Interview questions

Question 1

Tell me about your or your CV

Answer 1

• Completed training in the warwick training program with 2.5 yrs in foot and ankle
• Fellowship in foot and ankle - range of elective and trauma cases - including fusions, total ankle replacements, complex ankle fractures etc
• I believe in keeping updated and enhancing foot and ankle skills, most recently I have done; fellows forum, complex foot trauma, arthroscopy course and currently doing the BOFAS practice ready webinar series to discuss ocmplex cases
• Strong background in research, education and leadership

Research
- academic fellow
- successful completed PhD leading to several publications
- lead my own research projects and was awarded an investigators grant of £27000
- lead research associate for the multicentre RCT DRAFFT

Education
- I have organised, taught and examined
- I have completed the TOTs course and a surgical education course as part of my masters degree.
- I had two formal roles; core trainee teaching coordinator and digital teaching fellow - liasoning with consultants and facilitating sessions
- regularly taught at mutliple levels on multiple courses, recently this has included - the foot and ankle teaching day for core trainees which I co-organised with a senior trainees – and the royal college of emergency medicine excellence in minor injuries course
- I have examined in the warwick medical school OSCE exams, warwick training program vivas and the Wrightington Basic Science FRCS vivas

Lastly, strong believer in leading by example. In my role as LTFT representative for 3 years, acting as both an advocate for others training needs and providing advice to those new to flexible training. I was also awarded a fully funded place on the British Orthopaedic Association Future Leaders Program

Question 2

Why do you want to work for midyorks NHS trust?

Answer 2

1. Strongly align with the trust values (caring, respect, high standards, improving)
2. People
   - reputation for providing excellent amongst peers and trainees
   - trauma meeting I witness good team working with active and respectful discussion
3. the trust is now a Teaching hospital since 2023 and the orthopaedic department has trainees, in addition to taking an active role in both the deanery vivas x2 per year and ARCPs
4. Striving to achieve university status with the NIHR research hub (1 of only 20) and new appointments
   strongly aligns with my strong research and teaching background
5. lastly protected elective hub - allowing efficient elective practice and being able to achieve excellency

Question 3

what can you bring to the department?

Answer 3

1. Solid foot and ankle and general orthopaedic training - undertaken an excellent fellowship
2. Very driven, highly organised and good at multi-tasking
   - example - during the covid period in addition to my adapting to ever changing rotas, I:
   – LTFT rep
   — digital teaching fellow
   – Contributed to research on the impact of COVID-19 on nof patients
   – completed the DRAFFT 2 radiological outcomes data - 4500 xrays
   – home schooling

Question 4

how will you know if you are performing well?

Answer 4

• Monitor patient outcomes
  1. follow up
  2. PROMs - BOFAS and national joint registry
  3. Complication rates
• Feedback
  1. 360 degree
  2. patient feedback
  3. compliments and complaints
  4. Input from teams - how comfortable they are in seeking my advice, engagement in theatre
  5. Evidence I have reflected and acted on feedback
• Appraisal system
• Operationally
  1. Running predictable and efficient theatre lists
  2. Completion of cases
  3. Efficiency in clinics

Question 5

Do you think you are ready to be a consultant?

Answer 5

yes
- completed clinical training with 2.5 yrs foot and ankle, experience of multiple centres and now excellent renown foot and ankle fellowship giving me experience of both elective and foot and ankle trauma
- I’m excited and eager to get started in independent practice

Question 6

What teaching experience do you have and what can you bring to the department?

Answer 6

2x teaching courses
- regular med student teaching - suture teaching, ankle fracture, wrist fracture teaching
ran formal course - core trainee
2x roles
formal courses
trainees - basic science/ viva practice
exam experience

Coordinate teaching for core trainees
contribute to SPR vivas
Run training sessions for ED practioners and junior doctors
introduce simulation training for residents - e.g. wrist fracture simulation, arthroscopic basic skills, suturing

Question 7

Tell me about a mistake you’ve made in theatre?

Answer 7

broken drill bit during a DHS
- alerted the consultant when I realised I had made a mistake
- able to remove the bit and continue the procedure
- minor extension in the length of the procedure
- consultant performed duty of candour
- reflected on the mistake and discussed with the surgeon how to ensure it didn’t happen again

Question 8

Tell me about a mistake you’ve made?

Question 9

Tell me about a course or conference that has changed your practice?

Answer 9

course - arthrex complex foot course - discussion on the use of percutaneous screw fixation of calcaneum fractures

Question 10

which of the trust values are most important to you?

Answer 10

caring - ensuring quality of care is at the heart of everything we do

improving - we always look for ways to improve what we do. we encourage involvement, value contributions and listen to and positively act on feedback
respect - showing value and respect for everyone and treating others as they would wish to be treated
high standards - taking responsibility for providing the best services and patient experiences

Question 11

How can you introduce a new procedure?

Question 12

Patient attends after bad surgery elsewhere how will you manage them

Answer 12

duty of candour issue

Question 13

old lady comes to clinic confused what will you do

Answer 13

consent issue

Question 14

tell me about a quality improvement project that has changed practice

Answer 14

shoulder reaudit

Question 15

what research experience do you have and what are your research priorities

Answer 15

MSc in T&O evidence based medicine,
PHD
quantitative
mixed method
Lead research associate role
PI to my own studies

Research priorities
I have 2 priorities:
1. Clinical effectiveness of new procedures - particularly interested in the outcomes MIS surgery, complex ankle fractures, percutaneous fixation of calcs
2. reducing health inequalities through by addressing health literacy

• established infrastructure for collecting patient outcomes
• obtaining smaller grants - builds reputations for bigger grants - james lind alliance
• james lind priority -** what is the best surgery for bone and cartilage defects in the talus **
• ## regular journal clubs - mixed between departmental ones and specific foot ones

Question 16

How do you deal with stress

Answer 16

1. talk to colleagues - sensible friend
2. spend time with friends and family
3. exercise

Question 17

unprofessional colleague

Question 18

How would you improve the mid yorks trauma service? (Hip fractures)

Answer 18

Understanding Problems:
* national hip fracture database:
lowest quartile for:
- admission to Ortho ward in 4hrs (2.8%) - AE turnover, ward turnover - average is 13.8 %
- mobilising out of bed day 1 - 70.7% - average 82%
- 25 days length of stay - 5.5 days more than national average

• revision cases taking over trauma theatre

Solutions
* speaking to nursing/ PT/ OT staff to assess problems
- need to understand where the delay is .. .not enough physios…. patients drowsy from analgesia
- increase access to PT

• Assess theatre efficiency
• assess time taken for revision surgery and no. cases
• map the demand of the service
• time taken for patients to be transferred to and from wards
• Improve theatre utilisation
• improve theatre efficiency - use of holding bays, sending earlier
• utilise free theatres to improve theatre
• prioritise trauma over elective
• increase theatres with additional trauma theatres
• look for seasonal variations - increase elective when trauma demand is least and decrease elective when trauma demand is greatest.
• reduce the type of kit - to make scrubbing and assisting easier
• regular training - to ensure staff are aware of kit
• ensure presence of seniors in theatres
• staff meetings with all stakeholders

Question 19

How would you improve the mid yorks trauma service? (ankle fractures)

Answer 19

Problem:
* ankle fractures not reduced well enough needing ex-fix
* delays to fixing ankles - taking 3 weeks before fixing

Solutions
* recent work performed to look at improving ankle fractures
- meet with ED staff to discuss the problems experienced e.g. problems with analgesia/ sedation or lack of training or too busy
- introduce penthrox - free up ED staff
- plaster technicians to apply the cast
- increased training - simulation training

• reduce the type of kit - to make scrubbing and assisting easier
• regular training - to ensure staff are aware of kit
• ensure presence of seniors in theatres
• staff meetings with all stakeholders

Question 20

what do you know about the 18wk RTT?

Answer 20

currently uk achieves - 62%
NHS constitution standard is set for 92% RTT (elective) within 18 weeks
RTT = referral to treatment
last time the standard was meant was in 2015 - covid caused it to plummet
interim target is 65% by March 2026%
for nhs those not treated within 18weeks are within a year with 2% after a year
Factors affecting increase in waiting list - growing ageing population. specialist shortages (e.g. anaesthetists)
waiting list cleansing in 2024-2025 (remove people who no longer need ops, DNAs and those who change their minds
differences in waiting list by deprivation - lower in affluent areas - private healthcare, better health outcomes

Question 21

how can you improve 18 week RTT

Answer 21

RTT - influenced by clinic-diagnostics-theatre
BAU - business as usual - refers to level to keep waiting list steady at <18wks
Ways to improve 18wk RTT

Clinics
- pre-screening patients for adequacy/ pre-ordering imaging
- ultrasound in clinic by specialist physios - allows diagnosis and injections to be give in theatres
- Physios to takeover achilles ruptures
- increased information with immediate discharge from ED - discharge to PT
- Dedicated radiology

Diagnostics
- already has an improved diagnostic centre reducing the imaging waiting time to less than 6 weeks

Theatres
- minimise types of implant companies
- ensure good rep support
- rationalise kit to make it simpler
- in house training
- careful list management - balance trainee/ service needs
- utilise non-training lists at weekends
- increase day case procedures - more centres are introducing day 0 TARs and hindfoot fusions
- pre-rehab clinics

Question 22

What would your patients say about you? Example maybe if they ask patients coming out of clinic

Answer 22

Give an example of feedback _ thank you cards - in a recent email from the parent of a patient with significant metal health illness. They thanked me for my extremely empathic and professional deemenor keeping her calm e accept her treatment.

Question 23

You are in clinic (1hr behind), nursing staff ask you to see another patient with a diff

Question 24

how do you introduce a new service into the NHS

Answer 24

shockwave therapy

Step 1
1. identify the need - audits, local data, patient feedback
2. evidence basis for the change - is it effective
3. measure of effectiveness

Step 2
1. Identify and engage stakeholders - to ensure the service is designed for those who will deliver it and for the patients who need it

Step 3
develop a service model
- scope
- competencies of people involved
- safety checks in place

step 4
cost effectiveness -