This is always a difficult question to answer and I can only give my own opinion.
The Anaesthestist should be vigilant ("Eternal Vigilance" is the motto of the ASA), careful (primum non nocere : first of all, do no harm) and patient (a prolonged operation can still be very demanding of your attention: e.g. Aortic aneurysm surgery).
One should be caring (most patients are very anxious and have a lot of questions), empathic (many patients fear not waking up again and some are afraid of losing control, so they need to be reassured).
Honesty: Don't make unrealistic promises (for e.g. I will do my best to make sure you don't have any sickness afterwards, but unfortunately I cannot guarantee it). "Yes, dear, there will be some pain, but I will do my best to make sure you are comfortable afterwards".
Calmness: "If you can keep your head whilst all around you are losing theirs". When a patient arrests during a surgery, you need to have the clinical acumen to pick up the problem as it occurs, the knowledge to tackle it, the calmness and presence of mind to apply it and the authority to get people around you to help, without panicking.
Skillful: A lot of Anaesthesia is hands on work, which requires skills that have developed over many years. Yet, on a given day, even the best of us may struggle with IV cannulation, Endotracheal intubation, Spinal, Epidural, invasive monitoring. We may make silly mistakes due to distraction, fatigue or having to deal with too many things at the same time (e.g. on ICU), some of which could have disastrous consequences.
Communication: The Anaesthetist should have excellent communication skills since they are a part of a team that ranges from ward staff, Surgical Colleagues, patient, Theatre and the Intensive Care Unit.
There are a whole range of Allied Health Professionals like the Acute Pain team, Physiotherapists, ward nurses etc. who will be looking after the same patient who need to be kept informed.
Occasionally, when a patient has problems due to Anaesthesia (as for e.g. an anaphylactic reaction in one of my patients), the GP and perhaps the Allergy Clinic need to be given details about the sequence of events. They give very useful feedback
Knowledge, Attitude and Skills: These are the attributes expected of every Anaesthetic Trainee. Knowledge is acquired from reading, observing and doing.
Attitude: The right attitude towards your specialty, patients, colleagues, other staff and your teachers is very important. Having the wrong attitude hinders progress and can prove lethal to patients. Skills I have already highlighted above.
Diplomacy and tact: Especially in the ICU setting, this comes in handy when you are dealing with difficult relatives of patients and difficult colleagues (I know he has end stage multi organ failure, but till last week, he was walking about, so we should give him at least 24 hours {by which time, I will be off the on call and then it will be someone elses's problem} )
Stamina: You need plenty of this, since the moment you intubate a cardiac arrest patient, magically everyone disappears, leaving you to squeeze the bag. Just as you are looking at the clock and saying "thank God, I will be off in another 30 minutes" the crash call goes off (or if you are a registrar, a stat C section call goes off) after a busy night on call.
Please let me know if you can come up with more qualities and I will add them. I am sure you have all these qualities, so you should get the job!
All the best!
Another query cropping up with increasing frequency is :
Should one have a Post Graduate qualification or not? Or putting it slightly differently,
Do doctors with PG qualification have a better chance of securing a job?
Traditionally, SHO recruitments take place in February and August each year. This is when most SHOs would have finished their rotation, got through their Primary Exams and would be moving on to SpR posts.
Since the majority of the workforce lost consists of experienced candidates, District General Hospitals and even Teaching Hospitals tend to replace them mostly with experienced candidates. The experience is preferably in the UK (especially those who are already doing on calls) but the next best would be experience obtained overseas, so that they can quickly get through their competency based assessment (which can be 1-2 weeks to 1 month, depending on the candidate) and start doing on calls
Most DGHs can cope with only one novice at a time. This is because the novice needs 100% supervision on an average for 3 months and this further stretches an overstretched system.
So having a PG qualification and experience shoud theoretically be an advantage, at least in statistical terms. However, the competition is still very stiff since the sheer numbers are so huge.
I don't think there is any hard evidence that PG confers any improved success in securing jobs.
What matters is your individual ability, and preparation and performance in the interviews.
My own view is that if you are already in the middle of a PG course, it is better to finish it before coming here, so that if you decide to return, you have better chances of getting a job back home.
Q. 1
It would be excellent if you could provide details of any consultant
wishing to sponsor candidates of indian origin for the odts scheme,as
I have one sponsor in india but nobody willing to sponsor in uk
in spite of filling all other criteria of the rca under odts .
Hope some thing happens
A: It
is not a question of "wishing" to sponsor. There are many of us who
want to sponsor,
but there are a lot of restrictions ( I don't want to go into
the details).
The RCA requires the sponsoring consultant to find a job for their candidate
and also be responsible for their training (and their
mistakes) in the initial period.
While this has always been the case, till now it was not a requirement.
Now both the RCA and the candidate can make life miserable for the sponsoring
consultant.
The candidates are already doing it (I speak from personal experience of sponsoring
many many candidates)
but at least the RCA is not.
If a candidate (who we have never seen or heard of before) is not good, we have
to appear before the RCA.
With due respect, our sponsors, including some of my respected colleagues don't
bother about who they sponsor.
I sponsored a candidate who the whole dept. knew
was not suitable, but the sponsor claimed he did not know that person was not
suitable.
I narrowly missed being censured because of that candidate.
So you see, I can't blame anyone for not sponsoring. We don't gain anything
for sponsoring (apart from the satisfaction) and we stand to lose, in an instant,
all the hard work and reputation we have gained over many years.
I hope this gives you a better insight.
If you fill all the criteria of the RCA, including DNB, then you don't need
anyone else to sponsor you.
That is exactly why the RCA has taken over all sponsorship
Nanda Kumar
Q 2: ONE THING YOU HAVE MISSED AND WHICH I WANT TO KNOW DESPERATELY IS
THAT YOU HAVE NOT COMPARED CHANCES OF JOBS BETWEEN ODTS AND PLAB PASS .I AM PLANNING
TO APPEAR FOR THE EXAM BUT STILL NOT ABLE TO DECIDE THAT WHETHER I SHOULD GIVE
PLAB OR IELTS.SOME OF MY COLLEGUES TOLD ME THAT EVEN AFTER GETTING 7 BAND EACH
IN IELTS THERE APPLICATION FOR REGISTRATION IN GMC HAS BEEN REJECTED.CAN YOU
PLEASE GUIDE ME THAT WHAT SHOULD I DO
A: When you apply for a job, you
need to obtain registration from GMC. For this, you need PLAB
or exemption from
PLAB.
To get exemption from PLAB, you
need RCA sponsorship and you need to find a job.
This depends on your overseas
experience and DNB.
The main difference between the two methods of GMC registration is that, with PLAB, you can apply for ANY job whatsoever in the SHO category.
With RCA exemption from PLAB, you can apply ONLY for the specialty in which you are experienced.
Q 3: I was unable to get a satisfactory example of a sample CV (for applications to the post of SHO or for clinical attachments) from the site.
A: I have not included a sample CV because documents will make the web site unwieldy and bulky. Not being a professional webmaster, I sought advice from established webmasters and was told to include links rather than include the information itself.
Also, I don't want to put up a sample page that could affect a lot of our people, when I don't consider myself an expert on the subject.
It is very difficult to say what a "good" CV is! So, the page "Guidelines" http://www.nandu.org.uk/4930.html on my web site, has links to CV sites which are professional sites for this.
They have sample pages and templates, which you will have to modify to suit the requirements.
I don't have the time to go through CV's in detail, and I don't like to give an opinion after a cursory glance.
So I will give you some general principles which you can follow.
As College Tutor, in the past, I have heard my colleagues analyse CV's based on the
1) Layout (the way the information is displayed, paragraphs, alignment etc. and the paper quality (not necessarily expensive paper).
2) Content
This refers to the language, grammar, the actual work done, qualifications obtained.
In other words, this will tell your selector whether you have got enough credentials to be short listed.
This will also show if you have the necessary "Essential" and "Desirable" specifications.
3) Mission Statement (Objective)
This refers to your Aim or Objective in applying for the job.
For e.g. if you are applying for a post in Anaesthesia, you might say "I want to do my FRCA and specialise in Cardiac, Neuro, Paediatric etc. Anaesthesia or Intensive Care".
If you already have overseas experience in Anaesthesia, you would probably say: "I want to undertake further Anaesthesia training in the UK"
4) Additional Qualifications
For posts meant for candidates with previous experience, MD (and now DNB) is a bonus.
If you are looking for RCA sponsorship, DNB is now mandatory.
Things like awards during your Under Graduate or Post Graduate career, medals, scholarships etc,
carry additional value.
If you have organised or led projects, charity work, camps etc., the leadership qualities also help.
Other exams like MRCP, MRCS (even if it is just the Part 1) carry more weighting.
ATLS, ALS, PALS etc, are given credit.
5) Audit / Research
Audit and/or Research especially those that result in a change in practice, will carry a lot of weighting.
There is a group called Indi_go which you will have to become a member (Free) to access its information.
In the menu on the left, click on "Files" and then in the page that opens, on CV's and there are some tips on CV's http://health.groups.yahoo.com/group/Indi_go/
6) Address for contact:
It is always helpful to have a UK address. If you have a friend who can
If your document does not need an original signature, then you can email it back to your friend (or the UK hospital as an attachment) or if you have scanning facilities you can scan and send it as JPEG files (more faithful reproductions, especially of Letter headed paper).
Bear in mind it is entirely your responsibility to ensure that commnuications are reliable. You cannot hold the UK
hospital responsible for any lapse in communication.
I am currently working as a locum Senior House Officer in A&E
Q 4: I need some advice regarding the interview I' ve of anaesthetic rotation.
I've done 6 months a&e and 6 months medicine what are the usual questions asked and what do i need to prepare. Kindly give me some advice.
A: From my College Tutor days, I can give an example of an interview. Of course, the questions will vary and the clinical scenarios may vary. Remember that this is just an example.
CV:
One of the Interviewers usually asks about your CV in detail. So be prepared to explain anything different (including a different scheme of Training, different procedures, etc.) Be prepared with an explanation for gaps in the CV. If it is more than 3 months, try to offer an explanation (including time for Preparation for PLAB, General Practice, etc.) Highlight any awards, prizes, scholarships etc, and be prepared to explain about them in detail.
If you have quoted any publications, presentations, audit, research, etc. please prepare to explain fluently, what you did.
Clinical Scenario:
You may be given a Clinical Scenario, which might involve an irate surgeon, demanding that you do his less urgent case first, because he has to go and play golf etc. Remember that if you are not able to contact your seniors (your Reg. is busy with a Caesarian section, and your Consultant is busy on a Paediatric transfer), then the best approach is to see all the patients on the acute list, and form your own judgement of the priority and let the surgeons fight it out about whose case should be done first. There is no right or wrong answer. What they want to see is that you are diplomatic and calm and try to solve problems without being confrontational.
Another scenario is where you have had a cardiac arrest on the table even before surgery has commenced (or soon after the surgery has commenced) and despite your best efforts you have lost the patient. In any such scenario, picture yourself there and think like a doctor. Not as a candidate in an exam, trying to guess what the examiner wants. If you always think of the patient (as a doctor should), you won't go wrong.
In the above instance, mention that you would have called for senior help the moment things started going wrong and would have stopped surgery (if surgery had started) and perhaps even enlist the help of the surgeon in resuscitation. Don't forget to mention that you would be extremely upset by the tragic loss of a young human life.
After they tell you that you have tried everything, and it is all over, and how will you proceed, then mention that you will document everything accurately and in as much detail as you can recollect. Then you will wait for the consultant to arrive to talk to the relatives. Remember that you are an SHO and not the appropriate person to talk to the relatives. However, for your own education and to fill in any details required, you would accompany your consultant to talk to the relatives. One of the most difficult and stressful duties is breaking bad news.
After all this is done, you would go through the events with the consultant, to reassure yourself that you have done everything possible and to avoid repeating any mistakes in future (if there were any).
Best and Worst:
This is another possible question. What is your best moment as a doctor (and worst)? It could also be "What is the best thing about being an Anaesthetist (and the worst). Be honest. Nearly all of us would have made a mistake, sometimes resulting in very grave outcome. Also, you might have done something truly life saving.
Other:
The last component usually comprises one of "Latest or Hot topics" for e.g.:
SHO banding
Shift system European
Working Time Directive
Clinical Governance (more important for seniors)
Competence based assessment
Appraisals/Assessments
Changes in GMC Licencing
Foundation years 1 & 2 (replacing Basic SHO training)
Be aware of Intensive Care Medicine CCST (many candidates quote ICM as their aim) and training requirements
Be aware of your Career Structure (How many years of training as SHO, SpR etc. and the criteria for progression)
The Following questions were contributed by Dr Sanju Joy, who kindly agreed to let his name be included as well. These questions were actually asked, so you might that some of them have already featured earlier. Thanks Sanju!
QUESTIONS ASKED WERE:
SHO Training details,
SPR TRAINING,
what do u mean by competency based assessment,
career plans,
president of GMC!,
how are you planning to pass frca -1,
best medicaltextbook i like,
why outside interests,
revalidation by gmc,
clinical audit,
how u relax if u are stressed out,
how u react if there is problematic colleague, like drinking problems,
how my A/E and med jobs help in anaesthetics,
EWTD,
clinical governance etc
i think all these are ques asked in 3 interviews i attended for anaesthetics manchester rotation,
york and eastbourne in gwent rotation they gave
counselling a worried patient waiting for varicose vein surgery who is concerned whether she will die from the surgery since her father died in the same hospital last year following abdominal operation (the consultant acted as the patient and was yelling !!!!!!!!!!!!! believe me) hope this is of help
Questions contributed by another doctor:
1.Tell me two most important acheivements in your CV
2.What are the qualities of a leader?Tell me about any one with those qualities.Are you a leader?
3.You see your registrar pushing fentanyl himself just before an emergency case in the night.What will you do?
4.what do you know about Modernisation of Medical Careers?What is your suggestion to compensate the training which is lost due to reduction in working hours&period of training?
5.What are your strengths& weeknesses?
6.What are the differences in anesthetic practice in India&UK?
7.What are the requirements to apply for a registrar post?
More Questions asked in the Interview:
Here are some of the questions that I was asked in my interview last year -
1. Why do you want to be an anaesthetist?
2. What do you think of the new EWTD?
3. What is it about medicine that attracts you the most?
4. Dont you think that anaesthetics is a very boring speciality?
5. Why did you choose this hospital for anaesthetics?
Some More.......
1 Take me through ur CV
2 What are the differences in anaethesia in the UK and in India?
3 Suppose u have been an SHO and we were to assess u at a later date,what all do u think we should be assessing?
4 If a 2 year old child presented for appendicectomy when u are on call, what will be ur thought process?
5 How would u progress with the management of an 85 yr old woman who has presented with fracture shaft femur and is posted for hemiarthroplasty?
6 What are ur strengths and weaknesses?
7 Tell us about ur experience in anaesthesia
8 If I (the intervewer was a 30-35 yr old female) were to undergo a hemicolectomy,how would u convince me for an epidural?
I would be happy ,if u could post ur answers for the above questions.
A few Answers:
I will try to give you some answers from my own viewpoint.
The first two you can answer better than most, because you have arrived more recently.
In my time, I would have said drugs like Propofol and Fentanyl, Epidural infusions for Labour and post op analgesia, Recovery room, post op care, communication with patients, breaking bad news etc
Assessment (as opposed to Appraisal) is an evaluation of your abilities and progress. It is based on 3 key ingredients:
Knowledge, Attitudes and Skills
Knowledge is both clinical (hands on skills like Central line, arterial line, spinals, epidurals etc) and theoretical. My best teacher used to say that only if you have the theory knowledge, can you apply it!
Attitudes (often overlooked) are perhaps most important, because there is no hope for one who is ignorant and refuses to accept it, because if you don't accept it, you won't correct it.
I have seen a few trainees who after one week in Anaesthesia think that they know all there is to know. Confidence is useful but overconfidence could be lethal (to the patient and to one self).
These are times when even consultants are encouraged to seek help early and discouraged from taking on things they are not familiar with or don't do regularly (Clinical Governance). So remember to seek help and listen to advice (even if you choose not to follow it).
Skills are merely the extensions of your Clinical Knowledge and come with practice. There are core skills (competencies) which are life saving like Intubations which one needs to be able to do most of the time. All of us find some impossible. Maintaining the airway, CPR etc should be well established skills.
The way knowledge is tested is usually exams. The clinical knowledge and skills are tested by Competency based assessment.
For a 2 year old, first thing you do is inform your immediate senior, tell them you are going to assess a 2 yr old and that you will give them your findings after seeing the child.
Even if you are extensively experienced, at this point in time, an SHO should not do a 2 yr old unsupervised. It is upto the immediate senior whether they are happy to let you do it while they supervise you or they want to do it themselves or they call the consultant.
So your thought process is two pronged. Problems of potential full stomach, rapid sequence induction, cricoid pressure, ensuring adequate help available (and equipment).
The above should be suitably modified for the age of the child. A 2 yr old will have a parent in the Anaesthetic room (watching your every move, so it is good to have senior help and pass on the stress to them) and may not let you anywhere near the hand for IV access, so you might need rapid inhalational induction, with Sevo if IV access is not available, and cricoid pressure by the ODP, with you giving a friendly word of caution to the ODP to be very gentle. Ideally, the Paediatricians would generally have already established IV access, especially if the child had been vomiting. In this case, you can go for IV RSI.
The thought process should also involve using the time available to brush up Paediatric doses, fluid requirements, size of tubes, equipment checking, drawing up drugs suitably diluted and labelled etc. Even though senior help is available, you want to do it to gain the valuable experience. Be aware that in most DGH, children less than 3 needing emergency surgery are referred to the nearest teaching hospital. This is upto your consultant.
Regarding the 85 yr old, careful preop assessment, might reveal that the patient is demented, confused, dehydrated, can't give a history, weighs about 45 KG, with very visible spines, but narrow interspinous space, calcified ligaments, and kypho scoliosis and muscle rigidity because of the pain.
Most of these would be ASA 3 or more, so definitely for senior involovement.
They are also likely to be bedridden, prone for DVT/PE and might have been recently anticoagulated, with pnemonia, and febrile. If this is not enough, they are invariably hyertensive, with previous h/o CVA and IHD +/- MI.
This age group mostly tends to have hyponatraemia and hyperkalemia. Also bear in mind the high probability of cement embolism: (since it is a hemi arthroplasty as opposed to DHS)
Hemi arthroplasty is generally more common for # neck of Femur and # shaft of Femur is usually fixed by IM Nailing (please confirm this with an Orthopaedic colleague) and this group is at a high risk of PE intra operatively. IM nailing involves significant blood loss.
(I have seen patients dying within a few seconds of cementing). There are cementless prostheses, which you can suggest through your seniors, to the surgeons.
If there is no contra-indication, regional block like spinal, is safest option. If these patients are un-cooperative, GA (light) with a regional block (or a small dose of Ketamine to help them maintain position for the block), hypo baric Bupivacaine (no need to have affected side down) are alternatives. These are all theoretical and you have to say what you are familiar and comfortable with.
Post op. is also going to be difficult and early mobilisation is the aim. You don't postpone surgery unless absolutely necessary, because the delay can make things worse.
Convincing a young patient about the benefits of an epidural is to tell them that
1. The procedure itself should not hurt, since you would be giving them a Local Anaesthetic Infiltration
2. The quality of analgesia will be superior with less side effects like N&V, pruritus, constipation etc.
3. The patient if she has had children, would probably have had an epidural for pain relief during labour and/or LSCS, in which case, it would be very similar to that.
4. Post op, they will be more awake and able to co operate for physiotherapy, coughing, deep breathing etc.
These are only some of the benefits. You could also enlist the side effects of morphine to add to your case.
Yet another contribution from a successful candidate:
Here are few questions I was asked
1.Qualities of a good teacher
2.How will you prepare for an exam?
3.How will you organise a day's activities?
4.Example of a good team work(not CPR).Characteristics of a good team?
5.Recent situation you ahd stress.How did you cope with it?
Rest of them were routine questions like good qualities/ bad qualities/why are you leaving the present job etc.
Contributions from another doctor who wishes to remain anonymous
1. What do you know about Non Medical Anaesthetists? Do you think it is good or bad? If you were a consultant, would you say yes to it or not, and why?
2. What do you know about EWTD? how do you think that it will affect your training? do you think it is a disadvantage?
3. Recent journal article that you have read? How has it affected your practice?
1. Go through your CV
2. How do you describe yourself? And why do you think you deserve this job?
3. Because of career aims a) why are you interested in Chronic Pain Management? Any first hand experience in Chronic Pain Management? Seen any/done any?
b) What age pediatric patients are you competent in anaesthetising yourself? What do you do when you are anaesthetising a paediatric patient and the kid has a cardiac arrest, you dont have a venflon in situ, patient not weighed in the ward(because of some ??? reasons)? How do you go about it?
4) Describe Clinical Audit? Describe about your audit?
5) During anaesthetising a patient, you damage/knock off a cap/crown of the patient? How will you manage?
6) what are your comments about EWTD? What do you say about reduction in working hours?
A collection of questions from different candidates at the same interview. Kindly contributed by Dr Nandakumar Ponnusamy
1.Briefly explain our career after internship.
2.The clinical experience from the previous jobs and during clinical attachment.(what cases did we see.skills acquired.In A&E,Mdicine,ICU)
3.discuss your experience in clinical audit(if we havent done any audit,tell me the steps of audit).
what is audit cycle,what is closing the loop?4.What books did you read.(in anesthsia).
5.Have you read any journal in the recent past?
6.what resuscitations courses have you attended?
7.what is hospital by night?
8.How will you see yourself in 5 years from now?
9.Why did you choose this hospital?
10.Clinical Scenarios.
a. How will you assess a patient posted for Anterior resection(commonly done operation Grantham)2.Explain how you will asses and anaesthetize a diabetic patient for herniorrhaphy).
3.How will you explain the procedure and complication of epidural for anterior resection.
4.You are called to A and E For airway management of a patient with head injury who is unconscious?
5.HOw will you conduct a rapid sequence induction?
6. 45 year old male for umblical hernia ASA 1 ,after induction and muscle paralysis,on laryngoscopy cormack grade 4 view.how will you manage??
7.When will you call the consultant during oncall?
This is as far as people recollected and remembered,i will add further if there were more..
As I get more feedback, I hope to expand on this. So please give me feedback.
For detailed information that would be useful for Overseas Doctors Training in Anaesthesia in the UK, go to ODTA - UK
Q. Can you give me a Clinical Attachment in your hospital?:
A: Clinical Attachment is granted by the College Tutor based on the capacity of the Hospital and the Institutional policy in force at the time.
Remember it is not something we can "give" at our will and pleasure.
In some trusts like ours, it goes through the Post Graduate Clinical Tutor as well.
The reason this has come about is because some of the CAs have gone off with Library books, and some without paying the rent.Clinical attachments must be arranged between you and the hospital.
The Royal College of Anaesthetists cannot assist in this process.
Time spent in clinical attachments cannot be recognised towards UK training
SAMPLE CLINICAL ATTACHMENT CONTRACT
Click on the above link to see an example of a contract for Clinical Attachment
Q. HOW can i apply for attachments sitting in india,From where can i find a list of anesthesia tutors.
A: On my website in the "Jobs in Anaesthesia" page, there is a BMJ logo which when clicked, takes you to the current jobs for SHOs in Anaesthesia. You can also access past adverts. These will have the hospital details. Even if the College Tutors' names are not mentioned, you can address it to "College Tutor, ...... Hospital" and request a Clinical attachment.
Q. After doing my MD will it help if i pass DNB for better job prospects in u.k ?
A: If you have passed PLAB and are applying for jobs, any extra qualification helps swing things in your favour. It still does not guarantee a job, but improves your prospects.
If you are applying for RCA sponsorship (and thereby PLAB exemption), then you MUST have DNB
C G Nanda Kumar