Selection into general surgery training is decided in part by a structured interview that runs as a multiple mini interview: five stations of ten minutes each, two minutes of reading time before each, two panel members per station with an optional observer, three clinical stations and two non technical ones, two questions plus probing in each, all scored against the RACS competencies. It is one of the most structured interviews in Australian medicine and that makes it preparable.
How the day runs
You rotate through the five stations. At each you are given a scenario or question stem, two minutes to read it and make notes, then ten minutes with the two panel members. They ask two questions and probe your answers; unlike medical school MMIs, probing is expected and the assessors will push. Each station is scored independently and the scores are combined with your CV and referee reports.
The three clinical stations
The stems reported by successful candidates:
- Bowel obstruction: the seventy year old with distension, vomiting and no bowel motion for three days, then a closed loop obstruction on CT.
- Biliary sepsis: right upper quadrant pain, fever and jaundice, then hypotension overnight.
- Trauma: the stabbing to the chest with a blood pressure of 80.
- The deteriorating post operative patient: tachycardia, fever and pain three days after a colectomy.
- Appendicitis in pregnancy.
- The massive upper gastrointestinal bleed the endoscopist cannot control.
- The perforated viscus in a patient with dementia from a nursing home.
Answer as the surgical registrar on call: assessment, resuscitation, investigation, the decision about theatre, the conversation with the consultant and the family, and what you would do afterwards. The probing tests decisions: when would you operate, what if the patient refused, what if the consultant were two hours away. Say what you would do and why.
The two non technical stations
These cover the other RACS competencies: professionalism, communication, collaboration, management and leadership, health advocacy, scholarship, and cultural safety. The scenarios that recur:
- The overbooked theatre list with the consultant in clinic and the anaesthetist refusing to start a case.
- The consultant surgeon shouting at a trainee in theatre.
- The wound dehiscence after an operation you assisted on where you believe an error was made.
- Consenting a patient for a procedure you have never seen.
- The patient with capacity who refuses an operation you believe they need.
- Cultural safety for an Aboriginal patient.
- A leadership example, a conflict with a senior surgeon, and a research or audit project.
Structure these with patient safety first, then information, escalation and support, and give examples in STAR form where asked.
Preparing for the MMI format
The format rewards two things: using the reading time well, and getting the structure out early. In the two minutes, identify the problem, the immediate steps, the decision point and who you would involve, and write them in the order you will say them. Open with the structure so the assessors can follow, give the specifics, and leave time for the probes. Do not carry a bad station into the next one.
The competencies
Learn the RACS competencies and be able to name which ones each scenario tests, because the assessors are scoring against them and candidates who frame answers in those terms are easier to score highly. Cultural competence and safety is now one of them and will be tested.
A preparation plan
Four weeks out: the clinical stems, talked through aloud with the probes. Three weeks: the non technical scenarios and your STAR examples. Two weeks: timed practice with reading time and a bell, in rotation. One week: full mock MMIs with assessors who probe hard. The successful candidates are rarely the ones with the most impressive logbooks; they are the ones whose structure survives ten minutes of probing.