Anaesthetics: Staff Specialist Interview Questions Australia

You are on call. A registrar calls from the labour ward with a failed intubation at caesarean section and falling saturations. Talk us through what you do.

• Follow-up: The baby is out but the mother remains hypoxic. What now?

Lead by phone: declare the emergency, get the second anaesthetist and the obstetric consultant to the labour ward, oxygenate by whatever route works, move down the difficult airway algorithm with the registrar, and go. On arrival, take over; if oxygenation fails, the front of neck decision is yours. When the baby is out and the mother remains hypoxic, keep going with the algorithm, consider the causes beyond the airway, and get intensive care. Then the aftermath: the patient, the family, the registrar, the debrief, webAIRS and open disclosure if there was harm.

A surgeon insists on proceeding with an elective case you believe should be postponed. How do you handle it?

Hear the surgeon out, state the concern in terms of the patient's risk, offer what would change your mind, and if you still believe it unsafe, decline and involve the head of department and the surgical head. Your professional judgement and the patient's interests outrank the list. Say how you would keep the relationship.

Tell us about an anaesthetic complication you were responsible for and what you changed afterwards.

One case, your part owned, what you did at the time including open disclosure, what the review found, and the change you made and checked. Avoid the complication where someone else was responsible.

Your list is behind and a colleague needs help with a bleeding patient in the next theatre. How do you manage both?

Patient safety in both theatres: make your own patient safe or pause at a safe point, hand over to a colleague, go to the bleeding patient, and get a third anaesthetist in. Say what you would tell the surgeon, the anaesthetic nurse and the waiting patients, and that you would raise the staffing afterwards.

A registrar asks to run a complex list without direct supervision. How do you decide, and what do you say?

Assess the registrar's competence from their record and your observation, the list's complexity, the backup available and the time of day. Decide, explain the reasoning either way, and set the triggers for calling you. ANZCA's supervision requirements apply and you say so.

A trauma call and an obstetric emergency arrive at the same time after hours at a hospital with one anaesthetist on site. What do you do?

Triage by immediacy of threat: the obstetric emergency usually first because mother and baby are both at risk; send the second anaesthetist to the trauma call or call the on call consultant in. Tell both teams what is happening. Say what you would do if you were truly alone and how you would use the retrieval service.

A patient wakes in recovery in severe pain after a block has failed. What do you do, and what do you say?

Treat the pain now with the systemic options, assess the block honestly, apologise for the experience without blame, explain what happened and what will be done, and document. Offer to see them on the ward. Say whether you would report it and what you would learn about the technique.

An anaesthetic nurse tells you the machine check was not completed before the first case. What do you do?

Do the check now before any patient is anaesthetised. Then find out why it was missed, without blame: the nurse told you, which is the culture you want. Report it through the incident system and raise the process with the department. Say that the check is the anaesthetist's responsibility whoever performs it.

What do you know about the elective surgery waiting list at this health service, and how can the anaesthetic department help reduce it?

Know the categories and the current position. Then the levers an anaesthetic department has: pre assessment that stops on the day cancellations, start times, turnaround, scheduling that matches cases to list length, extra lists where the workforce allows. Say how you would measure it.

Theatre utilisation here is below target and first case start times are poor. How would you improve them?

Know the numbers. Then the levers: pre assessment, the first patient in the anaesthetic bay before the start time, the team briefing, turnaround, and the scheduling that matches cases to lists. Realistic about what one person changes and specific about measuring it.

What do you understand by perioperative medicine, and how should it be delivered in a hospital like this?

Assessing and optimising patients before surgery, shared decision making about whether to operate, prehabilitation, and care across the pathway. ANZCA's perioperative medicine programme and the diploma. Say what the hospital has, what it lacks and one thing you would build.

How would you support anaesthetic services at the district's rural and smaller sites?

Visiting lists, telehealth pre assessment and advice, supporting the GP anaesthetists and the rural generalists, credentialing and scope at the small sites, simulation training for their teams, and a clear escalation and retrieval pathway. Say what you have seen work.

What are the anaesthetic workforce challenges in Australia at the moment, and how do they affect recruitment here?

Maldistribution more than absolute numbers: the cities have anaesthetists and the regions do not, the rural generalist anaesthetic workforce is thin, and fatigue and wellbeing are driving attrition. Say what recruitment to a hospital like this needs and what you would contribute.

What are the quality indicators for an anaesthetic department, and how would you monitor your own outcomes?

Name the ones the department uses: on the day cancellations, PONV and pain scores, critical incidents through webAIRS, unplanned intensive care admissions, patient reported outcomes, start times and turnaround. Say how you would track your own and what you would do if they drifted.

How should a wrong side block or other anaesthetic never event be handled from theatre to the executive?

Stop, treat the patient, open disclosure, the incident reported as a sentinel event, support the staff, the review and the learning: the stop before you block process, the checklist, the training. Say the consultant's role at each step and that the executive hears about every sentinel event.

What is webAIRS, and how do you use incident reporting to improve practice?

The anaesthetic incident reporting system run through the colleges and the Australian and New Zealand Tripartite Anaesthetic Data Committee, pooling incidents across the region. Say that you report routinely, review the department's incidents at M and M, and use the published learning.

How would you contribute to the department's morbidity and mortality and peer review processes?

Present your own cases, chair when asked, make the meetings about learning rather than blame, and track whether actions are done. Give one change that came out of a meeting you were part of.

How would you contribute to teaching for the ANZCA Primary and Final examinations?

What you have taught, to whom, and how you know it worked; then the ANZCA specifics: primary tutorials in physiology and pharmacology, viva practice, the final's clinical judgement, the college's resources. Match it to the hours and say what makes a good anaesthetic teacher from your own training.

How would you teach airway and crisis management to the whole theatre team?

Simulation and skills sessions for the whole theatre team, because the anaesthetic nurse and the recovery nurse are in the room when it goes wrong. Give an example of teaching you have done across professions and what you learned from them in return.

What makes a good supervisor of training in anaesthesia?

Available, interested, honest and organised: regular meetings, clear expectations, specific feedback, early action when a trainee struggles, and knowledge of the college's requirements. Give one example of supervising a trainee well, or of a supervisor who did it for you.