CLINICAL GOVERNANCE

What is clinical governance?

A framework through which NHS organizations are accountable for continuously
improving the quality of their services and safeguarding high standards of care by
creating an environment in which clinical excellence will flourish.
Clinical governance domains
vidence based practice
!esearch and development
"linical information and audit
"ontinuing professional development
#rofessional self$regulation
"linical risk management
#atient and user involvement and complaints.
AUDIT
What is adit %
Audit is defined as a systematic clinical analysis of the quality of the medical care
including the procedures used for diagnosis and treatment& the use of resources and
the resulting outcome and quality of life for the patient.
'n other words& audit is a quality improvement process that seeks to improve
patient care through systematic review of care against explicit criteria and the
implementation of care.
Adit c!cle
(hat are we trying to achieve%
Are we achieving it%
'f not what is the problem%
(hat can we do to make things better%
Have we made things better%
"tages o# clinical adit
Stage )* preparing for audit
Stage +* selecting criteria
Stage ,* measuring performance
Stage -* making improvements
Stage .* sustaining improvement
RE"EARC$
What is research?
A systematic investigation undertaken to discover facts or relationships and reach
conclusions using scientifically sound methods.
!esearch is defined by NHS as work which is designed to provide new knowledge
and whose findings are potentially of value to those facing similar problems
elsewhere and also open to critical examination to all those who could benefit from
them.
$o% does research di##er #rom adit?
!esearch is concerned with establishing what constitutes best clinical practice /i.e.
tells us what we should be doing0 where as audit compares care provided against
agreed standards /i.e. whether we are doing it0
!esearch always requires the approval from the local ethics committee where as
audit usually does not require approval from the local ethics committee.
Tell me a&ot a research 'ro(ect !o have done?
EVIDENCE )A"ED *RACTICE
De#inition
1he 2udicious use of current best evidence based on systematic review of all
available evidence in making decisions about the care of individual patients.
Levels o# evidence
3evel )* systematic review of randomized control trials
3evel +* systematic review of cohort studies
3evel ,* systematic review of case control studies
3evel -* systematic review of case$series /and poor quality case control and cohort
studies0
3evel .* expert opinion /not based on research or explicit critical appraisal0
Grades o# recommendation
A* consistent level ) studies
4* consistent level + or , studies5 extrapolation from level ) studies
"* level - studies5 extrapolation from level + or , studies
6* level . studies5 inconsistent or inconclusive studies of any level
Clinical gidelines
Systematically developed statements to assist practitioner and patient decisions
about appropriate healthcare for specific circumstances.
Ris+ ,anagement
A hazard is anything with the potential to cause harm. A risk is the likelihood that
a hazard will cause a specified harm to someone or something. Ris+ management
is the 'rocess by which an organisation reaches decisions on the steps it needs to
take to ade-atel! control the ris+s which it generates or to which it is exposed&
and then developing strategies to manage the risk. 'n ideal risk management& a
prioritization process is followed whereby the risks with the greatest loss and the
greatest probability of occurring are handled first& and risks with lower probability
of occurrence and lower loss are handled later.4ritain7s Health and Safety
"ommission /HS"0 and the Health and Safety xecutive /HS0 are responsible for
the regulation of almost all the risks to health and safety arising from work activity
in 4ritain.
Adverse event
An untoward or undesirable occurrence in the healthcare process which has or
potentially has some impact on a patient or patients and results or may result from
some part of the healthcare process.
N*"A .National 'atient sa#et! agenc!/
1he N#SA is a Special Health Authority created in 8uly +99) to co$ordinate the
efforts of the entire country to report& and more importantly to learn from mistakes
and problems that affect patient safety. As well as making sure errors are reported
in the first place& the N#SA is trying to promote an open and fair culture in the
NHS& encouraging all healthcare staff to report incidents without undue fear of
personal reprimand. 't will then collect reports from throughout the country and
initiate preventative measures& so that the whole country can learn from each case&
and patient safety throughout the NHS can be improved.
N"0 #or children
NS:s set national standards& aiming to improve the quality of care and reduce
unacceptable variations in health and social services.1he "hildren;s NS:&
published on ). September +99-& sets standards for children;s health and social
services& and the interface of those services with education. 1he "hildren;s NS: is
a )9$year programme intended to stimulate long$term and sustained improvement
in children;s health. Setting standards for health and social services for children&
young people and pregnant women& the NS: aims to ensure fair& high quality and
integrated health and social care from pregnancy& right through to adulthood.
At the heart of the "hildren;s NS: is a fundamental change in thinking about
health and social care services. 't is intended to lead to a cultural shift& resulting in
services being designed and delivered around the needs of children and families.
1he "hildren;s NS: is aimed at everyone who comes into contact with& or delivers
services to children& young people or pregnant women.
INTERVIEW TI*"
)0 #re$interview visit or telephone call /minimum0
+0 1alk to present post$holder& consultant if possible
,0 !e$read your "</=now your "< well0
-0 Study the 2ob description>person specification
.0 #repare common questions and answers
?0 "onsider @mockA interview
B0 6ress Smart
C0 Dake sure you reach on time. 'f delayed $ please inform them /won7t go
down well Eunless it is not your fault0
F0 Have a smile on your face. !emember E everyone wants that 2ob and
everyone will be nervous
)90 Dake appropriate eye contact eye contact.
))0 6on7t waffle& speak clearly.
)+0 6on7t go on talking or speak in one or two words.
),0 Answer the question E no use beating round the bush
)-0 Never praise yourself too much E ' am hard working& sincereGGGG and
so on. #raise the department or others and you try to be a part of that.
).0 1ry to be animated and enthusiastic.
)?0 3isten carefully5 check if necessary.
)B0 #ause briefly to structure your reply5 keep to the point.
)C0 mphasise strengths. 4e honest but positive about weaknesses.
)F0 #repare a maximum of two questions to ask /preferably education>skills
related0.
+90 Smile and thank the panel H
+)0 4e clear how>when a decision will be available.
++0 Ibtain feedback
"A,*LE 1UE"TION"
Ta+e me throgh !or CV
What are !or strengths?
What are !or %ea+ness?
Wh! do !o %ant this (o&?
Jesterday ' visited this department& spoke to your SHI 6rGGG He told me
that this is a good department& with good teaching and they mentioned that the
2unior doctors are well supported and there are good opportunities for learning
and training.
' feel ' fit in very well in this department and given an opportunity ' would like
to be a part of that team and do a good 2ob.
Wh! shold %e give this (o& to !o?
1hough there are several well qualified doctors attending for the interview& '
believe ' hold an advantage over them as*
' am aware of the importance of teamwork am consider myself a team player.
' am aware of my limitations and do not hesitate to seek help in times of need
and consider myself a safe doctor.
Apart from competency in clinical procedures& ' am also very enthusiastic about
audit& research& teaching and other academic activities.
What %old !o &ring to the (o& and the de'artment?
What do !o e2'ect #rom the (o& and s?
What have !o learnt so #ar?
Tell me ho% !o co'e %ith the stress?
' regularly practice yoga and breathing techniques which help me stay relaxed.
Tell me a&ot a case !o have managed %hich !o remem&er %ell and tell s
%h! and %hat !o have learnt #rom it3
$o% %old !o deal %ith a clinical incident?
1he main principles are*
nsuring the safety of the patient
:illing a critical incident form.
6ocumenting the events exactly with timing.
'nforming the consultant> registrar on call about the incident.
Daking sure that such similar incidents do not happen in the future.
*ersonal 1estions
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(hat are your strengths and weaknesses%
6o you have any criticisms of yourself%
How would your best friend describe you%
1ell me about your career prior to this time%
(hat are you proud of about your career so far%

(here do you see yourself in . years7 time%

(hy did you go into surgery%
Are there any aspects you don7t like%
(hat do you have to offer us%
(hen would you be able to 2oin us%
6o you think that every trainee should undertake to do a period of non$surgical
training eg. '1K%
6o you think you should be appraised by I6As>nurses>midwives etc%
How should we measure the progress of trainees and consultants%
How do you keep yourself up to date in your practice%
6iscuss a paper you have written.
(hy do you think you7re ready for an Sp! rotation%
(hy should we offer you the post in front of the other candidates%
(hat do you want from the Sp! rotation%
(hat are your interests outside of medicine%
How would you balance extra$curricular activities with being an Sp!%
(hat experiences outside medicine have you found useful in your medical career%
(hat sort of hospital would you rather work in and why%
(hat will your previous employers remember you the most for%

(hat does being a professional mean to you%
CV 9 career 'lans
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(hat are your career plans%
6o you feel you have any gaps in your "<>training>other things you would have
liked to have done%
How can you improve your ".<.%
6o you think it7s important to keep a logbook and if so& why%
(hy haven7t you done part ) D!"s etc in your previous posts%
'f a cardiothoracic Sp! wants to change his sub$speciality to colorectal surgery&
how can it be done%
How can we tell from your ".<. that you have initiative%
How did you go about preparing for your D!"S exam% (hat resources did you
use% (hat help did you seek from others%
(hat advice would you give to a colleague sitting D!"S%
Adit 9 Research
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(hat is audit%
(hat makes a good audit%
(hy do audit pro2ests fail%
(hat is the difference between research and audit%
1ell me about your audit ... do you have any experience in audit%
How did you go about your audit pro2ect%
(hat changes did your audit result in%
(hat were the outcomes& if any& and did you close the audit loop%
6o you think everyone should do audit%
Live an example of a good audit in your hospital which has changed the
practice%
(hat National Audits do you know of% (hich ones have led to better patient
care%
(hat is research% (hy is it important% 'f you have not carried out any research&
why not%
6o you think that every trainee should undertake research%
6o you have any experience in research%
(hat do you think about research%
How do you go about setting up a research pro2ect%
(hat role do academic surgical departments play% (hy are they important%
6o you think everyone should do research% 'f not why not% 'f yes& why%
(hat do you know about government targets and deadlines.
(hy have you written so little%
Training
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(hat7s the worst>best case you have managed%
(hat is the most interesting case you have seen%
Has any recent incident in your practice made you change the way you
practice%
(hat do you think of competency based training% (hat are the pros and cons
of this training method%
How do you continue to improve your knowledge throughout training%
(hat is "D6%
How can consultants and trainees do their "D6%
(hat is the most useful course you have been on and why%
Have you used e$learning%
How do you aquire paediatric skills and maintain them%
Have you done any A3S>A13S>A#3S courses etc%
6o you think that every trainee should undertake an A3S>A13S>"!'S#
course%
(hat is the difference between an assessment and an appraisal%
(ho is the main beneficiary from appraisal%
How do you think the changes in service provision /eg independent sector
treatment centres0 will affect surgical training%
(hat do you think of #D14% 's there still a role for #art ''' :!"S%
(hat do you think about a uropean Subspeciality xit xam
Teaching
+9>9B>+99?
6o you have any teaching experience%
How do you teach%
6iscuss some teaching you have done recently and what teaching method was
involved%
How would you teach an SHIs to perform a laparoscopic appendicectomy%

(hat methods of teaching do you know% 6iscuss you teaching commitments and
the courses you run.

6iscuss any new teaching methods that you are aware of.
How would you go about teaching SHIs to manage a bad news interview%
(hat is competency% How would you assess an SHI7s competency in the
management of impending multiorgan failure%
f you found that an SHI was not competent& how would you handle this% (hat
if this SHI was due to go onto the on$call rota that weekend%
(hat would you teach a group of AM SHIs in ,9 minutes%
,anagement
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6o you think there should be protocols set down for calling in your "onsultant%
(hen did you last call your "onsultant in& and what for%
(hat7s the difference between a protocol and a guideline%
(hat do you think about management issues% 6o you think its something we
should all he getting involved in as clinicians%
(hat is clinical effectiveness%
How would one develope a new service eg.& laparoscopic colorectal surgery&
colonic stents%
How would you fund this%
(hat are the different grades of evidence.
(hat is evidence$based medicine% "ite a good surgical example.
(hat level of evidence would change your practice% 6escribe one or two recent
studies that have provided you with evidence to change your practice. (hat are
the dangers of evidence based medicine %
(hat7s the difference between assessment and appraisal%
How do you measure performance within a department>directorate%
(hat7s the difference between a teaching hospital and a 6LH%
How do you deal with a difficult colleague% >(hat do you do if you7re having a
dispute with another colleague>ward sister etc.
(hat do you understand by clinical governance
(ho implements clinical governance%
How does clinical governance affect your everyday practice%
How is a complaint handled%
6oes the LD" have a future%
6iscuss shift work and its effects on training and service provision
(hat would you do if a team member is not doing a good 2ob%
(hat is meant by a team%
(hat are the qualities of a leader% 6oes a team need a leader%
(hat makes a good team or a bad team%
Live examples of teams that you are involved with at work.
Live example of good>bad team management.
Live examples of teamwork in the theatre environment%
(hat is team working% (hat makes good team player% Live examples of team
working inside and outside of medicine.
(hat would you do if you felt that a team member was not pulling their weight%
(hat do you do after clinical management of the incident%
A 2unior surgical SHI is performing an appendicectomy under your supervision.
Half way through you realise that he is not competent to do it. (hat would you
do%
How do you give informed consent% (hat methods of reinforcement do you use%
(hen do you get consent% 's this appropriate% /i.e. one hour before the list0
How would you deal with an SHI>Sp! who is not getting on with those around
him>her%
(hat is risk management% Live examples in surgery.
'f you were to be given the role of risk manager& how would you go about
reducing risks in surgery%
How do you manage risk in your practice%
(hat risk management strategies were you introduced to during your induction%
(hat is N'"%
6iscuss any recent N'" recommendations you are aware of. (hat are the
disadvantages of these recommendations%
How are management skills reflected in day to day surgical practice%
Jou are to break bad news to widow of a man who died a few minutes ago in
theatre after a !1A. How do you do it%
(hat advice would you /as an Sp!0 give to a new SHI with whom you are
doing a first weekend on$call%
1here is a fire in the hospital x$ray dept& what should be done to keep the
hospital functioning%
Should clinicians be involved in management decisions% 'f so& what role should
they play%
(hat effect will the (16 have on your training& and how should it
be managed%
(hat do you think of the (16 and its effect on the medical services in this
hospital%
(hat do you think of DD" and its implications on your surgical training%
Jou are asked by a manager to do a waiting list initiative I#6 clinic. How
would you handle this%
(hat do you think regarding multidisciplinary teams% Are they important%
(hat are the qualities of a good leader%
1ell me about a difficult scenario you have faced so far.
"an you give me an example of risk management.
General -estions
(hat is the difference between an SHI and Sp!%
(hat will be different about working as a sp! compared to now% /ie as an SHI0

(hat qualities make a good Sp!%
xplain to a group of sixth formers what a surgeon;s 2ob involves.
(hen you make a patient information leaflet using patient groups& do you think
they self$select and are therefore not necessarily unbiased% (hat level do you
pitch your information at% (hich side do you lean towards* explaining in very
simple terms or more detailed% How do you stop yourself from using medical
parlance%
(hat resources are needed for Sp! training%
(hat skills do you think you need as a consultant% How do you ensure you
acquire these skills%
(hat does the college tutor do% (hat are his>her roles%
(hat are the roles of the "ollege and the Associations /A"#L4'& AKL'S etc0%
(hat is the 6eanery and what is its role%

6iscuss the importance of computer skills. "an they be of useful in surgery%
(hat are your views on information technology and how it is going to affect us
as surgeons%
(hat do you think about having non$medical surgical assistants% (hat are the
advantages M disadvantages%
(hen do you think :oundation year trainees should chose their speciality% (hat
can we do to prevent them from dropping out of surgery%
(hy do trainees fail to complete their training%
(hat can we do to attract people to surgery%
How do you think a blame$free culture can be brought about in the NHS%
1ell me about a paper you have read recently. (hat was the primary outcome%
(hat is the difference between the 2ournals "olorectal 6isease and the 48S%
'f ' gave you an unlimited amount of money and time& what would you change
about any of your previous posts %
What %as !or %orst night on call ?
Tell me something that !o have read recentl!3
't can be an interesting scientific article. Ir& if you are adventurous& use it to show
the breadth of your reading $ eg. controversy over foundation hospitals& ethics of
designer babies for treating genetic diseases& racism>sexism in NHS etc. 4ut be
warned& you should have sufficient maturity and knowledge to handle the latter
topicsH0
$o% %ill !o measre !or sccess at the end o# a !ear?
What di##erences have !o o&served &et%een the 'ractice o# medicine in !or
contr! and here in the U:?
Tell me a&ot one thing that !o %ill ta+e &ac+ to !or home contr! a#ter
the training here in the U:3
Tell me a&ot an adit !o have done and %hat have !o learnt
.
What did !o learn #rom !or last (o&? 6 What one lesson did !o learn in
!or 'revios (o&?
What is the most interesting (o& !o have done and Wh!?
Intervie% 1estions
A ; General &ac+grond6CV6A''lication 0orm
). 1ell me about yourself
+. 1alk us through your "<>Application form
,. 1ell us about your background
-. (hat is exceptional about your "<%
.. (hat part of your "< are you most proud of%
?. (hy is there no separate "linical Lovernance section in your "<%
) ; *ersonal -alities< motivation 9 drive
B. (hat made you go into Dedicine%
C. (hat is your career ambition%
F. (here do you see yourself in .>)9 years7 time%
)9. 'f you were to start your career again& what would you change%
)). (hy do you want to do this speciality%
)+. (hat do you like about this speciality and what do you dislike%
),. How would you dissuade somebody from entering this speciality%
)-. (hat are the challenges facing this speciality over the next ten years%
).. How do you know you are making the right career choice%
)?. (hat have you done to prepare yourself for a career in your speciality%
)B. (hy do you want to 2oin our 1rust%
)C. (hy do you want to train in this region%
)F. (hat do you have to offer us%
+9. Live us three ad2ectives that describe you best.
+). (hat would your friends say about you%
++. (hat kind of feedback would ' obtain from your patients if ' asked them%
+,. (hat would you like written in your obituary%
+-. (hat are your main strengths%
+.. (hat is your main weakness%
+?. (hat skills have you gained that will make you a good doctor>SHI>Sp!>"onsultant%
+B. (hat are the qualities of a good doctor>SHI>Sp!>"onsultant%
+C. (hat is the difference between an Sp! and an SHI%
+F. Name two skills that you would like to improve over the next two years.
,9. (hat skills do you need to develop most%
,). (hat 2ob have you particularly liked>disliked%
,+. How do you measure success%
,,. (ould you be happy being an average SHI>Sp!>"onsultant%
,-. (ould you like to become a "linical 6irector%
,.. (hat should we recruit you rather than any other candidate%
,?. (hat have you done that is different to anyone else%
,B. (hat makes you a good candidate for the 2ob%
,C. Having trained under the "alman system& do you feel prepared%
,F. How would your consultant>seniors motivate you%
-9. (hat concerns you about this 2ob%
-). (hat do you think will be your biggest challenge in this post%
-+. (hat are you hoping to gain from this post%
-,. 1ell us about your best consultant>colleague.
--. 1ell us about your worst consultant>colleague.
-.. (hat are your hobbies% How do they influence your medical practice%
-?. (hat experiences outside medicine have you found useful in your medical career
-B. (hat sort of hospital would you rather work in and why%
-C. How would you balance extra$curricular activities with being an Sp!%
C ; Commnication< Team *la!ing< Leadershi'< "tress 9 Con#lict Resoltion
-F. How would you rate your communication skills%
.9. Live us an example of a situation where your communication skills made a difference to the care
of a patient.
.). Live us an example of a situation where you failed to communicate appropriately.
.+. (hat skills have you acquired that make you a good communicator%
.,. How can you improve your communication skills as a leader%
.-. (hat are the attributes of a good team player%
... 6o you work better as part of a team or on your own%
.?. Live us a recent example of a time where you worked a member of an D61.
.B. (hat makes a good leader%
.C. (hat does leading by example mean to you%
.F. (hat makes a good team%
?9. (hat leadership skills have you acquired during your training%
?). (hat is the difference between a manager and a leader%
?+. 1ell us about your experience of managing a team of people.
?,. (hat is the difference between people management and leadership%
?-. How would you motivate others%
?.. 6escribe a situation where you had to give negative feedback to somebody.
??. 1ell us about a situation where you had to bring a difficult person on board.
?B. 1ell us about a situation where you showed leadership.
?C. 1ell us about a situation where you showed initiative.
?F. (hat makes you angry%
B9. 6o you ever lose your temper%
B). Have you ever been in a situation where you have had a conflict with a colleague%
B+. Live an example of a situation where your work was criticised.
B,. How would you cope with criticism or a complaint being made against you%
B-. (hat is your approach to resolving conflict%
B.. How would you handle a non$performing 2unior colleague%
B?. Ine of your SHIs says he is getting bored in his 2ob. How do you respond%
BB. How would you handle a situation where you had a disagreement with a nurse over the
management of a patient%
BC. (hat would you do if a patient disagreed with your treatment approach%
BF. How do you handle stress%
C9. How do you normally cope with pressure%
C). How do you recognise when you are stressed%
C+. (hat difficult decisions have you made in a clinical setting%
C,. (hen you make a patient information leaflet using patient groups& do you think they self$select
and are therefore not necessarily unbiased% (hat level do you pitch your information at% (hich side do
you lean towards* explaining in very simple terms or more detailed% How do you stop yourself from
using medical parlance%
D ; Research 9 Adit
C-. 1ell me about your research experience.
C.. 1ell me about your research. Assume that you are talking to a group of charity workers from your
funding organisation.
C?. How much of your research is your own design and how much was guided by your supervisor%
CB. How did you organise your research pro2ect% 6id you supervisor write your grant application%
CC. ' am worried about your lack of research experience.
CF. (hy is !esearch important%
F9. How do you go about setting up a !esearch pro2ect%
F). (hen doing !esearch& what is the one most important factor to get right%
F+. 6o you think all Sp!s should do !esearch%
F,. (ould you like to participate in !esearch if you were appointed%
F-. Should all !esearch be carried in tertiary centres or do 6LHs have a role%
F.. (hat is vidence 4ased Dedicine%
F?. (hat are the pros and cons of vidence 4ased #ractice%
FB. (hat is your understanding of the term N!esearch LovernanceN
FC. (hat are the different levels of vidence available%
FF. 6o you think vidence 4ased Dedicine is applicable to all specialities%
)99. (hat is an audit%
)9). 1ell me about your Audit experience.
)9+. (hat is the difference between Audit M !esearch%
)9,. 1ell me about the Audit cycle.
)9-. (hat problems are there with the way SHI
D ; Teaching6Training6Learning6:ee'ing ' to date6"ee+ing $el'
)9.. 1ell us about your teaching experience.
)9?. (hat methods of teaching do you know. (hich do you prefer and why%
)9B. Jou are given a group of six SHIs to teach in a week7s time on a sub2ect to be chosen by
you. How do you go about preparing for it%
)9C. (hat would you teach a group of 2unior SHIs in ,9 minutes%
)9F. How would you convince a 2unior colleague of the importance of teaching%
))9. Live me an example of a situation where you recognised that a member of your team had
a deficiency>difficulty.
))). (hat is #roblem 4ased 3earning% (hat are its pros and cons%
))+. How do you know what you don7t know%
)),. 1ell me about a memorable case where you have learnt something new
))-. How would you ensure that your team is up to scratch%
)).. How do you assess surgical competence in a trainee%
))?. 6o !egistrars have a role in teaching SHIs%
))B. (ith the introduction of the uropean (orking 1ime 6irective and the reduction in the
number of hours leading to ""1& do you feel you will be fully trained by the end of your !egistar post%
))C. (hat measures do you take to improve your training%
))F. How do you identify your training needs%
)+9. (hat do you get out of teaching others%
)+). (hat is the most interesting case you have managed%
)++. (hen did you last call your consultant%
)+,. (hat is the biggest mistake that you have made in a clinical setting%
)+-. How do you keep your skills up to date%
)+.. How did you keep your skills up to date during you research>career break%
)+?. (hat do you think about consultants referring to other consultants%
E ; Ethical Isses 9 Di##iclt Wor+ "cenarios
)+B. How would you handle a problem doctor $ for example if you suspected that your
consultant had a drink problem%
)+C. How would you react if one of your 2unior colleagues turned up drunk on the ward first
thing in the morning% (hat if it was your consultant%
)+F. A patient mentions to you that on two occasions they have smelt alcohol on your
consultant7s breath during clinic in the past few weeks. (hat do you do%
),9. How would you react if one of your female 2unior colleagues refused to treat a patient
who is a known rapist%
),). How would you react if a patient refused to be treated by one of your 2unior doctors
because he is foreign%
),+. Jou see a patient verbally abuse a nurse. (hat is your response%
),,. Ine of you peers arrives constantly late for work in the morning. (hat do you do%
),-. Ine of your 2unior colleagues is placing patients at risk. How do you react%
),.. Jour consultant does something that goes against protocol. How you do you tackle it%
How would you approach the consultant%
),?. Jour consultant does not provide adequate training and adopts a condescending attitude
towards you because of your apparent lack of knowledge. How do you react%
),B. Jour SHI mentions that another SHI is complaining about the fact that their consultant
does not provide adequate teaching. How do you respond%
),C. A patient mentions that& during an examination& one of your colleagues examined her
breasts. Although the patient is not aware that such behaviour was inappropriate in that context& you
are. How do you respond%
),F. Jou observe your consultant making inappropriate sexual remarks to one of your
patients. 1here are no other witnesses and the consultant is not aware that you were there. How do you
react%
)-9. Jour consultant mentions something to a patient& that you believe to be wrong. How do
you react%
)-). Jou have heard rumours that one of your colleagues is taking drugs. Jou also know that
some drugs have disappeared from the cabinet. How do you react%
)-+. Ine of your colleague seems to be suffering from stress. (hat do you do%
)-,. Jou have suspicions that one of your peers has been stealing an important amount of hospital
property /including stationary and needles0. (hat do you do%
E ; Clinical Governance and Other N$" Isses
)--. (hat do you know about "linical Lovernance%
)-.. How does "linical Lovernance affect patient safety%
)-?. How does "linical Lovernance impact on your daily work%
)-B. 6o you think "linical Lovernance is useful or is it 2ust another layer of bureaucracy%
)-C. Are there any problems with the way "linical Lovernance is implemented%
)-F. (ho& in your Hospital& is responsible for "linical Lovernance%
).9. (hat is "linical !isk Danagement%
).). (hat is a Near$Diss situation%
).+. (hat happens to "ritical 'ncidents :orms once they have been submitted%
).,. Jou are working as a consultant and you are recommending that one of your patient
should be given a particular treatment based on the best evidence available. Hospital managers inform
you that this treatment cannot be given as it is too costly. (hat do you do then% How would you
inform the patient% (hat if the course of action you recommended was actually contained in a N'"
guideline%
).-. (hat is N'"% (hat do they do%
)... 1ell us about a N'" guideline relating to your speciality.
).?. (hat is the National #atient Safety Agency%
).B. (hat do you know about the uropean (orking 1ime 6irective% (hat are its effects on
the medical profession in the K=%
).C. (hat is NHospital at NightN%
).F. (hat do you know about the Dodernisation of Dedical "areers%
)?9. (hat is the #D14%
)?). 1ell me what you know about :oundation #rograms% 6o you think this new training
structure will be successful%
)?+. (hen do you think :oundation year trainees should chose their speciality%
)?,. (hat can you tell me about appraisals%
)?-. 6o you feel appraisals are a useful process%
)?.. Some people think that appraisals are a waste of time and 2ust a paperwork>box$ticking
exercise. (hat do you think%
)??. How do you prepare for your own appraisal%
)?B. How would you prepare yourself to appraise one of your 2unior colleagues%
)?C. (hat do you know about !evalidation and Assessment%
)?F. 6o you feel !evalidation M Assessment will resolve the issues they are meant to
address%
)B9. (hat is the difference between Assessment and Appraisal%
)B). (ho is the main beneficiary in an Appraisal%
)B+. How can we persuade the public that doctors can be trusted%
)B,. 's the expanding role of nurses a benefit or a danger to the medical profession%
)B-. (hat is the role of the deanery%
)B.. How do you think a blame$free culture can be brought about in the NHS%
)B?. (hy do trainees fail to complete their training%
)BB. (hat is the difference between a protocol and a guideline%
)BC. (hat do you think about management issues% 6o you think its something we should he
getting involved in as clinicians%
)BF. How do you seek informed consent for the procedures that you do%
A""E"",ENT< A**RAI"AL 9 REVALIDATION
What do !o thin+ o# assessment and a''raisal?
O ' think that this is essential to enable both doctors and patients to see that there are mechanisms by which good
practice is acknowledged by peers and ultimately revalidation& and bad practice is identified and then addressed.
O 't will probably be similar to the annual appraisal that has been happening over the last ? years of my Sp!
training.
Di##erence &et%een Assessment and A''raisal=
1he difference between Assessment and Appraisal has been summarised thus* N1icking boxes set by othersN
/Assessment0 and N1icking boxes that ' have helped to set myselfN /Appraisal0
1he purpose behind appraisal for Dedical Staff under training is to set goals for training. 'n this context& it is
inevitable that career options will be discussed.
A''raisal 0rame%or+= )OGERD
> )ac+grond ? discuss "< and long and short$term goals.
> O''ortnit! ; departmental timetable and departmental protocols.
> Goals ; 1his is the essential part of any appraisal process. 1he goals should be simple and attainable.
> Evalation ; Having set the goals it is important to think about how to establish whether the goals have been
achieved. 'f they have not been reached& the evaluation process will help to establish why they have not been
successfully attained.
> Resce ; Dost people7s experience of life is that if a goal is not achieved& it has a negative effect on further efforts.
"onsider mechanisms for ensuring that these or alternative goals are achieved.
> Deal ? A commitment to achieving goals.
Revalidation
!evalidation is a process whereby doctors will have to demonstrate regularity to the LD" that they are fit to
practice medicine. 6octors who are successful will be granted licence to practice.
LD";s #3ANS :I! !<A3'6A1'IN
). Alter the Dedical Act& allowing the council to draw up registers from Spring +99+
+. "ommunicate with doctors to ensure they understand what will be expected of them
,. Assess fitness to practise by getting doctors to compile information folders
-. Assess a first wave of doctors in +99- based on two years; evidence
.. 6octors holding LD" registration numbers with a penultimate digit ) or ? will form the second wave the
following year& and so on
?. All doctors will be required to demonstrate their fitness to practise every five years
'n the current climate& hospital consultants are feeling the heat more than ever before. :ollowing the 4ristol 'nquiry.
1he Lovernment is determined to ensure patient safety by creating an array of bodies and processes to monitor
performance. 1he "ommission for Health 'mprovement& the National "linical Assessment Authority& the emerging
National Standards Agency and annual appraisals all place doctors working practices under intense scrutiny.
In top of these checks comes revalidation& which from +99- will require all doctors to produce evidence that they
remain fit to practise in their chosen fields. !esults from pilots carried out to date reveal most doctors support the
principle that their skills should be assessed every five years.
Im'ortant -estions
4ut the imminent advent of revalidation raises a number of important questions for hospital consultants. (ill it
expose weak points in a doctor;s range of skills& requiring hours of extra training they will have to make time for% 'f
so& who is going to provide the training and who will pay for it%
Dr Stephen 4rearley. consultant vascular surgeon at (hipps "ross Hospital. 3eytonstone. east 3ondon& believes
revalidation will be a culture shock for some consultants in particular those who have not kept up to speed with tech$
nological advancements. Dr 4rearley says skills training is vital to ensure consultants do not Pslip through the net.
P!evalidation is hound to pick up on certain areas in which a surgeon needs extra training.; he says& 7' am strongly in
favour of revalidalion as a concept hut while FC per cent of doctors might pass. it behoves the 6epartment of Health
to think about those that don;t.; Dr 4rearley believes the
6oH should provide additional funds in the form of Pretraining bursaries to be made available for consultants
needing to refresh their skills. P1here is a serious shortage of doctors in the health service as it is& and we need to
think about interest$free or low $interest loans to ensure we don;t lose any more because they can;t afford to retrain.;
1he 6oH is investing Q+9m in continuing professional development for NHS staff this year. with a further Q?9m
spread over the following two years.
However& a 6oH spokesperson says he is unable to say precisely how much will be allocated towards retraining for
consultants. 4ut he is keen to emphasise Pdevelopment needs will be met;.
P#recisely how much& depends on the need&; he says. P(e are working with the LD". colleges and others to
improve "#6. !evalidation is not a big hurdle designed to catch out very many doctors $ it won;t. 't is there to
ensure the problem is picked up and then
Wh! did !o a''l! #or this (o&?
O 8ob which will allow me to practice knee surgery as a special interest
O "olleagues
O 3ocation
O 1eaching Ipportunities
O Ipportunity to develop a Shoulder M lbow service for the local community
$o% do !o manage stress?
O #revention
O #roactive organization of time M demands
O Service configuration
O !ecognition
O 'dentify that there is stress present. 's the stress good or bad%
O Danage the cause of the stress
O 'dentify the cause of the stress& and then try to recognize which components of the cause you can manage on
your own and which need help from colleagues>management.
O Danage the symptoms of the stress
O 6iscuss with colleagues& spouse& friends
O Have quality time away from work to recharge your batteries
O Have hobbies and interests which are important to you
O xercise
What do !o thin+ a&ot research?
O !esearch is fundamental to the progress of medical knowledge. 't is important that research is properly
allocated resources such as time and money& because if it is poorly resourced then @goodA research will be
difficult to perform.
O 't must be led by people that are interested in research& as this will enable pro2ects to be structured and
executed correctly.
O 1he process of research allows an individual to develop skills in critical appraisal& methodology and stats&
which consequently gives the individual greater abilities to assess research as it is published.
What are !or strengths and %ea+nesses3
O Strengths
o Lood communicator
o =een teacher
o Attention to detail
O (eaknesses
o 1rying to do too much& ' must keep realistic goals
o 1ake myself and my work too seriously
Ero'ean Wor+ing Time Directive
O August +99- .C hour max for resident doctors& B+ hour max for non$resident
O August +99B .? hour max
O August +99F -C hour max for all doctors
O 3ongest shift that we are currently allowed to do would be ), hours& but we may be able to negotiate
/derogation0 out of this as long as the total amount of hours worked remains legal.
O (ith respect to training it is not can you train an orthopaedic surgeon within the confines of the (16& but
how we can achieve it.
O !esident on$call is ruled as being at work& thus all hours count towards the working week
O Non$resident on$call is not counted as long as you are not working in any way.
Wh! did !o choose a DG$ over a teaching hos'ital? .or vice versa/

Teaching $os'ital DG$
Advantages=
o Kndergraduate
ducation
o asier access to
Kniversity services&
such as research
collaboration&
academic information
o asier to develop a
1ertiary referral
service
o Ksually smaller
and therefore
closer
relationships
with colleagues
etc.
o No academic
pressures
Disadvantages=
o #ossibly less
community
involvement
o !esearch pressures
o ducational
commitments slowing
clinical work
o 4ig and cold
o 3ess conducive
to sub$specialty
service
o Dore difficult to
develop research
facilities M
support
Dy clinical work will be basically the same& but can develop special interest more.
$o% are !o going to deal %ith an incom'etent colleage
O :irstly& Nact -ic+l! to 'rotect 'atients #rom ris+ if you have good reason to believe
you or a colleague my not be fit to practiceN. 1his places a clear professional responsibility
on each individual to take action where they have serious concerns.
O A first step would be to discss concerns in#ormall! %ith a senior colleage such as the
"linical 6irector& Dedical 6irector& "hairman of the Dedical Staff "ommittee& or a
colleague in the specialty from another hospital. 'n doing so& it may be helpful to consider
whether the use of locally available informal procedures /counselling services& N1hree (ise
DenN or equivalent0 would be appropriate. 1he local 4DA office is a possible source of
advice on the range of informal procedures in the locality. 6iscuss it with D6K.
O 1he ""S" believes however& that merely discussing the problem with a colleague does
not in itself discharge the responsibility defined by the LD". Inly if the doctor is fully
satisfied after any informal action that the problem no longer exists has that responsibility
been discharge.
O 'f doubt remains& the doctor7s duty must be to &ring the matter #ormall! to the attention
o# the Trst or other em'lo!er. Normally this would require an approach to the Dedical
6irector& though another person having a formal management role& such as the "linical
6irector or the "hief xecutive& would also be possible. An equivalent formal process would
similarly be necessary in the private sector& for example a reference to the independent
hospital7s Dedical Advisory "ommittee. 1he doctor should formally record that this step has
been taken& for example by means of a letter to the Dedical 6irector& /which need not
mention the name of the doctor concerned0
Wh! do !o %ant this (o&?
1hink carefully about this question. Stress the positive aspects which have attracted you to
applying for this position. 6o not mention the negative aspects of your current 2ob or the 2ob in
question.
What -alities do !o thin+ %ill &e re-ired #or this (o&?
1heir advertisement for the 2ob may help you a little bit& but you should also think of the other
qualities that may be required. 1hese may include leadership ability& supervisory skills&
communication skills& interpersonal skills& problem solving& analytical skills& etc.
What can !o contri&te?
1his is your chance to shine. 1ell them about your achievements in your previous position/s0
which are relevant to the new position you are applying for.
Wh! do !o %ant to %or+ #or this com'an!?
mphasize the positive reasons why you want to 2oin their company& but avoid aspects such as
more money or shorter hours. 1hese would not endear you to a prospective employer.
What do !o +no% a&ot this com'an!?
1his is your chance to impress the interviewer with your knowledge of their company. Live them
a run down of their products>services& sales figures& news& company figures& customers& etc.
What interests !o a&ot or 'rodct .or service/?
Again& your research into the company should aid you in answering this question.
What can %e .the ne% com'an!/ o##er that !or 'revios com'an! cannot o##er?
1read carefully hereH Again do not mention money. Stress opportunities for personal growth&
new challenges& etc.
@o have not done this sort o# (o& &e#ore3 $o% %ill
!o co'e6scceed?
Say that you are the sort of person who aims to succeed at everything you do and that you are
very determined and will do whatever it takes to get the 2ob done.
Wh! shold %e em'lo! !o?
1he answer to this question will be based on your previous experience and achievements which
relate to the company. At the end you could add that you think there is a good fit between you
and the 2ob& and do ask the interviewer for their opinion.
$o% long do !o thin+ it %old &e &e#ore !o %ere ma+ing a signi#icant contri&tion to the team6com'an!?
'f you think that you could contribute from day one then say so. 1hen turn the question round on
them and say how soon would they expect it.
$o% am&itios are !o? Wold !o com'ete #or m! (o&?
6epending on the position you are applying for you may want to sound fairly ambitious& but do
not look as if you are after the interviewer7s position.
What do !o li+e and disli+e a&ot the (o& %e are discssing?
3ikes* stress things such as a new challenge or the opportunity to bring fresh experience to the
company. 6islikes* 'mply there is nothing to dislike about the 2ob& which is why you are so
interested.
Wh! did !o choose a career in A?
4e positive about your reasons. 'f you have changed careers make a logical argument as to why
you did so.
Wh! are !o changing careers?
1his question will only be asked if you are making a radical change in your career. Always stress
the positive aspects of the change rather than the negative aspects of your previous career $ you
do not want to come across as someone who is moving 2ust because you hate your old career.
Say why you think you will be good in the new career $ this should come from your experience
and achievements& stress the transferable skills you have& such as leadership ability& etc.
$o% mch does !or last (o& resem&le the one !o are a''l!ing #or? What are the di##erences?
1he interviewer is trying to see how well you would fit in to the position you are applying for. So
you should stress the similarities rather than the differences. (hen it comes to discussing the
differences it will help your case if you can show that either you have done something similar in
the past or that you can quickly pick up the new skills.
What do !o thin+ o# the last com'an! !o %or+ed #or?
Jou should stress the positive aspects of your last company saying that they were a good
company to work for. 1ell them about the training you received or the work related experience
you gained.
Wh! did !o (oin !or 'revios com'an!? Did the! live ' to !or e2'ectations? Wh! are !o leaving no%?
Always be positive about your reasons for 2oining and leaving a company. 4e very careful that
you do not say anything negative about your present employer. 'f you do& the new company will
wonder what you will say about them when you leave. Jou might want to stress that you are
looking for a new challenge and that you feel that the company who is interviewing you fits the
billH
E2'lain the organisational strctre in !or last com'an! and ho% !o #itted into it?
1his sort of question may be used to find out whether your old 2ob is at a comparable level to
your new 2ob. 'f the new 2ob being discussed would be a step up the ladder you will need to show
that you are ready for a more demanding position. Jou may be able to show that you have
already had many of the responsibilities and the necessary skills which would be required for the
next step.
$o% %old !o descri&e !orsel#? 6 $o% %old others descri&e !o?
#ick your best attributes and achievements from your career.
Do !o consider !orsel# sccess#l?
Jou should say you do. #ick some work related achievements that are in line with the position
that you are discussing.
What %as !or greatest sccess? $o% did !o achieve it?
Jou should pick an achievement which is related to their needs.
What has &een !or &iggest #ailre?
1ry to pick a failure which you were later able to correct or something that is not really
important.
$o% cold !o im'rove !orsel#?
6o not mention anything negative about yourself $ the interviewer is looking for a chink in your
armour.
Did !o #eel !o 'rogressed satis#actoril! in !or last (o&?
'f you progressed faster than normal you should say so. 'f growth was not as good as expected
then be careful how you phrase this.
Are !o a leader?
State how you have successfully acted as a leader& giving examples of your successes.
$o% do !o handle criticism?
Jour answer should be along the following lines* N' always think that it is important to get
feedback on how ' am performing so that ' can improve any areas which my manager>supervisor
highlights. 6o you have regular staff appraisals and a staff development plan%N
What sort o# manager are !o? 6 What ma+es a good manager?
Jou should say that it is someone who listens to other people and can delegate whilst
maintaining overall control of the task at hand& bringing in the pro2ect on time and to budget.
Lood planning skills are essential.
Do !o %or+ %ell %ith others? Or are !o a loner?
Some 2obs mean that you have to work very closely with other people whilst other 2obs mean
that you are largely working on your own& so you need to say that you are happy in both
situations.
Do !o need other 'eo'le arond to stimlate !o or are !o sel#;motivated?
Jou need to say that you are self$motivated.
Are !o acce'ted into a team -ic+l!?
Hopefully you can answer a resounding NJesN to this question.
Can !o act on !or o%n initiative?
Jou should say that you can. Jou could ask how much responsibility you would have.
What did !o earn in !or last (o&?
Jou have to be very careful when answering this question because once an interviewer knows
your current salary they will try and fix your next remuneration based on this figure. 1his may be
satisfactory if you only wanted a modest rise in salary and your current salary is in line with their
salary range& but& what if your current salary is substantially lower than the rate for the 2ob& or if
you want a substantial salary rise% 'n these cases you would be best advised to say that you do
not really want to pre2udice yourself by being too high or too low. Ask if you can discuss this
later after the responsibilities for the 2ob have been discussed5 you may also want to ask them
what the range for the 2ob is /if you do not already know0.
Do !o #eel !o are read! to ta+e on greater res'onsi&ilities?
Show how you have progressed throughout your life and how you have accepted and taken on
responsibility for the actions of yourself and others. 'f you have not really had many work related
responsibilities you can mention other responsibilities you have had outside work.
Questions to Ask the Interviewer
(hat will be my responsibilities%
(here will ' fit into the overall organisational structure%
(ho will ' report to%
(here does he>she fit in the structure%
(ho will report to me%
How experienced are they%
(hat do you expect me to do in the first ? months%
(hat level of performance do you expect from me%
(ho are your customers%
(here is the company going% Kpwards% xpansion plans%
(hat are the chances of advancement>promotion in this position% (hen%
(hat will be my salary& benefits and bonuses% R6o not bring this up too early in the interview $ wait until
they are sold on you.S
(ill travelling be required in this position%
(ill relocation be required now or in the future%
(hat training do you provide%
(hen will you decide on the appointment%
(hat is the next step%
.