Anaesthetics: NHS Consultant Interview Questions

You are the consultant on call. A trainee calls from a remote site with a failed intubation and falling saturations. Talk us through what you do.

• Follow-up: You arrive and the surgical airway has been attempted unsuccessfully. What now?

Lead by phone first: declare the emergency, get help into the room, oxygenate by whatever route works, move down the difficult airway algorithm with the trainee, tell them you are coming and to call the consultant. On arrival, take over and make the front of neck decision yourself if oxygenation fails. When the surgical airway has failed, keep going: a second attempt, a different operator, every other route, and the surgeon for a tracheostomy. Then the aftermath: the patient, the family, the trainee, the debrief and the reporting.

Your list is running late and a colleague needs help with a bleeding patient in another theatre. How do you manage both?

Patient safety in both theatres. Make your own patient safe and hand them to a colleague or pause at a safe point, go to the bleeding patient, and get a third anaesthetist to one of the theatres. Say what you would tell the surgeon, the ODP and the waiting patients, and that you would raise the staffing afterwards.

A surgeon wants to proceed with an elective case you believe should be postponed. How do you handle it?

Hear the surgeon out, state your concern in terms of the patient's risk, offer what would change your mind (optimisation, a different day, intensive care booked), and if you still believe it is unsafe, decline and involve both clinical directors. The patient's interests and your professional judgement outrank the list. Say how you would keep the relationship.

A patient on your emergency list is high risk and the family are expecting a straightforward operation. How do you approach the conversation?

SPIKES with the family and the patient together where the patient wishes: what they understand, the honest risk in plain words, the options including not operating, the question of what the patient would want if things went badly, and a documented decision. Involve the surgeon and the intensive care team in the conversation.

A registrar asks to do a complex case unsupervised. How do you decide, and what do you say?

Assess the registrar's competence from their record and your own observation, the case's complexity, the backup available and the time of day. Decide, explain the reasoning either way, and if yes, be available and set the triggers for calling you. If no, say what would change it. Panels want supervision that develops trainees without risking patients.

An obstetric emergency and a trauma call arrive at the same time out of hours. Who goes where?

Triage by immediacy of threat: the obstetric emergency usually needs the anaesthetist first because the baby and the mother are both at risk, the trauma call has a team already. Send the second anaesthetist, call in the third, and tell both teams what is happening. Say what you would do if you were alone.

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 the conversation with the patient and the duty of candour, what the review found, and the change you made and checked. Avoid the complication where someone else was responsible.

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

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 what you would learn about the technique and whether you would report it.

The RCoA census says workforce shortages are equivalent to more than a million operations a year. What does that mean for this department, and what can we do about it?

Know the headline figure and say what it means locally: lists cancelled, consultants working extra sessions, trainees losing lists. Then what the department can do: recruit and retain, support SAS doctors, use the workforce well, protect training, and make the case to the trust with the data.

What do you understand by perioperative medicine, and what role should anaesthetists play in it here?

Assessing and optimising patients before surgery, shared decision making about whether to operate, prehabilitation, and care across the whole pathway. Anaesthetists lead it because they see the risk earlier than anyone. Say what the department has, what it lacks, and one thing you would build.

GIRFT has recommendations for theatre productivity and day case rates. Which would you prioritise in this trust?

Pick two or three: first case start times, list utilisation, day case rates, surgical hubs, pre assessment that stops cancellations. Say which this trust needs most from what you have seen and how you would measure the change.

Our theatre utilisation is below the national target. How would you improve it?

Know the number. Then the levers an anaesthetist has: start times, turnaround, scheduling that matches cases to list length, pre assessment that stops on the day cancellations, and the team's engagement. Realistic about what one person changes, specific about how you would measure it.

What is your view on anaesthesia associates, and how would you work alongside them?

Measured and respectful. The Leng review's findings, the college's position, the scope of practice boundaries, and the supervision they need. Say that you would work alongside them as colleagues within a clearly defined scope and would speak up if the scope were exceeded.

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

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

What is ACSA, and what would accreditation mean for this department?

The college's accreditation scheme for anaesthetic departments against published standards. Accreditation would mean a structured review of the department's governance, equipment, staffing and training, and a public mark of quality. Say what you know of the department's status and what you would contribute.

How should an anaesthetic never event, such as wrong side block, be handled from theatre to the board?

Stop the list, treat the patient, tell the patient under the duty of candour, report it as a never 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 board hears about every never event.

Tell us about your involvement in NELA, PQIP or another national audit.

Your part in the audit, the data you collected or reviewed, what the department learned from its results, and what changed. If you have not been involved, say what the audits measure and how you would use them here.

How would you contribute to training for the Primary and Final FRCA, and what makes a good anaesthetic trainer?

What you have taught, to whom, how you know it worked; then the specifics for the FRCA: tutorials, viva practice, the primary's physiology and pharmacology, the final's clinical judgement, the college's resources. Match it to the job plan and say what makes a good anaesthetic trainer from your own experience.

How would you teach airway skills to ODPs and nurses as well as trainees?

Simulation and skills sessions for the whole theatre team, because the ODP and the recovery nurse are the people 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.