Interviews Flashcards
What are your interests outside of medicine?
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If you didn’t get fellow job, what job would you do next year?
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Have you been offered job opportunity in a particular hospital?
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Tell us about research that you have initiated and completed
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Can good quality care be achieved with low costs?
Some interventions, like good communication, cost nothing except time
Costs in care can be reduced by standardisation of procedures, efficient use of resources to eliminate waste, enhanced recovery programs and MIS to expedite recovery and use of evidence based practice to use efficacious treatments and avoid less efficacious ones
If you have unlimited resources and you could do a Australia-wide trial, then what would you do?
Combination of Hydrocort and external stents for high risk joins
Radiation preop to reduce panc ca - maybe in context of crt vs ct for NAC
Procalcitonin to detect infected panc necrosis
What’s involved as an AANZHPBA fellow?
Typically at least two 12-month placements
Quarterly journal club
Exam (2 papers, 4 vivas) at end
Annual meeting
Tell us about yourself and why we should select you?
Myself
Clinically - enthusiatic, keen hard working team member. Motivated to improve both myself and the dept in which I am working - evidenced by my involvement in collaborative activities- trauma mdt, teaching nurses, junior docs, as well as dedicated study, practice
Academic - keen to develop simulation, active in research locally
Education - passionate teacher of juniors as evidenced by teaching program
Personal - good team member, active socially outside of work
What are your future career plans? Where do you want to work? What sort of work do you envisage making up your usual practice
Resectional hpb and renal transplant, participation in trauma roster, fte for education and simulation training, time out for army surgical work
Have spoken to Christchurch and Hamilton both of whom would be keen to have me back
Really keen to develop MIS HPB wherever I end up
What do you know about the AANZHPBA program/ what are the requirements during training
Two 12 month jobs
Exam (2 papers, 4 vivas)
Quarterly journal club
Annual meeting
Research expectation
Are you willing to move around/ be flexible with placements?
What issues face AANZHPBA in the next 10-20yr?
Specialty challenges and broader issues
Specialty challenges
- Role of MIS
- Role of multimodality therapy
- Availability of organs as demand increases
- Managing obesity as a comorbidity
- Trainee experience
Broader issues
- Healthcare funding
- Appropriateness of treatments and treatment futility
Tell us about a problem you faced and wished you could turn back the clock, and how you addressed this
Pilonidal sinus complaint
Trying to help out with busy short staffed clinic whilst running acute theatre. Saw patient in a rush with med student - slow to heal pilonidal wound. Still smoking and not looking after himself but not happy that wound not yet healed. Told him it would be fine, takes time, needs to stop smoking, then rushed off back to OT. Pt not happy and complained. I was trying to be helpful but actually made things worse. Learnt that you have limits, can only do so much, better to do one thing well than split yourself too many ways. Also patients deserve better, even if their expectations are not totally realistic.
Tell us about a problem you have personally solved that had a positive outcome (either clinical or non clinical
Trauma MDT
Naomi MDT
Wanganui chest drains
Your Registrar tells you that one of your consultants was intoxicated when he came in to help the Registrar with an Emergency case. You also notice that same consultant has had adverse outcomes in the last few months, much more than others. How would you deal with the situation?
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Any questions for us?
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Tell us about a time where you had conflict with a patient
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Tell us about a time when you felt out of your depth
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Tell us about a time when you demonstrated empathy towards a colleague
Supporting Nat transition to reg
Sit down each week or two and talk things through
Tell her all the mistakes id made along the way etc etc
Tell us about a time when you delivered a successful presentation
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Tell us about a time when you made a change to practice
VTEPWTR audit
AXR audit
Trauma MDT
Tell us about a time when you received a complaint
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Tell us about dealing with an underperforming colleague
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Tell us about when you lead a team well
Trauma MDT
Motivation for the role
Clinical and personal
Why hpb?
Technical - difficult organs, mis,
Clinical - challenging pathologies, make a big difference, not seen same improvements in panc ca etc
Patient - closely involved for long journey, get to know well
Why should we choose you?
What I can bring to dept and what dept can do for me
What I bring
- Personable
- Empathic
- Dedicated
- Passionate advocate for junior staff and patients
- Enthusiastic learner and teacher
- Broad range of interests
- Keen to collaborate on research
What I can gain
- Bring back high volume, high end experience to NZ - inc MIS, transplant etc
- Gain academic experience in centre of excellence
- Potential future collaborations
- Continue longstanding relationship between Edin and NZ
What would your colleagues say about you?
Concientious
Advocates for patients
Supportive of junior staff
Responds well to constructive criticism
Hard working
A good colleague
Where would you like to work on fellowship?
Have been offered job in Edin to do transplant and HPB
After than try for high volume MIS liver unit - Pittsburgh, Heidelberg, Royal Marsden, Royal North Shore
Tell us about your research
High risk PJ - use of external stents and hydrocort
Outcomes of subtotal chole
CBD stones SR
Previously
Spleen MA
Tell us about your teaching experience
MRCS course -> book -> Ace The Exam
Trauma Forum
Chest drains and trauma scenarios in Wanganui
Teaching program in Palmy and Hamilton
Juniors seek me out for operative experience
Travelled to Uganda twice and taught on courses there
Invited to become EMST instructor
Outline your plan for a patient with a clearly resectable hilar cholangiocarcinoma who is deeply jaundiced with a small left liver remnant. Focus on broad concepts rather than precise technical considerations
Optimise pt inc relieve jaundice
Stage
Plan for surgery - FLR
Discuss - in MDT and with pt and family
You see a patient with Bilobar Colorectal Liver Metastases.
- What broad principles will you use to decide if this patient is resectable up front?
Optimise pt - nutrition
Stage
Plan - synchronous/staged, NAC, FLR, adjuncts (ablation, TACE)
Discuss - with mdt and pt
You see a patient with a head of pancreas lesion involving the Portal Vein.
- What broad principles will you use to decide if this patient is resectable up front?
Patient factors - fitness, comorbs, motivation
Surgical factors - is it anatomically resectable/borderline - vein involvement, arterial involvement, reconstructability
Disease factors - mets, biochemically borderline (CA-19-9)
‘Discussion at an MDT is critical”. Argue for or against this statement.
For:
Consensus decision of experts
Best evidence base
Fosters collaboration
Enables audit and research
Minimises bias
Against:
One strong voice can overpower others
Risks loss of patient ownership
May delay intervention - particularly if all cases being discussed, even those not really necessary
‘Neoadjuvant therapy is important’. Argue for or against this statement.
For:
Test of disease biology
Downstage, permit resection
Reduce systemic failure
Enable more delivery when pt still fit
Against:
If not effective, delays surgery
May miss the boat for resection
Pt debilitated when reaches surgery
Ileal NET with Liver mets
- Treatment priorities and options
Optimise pt - nutrition, comorbs, carcinoid syndrome
Stage
Plan - curative vs palliative. Systemic options. Synchronous vs metachronous surgery (is ileum obstructing)
At surgery - nodal resection. Look for synchronous lesions. Debulking >90% provides good palliation. Do cholecystectomy
Discuss in MDT and with pt
Tell us about something non surgical that you do
Mountain biking
Drums
Army
Why do you wish to be involved with AANZHPBA?
Support of society
Build on expertise of members - chance for continuing education and training
Opportunities to collaborate
Expert help in difficult situations
Support network
Build profile of the specialty in ANZ
How does research change your practice?
Produces the high quality evidence that guides my treatment decisions
Helps ensure the equitable and efficacious allocation of resources
Develops new technologies and treatments to realise improvements in care
Contributes to patient safety and quality improvement
Finally for me, it provides an opportunity to influence and improve medical care for a greater number of patients than I could ever do in a purely clinical setting
What do you bring to AANZHPBA?
I’m a dilligent and motivated individual who brings great passion and drive to anything I set my mind to. My CV and references attest to my passion for both the clinical and technical aspects of surgery, as well as my active involvement in research and education. I am passionate about mentoring and supporting juniors and improving their training experience. Finally, I care deeply about my patients and place great importance on communication with them and their family members.
