Surgery: Specialty Training Interview Questions

Why surgery, and what have you done to prepare for a surgical career?

Why surgery in terms of the job, with evidence: the rotations, the theatre time, the taster, the course, the MRCS part A if sat, the conference. Then what you have done on purpose to prepare, each with what it taught you.

Talk us through your portfolio: which of your achievements best shows you are ready for core surgical training?

Pick one and explain why it shows readiness: the operative experience and what it taught your hands and your judgement, the audit with a result, the leadership role. Say what the achievement shows about you as a future surgeon rather than what it was.

Tell us about your operative experience and the procedures in your logbook.

Know your logbook: the procedures, the numbers, the level of supervision, which you could do as first operator. Say what the experience taught you about your hands and your judgement and what you want to learn next.

What do you know about the surgical curriculum, the MRCS and how CST leads to ST3?

The stages of core training, the MRCS parts A and B and when they fall, the themed and generic programmes, and how CST leads to ST3 through national selection. Two accurate sentences, then how you would fit the MRCS around work.

Tell us about an audit or QI project you have done and what changed.

The problem, the standard, the measure, what you changed, the result and whether you closed the loop. Be clear about your own part. Know the difference between audit, QI and research and say which yours was.

Tell us about teaching you have delivered and how you know it worked.

One example in depth: what you taught, to whom, how you planned it, the feedback, what you changed. Say how you know it worked. A list of sessions does not score.

You are the surgical SHO. The registrar is scrubbed, the consultant is in clinic, and the ward nurse says a post operative patient is deteriorating. What do you do?

Go and see the patient now, ABCDE, treat what you find, and escalate past the scrubbed registrar: the consultant in clinic by phone, the critical care outreach team, an arrest call if peri arrest. Say what you would tell the registrar through the theatre and when you would call the consultant directly.

Tell us about a time you led a team on the ward or in theatre.

A real example where you took charge: an emergency before the senior arrived, a ward round falling apart, a theatre list reorganised. What you decided, how you communicated it, the outcome, and what you would do differently.

A junior colleague on the surgical team is not coping and patients are affected. What do you do?

Patient safety first: cover what is outstanding. Then speak to the junior privately and early, find out what is going on, help with the workload, and involve their supervisor if it continues or there is a wellbeing concern. Say how you would make them feel supported rather than targeted.

You see a consultant surgeon shout at and belittle a trainee in theatre. What do you do?

In the moment, if the patient or the trainee is at risk, something calm that lowers the temperature. Afterwards, the trainee supported, and the reporting route: the freedom to speak up guardian, the educational supervisor, the clinical director. Say what you would do if the consultant were your own supervisor.

A patient's wound dehisced after an operation you assisted on, and you believe a technical error was made. What do you do?

The patient's care first. Then honesty: tell the consultant what you observed, take part in open disclosure, present at morbidity and mortality. Do not speculate to the family about blame. The panel is testing whether you will speak up about a senior's error.

You are asked to consent a patient for a procedure you have never seen. What do you do?

You do not. Consent requires understanding the procedure, its risks and its alternatives. Explain why to whoever asked, find someone who can, and say how you would learn the procedure for next time.

A patient with capacity refuses an operation you believe they need. How do you proceed?

Confirm capacity, make sure the refusal is informed, explore the reasons, offer alternatives, involve the consultant, document, and respect the decision while leaving the door open. Say what changes if the operation is life saving and capacity is in doubt.

A 70 year old presents with abdominal distension, vomiting and no bowel motion for three days. Talk us through your assessment and management.

• Follow-up: The CT shows a closed loop obstruction. What now?

Resuscitate, nasogastric tube, catheter, bloods and a gas for the lactate, the CT, and the registrar called with the question of whether this needs theatre tonight. When the CT shows a closed loop, it is theatre now and the consultant and anaesthetist are called. Say what you would tell the patient.

A patient three days after a right hemicolectomy has a heart rate of 130, a temperature of 38.5 and abdominal pain. What do you do?

Sepsis until proven otherwise: the sepsis six, the thought of the anastomotic leak, the CT, and the early call because this patient may need theatre or intensive care. Say what you would do if the registrar were scrubbed.

A 25 year old is brought to the emergency department after a stabbing to the chest with a blood pressure of 80. Lead the primary survey.

The trauma call, the primary survey, two large bore cannulas and blood, the massive haemorrhage protocol, a chest drain if there is a haemothorax, and the registrar and consultant now. Say what would make you call for the thoracotomy.

A 45 year old woman presents with right upper quadrant pain, fever and jaundice. What is your approach?

Biliary sepsis: resuscitate, antibiotics, bloods including liver function and clotting, the ultrasound, and the question of cholangitis needing urgent decompression. The senior called early. Say what would make you worried about the patient overnight.

A patient on the ward has melaena and a haemoglobin of 70. What do you do?

Resuscitate, crossmatch, stop the anticoagulant, the gastroenterology and anaesthetic teams, and the major haemorrhage call if unstable. Say what you would do while waiting for endoscopy.

A patient presents with a painful, pale, cold leg. What do you do?

Time matters: analgesia, anticoagulation after discussion, the vascular registrar now, and the imaging the vascular team want. Say the signs that mean the limb is threatened and that you would not delay for a routine scan.

A 30 year old woman at 20 weeks pregnant presents with right iliac fossa pain. How do you assess and manage her?

Appendicitis until proven otherwise, with the obstetric team involved from the start. The ultrasound first, the discussion about further imaging and theatre with the senior, and the recognition that delay harms both patient and baby. Say what you would tell her.

A patient on warfarin needs an emergency laparotomy. What do you do?

Reverse the anticoagulation with the haematology advice, vitamin K and the concentrate, crossmatch, and do not delay the laparotomy for a perfect INR if the patient is bleeding or septic. Say who you would involve and what the anaesthetist needs to know.

What are the biggest challenges facing surgical services in the NHS, and how do they affect training?

Three pressures linked to what you have seen: the waiting list and surgical hubs, theatre productivity, workforce and rota gaps, the pressure on training lists. Say what a trainee can do about one of them.

What is GIRFT, and how has it changed surgical practice?

Getting it right first time: the national programme that benchmarks surgical practice between trusts and publishes recommendations on productivity, day case rates and quality. Give one example of a GIRFT change you have seen in a department.