Portfolio

Question 1

Surgical Elective

Answer 1

Major Trauma Centre at the Baragwanath Hospital in Johannesburg

• Hands on supervised/unsupervised experience with critical trauma patients from penetrating injuries/ blunt trauma / RTAs
• Appreciate that practice differs widely between countries but I think that the exposure will be helpful for surgical on calls if I’m based in a trauma centre or for surgical jobs in general.
• Why? - Trauma is an exciting and varied specialty. Working in Johannesburg allowed me to see a volume of trauma that I’d not have otherwise been exposed to and to see/assist in a variety of surgical procedures.
• Helped me practice my trauma/critical assessment of patients

Question 2

Research

Answer 2

The short answer is I’m yet unpublished but this is not from a lack of effort or desire.

During my BSc i conducted a meta-analysis looking at the efficacy of therapeutic hypothermia in stroke. Unfortunately a different research group published whilst I was deep into the research.

I’m subscribed to the BMJ and uptodate trying to keep abreast of medical and surgical guideline changes. I’ve had practice at critical appraisal through journal clubs at my current job and through my BSc.

Question 3

Financial Audit

Answer 3

I conducted a financial audit for the breast department at a DGH.

I looked through all elective breast procedures over a 4 month period and compared the tarriff we were paid versus what the national tarriff suggested we should be paid guided by the procedural complexity, patient comorbities and the NHS grouper tool.

I presented this at a breast conference.

Question 4

Weekend Handover Audit

Answer 4

With my fellow foundation trainees we felt that the current handover mechanism to the weekend team left room for things to slip through the cracks.

We developed a weekend handover system to tighten up the process and optomise patient safety.

We presented this at a local governance meeting. Our succeeding foundation trainee cohort continued to use the system and improve upon it.

Question 5

Teaching Experience

Answer 5

Surgical Finals Course

With a surgical minded colleague we developed a national surgical finals course which we delivered in conjunction with a university society.

We focused on exam success teaching

Question 6

Academic Performance

Answer 6

Multiple Distinctions - In clinical sciences, clinical practice, obstetriics and gynaecology and paediatrics

I believe dedication to academic

Question 7

Why should we choose you ?

Answer 7

CAMP

Clinical :

• Motivated to ensure good clinical care and to keep abreast of developments
• Have demonstrated a keenness for surgery through attending theatre where possible as seen in my logbook

Academic:

• I’m dedicated to learning as evidenced through my academic performance at university
• I’m committed to teaching as evidenced by self-directed creation of an undergraduate teaching course for surgical finals and through regular teaching of medical students.

Management:

Mention quality improvement projects

Mention financial audit - important for revenue securing and clinical governance

Organising hackathon

Both of my 360 feedbacks - mention these.

Question 8

What is your unique selling point?

Answer 8

I’m proud of my sound academic performance and being viewed by my colleagues as an asset to the team on multiple occasions. But my unique selling point is having developed a vast experience base through paid work in a managerial role at a GP practice and invovlement in a high level financial audit early on. I feel that these attributes set me aside from others and exemplify my versatility as well as a knack for management.

Question 9

Why Surgery?

Answer 9

CAMP

Clinical

Surgery is dynamic and evolving with a wide range of challenging specialties on offer.

There is a large mix of patients with regards to their age and comorbidites that makes the job very engaging.

Academic

There is a large scope for academic work and further improving techniques, guidelines and our understanding of physiology.

I look forward to being taught by senior colleagues and in due time I look forward to developing my own teaching techniques and teaching junior colleagues.

Management

I look forward to finding a role for myself in a department as I have a unique experience base centred around managerial/governance roles.

Developing organisation skills such as in organising patient lists and outpatient management.

Personal

I enjoy the pace and pressure of surgery, the immediacy of benefits that patients can have.

Most importantly I look forward to being a technician and honing my skillset. I like how there’s an endless scope to improve my technical abilities.

Question 10

What is your weakness?

Answer 10

I think having insight into my career development is important as I want to be the best clinician i can be. Despite completing a BSc and having great academic accolades from my undergraduate training I’m yet to be published. I have decent working knowledge of research skills and critical appraisal. Currently I’m working with the geriatrics and vascular team on antiplatelet administration in peripheral vascular dsiease in the elderly population. I look forward to starting a successful research career and to focus on meaningful areas of investigation.

Question 11

What do i least like about the profession?

Answer 11

The surgical profession overall seems to me to be extremely rewarding and has an almost addictive quality. However I think that as a trainee I want to spend as much time as I can with experienced surgeons learning important techniques. While i understand that emergency appendicectomies and incision and drainage are important to patients, I want to be learning on teaching lists. I guess this is why I will be preferencing the Improved Surgical Training programmes highly.

Question 12

Tell me about your communication skills

Answer 12

I think my communication skills are excellent. This is also supported through my supervisor feedback and my TAB feedbacks in my portfolio. I’m a versatile communicator able to relate clinial information to lay patients well whilst also able to effectively communicate with senior colleagues and ensure plans are laid out and employed correctly.

Question 13

Are you empathetic?

Answer 13

I view myself as a person posessing considerable capacity for empathy and have received this feedback from colleagues. An example that comes to mind is a patient recently under neurology who had an inflammatory pontine and midbrain process.

She was at loathe to have a repeat scan. I was able to sensitively elicit that the main reason was because of having to cease breastfeeding for the following two days and concerns regarding the safety therafter of contrast. I responded to non-verbal cues and her tone of voice. Listening to her concerns and adressing them enabled me to convey how important this was and to explore was in which we could minimise risk to her child.

I

Question 14

Example of bad teamworking

Answer 14

Situation: Whilst on surgery, i was very keen to attend theatre particularly on my consultants list. I also had the MRCS Part A exam looming.

Task: Another F1 passively mentioned that they hadn’t seen me on the ward lately and they had been very busy with the post take.

Action: I felt that I’d been selfish and had neglected to help my colleagues. I applogised to the team and I became more mindful of asking my colleagues via the whatsapp group or by going to the ward how they were managing with their jobs before going off to study or to theatre with the consultant.

Result: This sentiment within the team dissolved and we are all friends to this day. It has had a positive impact on my attitue to this day as I endeavour to ensure that I am always mindful of my colleagues and how they are managing with their worklaods.

Question 15

Example of good teamworking

Answer 15

STAR

Situation - Hackathon

Task - Organising the event, delegating tasks, ensuring smooth running of events on the day.

Action - Meticulous Planning amongst team members, understanding the skill mix, effective communication platforms - regular meetings, working group chats, shared task lists,

Result - effective event. Made representative of the month for the lifebox charity.

Question 16

i) What is an audit?

ii) Define audit cycle?

iii) Why is audit important?

Answer 16

i) A standards audit is a systematic quality improvement tool comparing current practice with set standards.

The aim is to maintain quality of patient care/outcomes

ii) Audit Cycle:

1- Identify issue

2 - Define Criteria and standards

3 - Data Collection

4 - Comparison

5 - Implementing changes

6- Sustaining improvements

iii) Audit is important to:

maintain standards

maintain and improve outcomes

identify areas where proceses can be improved

Help to disseminate strategies that work to other trusts or areas within the same trust

Question 17

Difficulty you experienced doing audit?

Answer 17

Whilst completing the financial audit I tried to be as thorough and comprehensive as possible. I contacted the coding department to see the process they were using to code the procedures and then how they coded comorbidity.

I met resistance from the department who seemed to be worreid regarding my scrutiny - “we perform our own audits”.

This attitude to audit can be detrimental to improving patient care and even financial performance of a department

Question 18

i) What is the difference between research and audit?

ii) Levels of evidence in research

iii) Should research be compulsary?

Answer 18

i) Whereas audit measures a departments performance against current standards,

Research

aims to answer a question with the future-centric outlook to improving the medical practice.

ii) I - RCT/Meta-Analysis / Mega Meta-Analysis

II - Cohort Study

III- Case-Control Study

IV- Case Series

V - Expert Opinion

iii) Research is important in improving our understanding of disease, developing novel treatments and in better selecting patients for various treatments. There are clear arguments for producing good quality research and I personally look forward to involving myself in research projects and becoming published. However not everyone has access to good quality projects for example in DGHs. Furthermore not everyone enjoys research or wnats to complete a higher degree and I believe that professionals should have autonomy over their career direction

Question 19

Talk about courses you have attended

Answer 19

I attended a breast awareness conference in Essex last year where I also presented a financial audit.

A lecture given on novel SNP assays and their use in identifying patients who may benefit from surgery sparing immunological therapies very interesting as it adresses a step forward in the breast oncology field currently being taken.

I also attended a basic surgical skills course taught at a trust wide level. This was delivered by senior general surgery registrars and focused on the basics of suturing, deep knot tying and haemostatic sutures. I appreciated the low ratio of trainees to trainers as this permitted closer supervision and individualised teaching.

Question 20

Describe how you would go about answering a research question?

Answer 20

Literature Search –> Clear delineation of a question

Idenitify supervisor

Null Hypothesis

Primary Aims

Calculations with stasitician ( power and sample size)

Ethics Committee

Financial modelling

Patient Recruitment

Data collection

statistical analysis

conclude

write up

publish -> present

Question 21

Research Questions:

i) What is validity

ii) What is reliability

iii) What is sensitivity

Answer 21

Validity - Comprehensiveness. Does it measure what it sets out to?

Reliability- Error in a measurement tool. The consistency of the findings.

Sensitivity - How accurately can a test predict a true positive

Specificity - How accurately can a test predict a true negative

Question 22

Professional Goals:

i) Where do i see myself in 4 years

ii) Where do i see myself in 10 years

Answer 22

i) In 4 years time I see myself as a junior registrar looking at an appropriate institute to conduct a pHD. I see myself having started a career in academia for myself.

ii) in 10 years time I see myself close to completing training and deciding where I want to settle down and have a substantiave job. Currently I’m interested in plastic surgery and in particular burns surgery so I’m confined to major burns units largely.

Question 23

Tell us about a mistake you have made

Answer 23

Situation: Deteriorating patient on a geriatric ward who we’d had difficult conversations with the family regarding stopping active treatment. They’d asked for us to remove unecessary devices to make her death more natural.

Task: I removed her PICC line only later realising that this was the administration route for her leviteracetam.

Action: Once i’d realised this I’d apologised to the family explaining what had happened and that I’d spoken to the palliative care team who advised that we could give midazolam Subcut which should mitigate this problem.

Result: The family were accepting of my apology and understood the events leading to this mistake. The patient fortunately did not have any seizures and passed away peacefully

Question 24

What makes a good teacher?

Answer 24

Having attended a 5 day teaching course regarding delivery of teaching and feedback models, I utilise some of these models in my own teaching practice for example the pemberton model of feedback.

However I feel that my best teaching encounters both being taught and through teaching come from teachers who:

exhibit genuine enthusiasm

depth of knowledge

and a multi-modal teaching method.

Objectives are clear ( SMART )

A very important characteristic that i have recognised and try to adapt into my small group/1:1 teaching methods is to be adaptive to the needs of your student. Recognising through verbal/ non-verbal cues that perhaps the tutee isn’t grasping the topic or is becoming disengaged and adjusting the method of teaching.