1. Interview skills and practice
Rachael Coutts
2019

2. Outline of this lecture
1. Hints and Tips
2. Group practice
and discussion of
questions

3. Hint # 1 Apply widely Check the PMCV website Know your closing dates
Rank as many hospitals as you can
Check all hospital websites for jobs outside the match
Apply rural as well

4. Hint #2 First impressions
Arrive on time
Dress the part
–clothes, shoes, hair, nails, jewellery, bags
Body language
Be confident, not arrogant
Smile
Shake hands
Maintain eye contact
Address the panel by name
Turn your phone OFF.
When you walk in the door, I immediately start making judgments about you. I'm trying to work out what your ethics are, if you will fit in, your professionalism, ability to communicate. There are a number of ways of making a positive impression. A volunteer, be the panel, ask them to present themselves. Talk about what not to wear

5. Hint # 3 Research the hospital
Look at their website
strategic plans, ethos, population base, vision, missions, commitments, special services
Call your friends that work there
Do a tour
Be able to indicate what it is that makes them desirable to you, and how it fits into your plans for training.
If you have no knowledge about the hospital, I will assume that you are just going through the process of an interview as a back up plan, and gaining a job here is not a priority. If you have made the effort to know a lot about the hospital, I gain the impression that you are willing to engage with the hospital, committed and involved.
Linking statements like “the patient population is very challenging and culturally diverse, which gives me the opportunity to develop skills in managing these issues. This is relevant to my plans to remain in the area and work as a general practitioner”.
Or “from discussions with some of the HMO’s who work at …… this hospital …… I have been told it is a very supportive environment with an excellent teaching reputation. This is a priority for me, as balancing the challenges of full time work, training and a family I would like to be in an environment that will enable me to excel and gain my exams.

6. Hint # 4 Prepare your answers
Anticipate what questions might be asked
Prepare answers
Practice your responses out loud and with friends

7. Hint # 5 Framework and structure
Sign post your structure – use key words to indicate what you are going to talk about
Makes your story easier to follow
Don’t be cluttered in your story – be focused on your key points
Shows organised thought
I would approach this problem in three ways.
The first is to ensure the safety of the patient and staff, the second would be to deal with the individual, the third would be to address the systems issues and understand the resources I need to enlist to help.
Then go back and fill in the details
Be succinct, don’t waffle, don’t give too much little detail, just enough to get the point across.

8. A framework for Clinical questions
?Risk Assessment:
?Resuscitation needed
ABC’s,
Differential diagnosis
triage and prioritise,
?met call or code blue,
Management
escalate care
Assessment
Referral/ Notification
Escalation if needed
History, examination, charts, medications, collaborative history, family (but target this)
Inform consultant/ registrar
Inform family/ NOK
Special features or risk
Referral to other team
Handover!!
The first priority is to determine is the patient is unwell, or well. I would do this by looking at the observations for tachycardia, hypotension, tachypnea, confusion. If they are unwell I will call a MET call. Or code blue
If in ED – I would ask the patient to be triage 2, and to go to a resuscitation room.
I would then address the resuscitation in an ABC manner, firstly looking at airway, determining if needs support, apply oxygen, commence CPR, Apply oxygen, give fluids, gain iv access,
If the patient is stable, I would then start my assessment to determine the differential diagnosis, or cause. The most important things I would look for are……..
The main points on history……
A focused examination would look at…..
The medication chart…..
The family may ……
The differential diagnosis that are a priority are ……
My management would involve …..
I would need to refer to …..
I would call my consutlant if ……

9. A framework for Behavioural Questions
Have examples you can adapt
How do you approach the problem 1:1 initially
Consider risk and safety, environment
How do you approach the systems issues
to yourself, the patient or family, staff
Escalation processes
Privacy
Resources you can draw on
Policies, guidelines, processes
Think of some challenging situations where you have needed to have discussions with patients, family or team members. Think more broadly about how it would be optimal, what you learnt from it.
Can someone give me an example of a challenge they have faced this year?
Patient leaving
Angry parent
Violent patient
Code grey
Be compassionate in your approach, gain rapport with the patient, tone of voice, deescalating, considerate of your colleagues,

10. A framework for Behavioural Questions
Why do we ask these questions?
Think about what the health service is looking for when they ask these questions
Generally:
Conflict resolution skills
Professionality
Team work skills
Personal wellbeing insight
Hospital Quality/ Risk Management processes
Make sure you have thought of some examples in advance. Take your time to think of a good one before answering

11. A framework for Behavioural questions
STAR principle
Situation
briefly outline the story you want to talk about
Task
detail your goal, how you analysed the situation, focus on key tasks
Actions
what you did about it, how you did it, why you did it
Result and Reflect
what happened
Situation:
The HMO came to me and told me their patient wanted to leave.
Task
My priority was two fold, whether the patient was safe to leave or not, and to give the HMO an opportunity to trouble shoot the situation themselves with my support.
Actions
We first discussed the clinical story, and made a plan about what best treatment was, and some alternative options and priorities. We also discussed ways to talk to the patient, some techniques in the approach and ways to deescalate the patient. I told the HMO I would remain near by if they had issues and could come back to me, or could intervene if they were unable to get their message across,
Result
In the end the patient still left, but we were able to educate them, give them their medications, make a plan for follow up that would keep them safe. The HMO was happy with the way she approached the patient and felt confident they could tackle the situation again by herself in the future.

12. Hint # 6 “Show” don’t “tell”
Give examples to show how your skills in that area
Eg “I have good communications skills” is very generic
Give evidence or a story that allows the interviewer to engage with you and understand your skills
How will these skills benefit the organisation or the role

13. Hint # 7 Personalise the answer
Always answer in the “I” or first person
I will ….
I did ……
How you would resolve the problem
It gains rapport and shows confidence

14. Practice Practice Practice

15. Good and Bad examples…

16. Why do you want to work here Qs
Why are you applying for an HMO3 General job at Northern Health ?
Where do you see yourself in 5 years?
I can see you have never worked at St Elsewhere’s Health, what made you apply here?
Northern values are respect, compassion, passionate, dedication. Tell us how you use one of these values in your work?

17. Behavioural Questions
Give an example of when you had to work with someone who was difficult to get along with. How/why was this person difficult and how did you handle it?
Prompt:How did the relationship progress?
Describe a situation where you had a conflict with another individual, and how you dealt with it.
Describe a leadership role of yours outside of work. Why did you commit your time to it? How did you feel about it?

18. You have worked a 13 hours shift (2 hours after when your shift was supposed to end) and are asked to stay back to help in theatre by the Surgeon for an emergency case that is about to start. What do you do?
Prompts: what if it is 11pm and you are rostered to start at 7am tomorrow.
You are an evening cover shift and are on the paediatric ward when the father a 17yo girl telephones and asks for a medical update. She was admitted with abdominal pain for investigation. What do you tell him?

19. Mrs W is admitted with pneumonia
Mrs W is admitted with pneumonia. This is on a background of dementia, usually home alone, but some increasing paranoia symptoms noted by the visiting carers. She has been commenced on IV antibiotics, but the nurses page you because she is increasingly agitated and has pulled out her IV cannula. How do you manage this situation?
Prompt: How does the Medical Treatment Act come impact on this situation.

20. Questions
You are on a cover shift and asked to see Mr W who is 3 days post laparotomy w adhesiolysis for SBO, you are asked to see him due to reduced conscious state. What would you do.
You are in the Emergency department when Ms W comes in. She is a 61 year old female with a history of obesity, Type 2 DM and has presented with sudden onset chest pain. What would your initial management be?

21. It is 8pm at night and ward staff page you to see Mr K who is a 38 year old male in hospital for treatment of subacute bacterial endocarditis. He is a known IVDU. He has been in hospital for one week. He is angry with how a student nurse spoke to him and has been yelling at her and the senior nurse a the staff station saying he is leaving. How do you handle this situation?
What are they looking for in this case?
Conflict resolution and Communication skills
Safety for staff- immediate and delayed (welfare/ debrief for nursing student after the event)
Discharge against medical advice process:
Risk assessment- especially need for IV Antibiotics in IVDU patient- IV line in the community?
Capacity assessment
Documentation
Escalation/ Notification (ie- notify treating consultant and ID team- when?)
Follow up plan- ?GP/ Clinic etc

22. Mrs Halima is a 91 year old Arabic speaking women who is from home with her family who provide support for domestic and personal ADLs. She has presented to hospital with abdominal pain and a CT scan reveals metastatic cancer, unknown primary. Your consultant asks you to arrange a liver biopsy of a lesion to determine primary origin of her cancer. The family request that Mrs Halima not be told she has cancer. What would your approach be to this situation and request?
What are they looking for in this case? [this is a REALLY hard one for a clinical question!]
Cultural awareness (this is not an uncommon request!)
Exploration of why family made this request- don’t assume it is cultural! May be that the patient actually has advanced dementia and won’t be able to understand the discussion.
Balance between cultural awareness and legalities of provision of care/patient autonomy
Communication skills around above
Consent process for liver biopsy
Consideration as to whether Liver biopsy is ultimately needed (will chemo be an option)

23. Questions
You are called to the ward to see Mrs W. She is a well 62 year old female with no past medical history who is due for discharge today after having had a fractured finger pinned. The nursing staff inform you that they have accidentally administered the wrong medication to her- she has received 25mg metoprolol that was meant to be given to Mrs M in the bed next door. What do you do?
What are we looking for:
Open disclosure
Apology
Risk assessment for managing complication of error
Prevention of repeat error: Riskman, exploration of how this occurred.

24. Can you tell us about the most stressful situation you have found yourself in at work?
Prompts: How did you handle it? What could you have done differently? What did you do for self care after the event?
Tell me about a situation where you had to solve a difficult problem. What did you do?
Prompts: What was the outcome? What do you wish you had done differently?
What is the most difficult decision you have ever had to make at work?
Prompts: How did you arrive at your decision? What was the result?

25. Questions
Describe a situation that required you to do a number of things at the same time.
Prompts: How did you handle it? What was the result?
Tell me about a time when you worked with a colleague who was not doing their share of the work. How did you handle it?
Tell me about a time when you had to work on a team that did not get along. What happened? What role did you take? What was the result?

26. Questions
Can you tell us about a time when you decided that the condition of a patient you were treating had deteriorated to a point where there was no further curative treatment possible and the patient was going to die, and the patient and family should be told
Tell us about a situation where your directions were incorrectly carried out by a member of nursing staff

27. GOOD LUCK! PRACTICE!!!

28. References http://biginterview.com/blog/behavioral-interview-questions
This site has a number of examples of how to answer some tricky questions like What is your greatest weakness? Where do you see yourself in 5 years? Why do you want to work here?

29. Extra questions…

30. Questions
Can you tell us about a time when a patient or family member complained about their care in the hospital or clinic
Can you tell us about a time when you were required to take a leadership role to resolve a conflict situation within a workplace
Can you tell us about a time when you had to organise the discharge of a patient with complex problems from hospital

31. Questions
Please describe a time when you experienced difficulty in obtaining an investigatory procedure for a patient, such as a CT scan.
Can you tell us about a time when you made a mistake that had an impact on a patient
Tell me about a time when an experience, inside or outside of medicine changed the way you practice

32. Questions
Did you turn up to all the education sessions this year. If not, why not. What do you think can be done to improve junior staff attending?
When was a time you working in a team that did not work well and how was it resolved?
Tell us a time you received negative feedback and what steps you took to improve on it

33. Questions
Your post op Hartmanns procedure patient has low urine output. How do you manage this?