Two of the five stations in the general surgery SET interview test the non technical RACS competencies: professionalism, communication, collaboration, management and leadership, health advocacy, scholarship and teaching, and cultural competence and safety. Candidates who have prepared only the clinical stems lose marks here that are easy to earn, because the scenarios recur and the structure for answering them is consistent.
The scenarios that recur
- You witness a consultant surgeon shouting at and belittling a trainee in theatre. What do you do?
- A patient's wound dehisced after an operation you assisted on, and you believe a technical error was made. What do you do?
- You are asked to consent a patient for a procedure you have never seen.
- A patient with capacity refuses an operation you believe they need.
- The theatre list is overbooked, the consultant is in clinic, and the anaesthetist is refusing to start a case they consider unsafe.
- A junior doctor on your team is not coping and patients are affected.
- A colleague appears to be operating while impaired.
- How do you provide culturally safe surgical care to Aboriginal and Torres Strait Islander patients?
- Describe a conflict with a senior surgeon and how you handled it.
- Tell us about a time you led a team through a difficult situation.
The structure for scenarios
Patient safety first, then information, then escalation, then support. For the shouting surgeon: the trainee's and the patient's safety in the moment, which may mean saying something in theatre calmly; then a conversation with the trainee afterwards; then the reporting route, because this is bullying under every college's and hospital's policy and the RACS has said so plainly. Say what you would do if the consultant were your own supervisor.
For the dehiscence: the patient's care first, then honesty. You tell the consultant what you observed, you take part in open disclosure with the patient, you present the case at morbidity and mortality, and you do not speculate to the family about blame. The panel is testing whether you will speak up about a senior's error and whether you know the process.
For consenting without knowledge: you do not. Consent requires understanding the procedure, its risks and alternatives, and you explain to whoever asked why, then find someone who can. Say how you would learn the procedure for next time.
For the refused operation: capacity, information, exploring the reasons, alternatives, the consultant's involvement, documentation, and respect for the decision with the door left open.
For the anaesthetist refusing to start: patient safety means you do not pressure them. You find out the concern, you address what can be addressed, you phone the consultant, and you reorganise the list. The panel wants to hear that you treat the anaesthetist as a colleague with a veto, not an obstacle.
Cultural safety
Expect a direct question. Define cultural safety as the patient's experience, not your intention: care the person feels is safe and respectful. Then your actions: asking about cultural needs, involving the Aboriginal liaison officer early, family involvement in decisions, flexibility about discharge and place of care, interpreter use, and awareness that hospitals have historically been unsafe places for many Aboriginal people. Give an example if you have one. This competency is scored, and a definition without actions scores poorly.
The STAR examples
Leadership, conflict with a senior surgeon, teamwork under pressure and a research or audit project are asked as examples. Prepare each in STAR form with your own actions clear, the outcome given, and a line of reflection. Avoid conflicts where you were plainly right; the panel wants to see how you handle disagreement with someone who outranks you.
What the panel scores
Safety, structure, honesty, knowledge of the processes, and the willingness to speak up and to act. The probes test persistence: what if the consultant denied it, what if the trainee asked you not to report it, what if the patient still refused. Give the next step. Practise these aloud with someone who pushes back, because in the room they will.