Introduction

Preparing for the first interview is always difficult especially for overseas doctors who are new to the system. Medicine is changing every day but some issues remain the same.  New topics come up every year. For example terrorist attack in London ^1,7 and how to deal with it, SARS infection or an epidemic and as a doctor what would be your role or issues with training like Foundation year training which have been introduced recently.

Medicine in United Kingdom is fairly advanced and a medical graduate is expected to know few basic issues.

Getting short listed for an interview is a joy , once  short listed try to celebrate. Have the job description ready. Read the job description thoroughly. Make sure you know what you have applied for. Know about the job, its benefits, duration,  and whether it is recognised or not.

Book an informal visit. Try to call the consultants who will supervise and discuss about the job and training   .Go around the hospital and attend ward rounds or clinical meeting.

Travel expenses are usually paid and try to book accommodation in advance. Most of the hospitals pay for your expenses including accommodation. Leave early for the interview

Go for an informal visit and visit wards departments, education centre etc. Phone them that you are coming. Try to form a group and prepare for mock interview. Speak to your bosses if you are working and inform your referees. Ask them for tips.

Know your Curriculum Vitae well. You may expect some questions from them. Read the Job description. Wear nice dark suit. Shake hands if they offer to. Look at the person-asking question and then at others. Don’t move hands .Be confident. You have nothing to lose.

If you do not know any question tell them that you are going to look about this today and that you do not know about this now .Ask for feedback. Prepare these questions well. Try to understand. Say thank you at the end of interview Shake hands at the end of interview if they offer. Read booklets issued by General Medical Council (duties of a doctor). Go through latest medical journals. Know about latest health issues in NHS

Some of the commonly asked questions and answers 

1          Please take us through your Curriculum vitae ¹²   ?

The best way to deal with this question is to go through important features in you CV example where you graduated, briefly about your medical school, additional information about additional degrees if you have and any other interests, publications or voluntary work if you have

2          Why did you apply to our hospital and why do you want this job ?

I heard through common friends that this is a good hospital and checked the website. Teaching is good and it’s a friendly hospital. The rota is good. Wide range of patients is admitted. Explain how you came to know about the job. Quote why you are interested in the job with an example like since I started my medical school, I was fascinated by General medicine. It’s challenging, has good scope and lot of opportunities. I did internship/attachment in medicine and liked this field. Quote some specific examples.

3          How does medicine in UK differ from your country?

I am from a medical school, which is attached to a tertiary hospital.

Though we have all facilities, because our patient turnover is huge and resources are limited and stretched to the limit we cannot request the same number of investigations as in this country. We see lot of tropical

                  Medicine/ diseases. Never say anything bad about your country/hospital

  4        Why should we take you?

I am hardworking, sincere, enthusiastic and eager to learn. I have done my

MBBS and as I fulfil the criteria I think I am a suitable candidate for this job.

5          They may give a scenario

Usually a common scenario or a clinical scenario can be given. Fir example you are working on a night shift and you have a problem, how will you deal. Tell that I will discuss about this with a senior if it’s a medical problem. Sometimes advice from a senior nurse or sister is equally useful.

6          What is Clinical Effectiveness ²?

            Clinical effectiveness is about doing the right thing to the right person

At the right time. They are three vital components. Obtaining information changing       practice and monitoring changes.

                  Information is based on Evidence from research, patterns of care,

                 Population needs and availability of resources.

                 Improved Clinical effectiveness will only be as a result of changes in

            Clinical practice by health care worker, patients and managers. These

                  Changes will be based using research, clinical audit, education,

            Raining, clinical guideline, patient client involvement and library

                  Services.

                  Monitoring demonstrates improvement in quality, effectiveness and cost

                  Effectiveness.

                  Measuring health benefits, clinical outcomes, deaths, patient surveys,

            Health indicators, clinical indicators etc.

7          What is NICE ²?

NICE stands for national institute of clinical excellence (www.nice.org.uk)  .It is a part of the NHS and its purpose is to provide patients, health professional and

            The public with authoritative, robust and reliable guidelines on the

            Current best practices. The guidance will cover both individual

                 Technologies and clinical management of specific conditions.

8          What is NICE research and Development ²?

            The programme will focus on using research to improve the guidance NICE

            Can offer to NHS, using research to see for methods in which

                  Implementation of the NICE guidelines can be done.

9          What is Appraisal ^3,6?

Appraisal is a continuous form of assessment and to ensure practice quality is assured. All NHS doctors will discuss their practice with an appraiser on an annual basis. Part of this appraisal system is a review of the standards set by Good

                  Medical practice. These measures address quality at the organisational and

            The service levels. Appraisal is an important means by which individual

Practice quality is assured. It also includes a personal development programme depending on the needs of the individual and that of the organisation. More information can be found on www.gmc-uk.org

10        What is revalidation ¹³?

            As appraisal is being developed the GMC made proposals to revalidate all

                  Registered doctors. According to this all doctors who want to remain in

                  Practice must show evidence to the GMC every 5 year so that they are up to

            Date and competent in their field of practice. The appraisal system for

            NHS doctors are designed to support the process of revalidation.

11        What is teamwork ¹⁴?

            Team work includes shared learning, shared decision making and shared

                  Multidisciplinary learning. It extremely important in good patient care.

12        What is Continuous professional Development ⁶?

            CPD is a life long process where you identify your strengths and weaknesses

            And plan how u are going to reach your goals .It is about planning your

                 Development in your way and at a time and pace that suits you.

            It includes three areas

            a. Professional Practice

            b. Education and training

            c. Personal Development.

13        What is evidence-based medicine ²³?

            It is the conscientious, explicit and judicious use of current best

                 Evidence in making decisions about the care of the individual patient. It

            Is about integrating clinical expertise with patient values and the best

            Clinical evidence.

            Start with the patient-a clinical problem or question arises out of the patient.

                  Construct a well-built clinical question.

            Select the resource and do a search.

                  Appraise that evidence for its validity and applicability.

            Return to patient; integrate with patient values and clinical expertise

            And implement.

                  Evaluate your performance.

            The practice of EBM is a process of life long self-directed problem based

                  Learning in which the care of your own patient creates a need for

                  Clinically important information about diagnosis, prognosis and therapy

            . It converts the abstract exercise of reading literature into a pragmatic

            Process of using the literature to benefit individual patients while

                  Simultaneously expanding the clinician’s knowledge base.

14        What is CHI (commission for health improvement) ¹⁵?

            CHI stands for Commission for health improvement  .It is a statutory

             Independent inspector of NHS. It aims to bring about demonstrable

             Improvement in the quality of health and social care. It helps NHS

                  Organisations assess and improve themselves. CHI guiding principles are

• Patient centred
• Independent rigorous and fair
• Developmental and supportive approach to improvement
• Use best available evidence
• Open and accessible

            Apply the same expectations to us

15        What is CHAI (Commission for healthcare audit and inspection) ¹⁶?

                 Commission for healthcare audit and inspection it exists to promote

                Improvement in the quality of healthcare in England and Wales by being an

                  Authoritative and trusted source of information and ensures that this

                  Information is used to drive improvement

16        What are European Union Directives for Junior Doctors⁶?

                  According to the EU Directives he work time for junior doctors should be

             Limited to 48hours per week. Which is being implemented from August 2004

             In a phased way. From Aug04 to July 07 it will be limited to 58hrs per

            week. From then to July 09 to 56 hrs per week .It is also included that

                  Doctors should have at least 11hours between 2 working days and one day

            Free in a week and in breaks given. Where an employee work needs

                  Continuity these can be dispelled and a compensatory rest break given.

17        What is the junior doctors contract or new deal ¹⁷?

                  According to this junior doctors can work for 56hrs per week with the ones

                  Working above 48hrs per week being given increments which can go to upto 

            100% of their pay. A vital difference between the above 2 is that in the

            EU directives the 48hrs includes all the time the doctor is in the

                  Hospital, whereas in the latter it relates to the actual working time.

18        What is modernising medical careers ^{6, 18}?

                  According to this system after medical school a 2-year foundation

                  Programme is introduced to help trainee doctors deal with emergency

                  Situations and make them more competent in clinical medicine and to meet

The patient’s expectations. The Foundation year1 will be paid, as equivalent to a Pre registration house officer and FY2 will be paid equivalent to that of a first year SHO. After the 2 years they can be absorbed directly into the second year of SHO but this is being talked over with the concerned. Royal Colleges and the Joint Committee of Post Graduate Education. This has started in majority of hospitals

19        What do you understand by star rating to hospital ^{19, 20}?

            The highest rating hospitals will be given 3 star and the hospitals not up

            To the expectations will not be given any stars. If the hospital doesn’t

                 Improve management managers from the best hospital will be shifted to

            This hospital. The grading is done not only on the services but also the

                  Organisational skills. Patient concerned topics such as hospital

                  Cleanliness and waiting periods will also be judged. This is done to allow

                  Hospital with stars more freedom in how they use the funding and to advice

                  Government and to give help to other hospitals.

20        How would you deal with an under performing doctor ²¹?

            If I had concerns about a doctor’s performance I would confirm if others

            Too had it. I would ensure patient safety first If the concerns were justified I             would    inform our clinical supervisor or medical director and discuss in an open             strategy. I it continues I would talk to the clinical tutor.

21        How would u deal with abuse by a patient?

            If I faced with an abusive patient I would try to talk to him that abusing

                  Wouldn’t lead to anywhere and to talk his problem and we are here to help

            Out with his problem. I would take the help of a nurse to stand by me. I

            Would also tell him that most hospitals have a no abuse tolerance system.

            If he were physically abusive I would press the alarm button and call for

                 Security.

22        What is clinical research ²⁵?

The Medical Research Council defines clinical research as research based primarily on patients or ex-patients and designed to answer a question about disease (etiology, concomitants, diagnosis, prevention, outcome or treatment). In addition to direct clinical examination, it includes the study of blood, biopsy material or post-mortem tissue deriving from the individuals concerned and of normal subjects where such study relates to a disease process being investigated. The definition includes clinical trials, and of course much other work on the clinical characterization of disease or ill health.

23        How does audit differ from research?

                  Whereas Research is creating new knowledge. Audit is to make sure the

                  Knowledge is being implemented. Research involves a huge number and is a

            Large scale process where as audit is usually a small number and in a 

            More limited time.

24        Some salient features of research ²⁵                                                                                                                                                         

            Aims to establish best practice

            Quest for new knowledge                     

            Is practice based?

            Often a one off study                                             

            May involve administration of placebo           

            May involve new treatment                                 

            Aims to generate new knowledge                     

            Initiated by researchers 

           Needs ethical approval

            May need funding

25        What do you understand  by clinical audit  ²³?

            Analysis of clinical data to improve Quality of care

            Aims to find how close our practice is to the best practice

            Its theory driven

            It is an ongoing process

            Never involves placebo

            No new treatment

            Aims to improve services

            Is usually led by service providers

            No need for ethical approval

            Usually funding not needed

            Try to understand about audit cycle.

26        What is Clinical Governance ⁶?

            It is a means by which the organisation is accountable for continuously

                  Improving the quality of care and assuring high standards of care by

                  Creating an environment in which clinical excellence will flourish. The

                  Elements of clinical governance are

            Clinical audit, research, education and training, openness, clinical

                  Effectiveness or evidence based medicine, risk management, personal

                  Development plan.

27                What do you understand by audit cycle ²⁶   ?

The audit cycle is a description of how audit ought to work in clinical practice, with continual assessment and feedback:

Set standards

Measure performance

(The cycle is often interrupted here...)

Diagnose problem:

• Knowledge
• Skills
• Attitude
• Organization

Implement change, Return to the measurement of performance

28        How are complaints dealt with?

                  Complaints must be dealt by talking over with the patient. If they would

            Still like to proceed further-the complaint must be registered with the

                  Designated officer .The officer must give an acknowledgement letter that

            The complaint has been received. Ideally complaints should be dealt with

            As soon as possible. The general manager of the department needs to

                  Investigate the complaint and draft response letter on behalf of the chief

                  Executive as soon as possible.

            The complaint must be recorded properly so that even if a long time has

            Elapsed the complaint can be addressed properly.

29        What do you understand about guidelines and protocols ²²?

                  Guidelines are used to put current evidence of best medical practice into

            use. Guidelines should be easy to follow step wise .If there is   failure

            or bad practice it is either they are difficult to follow or the doctor is

            not fit to practice. Guidelines are written and reviewed. There are

                  guidelines from NICE( national institute of clinical excellence in NHS )

            Protocols are designed at local levels

30        What is Quality ¹¹?

            Quality is meeting the needs of patients, maintaining good medical

                  Practice and minimizing mistakes

 31       What is clinical risk management ¹⁰?

            To reduce and as far as possible eliminate harm to the patient.

            Protect staff and support when adverse reactions occur.

            To ensure that patients are handled properly when an adverse event occurs.

            Risk identification, Risk analysis, Risk control, and Risk appraisal.

32        What is leadership ²⁸  ?

      A leader is someone who can

• Offer confidence
• Support
• Absorb anxiety
• Can deliver
• Is accountable
• Team worker
• Can be a model for others

33        What are your strengths and weaknesses?

            This is a difficult question to answer. You can put in different ways. It’s easy to             showcase your strengths. You can give an example, which is listed

            I am young and enthusiastic. I practice medicine as evidence based. I

Have a spirit of teamwork and good organisational abilities. I have good communication skills and am concerned about my patients. I am humble and willing to seek help and advice when and as necessary.

I am a bit obsessed about perfection and that might pressurize my colleagues a bit. But I am careful not to carry my stress home and will cater time for work and leisure .If you are an overseas doctor and English is not your first language then you can quote that.

34                Who should be appointed for this post?

      I feel this is a tough question but can be asked sometimes in the interviews

      You can say that the person

• Should have the required medical qualification-MBBS
• Should have good communication skills
• Should maintain patient trust.
• Should maintain confidence
• Should be a good team player
• Good at organisational skills.
• Should be inclined to that post
• Should be able to have empathy with the patient.
• Should be able to meet the post requirements like travelling etc.
• Should contribute to the department.

36        What are your hobbies?

            Tell about your hobbies. If you have special hobbies like stamp

                  Collection, painting, writing let them know

36        How is medicine in your country and how is it different?

            If you are from a developing country tell good about your country. Tell

            That though we have all the modern investigations, our resources are

                  Stretched and limited. . Tell about tropical medicine, the language of

                  Communication and how the cases are different.

37  Why did you choose to be a doctor?

      This is one of the commonly asked questions in interviews. You can give a reason       why you chose to be a doctor. We have given an example

            (When I was young I chose to become a doctor as it helps me to serve

                  humanity and its always considered a noble profession and as I wanted to

            Work with humanity I chose medicine Now I feel very satisfied with my

                  Profession though its demanding)

38        Where do you see in 3-4 years time?

            Tell that you hope to complete recognised training posts and that you will

                  Complete membership/fellowship exams and wish to practice as a Specialist

                  Registrar or General Practitioner and that you will be a competent doctor.

39                Why did you come to this country ?

      Always talk positive about your country no matter where you come from

            You can say (As medicine is quite advanced in this country it would give me             more experience and that the exams are recognised all over the world and of

            High standard I chose to come here. I chose to gain some experience in

                  Western modern medicine).

40        If your colleague is not performing up to the mark or if you are concerned

            What will you do?

            Well I will ensure that our patients are safe and not at risk.

            I will try to speak to my colleagues or seniors if they feel the same

            I will inform my registrar or consultant and take an opinion.

            I will try to speak to my colleague and try to find whether he is stress

            Or going through a bad phase

41        If your staff nurse or a patient complains against you, what are you going

            to do?

            If so I will  try to find the reason for this and apologise and if I am at  fault I

            try to find the reason . If I am not at fault, I will try any answer  concerns

You can discuss this issue in department meetings which are held every week and try to resolve the issue.

42        Why should we chose you when there are so many candidates who are equally

                  Qualified?

            I am hard working and given an opportunity to work will work to the

                  Satisfaction and set high standards in clinical care. I am well qualified to take this       job. I will strive for this hospital and contribute to audit and research

43        What is competency based training ⁹  ?

            It’s an approach that is advocated as part of undergraduate and post

                  Graduate medical training. It includes, OSCE (objectively structured

            Clinical examination), and RITA (records of in training assessment)

                  Advantages include individualised flexible training, transparent

                  Standards, increased public accountability.

44  What is Foundation Trusts⁶?

          NHS Foundation Trusts are a new type of NHS Hospital tailored to the needs   of local populations and run by local managers, staff and members of the    public.             The Health and Social Care Act 2003 establishes NHS foundation             trusts               as             independent public benefit corporations modelled on co-operative             and             mutual             traditions. The first NHS Foundation Trusts were authorised by Monitor             (whose             statutory name is the Independent Regulator for NHS Foundation             Trusts)             from 1 April 2004.There are now      thirty one NHS Foundation Trusts.

     45   How can you develop our department or change our practice here?

Well I will try to see how our department works and how the rota is. I will do audits and research if possible. I will try to find ways to improve our

Department. I will try to help in organising teachings, multi-disciplinary meetings etc

46        What are your future plans or where do see yourself in next 5 years?

            Say realistic plans eg I wish to complete MRCP/ MRCS examinations

and work hard to obtain specialist Registrar training post. You can also answer in a way you feel you see yourself in 5 years time

47        How will you deal with a terrorist attack ⁷?

I will ensure that I will inform police, emergency service, fire safety team etc

I will activate the emergency management team, which will call the doctors, and healthcare team who will come to help and are on standby

I will make sure that the nearest hospital knows about this

Remember emergency ambulance services in UK can be dialled on 999 and police/fire safety usually 100.

48        Did you do any research/audits or were involved in similar activities?

I did not get a chance to do research activity as I was writing examinations but now I am interested to do the same. (Doing research is not as easy as it sounds. It needs lot of paperwork, ethics committee approval and funding). I will try to do case reports and audits. If you have done make sure you take a copy and discuss about it when asked

49        How will you help to prevent spreads of infections in hospital like MRSA ⁸ ?

MRSA means Methicillin Resistant Staph Aureus. It’s a latest issue as lot of deaths occur. Regular hand washing and following strict protocols for barrier nursing helps spreading this.

Use of alcohol gel and cleaning your stethoscope after reviewing each patient helps 

50        If your  are sick what will you do?

I will inform my team, usually consultant or registrar and also the medical personnel. If I am on call I will try to inform at the earliest so that cover can be arranged. I am sick for few days I will go to occupational health or my general Practioner for advice

51              Can you describe an event, which changed your practice?

You can quote any example, which changed your practice

In this you have to describe a clinical situation or an event at work when you learnt something through a mistake   for example (I examined an elderly patient in A&E. she was admitted with mild confusion. I examined her and her mental status and observations were normal. We were about to discharge when one of the nurses mentioned that she was complaining of hip pain when she was being dressed)

I examined the hip and got an X ray and it showed a fracture hence we need to look at other aspects when someone is admitted with confusion.

52        When some one wants to self discharge²⁷ and you do not feel that the patient is well enough to go home. what are you going to do?

I will look through the notes and examine the patient and talk to him. I will ask him the reason why he wants to go home. I will explain the reason why he needs to stay in the hospital and whether anything can be done for him or if he is unhappy with care. I will inform my senior colleague and if he is still adamant will request senior colleagues opinion and if needed we will get the patient to sign a form (discharge against medical advice)

52              What are the issues in the NHS ⁴?

      You can quote current issues like waiting lists, funding issues, modernising       medical careers, manpower shortages etc. Remember every patient has to be seen       in A&E or MAU (Medical Assessment Unit) within 4 hours. Every new patient       has to be seen by a consultant within 24 hours of admission

Conclusion

In addition to these questions you can expect clinical questions , about recent trials or papers published  in your field of choice. You need to know about accountability in NHS and about some useful sites which have been provided below. You can find books or courses on interviews skills majority of which advertise in the BMJ careers.

References

1.      Resuscitation. 2005 Aug; 66(2): ix-xii. Lockey DJ etal

2.      http://www.nice.org.uk

3.      http://www.gmc-uk.org

4.      http://www.nhs.uk

5.      http://www.rcplondon.ac.uk

6.      http://www.dh.gov.uk

7.      Chaloner E blast injury in enclosed spaces BMJ. 2005 Jul 16; 331(7509): 119-20.

8.      Lucet JC, Paoletti X Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med. 2005 Aug; 31(8): 1051-7

9.      http://www.bma.org.uk/ap.nsf/Content/BecomingDoctorintro

10. http://www.nhsla.com/RiskManagement

11. Youssef FN, Nel D, Bovaird T Health care quality in NHS hospitals. Int J Health Care Qual Assur. 1996; 9(1): 15-28

12. Sonia Hutton Taylor, spruce up you CV and interview skills BMJ. 2002 Nov 16; 325(7373): S165. Review

13. Norcini JJ Where next with revalidation? BMJ. 2005 Jun 25; 330(7506): 1458-9

14. Smith GW Teamwork in the N.H.S.--myths and models. Health Serv Manpow Rev. 1979 Feb; 5(1): 8-13

15. http://ratings2003.healthcarecommission.org.uk/ratings

16. http://www.chai.org.uk/Homepage/fs/en

17. http://www.bma.org.uk/ap.nsf/Content/HospitalDoctorsJunHrs

18. http://www.mmc.nhs.uk/pages/home

19. http://ratings2003.healthcarecommission.org.uk/ratings/

20. Kathy Rowan, Hospitals' star ratings and clinical outcomes: ecological study, BMJ 2004; 328:924-925 

21. George Taylor, Underperforming doctors: a postal survey of the Northern Deanery, BMJ 1998; 316:1705-1708  

22. http://www.nelh.nhs.uk/quality

23. http://www.cebm.net/

24. http://www.cgsupport.nhs.uk/Resources/Clinical_Audit/

25. http://www.mrc.ac.uk

26. http://www.gpnotebook.co.uk

27. V L Henson et al Patient self discharge from the emergency department: who is at risk, Emerg Med J 2005; 22:499-501

28. http://www.executive.modern.nhs.uk/framework/deliveringtheservice/holdingtoaccount.aspx