Advanced training positions are unit appointments. There is no central college interview; the head of unit, a specialist colleague and often a nurse or research lead interview under hospital merit selection, criterion mapped, for about thirty minutes. The questions assume you have passed the RACP examinations and are asking whether you can run the service at advanced trainee level and whether you will fit the unit. This guide covers what comes up almost everywhere, whichever specialty you have chosen.
Why this specialty and this unit
- Why this specialty, and what have you done to prepare for it?
- Why this unit, and what do you know about the service we run?
- What will you bring to the unit that we do not have already?
- Where do you see yourself at the end of advanced training?
The head of unit wants evidence: the rotations, the cases, the project, the course, the conference, each with what it taught you. They also want to know you have done the homework on their service: its subspecialty strengths, its research, its teaching, its pressures. Reasons the panel can verify score; generic enthusiasm does not.
The clinical scenarios
At advanced trainee level the scenarios are the specialty's emergencies and its hard decisions, and the panel expects you to decide. For cardiology, the ST elevation infarct two hours from a cath lab and the unstable arrhythmia; for respiratory, the tiring asthmatic and the massive haemoptysis; for gastroenterology, the variceal bleed the endoscopist cannot control; for nephrology, the dialysis patient with a potassium of 7; for geriatrics, the delirious patient whose family want them home; for oncology, the febrile neutropenic patient and the conversation about stopping treatment.
Structure the answer as the senior registrar: assess, stabilise, decide, escalate with a plan rather than a request, communicate with the family, and say what you would do afterwards. Say what you would do if the first plan failed.
Research and teaching
- What research have you done, and what would you want to do here?
- What would you do with the research time this position carries?
- Tell us about your teaching and how you would contribute to the unit's teaching.
Be realistic and honest. Describe what you have done, what it found and what you learned about the process. If you want to lead a project, name the question, the collaborators and the time it needs. If you would rather support the unit's trials and supervise basic trainees' projects, say so; it is a credible answer and heads of unit respect it more than inflated ambitions.
The unit's pressures
- What are the main pressures on this service, and how would you help?
- How would you contribute to the waiting list or the outpatient backlog?
- Tell us about a quality improvement project you have done and what changed.
Know the service's activity and its problems before the interview, and offer one realistic contribution a trainee can make.
Professional questions
The impaired colleague, the junior who made an error, the family who refuse a treatment, cultural safety for an Aboriginal patient, and how you will sustain yourself through advanced training. Answer in STAR form where an example is asked for, and with structure where a scenario is given.
Preparing
Write a one minute answer to each question above with a specific in it. List the ten emergencies and hard decisions in your specialty and talk each through aloud. Read everything the unit publishes. Then practise with someone who probes, because a head of unit interviewing for a colleague will.