Anaesthetics st4: Specialty Training Interview Questions

Why anaesthetics as a career, and what have you done at core level to demonstrate your commitment beyond the rota?

Evidence from core training: the subspecialty exposure sought out, the audit or QI project in theatres or pain, the teaching delivered, the research, the courses beyond the compulsory ones, the Primary FRCA passed. Say what each taught you about the job. The assessors have your portfolio and want the story behind it.

Talk us through your core training and what has prepared you for ST4.

Two minutes mapped to what an ST4 does: the solo lists, the obstetric and paediatric and intensive care experience, the cases you have managed alone, the complications you have handled. Name the hardest module and what it taught you. End on what you still need to learn.

Which subspecialty interests you, and why?

An area with reasons from what you have seen in core, and openness about how higher training will shape it. Say what you know about the stage 3 special interest areas and how the programme supports them.

What do you know about stage 2 and stage 3 of the curriculum and the Final FRCA?

The stages, the capabilities, the Final FRCA and when it falls, the special interest areas and the dual training options. Two accurate sentences, then how you would fit the Final around a full rota.

Competition for ST4 has risen sharply. What would you do if you were not appointed this year?

A calm plan: a post that keeps you in theatre, the Final sat, the portfolio strengthened in the domains that scored lowest, feedback sought. Say that you understand the bottleneck without grievance.

You suspect a colleague has been diverting controlled drugs. What are your obligations?

Patient safety first: the colleague must not have access to drugs or patients until it is dealt with. Then the head of department or the clinical director, because you cannot manage this alone. Know the controlled drugs accountable officer and the GMC's expectations. Support the colleague, who is unwell. Say what you would do if they asked you to keep it quiet.

A consultant's plan for a patient is one you believe is unsafe. What do you do in the moment and afterwards?

Patient safety first: say your concern with the specifics, ask for the reasoning, and if the patient is at risk, act on it and involve another consultant. Afterwards, a private conversation, reflection on whether you were right, and the educational supervisor if it is a pattern. Keep your own conduct impeccable.

A core trainee made a drug error in theatre that reached the patient and has not told anyone. What do you do?

The patient first: assess and treat. Then the trainee told that it must be reported, the consultant informed, the incident reported, the duty of candour conversation with the patient, and the trainee supported without blame. Say what you would do if the trainee refused.

A patient refuses a blood transfusion before an operation that may need one. How do you approach it?

Confirm capacity, make sure the refusal is informed, explore what the patient will accept including cell salvage, involve the surgeon and the consultant, plan the anaesthetic to minimise loss, document the refusal and the plan, and respect it. Say what changes if capacity is in doubt.

You are the senior trainee on call. A core trainee calls from the emergency department with a failed intubation and falling saturations. What do you do?

• Follow-up: You arrive and the surgical airway has been attempted and has failed.

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; if oxygenation fails, the front of neck decision is yours. When the surgical airway has failed, keep going: a second attempt, a different operator, every other route, the surgeon for a tracheostomy. Then the patient, the family, the trainee, the debrief and the reporting.

An obstetric emergency and a trauma call arrive together out of hours and you are the only anaesthetic registrar. What do you do?

Triage by immediacy of threat: the obstetric emergency usually first because mother and baby are both at risk and the trauma call has a team already. Send the core trainee to the trauma call with clear limits, call the consultant in, and tell both teams what is happening. Say what you would do if the consultant were thirty minutes away.

A surgeon wants to proceed with an elective case you believe should be postponed and the consultant is not available. What do you do?

Hear the surgeon out, state your concern in terms of the patient's risk, offer what would change your mind, and if you still believe it unsafe, decline and say you will discuss it with the consultant. Your professional judgement and the patient's interests outrank the list. Say how you would keep the relationship and what you would document.

A woman at caesarean section under spinal becomes hypotensive, breathless and confused. Talk us through your management.

The differential: high block, amniotic fluid embolism, haemorrhage, anaphylaxis, local anaesthetic toxicity. Call for help and the consultant, oxygen, the vasopressors, the airway secured if the block is high or she deteriorates, the obstetric team told, and the baby delivered if not yet. Say what would make you think of each cause and what you would do for the one you suspect most.

A patient wakes in recovery in severe pain after a block you performed 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 ODP tells you the anaesthetic machine check was not done properly before the first case and the surgeon is scrubbed. What do you do?

Do the check now before any patient is anaesthetised, whatever the surgeon says. Then find out why it was missed, without blame, report it, and raise the process with the department. The check is the anaesthetist's responsibility whoever performs it.

A frail 88 year old with heart failure and renal impairment is listed for an emergency laparotomy. How do you approach the pre operative assessment and the conversation?

The risk assessed with the scores the department uses and the NELA pathway, the optimisation that is possible in the time, the intensive care bed arranged, and the conversation with the patient and family about what the operation can and cannot achieve, with the surgeon and the consultant anaesthetist. Say what you would do if the patient declined.

A patient tells you in the anaesthetic room that they have changed their mind about the operation. What do you do?

Stop. Find out why, make sure the decision is informed and the patient has capacity, involve the surgeon, and respect the decision if it stands. Say what you would document and what you would tell the theatre team.

A child in the emergency department needs an emergency anaesthetic and the paediatric anaesthetist is an hour away. What do you do?

Assess whether the child can wait or be transferred, use the paediatric retrieval and advisory services, prepare with the equipment and the doses by weight, call the consultant on call, and proceed if the child cannot wait, with the most experienced help available. Say what would make you proceed and what would make you wait.

What did you make of the latest RCoA workforce census, and what does it mean for training?

The shortfall equivalent to over a million operations a year, the wellbeing and retention findings, and the ST4 bottleneck. Then what it means locally: lists cancelled, fewer training opportunities, pressure on productivity. Say what you think the specialty should do with a view, not a complaint.

What is your view on anaesthesia associates after the Leng review?

What the review recommended on scope, supervision, title and settings, the college's position, and a measured view that respects both patient safety and the associates as colleagues. Say how you would supervise and work alongside them within a defined scope.

What has the specialty learned from NAP7, and how should it change practice?

Two or three findings on perioperative cardiac arrest: the frequency, the role of frailty and bradycardia, the importance of the pre operative assessment and the team's response. Then one change in practice you have seen or would make.

What do you understand by perioperative medicine, and what is the anaesthetist's role?

Assessing and optimising patients earlier and better before surgery, shared decision making, prehabilitation, and care across the pathway. Say what you have seen done well and what a registrar can contribute.

Tell us about an audit or QI project relevant to theatres, pain or perioperative care, and what changed.

The problem, the standard, the measure, what you changed, the result and whether it lasted. Your own part clear. Say why it mattered for anaesthetics and what you would do next.

Tell us about a critical incident you were involved in and what the department learned.

The incident, your part, how it was reported, the review, the patient told, the staff supported, and the change that followed. Candour and learning, not blamelessness.

What teaching have you delivered, and how would you teach as a registrar?

One example in depth with evidence it worked, then the plan: the core trainees on the list, the Primary tutorials, the simulation, the ODPs and the recovery nurses. Say what makes a good anaesthetic teacher from your own training.

What research or publications have you been involved in, and what did you learn from the process?

Honest and specific: your role, the question, what it found, what you learned about doing research. If little, say what you have done instead and what you would like to do.