Portfolio

Question 1

How have you tailored your training to date to suit career in T&O?

Answer 1

Standard answer

Question 2

Why should we choose you?

Answer 2

Hard working, approachable doctor, work well in a team and leading it

20 extra capsular and intra capsular NOF #
MSF- friendliness and team working ability

Clinical and lab based research- MRES

Pgcert/audits

Teaching

WAD
Volunteer to trustee. Managing first employee, 100s of volunteers and £100,000 of donations.
Thrive in orthopaedics

Question 3

What are you most proud of?

Answer 3

Charity that aims to increase blood and organ donation rates by educational interventions delivered by university student volunteers to school aged children.

I first became involved as a volunteer in medical school. The appointed Secretary of the NSC then because of my continued work I was made a trustee of the charity.

I have learnt how to lead and motivate a team spread across the country. I have led grant applications from which we have received over £60,000 of funding in the last 2 years with over a £100,000 donated over this time period as well to the charity.

How to manage and direct our first paid employee and ensure our 13 universities nationally are hitting their targets.

These skills of leadership, time organisation and working under pressure are all skills I can bring back to being a registrar.

Question 4

What is your biggest weakness?

Answer 4

Avoid conflict
Want to make everyone happy

CT1

Question 5

Why orthopaedics?

Answer 5

A difference to young and old, at the lowest most unexpected part of their life

Evidence based medicine- shared patient decision making. Mention research- distal radius paper. Audit- hip fracture one.

Hands on nature of an operating theatre.

Team based aspect
Large, MDT approach
Fostering a caring and fun environment

Question 6

What do you like least about this specialty?

Answer 6

Lack of interaction sometimes between the doctors on the ward and the consultants in clinic/theatre. This will be something as a consultant I will try hard to improve within my department. Whether that be allowing for more opportunities for juniors to get theatre and clinic experience as well as ensuring there is good supervision for the juniors as well as pastoral support.

Journal club

Question 7

What will be the biggest challenge for you as a junior registrar?

Answer 7

The step up in terms of responsibility and time management. This is something I often notice when interacting with my seniors. More clinic time, more responsibility for the running of lists and clinics more decision making responsibility.
Something will try to prepare myself for by asking advice from my seniors/peers
Shadowing them on a normal working week

Question 8

How would you describe your communication skills?

Answer 8

I would describe myself as having good communication skills Demonstrated by MSF which have always commented on this as a strength forme. But also from having received peer nominated awards as being teh most supportive sho.

More leadership role- expectation setting for juniors and delegating

Communication in conflict/stress

Plans in place
Calm, empathising, acknowledge the emotion in the conversation

Question 9

An example of when you showed empathy to a patient?

Answer 9

Infected non union
Admitted did everything for me

Walking to go home cannula tissued
V stressed
Talked about everything

Assessing him urgently
Handing over to the on call team
Empathising with him

Visiting the next day
Take time + seeing a friendly face

Question 10

An example of when you had to deal with a vulnerable patient?

Answer 10

Deep osteomyeltitis post open fracture- patient very upset- refusing to stay in despite being septic

Question 11

What is a team?

Answer 11

A group of individuals coming together to work towards a shared goal.
Healthcare- all of the MDT working together to look after patients and make them better

Question 12

An example of a mistake you made?

Answer 12

Tongue type Calcaneal fracture

Sent home without inspecting posterior skin + putting in equinus cast.

Apologised, explained risk of being sent home
Discussed with reg
Explained situation with consultant in the morning
Documented my mistake

CBD
Created a teaching session on calcaneal fractures for the SHOs- I know do this every rotation to make sure they do not miss things like this

Question 13

What is the difference between management and leadership?

Answer 13

Leader has a vision, inspires others, sets the course
Manager controls resources to reach a pre set goal

Question 14

What makes you a good leader?

Answer 14

We Are Donors/Rota coordinator

Question 15

What is your leadership style?

Answer 15

ImplementChange, invest in people, to get results
We are donors- trustee- motivate and enable volunteers. Regular check. Focus on the end goal. Review and adjust things as we go to ensure we are getting results
Rota coordinator- approachable and friendly

Question 16

Tell us about your teaching experience?

Answer 16

PGcert + 3rd year teaching
Buddy systems
Improved feedback and end of placement OSCEs

National online teaching- engaging multipe people via online teaching

Made me a better learner- maximise learning opportunities

Question 17

What are the different types of teaching and what are the pros and cons of each

Answer 17

Lecture base- large audience, didactic- how much engagement are you actually getting
Problem base learning- encourages independent learning, guided by each other so many not actually get to the point of the session
Bedside- true patient interaction, unpredictable
Simulation- immersive but safe, expensive
Online- convenient, lack of engagement

Question 18

What is an audit?

Answer 18

Process which compares clinical practice against set standards and forms part of clinical governance
Audit cycle- Identify problems/issues, define standards, data collection, analysis, implement change, re audit

Question 19

Tell us about an interesting audit/QIP?

Answer 19

Neurovascular status documentation
HASTE
Misidentification QIP

Question 20

Why is audit important?

Answer 20

Clinical governance
Maintaining of standards
Identify areas for improvement and investment
Training healthcare professionals to be analytical

Question 21

Problems with audit?

Answer 21

Lack of resources
Lack of expertise
Organisational impediments

Question 22

What is research?

Answer 22

Research is the process of systematic enquiry of a question where there is no previous answer. This normal requires data collection, analysis and conclusions being drawn. This can be clinical or non-clinical. Require ethical approval or not.

Question 23

Tell us about your research experience?

Answer 23

MRes- novel biomarkers for AKI post cardiac surgery
Ethical approval, funding, consenting and recruiting patients, collecting and processing samples, analysing and writing up the data

Separate first author publications related to clinical surgery
Review process and how to write a paper

Question 24

What is the difference between standard, guideline and protocol?

Answer 24

Guideline is simply to give an overview of how to perform a task. Procedure tells us step by step what to do while standard is the lowest level control and states what is required.

Question 25

What is Clinical governance and how it applies to you?

Answer 25

A framework by which the quality of healthcare is maintained and improved across an organisation and how we can demonstrate accountability to the public. It consists of 7 pillars and the ones I have had most experience with are-
* CLINICAL EFFECTIVENESS & RESEARCH
* AUDIT
* RISK MANAGEMENT
* EDUCATION AND TRAINING
* PATIENT AND PUBLIC INVOLVEMENT (PPI)
* USING INFORMATION & IT
* STAFFING & STAFF MANAGEMENT
* GOVERNANCE STRUCTURE

Question 26

Tell us about a paper that has changed your practice?

Answer 26

Reducing radiation exposure in Vascular surgery Haggani et al. 2011 + BOA guidelines:

Basic science paper that assessed the amount of radiation experienced dummy surgeons and assistants during angiography of a cadaver

Demonstrated that a 70o degree lateral reduces the operator’s scatter radiation exposure level by 50%

Now apart of the BOA recommended guidelines for reducing radiation exposure intraoperatively to operators, assistants and theatre staff.
Especially important for not only myself but my assistants. Ensure they have thyroid shields.

Question 27

What are the different levels of evidence available?

Answer 27

Expert opinion, case series, case controlled studies/retrospective cohort studies, RCTs, Meta-analysis of RCTs

Question 28

How have winter pressures/strikes affected your training?

Answer 28

Higher number of inpatients- greater strain on wards. Harder to get away to clinic/theatre. I have to make sure the juniors on the ward are well supported and not overwhelmed. Increased cancellation of elective operations- fewer operating lists to attend.
Adjust my focus to clinics/research/audit/teaching
Make sure to focus on each patient rather than on getting them out of hospital.

Strikes- less clinical opportunity, need to focus on maximising my clinic/theatre time.
On the flip side I have felt more energised and rejuvenated- so have the other juniors so I have more energy to give when I am in work to maximising this.
Also I can focus on doing papers/revising/doing audit

Question 29

What will you do if you are unsuccessful in obtaining a training number this year?

Answer 29

Take some time
Analyse why it went wrong
Get the transcript of this interview and your feedback
Work pout what is important for me
Apply for jobs in the region- ST3 equivalent reg jobs- 50/50 teaching/clinical role

Question 30

Tell us about the National Joint Registry?

Answer 30

Monitors joint arthroplasty outcomes to improve patient outcomes

Established in 2002 due to high THR failure rates
Now includes, knees/hips/ankles/shoulder/elbows
Open access reports for public, more detailed confidential performance reports for individual surgeons/hospitals/industry bodies
6 monthly review so any adverse outcomes can be urgently acted on
If >95% deviation for surgeon- should be reviewed with local colleagues
Powerful research/audit tools, highlights prosthesis issues, evidence based, compares national practices
Financial issues, bad press, accuracy of reporting

Question 31

Tell us about GIRFT?

Answer 31

Get it right first time, Prof Briggs
Right surgeon, right patient, right hospital, right time
Aims for higher care at lower costs and reducing variation and practices
Identifying and correcting clinical variation
Data shared between trusts
Resulted in specific elective orthopaedic beds, enhanced recovery, fewer loan kit, best practice guidelines- cauda equina

Question 32

National Hip Fracture Database?

Answer 32

Nationwide quality improvement project concerning the management and outcomes of patients with hip and femoral fractures
Key performance indicators introduced in last few years- orthogeris review within 72 hours, prompt surgery, NICE compliant surgery, admission to specialist ward, prompt mobilisation, bone meds, dietician review
Success- orthogeris review has noew incereased to 90%

Question 33

What is the UK Trauma Network?

Answer 33

Hub is MTC with peripheral trauma units
MTC is a 24/7 consultant led trauma service with all necessary specialties involved
Pre hospital team transport directly to MTC if criteria met
Advantages- improved outcomes and experience/exposure for specialists and trainees at MTCs
Disadvantages- decreased skill and training of trauma teams in MTCs
Longer transfer times/repatriations

Question 34

What Challenges does T&O face in future?

Answer 34

EWTD- shift pattern for trainees impacting operating and clinic time- less time spent with trainer
Infections and Abx resistance
Winter pressures cancelled elective operations
Trainees used for service provision
Release of outcomes to public
Reduced patient contact time

Question 35

How are T&O registrars trained?

Answer 35

6 years from ST3 to ST8
JCST advisory body to RCS for training matters
Training organised by regional deanery
Minimum average of three operating lists and two outpatient clinics per week
1 regional teaching session per week
UKITE
ARCP
FRCS
1800 cases in 6 years with 70% as first surgeon
1 MSF a year
Higher degrees
Critical conditions and PBAs for specific operating cases
Regional teaching
Research
Audit

Question 36

If you could change one thing about the current orthopaedic training program what would it be?

Answer 36

A realistic and achievable thing to change is having Single lead employer for orthopaedic trainees within their region.Doctors in Training report an increased overall satisfaction with the employment,
deployment, and induction experiences during their training
✓ Continuous management and support by the same employer bring continuity from a
health and wellbeing perspective, as well as continuity of employment for the payment of
parental leave
✓ An increased number of days are available for clinical time which would otherwise be
required for rotation-based administration tasks including repeating employment checks
and training
✓ Less time spent form filling and supplying data to employers
✓ Less repeated immunisation, vaccinations, or screening tests
✓ Less duplication of statutory & mandatory training
✓ Equitable treatment of trainees and a more consistent employment experience
✓ Improved trainee experience with regards equality, diversity and inclusion, as lead
employers are able to see and monitor trends and work strategically across the system to
make improvements.

Question 37

What are your short and long term goals?

Answer 37

I think this is best started by thinking about my long term goals and working backwards.

In the long term I wanted to be an upper limb orthopaedic surgeon working in a DGH with a good mix of trauma and elective work. I really have enjoyed my time working in a DGH with the mix of patients and feeling of knowing everyone within the hospital. I could see myself working there in the long term. I think this also reflects my enjoyment of upper limb surgery which has a good mix of cases and variety

One of the key aspects of orthopaedic that I enjoy is the use of large scale pragmatic trials to guide our decision making as such I want to be a primary investigator for these trials in my local unit.

I also want to continue my work as a trustee for We Are Donors and be looking to take it to the next level in terms of getting long term permanent funding from the NHS BT

Lastly I want to focus on having a good work life balance, so I can spend time with my family friends.

To do all of this I will need to gain experience in upper limb surgery during my rotational training and also look into getting a TIG Hand surgery fellowship post completing my FRCS.

I want to do a further degree in clinical research and specifically I would be interested in being involved as an assistant PI/in the development of a pragmatic trial such as DRAFFT.

Then in terms of maintaining my work life balance I want to always be communicating with those close to me to ensure I am not loosing that.

Question 38

What is ODEP?

Answer 38

Orthopaedic Device Evaluation Panel

15A*
Number of years of evidence
Letter denotes the quality of evidence available about the implant

Question 39

What is the MHRA?

Answer 39

Medicines Health and regulatory agency

Question 40

How can you demonstrate your commitment to Orthopaedics?

Answer 40

I can demonstrate my commitment to being an orthopaedic surgeon by the my skills and experiences I have had throughout my medical career.

Firstly: Clinical
Research
Teaching
Leadership

Question 41

Describe a paper you have published.

Answer 41

First author publication: Early protocol computer tomography and endovascular interventions for pancreas transplantation.

Retrospective study with a historic control- compared our performance pre and post implementation of a CT protocol. Evaluating one units pancreast transplants outcomes pre and post introduction of a early protocolised CT on D3/5 to identify subclinical thromboses.

Led to a higher rate of identification of thromboses and less invasive treatment with more transplants being managed with conservative management only.

Low numbers + should we not just use USS instead?

Question 42

How to approach discrimination?

Answer 42

Call it out
Support + escalation process
Open and honestM

Question 43

Most important Ortho paper this year?

Answer 43

Scott et al.

Worsening QALYS on waiting list from 6 months to 12 months

Prospective cohort study

Question 44

How have you changed departmental practice

Answer 44

Neurovascular status audit
Embedded within the department
Proforma
Induction teaching

Question 45

Conflict within Orthopaedics?

Answer 45

Elective vs Trauma operating

Protected elective operating and cold site operating
Increasing waiting lists

I have been involved in the workforce planning for the SHOs to staff a new Elective Cold site Orthopaedic operating centre. More opportunity for SHOs but will require a heavier on call and for more recruitment at SHO level- a difficult task already- more trainees are hard to get.

Question 46

How to improve sustainability/environmental effect in orthopaedics?

Answer 46

Reduce- bone health treatment could reduce NOFs
Reuse- limit single use items
Recycle- education and ease of use, 99% of non contaminated arthroplasty equipment is recyclable
Change the culture- stakeholder engagement