would ask for in the history, differentials, investigations and management

  • Gallstone disease, complications and management, including pancreatitis

  • A telephone conversation to a senior colleague about a patient and receiving information from a nurse about an unwell patient, what questions to ask, remember SBAR

 

The management station

In this station you will be tested on your knowledge and experience on ethical, legal issues, communication skills to a certain degree and principles of safe surgery. This station is designed mainly to check if you are a "safe" doctor. Sample scenarios will include:

  • How would you surgery make safe? - Talk about pre-assessment, op day, operating theatre and post op safety measures. More importantly what they looking for is the WHO checklist. Know the components of it.

  • EWTD and working hours - E.g. Can you stay over if the colleague taking over you after an oncall is unavailable? The answer is yes as leaving without arranging cover will compromise patient safety even more.

  • Consent the dos and don'ts

  • Know about the chain of command. Who do you go to if you have concerns about anything (clinical/educational supervisor --> departmental lead --> director of surgery --> medical director --> chief executive this is within the trust. Within the deanery clinical/educational supervisor --> programme director --> head of the deanery)

  • Ethical scenarios - E.g. You have done a night shift and the colleague following you doesn't turn up, A senior colleague turns up to work under the influence of alcohol, There are bed pressures and you have to cancel a few cases - what would you do?

  • How can you improve surgery? - Audit, research, clinical governace (read up on the pillars of clinical goverance)

  • How can you improve surgical training? - Talk about different work based assessments (DOPS, CBD, Mini-CEXs), simulation training, courses etc.

  • Give examples where you have shown leadership, team work etc

  • Break bad news to a patient (e.g. may be asked in conjunction with the case above where a patient's surgery is being cancelled and the final part of that discussion may include you having to break the bad news).

Key think they are looking for in almost all these cases is that you give patient safety precedence(a key word you should highlight wherever it's appropriate). Furthermore they want to know you are sensible and empathetic - e.g. the whole colleague under the influence or the colleague who turns up sick - always important to highlight what you would do as a fellow human being, find out why they are ill why they are drinking more etc., problems at home/work?

We recommend the book ISC medical interviews to help prepare for this type of station.

 

Portfolio station

Make sure your portfolio is up to scratch and you know your CV by heart. Organisation of portfolio counts and you get points for this. Don't put anything in your CV which you haven't supported with evidence in the portfolio. Be ready to talk about everything you have put down on your CV. Here you may be asked to talk about the courses you have done, exams and research. You may be asked about audit or whether or not you have completed the audit cycle. Make sure you know the definition of an audit by heart.

You may be asked about courses you plan to do. You will be asked about your logbook. Be ready to talk about some assessments from your portfolio. Select and rank any assessments you are particularly proud of and are able to discuss. You may be asked about any teaching you have done. You may be asked to show instances where you were good team player, leadership. You may be asked about different methods of assessment. (Note some overlap with questions from the management station.

Having done the basics will also get you points in this station. These include the MRCS (full points for both parts, half for part A), BSS and ATLS.

This station is something that you could control. The more you have done to show your commitment the more you can talk about them and keep control of the interview and highlight important thinks for the interviewers.

General tip for all stations try not to exaggerate, always be humble, show you are keen to learn, to teach and that you know you have a lot to learn. They are looking for someone who could get along with their colleagues, a good team player, who respects their seniors and who are keen to carry on all the way.