There is no central interview for intensive care training in Australia. The College of Intensive Care Medicine assesses trainees through the Foundation term and referee reports once they are in post, and entry is by appointment to an accredited unit under hospital merit selection. The interview is therefore a unit panel: the head of unit, a second intensivist and the nurse unit manager, direct and practical, for about thirty minutes. Because units want the same things, the questions are consistent, and this guide covers the ones that recur.
Motivation and the programme
- Why intensive care, and what experience have you had in critical care so far?
- What do you understand the ICU registrar's role to be, and what will you find hardest about it?
- What do you know about the CICM training programme, the Foundation term and the examinations?
- Intensive care has long shifts and high emotional load. How will you sustain yourself?
- Which pathway are you considering, intensive care alone or dual training, and why?
The head of unit wants evidence: the intensive care and anaesthetic terms, the sick patients you have managed, the procedures, the courses. Know the programme in two sentences: the Foundation term and its assessment, the core and transition years, the primary and second part examinations, the requirements for rural and paediatric experience. Answer the wellbeing question with a strategy and an escalation; units have watched registrars burn out.
The clinical scenarios
At ICU registrar level, usually with reading time:
- A ward patient with a respiratory rate of 40, saturations of 85 on 15 litres and a blood pressure of 90, then the need for intubation with the consultant thirty minutes away.
- A patient on noradrenaline with a sudden drop in blood pressure.
- Severe sepsis not responding to fluid.
- A ventilated patient who suddenly desaturates.
- The patient admitted after cardiac arrest and the priorities in the first hour.
- Diabetic ketoacidosis with a pH of 6.9.
- The severe head injury with a dilating pupil.
- The dialysis patient with a potassium of 7.
- Massive haemoptysis on the ward.
- The patient who is not waking after sedation is stopped.
Answer as the registrar who will be in the unit tonight: systematic assessment, the immediate treatment with specifics, the decision, the escalation with a plan, and what you would do while waiting. For the intubation with the consultant distant, say that you would prepare and proceed if the patient could not wait, with the senior nurse and the anaesthetist, and what you would do if it went wrong.
The family conversations
- A family want everything done for a 90 year old with multi organ failure.
- How would you approach a conversation about organ donation?
- A daughter is angry that her father was not admitted to ICU earlier.
- A patient with an advance care directive refusing ventilation deteriorates and the family want them intubated.
SPIKES, with the clinical reality explained plainly, the patient's wishes if known, the goals of care, and the involvement of the consultant for decisions about limits of treatment. For organ donation, say that the conversation is separate from the conversation about death, that the donation agency is involved early, and that you would not raise it before the family had understood the prognosis.
The ethics of the full unit
- The unit is full and two patients need a bed: a 30 year old with severe sepsis and an 80 year old post operative patient. How do you decide?
- A colleague's treatment plan is, in your view, futile and causing suffering.
- What are your obligations if you believe a death should be reported to the coroner?
Say how you would assess both patients, what the criteria for admission are, who you would involve (the consultant, the bed manager, the other hospitals), and that the decision is clinical and documented. For futility, the conversation with the colleague, the consultant, and the family, and the ethics committee if needed.
Teamwork and the nurses
- Tell us about a time you worked closely with nursing staff to manage a critically ill patient. What did you learn from them?
- You are leading a MET call and a senior colleague arrives and gives different instructions.
- How do you give feedback to a junior who made an error during a resuscitation?
ICU nurses are the unit's memory and the nurse unit manager is on the panel. An example of a nurse who taught you something scores; an example where you gave orders does not.
What the panel scores
Clinical structure and decision making under pressure, early and clear escalation, honest family conversations, ethical reasoning about scarce beds and limits of care, respect for the nursing team, and a credible plan for sustaining yourself. The common failure is the candidate who answers every scenario by waiting for the consultant.
Preparing
The ten clinical scenarios aloud with the worsening prepared. The family conversations practised with someone playing the family. The ethics scenarios with the next step ready. One minute answers to the motivation questions. Then a timed run with someone who probes, because a head of unit interviewing for a registrar will.