Emergency medicine: Specialty Training Interview Questions Australia

Why emergency medicine, and why this department?

Evidence: the emergency terms, the undifferentiated patients, the course, the audit in the department, the conference. Then this department: its case mix, its teaching, its reputation, in terms that show homework.

What makes you suited to a career in emergency medicine, and what will you find hardest?

Qualities with evidence: the sick patient managed, the department run, the team led. Then the honest difficulty: the shift work, the crowding, the emotional load, the decisions with incomplete information. Say how you would manage it.

What do you know about the ACEM training programme, its examinations and what it will require of you?

The structure of training, the primary and fellowship examinations and when they fall, the special skills terms, the supervision requirements. Two accurate sentences, then how you would fit the examinations around shifts.

Emergency medicine has high rates of burnout. How will you sustain a long career in it?

A real strategy: shift patterns and recovery, life outside the department, what you would do when you noticed the signs, what the department can do. Candidates who say they thrive on the pace read as not having thought about it.

What would you bring to the department's teaching, quality or research work?

One concrete contribution with evidence: an audit skill, a teaching session you have run, a research link, a quality project. Say how you would deliver it around shifts.

A patient who has taken an overdose wants to leave the department. What do you do?

Assess capacity with the overdose in mind, find out why they want to leave, address what you can, explain the risks, and if they lack capacity the mental health legislation allows you to keep them for treatment. Involve the senior and the mental health team. Say what you would do if they had capacity and still left.

The waiting room is full, ambulances are ramped, and a frail patient in the corridor is deteriorating. How do you prioritise and escalate?

The corridor patient first: assess, treat, and get them into a monitored space. Then triage the department, delegate explicitly, and escalate: the consultant, the nurse in charge, the bed manager, the after hours executive, the state's ramping escalation. Say what you would tell the waiting room and the ambulances.

A 15 year old attends with a friend and asks for emergency contraception without her parents knowing. What do you do?

She is your patient. Assess her capacity, explore the relationship and the circumstances, explain confidentiality and its limits, encourage a trusted adult, and involve child protection if there is any concern about exploitation or the age of the partner. Know your state's rules on treating minors.

A colleague discharged a patient you think should have been admitted, and they return the next day much worse. What do you do?

The patient first. Then tell the consultant what happened, report the incident, speak to the colleague without blame, and open disclosure if there was harm. Say how you would make sure the learning reached the department.

An Aboriginal patient wants to leave before their work up is complete. How do you approach the conversation, and who do you involve?

Find out why, early and without judgement. Involve the Aboriginal liaison officer now. Address what can be addressed: family, food, fear, the environment. Explain the risks plainly. If they still leave, plan safe follow up with the community health service and document. Then look at whether the department could have prevented it.

A 45 year old arrives by ambulance hypotensive, tachycardic and drowsy with no clear history. Talk us through your approach.

• Follow-up: A bedside ultrasound shows free fluid in the abdomen. What now?

Shock with no history: the primary survey, two large bore cannulas, bloods and crossmatch, a fluid bolus with reassessment, the ECG and glucose, the bedside ultrasound. When there is free fluid, this is a bleeding abdomen: the massive transfusion protocol, blood, the surgeons now, theatre or interventional radiology. Say who you would call and what you would tell the family.

A motorcyclist is brought in after a high speed crash. Lead the primary survey.

• Follow-up: Breath sounds are absent on the left and the trachea is deviated. What do you do?

The primary survey in order with the trauma team allocated. When breath sounds are absent on the left and the trachea deviated, it is a tension pneumothorax: decompress now, then the chest drain. Say what you would do if the patient arrested.

A three year old arrives with a fever of 40, a non blanching rash and a prolonged capillary refill. What do you do?

Meningococcal sepsis until proven otherwise: antibiotics now at the weight based dose, fluid boluses by weight with reassessment, oxygen, access, cultures, the paediatric team and intensive care or retrieval called, the parents told. Say the dose per kilogram and that you would not wait for results.

A 70 year old with chest pain and ST elevation presents to a hospital two hours from a cath lab. What do you do?

Thrombolysis within the window unless contraindicated, with the cardiology advisory line on the phone; aspirin and the second antiplatelet, analgesia, monitoring, and the retrieval service for transfer. Say what would exclude thrombolysis and what you would do during the two hours.

A patient with asthma is tiring, silent chested, saturating 88 on high flow oxygen. What do you do, and who do you call?

The silent chest and the saturations on high flow are the warning: nebulisers, steroids, magnesium, a gas, and intensive care and anaesthetics called now because this patient may need intubation. Say that you would not leave the bedside.

A patient brought in by police is intoxicated, combative and has a head injury. What are your concerns, and how do you manage them?

Safety for everyone first; the police can help. Then the head injury is the priority: the GCS, the pupils, the mechanism, the anticoagulants, the CT by the guideline. Sedation only if needed for safety and imaging, with the airway considered. Say what would make you call the neurosurgeons and retrieval.

A woman at 30 weeks pregnant arrives with heavy bleeding and abdominal pain. What do you do?

Antepartum haemorrhage at 30 weeks: resuscitate, no vaginal examination, the obstetric team now or the obstetric advisory line and retrieval if there is no obstetric unit, bloods and crossmatch, anti D considered, fetal monitoring, steroids for the baby. Say what you would tell the woman.

A patient presents with a sudden severe headache an hour ago. What do you do?

Subarachnoid haemorrhage until proven otherwise: the CT now, analgesia, observations and the GCS, and if the CT is negative the lumbar puncture at the right time. Say what else is in the differential and when you would call the neurosurgeons.

What do you understand by access block and ambulance ramping, and what can a department do about them?

Patients who need admission cannot leave the department because there are no beds, so the department fills, the waiting room backs up and ambulances cannot offload. It is a hospital problem of bed capacity and flow. What the department can do: early senior review, short stay units, ambulatory pathways, escalation with data, and protecting the sickest.

What are the emergency access targets in this state, and how do they affect how the department runs?

Know your state's targets and what they measure: the share seen within the time, the long stays, ambulance offload times. For the department they drive flow, staffing and escalation. Say what they do and do not measure.

How would you teach interns and students in a busy emergency department?

On the floor, at handover, in protected sessions, with feedback that is specific and timely, and simulation for the resus skills. One example of teaching you have done and how you knew it worked.