Leadership Questions

Question 1

What is situational awareness?

Answer 1

Is being aware of your surrounding and being able to respond quickly to prevent mistakes

Question 2

Good example of situational awareness

Answer 2

When in theatre
you need to be aware of what your registrar or consultant are telling you, what stage of the operation you are at, the duration of the operation, the observations on the anaesthetic monitoring, the doors of the theatre being shut, the position anyone nearby to avoid break of sterility

For example, I was assisting with a difficult IM nail and the bipolar and suction were loosely placed on the patient, I asked for a clip to secure it in order to avoid loss of equipment and potential patient safety compromise

Question 3

Should doctors be educators

Answer 3

Education is key as doctors, we have a workforce crisis with an ever-increasing demand on the NHS, we need to train juniors to ensure sustainability. Plus the lack of opportunities due to the pandemic means that doctors to be good educators, or we will end of with a worse workforce problem than already predicted.

I am currently doing a teaching job where I have developed my teaching skills greatly. Through doing PG cert I have come to appreciate the importance of setting up a good learning environment, clarifying learning outcomes and including a range of activities as means of enhancing the quality of the teaching.

For example, no matter how good the content, if teaching in poorly lit room just after lunch, the juniors less likely to learn

Question 4

Tell me about a challenge you’ve faced as a leader and how you have overcome it

Answer 4

Situation: When I started delegating tasks as a part of my organisation, tasks were coming back to me incomplete, late or completely different from what I was expected. This made both me and members of the team frustrated
On reflecting on this, I realised it was my communication that was the main issue:

• Used closed loop communication
• I included more specific instructions, a deadline
• gave opportunities to ask questions
• also if it was a more complicated task, or something completely new, I communicated this through a phone call or a video call

This led to a much better team environment where everyone knew exactly what was being asked of them

Question 5

WHO checklist

Answer 5

It was introduced in 2008 to improve safety of surgery and prevent never events

Question 6

WHO surgical checklist

Answer 6

Sign in: before induction of anaesthesia
Time out: before skin incision
Sign out: after op before patient leaving the theatre

Question 7

Sign in Qs

Answer 7

Identity 
Consent form 
Site of op ?marked
Name of Procedure 
Estimated blood loss

Question 8

Time out components

Answer 8

Members introduction
Name of pt and procedure
?special equipment 
Abx prophylaxis
Diabetic control 
Hair removal

Question 9

Sign out Qs

Answer 9

Instruments swabs and needles counted
Faulty equipment reported
Specimens sent
Recovery concerns

Question 10

What is a clinical audit

Answer 10

A systematic review of how well an organisation is doing a certain procedure compared to a pre-set standard such as NICE guidelines

Question 11

What is clinical governance def

Answer 11

• Quality assurance process
• ensuring standards of care are maintained and improved
• ensuring that NHS is accountable to the public

Question 12

What are 7 pillars of clinical governance

Answer 12

PIRATES
Patient and public involvement (patient feedback questionnaires, PALS, patient forums)
Information and IT
Risk Mx (guidelines/protocols/M&M meeting to minimise risk to pt/staff)
Audit
Training and Education
Effectiveness and research (evidence based, research, NICE guideline implementation)
Staff management (staff retention by motivating/developing them, good working conditions)

Main 4: CARE
Clinical effectiveness 
Audit 
Risk management 
Education and training

Question 13

4 main ethical principles

Answer 13

Beneficence - act in best interest
Non-maleficence - do no harm
Autonomy - right to choose
Justice - must be treated fairly: distribution of scarce resources

Question 14

What makes a good core surgical trainee

Answer 14

Good at prioritising

Knows limits, when to escalate

Organised, gets tasks done efficiently to get more experience on the wards

Team player: works well with the juniors and seniors

Question 15

Good communication example

Answer 15

STAR:
Situation: attending a cardiac arrest.

Task: Performing CPR

Action: clearly explaining when we should change, counting us in, commenting on our depth/quality of compressions.

Reflect: I think this was a great example of leadership. A good use of closed loop communication, as well as saying out loud at what stage we were, so we had ruled out several causes for this patient’s cardiac arrest and what were going to do next. Kept everyone motivated as were aware of what was happening and what was going to happen next

Question 16

Bad communication example

Answer 16

STAR:
Situation: consultant prioritised one of their private patients over the NHS patients without informing the juniors of the reasoning.

Task: This put the team in a difficult position when providing care for this patient as one contradicting one of the four ethical principles: justice: making sure fair distribution of resources amongst the patients.

Action: However, I explored this with the consultant and clarified that the private patient’s operation was expedited due to their deteriorating health.

Reflect: I think this was a failure of leadership. A good leader will predict this potential conflict of interest issue and inform the team of the reasoning behind the decision making.

Question 17

Good culture of team building and motivating

Answer 17

Situation: Low moral as understaffed and redeployment
Task: SpR met one on one with all of the juniors to explore our concerns and suggest solutions where possible. Also was bringing snacks for everyone, creating a friendly team environment. Lastly made herself more available on the wards so all the issues were addressed with early senior support

Reflect: On reflecting on this, this registrar was demonestraing qualities of a great leader, recognising there was a problem within the team and coming up with stragies to address it, boosting moral and motivating everyone to keep going.

Question 18

Bad culture of improvement

Answer 18

Situation: a patient safety issue was discussed in the M&M meeting,
Task: instead of coming up with solutions to avoid in the future, one of the consultants was very keen to find out who was responsible for the mistake, making the team spend 10 mins trying to find out using the notes

Initiave: the junior involved had already had multiple incidents regarding this and the issue was considered solved, however the blame culture led to embarrassment of the junior

Reflect: on reflecting, there is a reason to find out who made a mistake to ensure they receive the support/training needed to avoid in the future, but doing this in front of everyone and not acknowledging that actually multiple things went wrong and it was the Swiss Cheese model that led to this and not a single failure was failure of leadership. As this led to lowering of the team moral.

Question 19

Good teamwork

Answer 19

We realised when splitting the ward round, everytime one specific consultant was on, the ward round would run really late, meaning the junior will finish the ward round late and need to stay to complete the jobs.

We decided to have a shared jobs list when that consultant was on, meaning that everyone would help to finish all the jobs before going home. This helped create a much more friendly environment and boosted moral.

Question 20

Examples of never events

Answer 20

Surgery on the wrong site 
Procedure on the wrong patient
Long blood type transfusion
Foreign body left in patient post op
Severe Pressure ulcers acquired in hospital

Question 21

What is the definition of never events

Answer 21

An event that is completely preventable, and could lead to serious harm to patient

Question 22

Example of audit that you were involved with?

Answer 22

Under the supervision of one of the orthopaedic consultants, I led a retrospective audit of IM nails performed over one year period looking to see if certain standards such as Tip Apex Distance (TAD) of less than 25mm were met on the post-op films this standard was taken from a Baumgaertner 1997.

We presented these findings at an M&M meeting and collected another set of retrospective data to see if this had improved things.

We then repeated the measurements to see if our intervention: improved from 5 out of 89 to 2 out of 90

Question 23

Example of QIP that you would have done

Answer 23

I have led on QIP project completing 3 PDSA cycles, presenting the findings to the quality improvement team.

Improving the weekend handovers ensuring they included specific details such as what day, specific task and what grade should be

At first, only 38% of the handovers included all that information
However, over the course of the year and by putting up 3 interventions, this increased to 93% improving patient safety

Presented to the hospital improvement team who started work on incorporating the template into the hospital systems.

Question 24

QIP definition

Answer 24

improving services to enhance patient experience or safety

Uses a PDSA cycle of plan

Question 25

Research definition

Answer 25

Aims to create new knowledge, eg whether a new treatment works, to what extent it works etc.
Using a PICO model to answer a clinical question
Population: children with headache
Intervention: paracetamol
Comparison: vs placebo
Outcome: paracetamol better than placebo

Question 26

Should doctors be good leaders

Answer 26

Yes there are many situations that a core trainee need to demonstrate leadership

For example, CST is normally responsible for handling the acute take, especially if the reg and consultant are in theatre. In that scenario needs to take responsibility by ensuring the patients are being seen safely and in a timely fashion as well as recognising the limitations of themselves and the juniors and escalating appropriately

Also as a core surgical trainee, there are opportunities to design and deliver teaching programmes for foundation doctors and medical students which I am very interested in as currently hold a teaching fellow job and doing a PG cert in Med Ed. This requires having initiative, organisational skills and be able to motivate other team members to join teaching programmes.

Question 27

Difference between leadership and management

Answer 27

A leader sets a vision for a team and motivates the team to move towards that vision

A manager distributes tasks and resources to achieve the team’s goals.

For example when attending a trauma call

A person in charge would be a manager by ensuring all the steps of the ATLS algorithm are met in order to achieve the goal of improving the patients health

They would be a leader by ensuring everyone has specific tasks and by motivating them by post discussing learning points with the team afterwards

Question 28

What are the attributes of a good leader

Answer 28

Effective communication:
For example, a consultant prioritised one of their private patients over the NHS patients without informing the juniors of the reasoning. This put the team in a difficult position when providing care for this patient as one contradicting one of the four ethical principles: justice: making sure fair distribution of resources amongst the patients. However, I explored this with the consultant and clarified that the private patient’s operation was expedited due to their deteriorating health. I think this was a failure of leadership. A good leader will predict this issue and inform the team of the reasoning behind the decision making.

Taking responsibility: if managing a busy on-call, without the registrar or consultant available, will need to step up and take responsibility and ensure patients get prioritised and get seen in a timely fashion. Also appreciating own’s limitations and escalating appropriately

Taking an interest in the team’s development

Avoiding the blame culture

Question 29

Different types of leadership

Answer 29

There are set styles such authoritative, collaborative and democratic leadership

Question 30

Difference between management and leadership

Answer 30

Leadership: sets a direction or vision that others follow

Management: directing resources/people to achieve the vision

Leadership without management: Asking MPH team members to eradicate inequalities in career progression, but not specifying how. A consultant asking jrs to make patients better without telling them how

Management without leadership: Doctor following protocol without questioning its relevance to specific patient