ST Interview Time Again!

Ok, the 2009-10 applications are well underway, and in fact some of them have finished. I had planned to post a few months ago, but got sidetracked. However, a spate of recent e-mailing from a number of people with upcoming interviews in Yorkshire has reminded me to do this. While I am happy to give advice to people with interviews, as I am giving the same advice out again and again, I've decided to save a little time and just post my bits here :p Sorry, this is a long post...

So here's some basic advice for a ST interview for Ophthalmology:

1. Dress smartly/formally

No matter now many times you tell people this over the years, someone always manages to look like they just rolled out of bed. I don't just mean wearing a suit, or a nice skirt (or trousers if you prefer) and blouse - make sure they look ironed! Ladies, if you want to go down the short skirt / low cut top route, that's your prerogative, but not every interviewer might appreciate the "view", so it's probably safer to dress conservatively (and yes, once again I have seen some women wearing smart yet revealing clothes that don't really look appropriate for an interview that's this important).

2. Preparation, preparation, preparation!

Consider going on an interview preparation course. There are a number, so speak to a few people first to see their opinions regarding them. The courses might not be ophth specific, but they will cover generic topics (eg: NHS sturcture, Clinical Governance...etc...).

Make sure you know exactly where you are supposed to be and when. Make sure you know how to get there (including alternative routes/methods, just in case), and make sure you get there early (if that means you have to wait somewhere, that's fine - you can read a newspaper, or your prep notes - it's better than arriving late!). I personally aim to go up the night before if it's far, and attend the venue 30-60 mins early on the day. If you need to stay the night before, find an appropriate hotel ASAP, and book it. There's nothing worse with only remembering 2 days before that you haven't sorted a hotel, and finding everything in the nearby area is already booked because some convention is going on.

Make sure your portfolio is organised in a sensible fashion (follow the guidance available on the RCOphth website), and is ophth orientated. While some non-ophth things may be significant enough to include, especially if you're in Foundation training and don't have much ophth experience (if any), padding the portfolio in an attempt to look like you have done a lot of stuff will just annoy people. Whilst looking at portfolios was almost never done when MMC kicked off, it is becoming a more common practice, and noone wants to see swimming/GCSE/A-Level certificates, and random presentations you made as a medical student (unless it was ophth related, and you think it was very good for a particular reason). You should be able to instantly open your folder to the right area when asked a question, and be able to show interviewers whta they want. If the interviewers want to examine your portfolio themselves, they should be able to tell what is in which section, and not get lost in a myriad of paperwork.

Make sure that you know your portfolio inside out, and can talk about everything inside it. Considering it's filled with your achievements, one would think it's not that difficult, but people have been caught out before (eg: when suddenly asked to talk in detail about the paper they wrote that was published a year ago that you put in the portfolio).

Finally, make sure you've had your visual acuity checked (and know if you require refractive correction if needed), as well as your stereoacuity (see an orthoptist for this). It's pretty poor if you want to be an ophthalmologist but either have poor eyesight because you haven't bothered to get glasses/contact lenses, or your stereoacuity (ie: your ability to perceive your surrounding in 3D, and therefore determine depth) is low - Poor visual acuity and/or stereoacuity don't go well with a career in ophthalmology, and while you might be able to do something about the former (depending on the cause), you won't be able to do much about the latter. If your stereoacuity or corrected visual acuity is low, then ophthalmology probably isn't something you should be applying for.

3. The interview

Interviews were quite variable at the start of MMC (if you look at previous posts in this blog, you'll get an idea of what things were like). Nowadays, deaneries are beginning to get their act together and are becoming a little more standardised and reasonable in what they're expecting ST applicants to do....

Critical appraisal almost always come up nowadays. You'll generally be given around 10 mins to read a paper (that chances are you'll never have seen before), and appraise it. The next 10 mins will be spent being asked questions about the paper itself, your opinions of the study and the way it was written based on your appraisal, and how you might do/write things differently (hopefully Peninsula have moved on from a few years ago and become a little more sensible - they used to give people 10 mins to read and appraise a paper, and create a flipchart presentation of it! you'd then spend the next 10 mins presenting it and being grilled on it.). You may also be asked about some research you have done and written up, and be asked to give a summary of what you did, your findings, what faults you thought there were, and how you might fix them. Make sure you know your basic statistics, as some places do like to ask questions regarding this, to ensure that you know what you're talking about when you're spouting terms like "odds ratio", and "t-test", and "bias".

Microsurgical skills testing has always been popular. Previously used at the start of MMC (when noone knew what was going to happen) even at ST1 (!) to blatantly separate people with significant ophth experience (generally a few years - they should never have been allowed to apply for this level as far as i am concerned) from people without (F2's...etc...), it's commonly accepted now that this can turn up. Make sure that you know what basic instruments look like, and that you know how to hold them properly (they are not like general surgical instruments!). Make sure you can do a couple of interrupted sutures and instrument tie them with 7/0 sutures. Make sure you know the basic theory behind how to suture (the basic (general) surgical skills course teaches this well, but the microsurgical course (which hopefully you've done) covers this as well), as you could be asked.

Communication skills pops up from time to time. This generally revolves around an actor/actress, and a particular scenario. I have previously been asked to tell an already anxious patient who has come for cataract surgery (and been cancelled twice already for various reasons) that she is cancelled again as the operating microscope has broken, we don't have a spare (they're expensive, don't you know), and the technician can't come till tomorrow....Cue tears, hysterical theatrics, anger, wanting to know who to blame, and wanting to make a complaint. Now, don't go preparing for this, as I wouldn't expect a deanery to use the same scenario twice (unless they're lazy - recycling does happen on the odd occasion).

Clinical scenarios can pop up too. They may not be obviously ophth related at first, so you may need to think laterally. The best way to approach any scenario is as you would in any exam setting. Start from basic principles, and be safe and methodical. In any scenario where acute problems are occurring, if appropriate work with ABC's. For more specific problems (eyes only), or more chronic ones, this may not be required. Always make sure you take a thorough history and examination - while you won't be asked to literally do this, you'll need to say what you want to do/ask, and hopefully will get answers back for this. You could be asked to give a differential diagnosis based on what you've learned, or asked to give a management plan. This can be difficult without ophthalmic experience, hence they generally (at least nowadays) do scenarios that one should theoretically be expected to do as a competent A+E or GP F2.

Finally, know a little about pre-assessment for operations, and how one might decide whether a patient is suitable for a general or local anaesthetic, and whether the operation can accommodate a patients' problems (eg: an 80 year old lady going for a cataract operation in her left eye has a medical history of CCF, arthritis, and ankylosing spondylitis, and cannot lie flat or move her neck too much. However, she wants to be done under a general anaesthetic. What issues surround this and what might you say?) Apart from cataract ops, you shouldn't be expected to know details for ophthalmic ops as you don't have the experience (and even for cataract ops, you might have little/none), but a lot of the principles are similar to ops done under GA/LA for General Surgery...etc...so there is no excuse for not knowing basics, as by this stage everyone has done at least 1 surgical rotation.

*****

Ok, I think that covers most of the things that could occur. This is not an exhaustive list, and over time this may even become obsolete as new methods of assessing candidates are put in place. There have been rumours for the last few years that perhaps one day a written paper (similar to the GP application exam) may occur. The RCOphth has also recently acquired a surgical training simulator, which allows trainees to practice their skills, both generically and also op-specific. Deaneries are slowly obtaining these machines (which are very expensive), and perhaps one day, applicants might be assessed on their hand-eye co-ordination / potential for microsurgical skills by carrying out certain generic tasks.

While 2009-10 applications are pretty much over by now, hopefully this will help interviews for 2010-11 and onwards. If you find this info useful, please post a comment saying that, so I know. If there're any other specific questions not answered here that would be useful for ST ophth interviews, feel free to contact me, and if I think it is appropriate i'll post something about it here. Please don't ask me to review application forms or CV's because it not only takes a lot of time, but I think there are many other better qualified people out there for that.

Good Luck!