Anaesthetics: Specialty Training Interview Questions

When did you first realise you wanted to do anaesthetics, and what have you done since to test that?

A specific moment, told briefly, then what you did afterwards to test it: the taster, the time in theatre or intensive care, the course. The assessors score the testing, not the realisation.

What have you done to demonstrate commitment to anaesthetics?

Three things done on purpose with what each taught you: the taster, an airway or simulation course, an audit on pain or theatre efficiency, time with pre assessment, a conference, the trainee association. Three told well beat ten listed.

What do you know about the anaesthetic training programme, the stages and the FRCA exams?

The stages of training, the Primary and Final FRCA and when they fall, the structure of ACCS and where it leads. Two accurate sentences, then how you would manage the Primary alongside full time work.

Which parts of anaesthetics do you think you will find hardest?

Honest and specific: the exams, the solitary responsibility, the moments when things go wrong fast, the night work, the pressure of a list. Name one, say why it will be hard for you, and how you would manage it.

Why ACCS or core anaesthetics, and what is the difference?

Explain the difference: ACCS covers emergency medicine, acute medicine, anaesthetics and intensive care over three years before the parent specialty; core anaesthetics is two years of anaesthetics and intensive care. Say which you want and why in terms of the breadth and the career it leads to.

What is the biggest challenge facing anaesthetics in the NHS right now?

Pick one and link it to what you have seen: the workforce shortfall in the college census, the waiting list and theatre productivity, anaesthesia associates and the Leng review, the training bottleneck. Say what a trainee can do about it.

You are the SHO on call and are fast bleeped to the gastroenterology ward because a patient has vomited a large volume of fresh red blood. Describe how you would approach this.

• Follow-up: The blood pressure is 80 systolic and he is becoming drowsy. What now?

ABCDE, two large bore cannulas, bloods and crossmatch, fluids then blood, stop anticoagulants, and the gastroenterology and anaesthetic registrars called. When the pressure is 80 and he is drowsy, the major haemorrhage call and the senior now. Reflect afterwards on what the ward could have done earlier.

You are called to recovery because a patient who had a hip replacement is drowsy, with a respiratory rate of six and small pupils. What do you do?

• Follow-up: Who do you call, and what do you tell them?

Opioid toxicity until proven otherwise: oxygen, airway support, naloxone titrated, and the anaesthetist who gave the anaesthetic called. Review the prescription and the handover from theatre. Say what you would tell the recovery nurse to watch for.

A patient on the surgical ward two days after a laparotomy is tachycardic, hypotensive and oliguric. Talk us through your assessment and management.

Sepsis, bleeding or the leak: the sepsis six, fluids, bloods and a gas, the surgical registrar and critical care outreach called early. Say what you would do if the registrar was scrubbed and the patient did not improve.

You are asked to see a patient in the emergency department with a severe asthma attack who is tiring. What do you do?

The silent chest and the saturations on high flow are the warning: nebulisers and steroids, a gas, magnesium, and the anaesthetist and intensive care called early because this patient may need intubation. Say that recognising the tiring patient before the arrest is the skill.

A patient becomes acutely agitated after surgery and pulls out their cannula. How do you manage the situation safely?

Safety for everyone, calm de escalation, find the cause (pain, hypoxia, withdrawal, delirium), replace the cannula when safe, and involve the senior. Never restrain alone. Say what you would do if the patient tried to leave.

You are the only doctor on a ward at night with two deteriorating patients and the registrar is in theatre. How do you prioritise and get help?

Triage by acuity, treat what you can, delegate to the nurses, and escalate past the registrar: the consultant on call, the critical care outreach team, an arrest call if either is peri arrest. Say what you would do about the unanswered bleep afterwards.

An anaphylaxis call goes out on the ward. You arrive first. What do you do?

Call for help and the arrest trolley, stop the trigger, adrenaline intramuscularly at the right dose, oxygen, fluids, the ABCDE reassessment, and repeat adrenaline if needed. Then the observation period, the documentation and the referral to allergy. Say the dose.

A nurse tells you a patient has received ten times the intended dose of an opioid. What do you do?

The patient first: assess, naloxone and monitoring, the senior told. Then the incident report, the duty of candour conversation with the patient, and support for the nurse. Say what the review would look at and that you would not blame the nurse.

What do you understand by perioperative medicine?

Assessing and optimising patients before surgery, shared decision making, prehabilitation and care across the pathway. Say what you have seen of pre assessment and why it matters for the sick patient on your ward.

What is the role of the Royal College of Anaesthetists in your training?

The college sets the curriculum and the exams, approves the training programmes, and sets the standards of practice through its guidance. For you it is the FRCA, the e portfolio and the standards you are assessed against.

Tell us about any audit or QI you have done that relates to theatres, pain or perioperative care.

The problem, the standard, the measure, what you changed, the result and whether it lasted. If it was on pain, theatre efficiency or pre assessment, say why that mattered for anaesthetics. Be clear about your own part.