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USPs, PERM, Examples Flashcards

1
Q

USPs

A

PRU experience; community management
L+M: Community management discharged
EPR development
Employed Uni Bath; teach on Masters
Associate PI

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2
Q

Experience PRU
Community management pre Hosp

A

On average see 4-5, advice 3-4
Helped me as a clinician
1) patient centred care; patient survey, satisfying
2) relying on clinical, weigh risk hospital, shared decisions, (HI, NOAC, bleed audit)
3) improved awareness and MDT working; paramedics, community teams (frailty, falls)
Interest in community management

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3
Q

Utilise Community management discharged

A

Inertest started
Local context
- bed occupancy, flow, overcrowding
- lots teams, poorly defined referral criteria
Leadership and management project
- I have created guidelines for referral to all teams
- I will. missed opportunities audit, test SOP ?QIP
- Gathering referral data
National context

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4
Q

Developed new EPR (L+M)
Developing digital technologies

A

Interest started; QIP; data and bundle
Culminated; new EPR, local context
I led a project to create new EPR.
- Designed the data capture and format
- vision: productivity and data: value added
- worked with DM, supervised Cons. CG
- £10,000; delivered Jan
Outcomes: CG data, QIP, research
National context

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5
Q

Education

A

Long-standing interest
In hospital
- Organised teaching programmes (3)
—- created course for new F1s, common presentations and issues whilst on call.
- 12 lectures, 20 sim sessions, 3 OSCE
Employed Uni Bath; masters course
Monthly, 10, mixed methods, assessment OSCE
Feedback ; 80% excellent, 20% good
Use experience in teaching and sim to organise teaching in Dept to train staff and test departmental protocols

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6
Q

Research

A

Inertest in
Importance of research
NoPAC; screening and enrolling
Associate PI role: DEXACELL
My role
- coordinating
- training staff; 27 so far, delegation log
- enrolling begins
Edd Carlton; amazing, and Xperia xr
Future; PI and develop research team

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7
Q

PERM… P

A

I would like to be a Consultant at AB
Friendly, proactive and experienced
Environment where; I can help
Improve department, hospital and community

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8
Q

PERM

A

P: team, help improve
E: Severn D, clinical fellow
Improved my MDT working; para, community
L+M; current: writing SOP for community teams, missed opportunities audit, refferal data
L+M; developing digital tech. EPR. Data fields and format. Aim; productivity and value added. D manger, supervised.
T; 3 programmes, 12 lectures, 20 sim courses, reg life support. Employed bath, monthly, mixed, 10. Feedback 80% excellent
R: Associate PI, coordinate, SIV, trained 27, delegation log, start Feb, EddC amazing, experience, future PI develop research team

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9
Q

Underperforming colleague
Conflict with colleague

A

I: supervising junior doctor audit for QIP. Missed deadlines and poor communication
M: project lead, colleague responsibilities
S: understand, coms issue, Ed sup
Prevent: discuss performance; disagreed that this was an issue, plenty of time, explained how this affected aims of project , options. Feedback to Ed sup
O: completed successful QIP; delivered RSI station, presented results to department.
Reflected in port and Ed sup
Lessons learnt: understanding, welfare, graded assertiveness

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10
Q

Conflict with patient, EPIC skills

A

I: Pt chronic leg ulcer. Demanding IV Abx. Shouting at triage nurse.
M: responsible Pt safety, staff safety and departmental safety.
S: clinically well. deescalate, set boundaries
Saw in time order
Listen, frustration
Explained management, align expectations
O: bloods and obs normal.
Home without better understanding
Learning points: EPIC; situational awareness, proactive; Deescalate; safety, patient, department, protect staff

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11
Q

Mistake

A

I: Working as EPIC daytime busy shift, missed hypoglycaemia in confused Pt. Pt handed over to nurse who notified me.
M: As EPIC responsible for patient safety and deploying resources
S: check patient, start treatment. Told daughter, apologised, ask resident doctor to see next.
O: no significant outcome, DATIX
Felt awful; has changed how I review gases; ask for context and review, then check asterix

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12
Q

Duty of Candour

A

I: Prescribes Abx, nurse gave to wrong patient, similar name (hearing), allergic penicillin -> rash
M: senior doctor; patient safety and staff support
S: patient safety, check, duty of candour, plan for possible allergy, apologise, update doctor and NIC. Move patients and star. DATIX, CG
O: no major allergy, my patient received Abx, felt awful for nurse - worried, reassured. CG

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13
Q

MDT; shared decision, pt centred care

A

I: PRU, asked to review; frail patient, daughter, hypoactive delirium and Pyrexia.
R: attending clinician: balance risk and benefits. Patient centred care
S: d/w family, preferred not admission. D/w frailty; IV Abx, bloods, see tomorrow
O: successful community management, without conveyance, admission. Led to project better utilise community teams Southmead; created guidelines; missed opportunities audit. Refferal data
Shows engage MDT, patient centred care, lead projects to change systems

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14
Q

EDI

A

Equality - treating people equally (does not mean that everyone will have the same chances in life)
Equity - provide extra help to some groups to give people the same chances.
Diversity - wide range of backgrounds
Inclusion - fee comfortable and be themselves
Benefit; different POV; creativity, valued; staff retention and represent the community
Ensure; respectful, recognising people have different needs and providing for those needs

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15
Q

How do you engage with CG. Ensure high quality care. Patient department safety

A

High quality care: safe, effective, pt centred
Risk management
- DATIX, complaint, PSP
Staff management
- clinical supervisor; (develop staff, retention and underperformance)
Audit
- QIP (8), audit 12. EoL audit
Clinical effectiveness and Research
- EBM and associate PI

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16
Q

Key data from ED

A

GIRFT SEDIT, compares against national average
4 h performance: flow
- 95% target. Currently 75%
Wait to be seen: 160mins
- aim under 60mins
Over 12h in ED; exit block
- aim 0, over a 1000
Ambulance handover; overcrowding
- 160mins, aim 0 over 1 hour

Staffing

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17
Q

Cope with High pressured situation
Example leadership/ communication
Interesting case

A

Important to high quality care
Incident. Example. CA in car park. EPIC at night
Skills I used as EPIC in this scenario
Prepared for unexpected: resus spaces, trolley
Lead my team calm but motivated attitude.
Clear, direct communication . closed loop.
Share mental model. utilise experience team.
ROSC. Transfer PCI.
Debriefed ensure wellbeing and thank staff, identify learning opportunities
Demonstrates prep, leadership and com.

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18
Q

Example of conflict (within team). With another doctor. Persuade a doctor.

A

Incident. EPIC busy night shift. Nurse crying. Rude surgical registrar
Responsibility for patient and departmental safety and staff wellbeing.
Checked Pt, Abx. Break.
Discuss. “Prioritise safety over breaks”. Other nurse giving Abx. Other nurse tearful - effect care in whole department
Importance civility. Other issues? Very busy ensure critical meds prescribed for pt. Break
Outcome: patient Abx, apologised, informed Ed supervisor in case pattern.
Example shows; de-escalation, resolve conflict: ensure patient, depart, staff safety, used learning opportunity - avoid future conflict

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19
Q

Future plans. Why this hospital. What kind of hospital would you like to work in? How would you judge your success as a Consultant

A

Hoping locum lead to Substantive post NBt
Work at NBT partly;
Centre excellence, MT, research
Mostly Staff; friendly proactive. Experived
Improve department, hospital and community
Particular continue lead projects; community management patients to aid discharge; missed opportunities form QIPs
Continue developing as a teacher; recently employed by Uni Bath; masters once per month. Mixed methodology. Importance teaching MDT.
Finally continue active research. PI help develop research team to allow for seamless research activity alongside excellent service provision.
This how develop Consultant and my long term goals

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20
Q

Time answered complaint

A

Different hospitals different process
Recent complaint
Pt FND complaint about attitude of doctor
Listed issues from complaint
Checked notes
Timeline
Discussed with doctor
- discussed importance pt dignity
Respond to complaint; answer issues listed
- mitigate issues (no harm), enact change to reduce future risk (PSP)
Ward manager, divisional, executive sign
Shows I have experience in managing complaints, staff management and risk management

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21
Q

EoL QIP

A

Qualitatively Analysed M+M SJR
Most common issue EoL medications and symptom control
QIP improved EoL medication prescription and consideration of use from 33 to 83% over 6 months
Intervention; electronic bundle
Interest in use digital technologies

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22
Q

Complex scenario: conflict family / difficult decision

A

I: Functional seizures ? Hx seizures
Prealerted. Tx benzo
Appearance functional
R: EPIC; patient safety
S: family demanding further treatment
Explained difference, why I believed functional harms of continued treatment
O: seizures terminated without further Tx
Multiple previous presentations mixed management.
HIU plan: neurology had documented believe she only had functional

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23
Q

Which part of CV are you most proud of

A

PRU, interest in community management
EPR
Bath university
Associate PI

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24
Q

Describe your recent clinical work and how that demonstrates your ability to do this job

A

Trained Severn deanery
Variety hospitals
AB; PRU
Roles
Service provision;
- Practise EBM; patient centred, shared decision making
- EPIC, supervise: responsible safety and high quality care
- Training; opportunistic; WPBA
Shows; wide experience, high quality care, motivate staff with training

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25
Example of teaching you are proud of
Wealth of teaching experience… Most proud of Developed teaching course for new F1 ~20 doctors, delivered 6 sessions CBD; common issues on call - targeted to needs Drs - Management; uncertainty and risk. - taught about system working in. - Feedback was excellent; useful for stage of training Shows; as Consultant here I can create training covering trainees curriculum improve staff performance within system and devise training that tests system
26
How do you go about investigating a critical incident
Example TTP death Root cause analysis Identify issues DATIX/complaint Timeline of events from notes Debrief/statements those involved Fish bone; underlying factors - crowding in ED queued on ambulance Report care given vs policies/standards Identify gaps Held on ambulance see. In 1h, moved to bed in 2h. Unlikely outcome would have changed due to rapid deterioration. Risk of an overcrowding escalated to triamvurate. Initiates in place Draft sent to division for approval Discussed at M+M Duty of candour completed Shows how I engage investigate and improve care in blame free way.
27
Did not follow guidelines, shared decision
I: night shift EPIC (new department) patient with anaphylaxis, seen by Dr wanted to self discharged. Single dose adrenaline R; patient safety; aware risks S: teaching RCUK guidance, 2h w EpiPen D/w patient, rare complication biphasic. ED did not have EpiPen TTA Patient had family at home. FP10 O: patient left FP10 MiniCEX Discussed at CG Introdocued EpiPen as TTA Shows; shared decision, lessons learnt, CG, improve service
28
How would your seniors motivate you?
Emphasising what I like about EM - variety; generalist - challenge (developing and improving) - appreciated
29
A healthier Wales (NHS wales)
Long term plan health and social care Refreshed plan 2024 - patient centred: community care - develop digital technologies; improve productivity and data - strengthen research - create single system health and social care
30
Which post did you find most enjoyable and why?
Most enjoyable and informative Clinical fellow AB PRU - patient centred service Team; friendly, experienced, proactive
31
Example where you didn’t communicate well
Weakness - quiet Aspects to communication
32
Situation where your work was criticised.
Weakness I: leading trauma, Cons observing R; role S: other opinionated colleagues O: shared mental model Shows; reflection, CPD, constructive Criticism
33
SHED
SHED: Prospective multi centre cohort study diagnosing SAH in ED Evaluating diagnostic approach to severe headache ~3600 patients enrolled ~230 SAH confirmed CT within 6h; sensitivity 97%? CT within 24h; sensitivity 95% Post test probability less than 1% and less than 0.1% for aneurysmal SAH Non aneurysmal managed conservatively
34
Example of a failed change project or QIP
EoL QIP RESPECT draw in resus Symptom control obs charts
35
Describe some who has influenced you
Nicky Moore Set up PRU in Bristol Learnt about model and service Influenced me to take CF job PRU; patient centred, clinical acumen, MDT Interest in Grange Influenced to lead big project Led to new EPR Reflect on good practice, encourage into own practice
36
Health inspectorate Wales report Challenges; improvements HIW Oct 2024
Challenges Patient flow - RAT to stream to alternate pathways - develop SDEC pathways Clinical oversight of waiting room - new WR with better visibility Patients w/o pain assessment/ analgesia - RAT teams Staff response survey: mixed - staffing levels and flow - QR codes to report staff issues
37
Role as clinical supervisor
Ensure patient safety - safe care within scope of practice - identify areas to improve (FIB) Ensure departmental efficacy - provide feedback (issues with IT process) Staff development - identify their needs and create plan - interview practice - got training role - motivates, performance and retention. Summary: ensure pt safety, department performance and motivation of staff
38
Role as EPIC
Patient safe + care - sick patients identified and seen, plans Departmental - Resource allocation, situational awareness, risk management, handover Staff management - Training and motivation; challenge and variety Hospital - better referrals, more appropriate discharges. Improved outcomes and efficiency
39
Six Goals for Urgent and Emergency Care National Programme (NHS Wales)
- Signposting to right place first time Danger of wrong place MIU/unwell - clinically safe alternatives to hospital admission - rapid response in a physical or mental health crisis
40
Good medical practice (GMC)
GMC Professional standards - performance; up to date CPD - communication; shared decision - safety; clinical governance trusts; probity; honest exp, mistakes
41
Example research that changed practice
NoPAC Multi centre RCT Topical TXA vs placebo for epistaxis Null trial Prior to this would try TXA soaked gauze Enrolled patients on NoPAC Importance of research; improve practice Shows Importance of research in ED and EBM. Would like to continue active research
42
Health inspectorate Wales report positives Good current practice HIW Oct 2024
Challenging conditions in NHS Effective care - improved traige times (etriage) L&M - Staff retention improved - Reduced reliance on agency Patient experience improved since 2022 - improved traige time (etriage) - good care from staff; challenging setting - awaiting new building (RAT zone) Demonstrates; staff proactive and experienced at delivering change; environment I would like to work in
43
Wales organisations that set standards
NICE NSF; national service framework GMC; professional standards; duties of a doctor
44
Persuade a colleague , direct conflict
I: elderly abdo pain post cholecystectomy, review patient doctor, radiologist refused scan, difficult discussion R: patient safety S:understand concern, explained although unlikely, not safe to discharge home without explanation. Advised surgeons. Surgeons in theatre, in patient interest. Could go home if CT Normal O: dropped gall stone and collection Washout in theatre Shows; clinical judgement, common ground, reframe issues on patient, persuade
45
Martha’s law
Call 4 concern in Wales Critical care outreach team for review
46
GMC National Trainee Survey
Good points - supportive environment - local teaching - handover
47
National service framework
Increase standards across wales Reduce variation in care Specific NSFs
48
Aneurin Bevan targets
12 hour waits to be reduced by 20% by March 2025 from Sept. Awaiting results Reduce ambulance handovers over 1 hour by 30%
49
ABUH annual plan; Emergency care focus
Experience; increase consultant; RAT Access; ambulance handover, 12h waits, wait TBd Discharge pathways; discharge lounge
50
Asked for help
I: Ruptured Ectopic, walked in Moved direct to resus; hypotensive pale R: rapidly resuscitate and get to definitive surgery S: help from consultant, asked them to contact gynae, anaesthetics, for immediate review. Important: - humble; Recognise when you need help - Know what help you need; allowed me to focus on direct patient care - Set an example that it is ok to ask for help ; stronger as a team. O: resuscitated with blood, taken to theatre. Good recovery Shows; know when to ask for help, set an example of how good team work makes our service safer and higher quality.
51
Initiative that worked somewhere else How did you effect others initiative?
RAT and pit stop at GRH Benefits: faster time to senior decision maker - front loading appropriate investigations - effective streaming to other services - rapid initiation of analgesia and treatments Challenges - resistance to change; won over by good communication and data showing improvements; time to analgesia, Abx, scan - flexible approach; fed back issue: delays with porters; change: posted to RAT zone
52
EPR how change implemented
Changes - streamline, automate: productivity - capture value added by PRU - care outside scope standard paramedic Implementation - designed the data fields - coordinated implementing new system and retiring old system. Communication - ensured snags were resolved. RAID log Risks, assumptions, issues, decisions Maintenance - benefit digital systems: once steady state no further maintenance from team - creating dashboard - as consultant QI project from data - publish research using data. Pioneering service and data from EPR is designed to be easily captured and published to show the benefit PRU Show project management, what I could provide as a consultant here AB
53
Examples DEI
iPads via switch: access sign language interpretors - area of improvement; awareness, set an example Clinical fellow: Difficulty with interviews, understanding how to answer questions. Second language Complaint; misunderstanding pathology regarding functional illness and the patients abilities to control Sx
54
Enhanced monitoring
Reduction ambulance handover time Reduction in time to be seen by a clinician Reduce 12h waits Deliver effective flow over budget; breakeven position
55
Putting things right
Process to investigate complaints and concerns Via health board Respond within 30 days Not satisfied: ombudsman Ensure lessons are learnt Improve trust from public
56
Recent audit (short)
EpiPen
57
IMTP
Integrated medium term plan
58
EMAR
Emergency medicine airway registry National database Introduced this registry Important to understand care from high risk procedure, variety of practice One of the top sites entering data QI project increased medication documentation from 30% to 90% Shows engage national research and QI. Initiate change and maintain
59
NHS planning framework
Integrated planning Health board submits plan Approved by health ministers Comply with financial break even duties Board submits. IMTP (3y) Integrated medium term plan
60
Describe a near miss
Hypoglycaemia - no harm
61
ABUHB values
Echo, aligned with, People first; promote safety Passion for improvement; actively look for improvements Personal responsibility; challenge behaviour, Pride in what we do; lead by example, motivate team
62
RAT benefits and challenges
Benefit - senior decision maker early in pt journey - stream - Ix - treatments; HIW Challenges - opportunities removed from clinicians (streamed away) - effect on training, motivation - undifferentiated pt, own plan - confirmation bias; based on rapid asssessment, high cognitive load - possible safety concerns
63
Welsh emergency care data set
High quality standardised data set - service improvement - public health ( police hot spots) - benchmarking - compare to average Evidence need for better care to government to provide funding and back change Feed into GIRFT SEDIT tool Training in SEDIT Powerful to compare departments against national average See where improvements can be made and chart improvements Priority NHs Wales quality statement
64
eTriage
65
RAT implementation
66
Time you showed leadership and challenges you faced
EPR Designed - Vision Implemented - not working at the Grange - close contact with clinicians working during shifts to identify problems. First launches failed; unforeseen coding errors. Had continuity plan - service not effected by failed launches. Maintained - challenge monitor all outstanding issues - RAID log Labour of love - keep developing improving
67
Ethics general answer
Patient safety Departmental safety; colleague cover and aware Staff - sensitive, open honest discussion Understand, Context specific Challenge inappropriate behaviour Graded assertiveness Duty of candour, apology Upset - reassure; never solely individual Systems failure DATIX; Lessons learnt Go home, locum request, next shift Safe to go home Inform ES, clinical lead, divisional lead
68
Corridor care
RCEM newsletter endemic Locally; policy for no corridor care Patient safety issue - lack access to monitoring and equip Privacy, Undignified - public space, unwell and on show Moral injury - demoralising, staff retention UNCORKED study designed to look at effects of corridor care and escalation areas Shows understand local and national context; responsible leadership
69
How would you Supervise ACP or ENP
Role as clinical supervisor - regular meetings; ensure safe and effective - meeting curriculum - welfare needs met - help tailored to individual ACP supervisor training

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