General Interview - Anaesthetics Flashcards
Why anaesthetics?
- Since 1st student placement. (SSC, taster weeks, ITU + comp specialties)
1. Challenging + varied
2. Hands-on, enjoy practical skills + good feedback in taster week
– trainees find rewarding, particularly 1:1 time with consultant
3. Academic - in depth physics, physiology, pharmacology. Loved weekly teaching in ITU on this + course (BASICs). Challenge - Most interesting parts of medicine: variety, hands-on immediate interventions; using scientific knowledge. Periop physician. Good experience to start. Think I’ll be a great fit.
Talk me through your training?
- Thoroughly enjoyable
CLINICAL - >20 months experience in complimentary specialties: EM & acute med, trauma. 4 months f2 job in ICM/Anaesthesia - including 2 taster weeks of anaesthetics. Practical skills, log book proud - A-lines, CVC, LP, FIB - satisfying
ACADEMIC - courses + achievement at med school (Top 10% in final year). Improve as clinician - teaching the teacher, BASIC & EM USS. I know anaesthetics hard, think i have brains, determination, work ethich for it
OUT OF HOSPITAL - developed non-technical skills, leadership + education. Elite sport - rugby, england. CrossFit (top 5% in the world in recent Open competition + coach at local gym)
Speaking to anaesthetists - calm + confident leadership are working in MDT - look forward to this
CONCLUSION
- lots of experience working directly with anaesthetists and alongside as part of wider MDT. my experiences leave me in great positoin
Your biggest weakness?
- Difficult question to answer, well rounded and, received good excellent on WBAs & multi-source feedback
- F3 EoY appraisal: high standards, ambitious, aspirational - often disheartened if not achieving goals.
- e.g. pdp - regional analgesia for rib fractures
- no need to rush to achieve things, reflect on how much ive improved in the time working as doctor
- However +ve in steep-learning curve towards IACs.
Worst thing about anaesthetics?
-No career is without its negatives. Pros>cons
- Tricky exams - recent change in curriculum from RCoA giving more time - big fan
- Not run through, bottleneck at ST4. But chance for a break, without looming exams/ARCP. Fellowship in area of interest. PHEM/ US/ ITU /pre-op
- CONCLUSION. though long and hard. speaking to trainees / consultants - generally happy and enjoy their job. way more positives
Courses you’ve been on? How has this changed your practice?
ALS - MDT training, great course, given me a lot more confidence in management of acutely unwell pts. Non-technical skills.
- Particularly useful was the teaching on SBAR handovers; as F1 i’d often found it difficult to handover and escalate patients to seniors quickly & efficiently. But since using and practicing this framework I have had much more success.
– Recent example, deteriorating gentleman with poor oxygenation despite high-flow. Able to concisely refer to ITU who quickly came down to review him.
- Conflicts & complaints framed conflict as a positive + necessary part of teamwork / human interaction.
Teaching experience?
- Really enjoy teaching; huge part of being a doctor.
- Variety of styles: didactic lectures, group discussions, simulation, practical, bedside.
- Variety of audiences: medical students, other junior doctors, MDT
- Peer teaching society, medical student sim teaching. Attended teaching the teacher - learnt about theory of learning - helped my practice - clear learning objectives
- Most proud of: during psych placement developed + delivered regional simulation teaching programme for med students - 6-week course
- Excellent feedback : but wanted less didactic, larger focus on simluation -> changed it and improved for ongoing cohorts
What makes a good teacher?
From teaching I’ve attended, the qualities most important
- Enthusiastic/engaging
- Clear learning objectives + achieve them!
- Receptive to feedback and flexible
- I try to use this as whenever I teach. Lots of experience; PTS, med-student teaching, peers and MDT colleagues. Variety of styles: lecture, seminar, bedside.
- 1 Eg is Med Student Psych teaching - D&D 6/52 course. Objectives of patient encounter, focused Hx + MSE.
– Good feedback but asked for more focus on patient –> changed for next cohort and excellent feedback
Research, audit, QI?
- Research = novel
- Audit = comparing current practice to set standards
- QIP = making changes to current practice and reviewing - PDSA cycles
– Experience in all 3. Recruiting to trials. Auditing sedation holds on ITU. Most enjoy QIPs - Successful audit/QIP in early pregnancy attendance in ED, completed 3rd PDSA cycle, shown a reduction in time waiting in ED by 31%
- Poster to be presented at conference
- Also, leading project in anaesthetics: peri-op monitoring of NOF patients
Tell us about your role in clinical governance?
Part and parcel of daily role. Improving patient care & service quality.
7 pillars. A few good examples are:
- Teaching - educating med students + colleagues. Attending courses + training
- QIPs - EPAU. NOF
- Patient safety through critical incident reporting & DATIX
7 pillars of clinical governance?
- Audit/QIP
- Education/training
- Clinical effectiveness
- Risk management
- Data & info
- Staffing
- Patient involvement
What skills would make you a good anaesthetist?
I think I have many strengths that lend themselves well to anaesthetics and have had good feedback during taster weeks, foundation jobs and current role. Comms, calm, quick learner.
- Communication - with MDT team/leading (TAB feedback) & put patient’s at ease during stressful time -> pt with ischaemic limb palliated -> family were complimentary with my explanations
- Calm under pressure - enjoy acuity. Logical and systematic / thorough - helps me keep cool head in stressful situations -> JCF in ED / ITU placements
- Quick learner (notoriously steep learning curve passing IACs + FRCA); organised + keen- logbook of practical skills (CVC, A-lines, USS, LPs, intubations), manual dexterity for tricky & challenging procedures
CONCLUSION - many skills required to be a good anaesthetist, i have a good baseline to start training
Failed to manage a patient’s pain?
- Young lady, regular attender with non-specific abdo pain. 2nd in 2 days. Normal obs, bloods, examination, reassured + sent home. But she represented the next day.
Reflected on this… - Pain can be a complicated symptom. Multifactoral. Concerns, worries & expectations can play a large part. Going forward i take this into account more -
S- E.g. 56yo lower abdo pain, 2/12 GP / Gynae 2WW. a/w further tests including a hysteroscopy
T- Thorough assessment, hx + examination.
A- No change. No new issue. Not surgical abdomen. - Long discussion, reassurance about no change, advise to optimising analgesia, safetynetting, shared decision
R - Ultimately, no improvement in pain. However, patient’s understanding, decreased worry about urgency of treatment, helped her to manage symptoms
Dysfunctional team you’ve been a part of?
** STICKERS QIP ** better opportunity, recognised negatives and improved it
S- Resus, x4 patients I+V.
- 1 patient was young man, trauma, jumped from building. Head + pelvic injuries.
- BP dropping, anaes bolus metaraminol & ivi. Not feeding back to team leader. Appropriate in theatre, if vasodilation/sepsis but not in trauma ?bleeding
T- Crashed BP, required MTP. Eventually stabilised
A -
R - flash team, unfamiliar people / place / patient group. Independent working rather than collaborative via team leader.
- in future, acknowledge limits of practice; escalate all to team leader (oversee + big picture) better placed to make decisions
How have you made a change in the working of a team? Leadership / Management?
Acute Med stickers QIP.
S - big hospital, 2 arrest teams. Many on-call bleeps and baton bleeps - list explaining on piece of paper in doctors office. Several arrests without full team
T - improve knowledge + arrest care
A - surveyed docs, uncertain. Intervention = stickers on all bleeps (1, 2 or none).
R - led to huge improvement in knowledge, attendance at arrests and subsequently patient care.
Particularly proud of this, recognised + implemented independently. Improved patient outcomes in arrest, care of acute patients is something i am passionate about -> anaesthetics
Reflect on a time you’ve communicated badly.
- Resus: patient with pneumonia, verbally asked nurse to give abx + ivi
- later realised, they were on a nebuliser which i’d not px.
- patient no harm
- ensured treatments were given as intended
– Reflect on importance of clear closed loop communication + the importance of a written prescription - DATIX + discussed at meeting
– Now must be a written/electronic prescription before medication administration -> safer as a department - Change my comms, take more time + closed loop
