Psychiatry: Specialty Training Interview Questions Australia

Why do you want to train in psychiatry, and what experiences led you here?

The experiences in terms of patients and moments: the person you sat with, the ward that changed how you saw the specialty, the thing you noticed that others did not. Then what you have done since to test it. Avoid abstractions about the mind.

What do you understand the work of a psychiatrist to be, and how is it different from what you have seen as a resident?

The biopsychosocial model, formulation rather than diagnosis alone, long relationships with patients, work with families and the multidisciplinary team, the legal framework, and the slow pace of change. Say what surprised you as a resident.

What experiences and skills, inside or outside medicine, will you bring to psychiatry?

Diverse experience is scored. A previous career, a language, community work, creative or sporting pursuits, caring for someone, all count if you say what they taught you about people. Be specific.

What do you know about the RANZCP training programme, its stages and its assessments?

The stages, the assessments and examinations, the rotations including rural and subspecialty, the supervision. Two accurate sentences, then what will be hardest for you.

Which areas of psychiatry interest you most, and why?

An area with reasons from what you have seen, with openness about how training may change it. The panel wants direction and curiosity, not certainty.

Psychiatry can be emotionally demanding. How do you look after yourself, and how will you know when you need help?

Name your warning signs, your routine, your supports including your own GP and the college's services, and when you would ask for help. One example of a time you noticed you were not at your best and acted. Say that supervision and reflective practice are part of the answer.

Tell us about a time you built rapport with a patient others found difficult.

A real patient, what others found difficult, what you did differently: time, curiosity, patience, finding what mattered to them, not taking the hostility personally. The outcome and what you learned.

A patient tells you they are hearing voices telling them to hurt themselves. Talk me through how you would respond in the room.

Stay calm and curious: take the voices seriously, ask what they say, whether the patient intends to act, whether they have ever acted before, what helps. Assess the risk now. Make the environment safe, involve the team and the consultant, and say what you would do if the patient tried to leave. Do not argue about whether the voices are real.

Tell us about a time you had to deliver difficult news to a family.

SPIKES with a family: the setting, what they understand, a warning shot, the information in plain words, silence, and the plan. One real conversation and what you would do differently.

How do you communicate with a patient who is acutely psychotic and frightened?

Calm, low stimulation, one voice, distance and space, no challenge to the delusions, acknowledgement of the fear, simple choices, and time. Say when you would involve security or medication and that you would try de escalation properly first.

A patient with depression refuses treatment and wants to leave. How do you decide whether they can, and what is your role under mental health legislation?

Assess capacity for this decision, find out why, address what can be addressed, explain the risks. If the patient has capacity, they can leave, with a safety plan. If they lack capacity and are at serious risk, your state's mental health legislation allows assessment and treatment; know the criteria and who decides, and involve the consultant.

A patient discloses in confidence that they have harmed someone. What are your obligations?

Confidentiality has limits where there is a serious risk to others. Explore what happened, assess the risk now, explain the limits honestly, involve the consultant, and know your obligations to warn or report in your state. Say that you would not promise secrecy you cannot keep.

A colleague on the ward speaks about a patient in a demeaning way. What do you do?

Say something at the time if you can do it without humiliating the colleague, then speak privately. Patients can hear and the culture of a ward is set by what goes unchallenged. If it continues, the nurse unit manager or the consultant.

How would you provide culturally safe mental health care to an Aboriginal patient and their family?

Define it as the patient's experience, then your actions: asking about cultural needs, involving the Aboriginal mental health worker early, the family's role, the meaning of the illness in the community, flexibility about where care happens, and awareness of the history of psychiatry and Aboriginal people. One example makes it real.

A patient asks you to be their friend on social media. How do you respond?

Decline kindly and explain why: the relationship is professional and the boundary protects them. Reflect on what the request might mean for the patient and raise it in supervision. Know your college's and hospital's guidance on social media.

A 25 year old presents to the emergency department after an overdose and says they still want to die. How do you assess risk and decide what happens next?

Safety first, then the assessment: the overdose, current intent and plans, access to means, static and dynamic risk factors, protective factors, collateral, the mental state. The decision: discharge with a safety plan and follow up, or admission voluntary or under the legislation, with the consultant for any involuntary decision. Say what you would do if the patient tried to leave before the assessment.

A patient on the ward is acutely agitated and threatening staff. Talk us through your management.

Safety for everyone: call for help early, remove hazards and other patients. De escalation properly: one voice, calm, distance, acknowledgement, choices, time. The least restrictive option: oral before intramuscular, restraint and seclusion only as a last resort under the policy. Find the cause. Afterwards the documentation, the incident report, the debrief for staff and patient.

A 70 year old is brought in confused and agitated. How do you distinguish delirium, dementia and depression, and what do you do?

Delirium: acute, fluctuating, inattentive, a medical cause to find. Dementia: chronic, progressive, cognition first. Depression: mood, with the cognitive change secondary. Assess the history, the collateral, the mental state, the physical examination and bloods, treat the medical cause, keep the patient safe without sedation if possible, involve the medical team.

A patient on lithium presents with vomiting, tremor and confusion. What do you do?

Lithium toxicity until proven otherwise: stop the lithium, the level now, bloods for the renal function and electrolytes, fluids, the medical team and the poisons line, and dialysis if the level or the clinical picture demands it. Find the cause: dehydration, a new drug, renal impairment.

A young man presents with his first episode of psychosis. How do you assess him and what are the priorities?

A full assessment with collateral, the organic causes excluded, the substance history, the risk to self and others, the mental state. The priorities: safety, engagement with the patient and family, early treatment with the right agent at the right dose, and the early psychosis service. Say what you would tell the family.

A patient taking clozapine has a fever and sore throat. What do you do?

Neutropenia until proven otherwise: a full blood count now, the clozapine withheld pending the result, the medical team if febrile and neutropenic, and the monitoring protocol. Say what you would tell the patient and that you would check the last count.

What do you know about the mental health system in this state, and how do inpatient and community services fit together?

Inpatient units, community teams, crisis services, the emergency department, forensic services, child and adolescent services, and how a patient moves between them. Say where the gaps are from what you have seen.

What are the main pressures on public mental health services at the moment?

Workforce, including psychiatrist resignations over pay and conditions; demand outstripping beds and community capacity; the emergency department as the default; the gap for rural and Aboriginal communities. Say what a registrar can do about one.