New Ways of Interviewing

Over recent years there has been a significant move away from the traditional interview format for junior doctor appointments with the increasing use of either competency based interviews (also known as criteria-based interviewing, behavioural interviewing and situational interviews) or assessment centres. Both of these approaches are labour intensive but are felt to ensure a more objective, rather than subjective, approach to choosing the right candidate. Additionally, assessment centres give candidates an opportunity to reinvent themselves between ‘stations’ and a new set of assessors. Assessment centres also give those candidates who naturally struggle with the interview format more opportunities to shine, and for the assessment team to get to the underlying person in more ways. These two approaches are now being explored and utilized in some consultant interviews. Behavioural or competency-based interviews are often being done back-to-back with a traditional interview. Assessment centres are being used more and more for senior appointments, e.g. Medical Director posts, advertised externally. Finally, it is even possible today to find yourself subject to Objective Structured Clinical Examination (OSCE) in an interview situation. However, this is rare but may become more prominent as different colleges take differing approaches to exit exams and final CCT attainment. However, preparation for this, besides what has already been covered in preparing yourself, developing confidence, etc., is beyond the scope of this book. If you find yourself in the unusual position of undertaking an OSCE, then it must be considered in the same light as any other clinical exam, with preparation accordingly. It is likely that new techniques and combinations will be adopted in interviews, as the requirements of consultants evolve and so too do the methods of assessing them. It is important to always find out exactly what will happen to you so that you can be appropriately prepared. These are also known as criteria-based interviewing, behavioural interviewing and situational interviews. They are increasingly used in StR interviews and there have been some trials at consultant interview level.

Interview Preparation

This chapter focuses on the preparation you will need to go through to be successful at the consultant interview. Many candidates wrongly think that the key to interview success is to know about everything political that has ever happened to the NHS or their speciality. Unfortunately this belief sets them up to be unsuccessful. The key is to take time to learn as much about yourself as possible so that you can use every interview question as an opportunity to promote why you should be given the job. In this chapter we explore: • An appropriate preparation plan • Key sales techniques • Key rules for answering questions effectively • Key tips for answering specific types of question, e.g. the negative question or the opinion question The preparation needed for answering political questions is addressed in Chapter 9. Guidance on how to approach answering questions within the interview itself is addressed in Chapter 6, e.g. not understanding the question asked. It goes without saying that the purpose of the interview is for the interview committee to appoint the right person for the job. In general this will be the person who they feel: • Will most fit with the ethos of the team, service and Trust • Is a safe doctor • Will be both a leader and a team player • Will proactively develop the service • Will work collaboratively with Trust management However, not all interview committees want all of the above in all cases. For instance, although many Trusts are currently looking for proactive, business-focused goal achievers (because there is a shortage!), some may simply want a quiet, methodical clinical professional. At the pre-interview visit it is vitally important to get a sense of what the key players really do want so that at interview you can effectively promote the benefits you will bring to the post in that regard. It is equally true that not all panel members are the same. Many panels are made up of people with divergent requirements.

Understanding You and Your Interviewers

This chapter seeks to demystify the complex area of human behaviour and motivation in a manner that makes it not only accessible but also useful to someone facing an interview situation. Far from being filled with complex, interrelated behavioural constructs, we have simplified a genuinely complex area sufficiently to allow practical application in the form of conscious competence. A thorough understanding of what makes people tick is a significant competitive advantage in an interview. This section is in sufficient depth to give you the edge, but if you would like to understand more about behaviour, difference and influencing, then we’d strongly recommend attending a good course on the subject. It will benefit your interview and indeed the rest of your working life. . . . Can and should we consider ‘classifying’ individuals? . . . Some might consider that delving into human psychology in interviews represents a risky departure from the factual and predictable into a less ‘tangible’ field. We see it differently. An otherwise good candidate who ignores interpersonal difference at interview runs the risk of being inadvertently declined, not because he/she is not worthy of appointment but because he/she is simply a poor behavioural match to the decision makers. It is vital that we appreciate the decision to appoint is as much an emotional one as a logical one, however much we would like to kid ourselves otherwise. Interviewers hold a mandate to assess candidates for ‘fit’ to the department they will join. After all, you may well work with your new colleagues for many years and those years could seem long for everyone if the fit is not good. Fit is very much an emotional judgement, rather than an objectively detached one. Whereas many inputs will form the ultimate decision to appoint or not, likely fit with fellow department members will be an important consideration, with roots firmly in ‘gut feeling’ rather than rational assessment. What is important is that you adopt a simple and easily manageable framework for behaviour that allows you to adequately and smoothly adapt your approach with confidence.

If You Do Not Get the Job

If you do not get the job you are bound to feel disappointed, particularly if you have worked really hard in preparation. Remember, there can only be one appointment and it is possible you did everything right on the day and it sadly came down to something tiny. Interview panels can deliberate for hours, but the answer you get is still either ‘yes’ or ‘no’ and, if it’s the latter, it hurts. However, it is important to both learn from the experience through feedback and reflection and pick yourself up and start again, positively and proactively. This chapter looks at: • Getting effective feedback • Reflecting on that feedback • Common feedback • Picking yourself up and starting again You should always be offered feedback if you are unsuccessful at interview and it is really important that you accept this, despite how hurt you may feel in the aftermath. Indeed, if you are not offered feedback, always ask for it because it is an essential component of either improving next time or perhaps even not changing your approach at all. If someone else had a skill you just didn’t have, you can’t easily change that in short order and so if everything else was spot on, don’t break the formula! The best time to have feedback is some days after the event but close enough that you can remember what happened. Having feedback immediately after being told you were unsuccessful is likely to be less productive, as you are carrying the pain of rejection and normal defence mechanisms make it more likely that you will reject the feedback. Remember, feedback on a failure to be appointed is much like receiving bad news in medicine and, as we were taught in medical school, when given bad news most of us will not hear beyond those first few words, in our case ‘Sorry you have been unsuccessful’. By letting the dust settle and then approaching it with a mindset that says ‘This will help me learn, improve and be successful next time’, we can utilize the feedback to hone our approach to the next level.

Presentations in Interviews

It is increasingly common at consultant interviews to be asked to make a presentation. Presentations enable others to observe a variety of skills deemed necessary to be an effective consultant, including: • Clear communications skills • Teaching skills • Ability to confer potentially complex information in a clear and succinct way • Ability to engage, influence and persuade • Ability to organize your thoughts and to develop: • rapport • a cohesive argument • conclusions • Your ability to inspire others • Ability to remain calm and relaxed in a stressful situation It is important from the outset to understand that it is these attributes that are being examined, not the panel’s burning desire to increase their knowledge in your chosen subject. Consequently, the enabling question you need to ask yourself is not ‘What content would be interesting?’ but ‘How can I demonstrate the above attributes most successfully through the presentation I have been asked to give?’ This latter question should direct the content, style and approach you take. Presentations at consultant interview can take a variety of formats: • PowerPoint presentation to a larger audience prior to the interview • PowerPoint presentation to the interview panel immediately before the interview • Presentation without visual aids to the interview panel immediately before the interview • Rarely interviewees are given a short period of time (e.g. 30 minutes) to prepare a presentation, usually to the interview committee only, immediately prior to their interview The format does not alter the primary purpose—which is to assess those ‘consultant attributes or qualities’ that we mention above in the Introduction—but will affect how you go about your preparation and delivery. Topics are not always easy to predict but will often relate to something that is currently troubling the consultant body or Trust, i.e. is topical and relevant. Examples include: • With cuts to training numbers how would you ensure this department meets the EWTD requirements? • What will be the effects of the government White Paper on this service? • How can service x work more effectively across primary and secondary care?

Interview Candidates

In this chapter, we focus on the dynamic brought by different combinations of candidate, looking at three specific scenarios. Firstly, we look at the implications of there being an internal candidate, from the perspective of being both the internal candidate and the competing external candidate. We then examine the implications of being either the only candidate or a head-hunted candidate, two scenarios where it is easy to ‘undo’ being offered the job. There is no doubt that being an internal candidate can put you at a considerable advantage. Some of the interview committee may well: • Know your past, your good points and bad points and will be better able to judge your likely future contribution • Have already developed a relationship with you, including a sense of whether they feel comfortable working with you for the next 30 years However, this familiarity or perceived familiarity can also be the internal candidate’s downfall. It is not infrequent that we come across internal candidates who believe the job is in the bag and so fail to prepare or engage in the activity that ensures they are likely to be offered the job, e.g. undertaking pre-interview visits. Sometimes it is because they think it is embarrassing to do something like a pre-interview visit if they are already employed in the Trust and know the staff well. We also find internal candidates who are reluctant to really sell themselves at interview when already known, again out of embarrassment. The advice is clear—prepare as though you were an external candidate whilst making best use or advantage of your internal status. Take nothing for granted and ensure you do your homework as thoroughly as any good external candidate. When experiencing your efforts to prepare, your colleagues, far from thinking it is weird, are likely to view this as the sort of commitment they would want from a future colleague. Box 7.1 explores the internal candidate’s ‘must do’ list if you are to be successful.

Job Applications

This chapter deals with the application process. By the end, you should have a thorough understanding of: • The regulations that apply • How to apply • Critical considerations when applying • How to improve your chances of being short-listed • Key pitfalls to avoid All appointments to the role of consultant are governed by specific regulations at both a health service level and an employment law level. All potential employers must adhere to the rules and regulations existing under British law that relate to equality, diversity and discrimination. Additionally, NHS Trusts, Primary Care Trusts (PCTs) and other healthcare bodies employing clinical staff need to adhere to certain regulations that are healthcare specific, e.g. advertising widely and having a Royal College Representative on the interview panel. However, although many still comply with the spirit of the regulations, Foundation Trusts are not required to follow the same rules and this is increasingly apparent as the number of Trusts holding Foundation status increases. Often, their divergence includes dispensing with the Royal College Representative, atypical patterns of advertising and even not specifying a particular CCT. This is a trend that we believe will only increase as Trusts grapple with workforce redesign as a solution to increasing austerity. As the chapter unfolds, we will endeavour to raise critical considerations that need addressing regardless of whether it is a Foundation or non-Foundation Trust you are applying to. However, regardless of whether a Trust is currently Foundation or non-Foundation, it is likely that all Trusts will become Foundation Trusts over the next few years. Wherever feasible, we will include specific pointers on how to improve your application’s chances of success, i.e. getting you short-listed for the job you really want. . . . When can you apply? . . . It is a legal requirement to be on the GMC Specialist Register before taking up a consultant appointment. However, you are eligible to apply for a consultant post when the interview date is within 6 months of the expected date of your CCT (or recognized equivalent if outside the UK).

Getting the Job—What Next?

Congratulations. You were successful at your consultant interview and you are now looking forward to the next phase of your career. So what happens next? It’s easy to think of the journey as being essentially complete at this point, but we strongly advocate using this period—between acceptance and starting—productively to ensure that your interview success turns into a fulfilling consultant career. This chapter outlines some of the key things to consider during the period leading up to starting as a consultant and in those very first few days and weeks in your new post. The chapter starts by looking at some of the immediate considerations: • When should you resign? • When should you start? • Should you take a break? It then moves on to think about how you start to establish yourself in the first 90 days as a new consultant—probably the most important period you have to face yet! It is very tempting, having been offered a consultant post, to immediately resign your StR or SAS post—don’t! Your offer of a post no doubt came with some conditions. These might include: • Subject to references • Subject to a satisfactory health check • Subject to confirmation of your qualifications Until you have confirmation that all of the conditions have been satisfied, hold back from handing in your notice. We’re not being pessimistic and you are probably reasonably certain that everything will be fine, but until you actually hand in notice, you have full employment rights with your present employer, even if they know that you intend to leave. Until you have the security of employment confirmation without conditions, it is just safer to be cautious. Depending on factors such as the remaining length of your post, etc., it is usual to have to give 3 months’ notice if you are resigning from an StR or SAS post. If you are in a locum consultant position, check your contract and if necessary seek advice from Medical Staffing. Before deciding on your resignation date consider what this might mean for your starting date.

Specialty-Specific Interviews

This chapter is designed to provide a brief insight into the differences between specialties and how they approach the interview process. It should be read in conjunction with Chapters 4 and 6. The specialties covered are: • Anaesthesia • Emergency medicine • Medicine • Psychiatry • Obstetrics and gynaecology • Paediatrics and neonatal specialities • Pathology and laboratory-based specialities • Radiology • Surgery Each of these sections has been written by a guest author from within that specialty. Across the board, they are all experienced, senior clinicians with many years’ experience in interviewing for consultants. However, it is also important to remember that they are individuals and each individual has their own unique way of thinking too. We have done comparatively little editing and given relatively free rein to those individuals in deciding what’s important. Each was provided with the broad section titles for some consistency. The content is very much their own and we have left it largely untouched so that you may get a feeling for style, psychology and focus, accepting that they are also unique too. As a consequence, although the section structure is consistent, you will find a considerable variation in what authors have chosen to focus on. In each specialty, we have provided a perspective on the likely psychology of the individuals you may come across. This is written by us, not the guest authors, who we can’t expect to have sufficient understanding of psychological difference. However, what we have written must never be taken as gospel. There is no substitute for being a good detective and finding out exactly who is on your panel and exactly how they are wired as individuals. Dr Helga Becker, Consultant Anaesthetist, Dudley Group of Hospitals NHS Foundation Trust. In terms of number of consultants, anaesthetics is often the single largest department in a Trust and so the interview panel will not be particularly representative of the department as a whole. Besides the usual suspects like Chief Executive and Medical Director, the panel will probably have the Clinical Director and maybe another consultant from the department.

Interview Questions

This chapter outlines typical interview questions only. It does not tell you how to prepare yourself so you can answer these questions effectively or give you model answers. We strongly recommend, regardless of how late you have left your interview preparation, that you do not start by reading this chapter. Instead, start by working through Chapter 5. The questions in this chapter are best used to supplement the preparation you will undertake in Chapter 5. These questions are all real questions collected from previous interviewees. As such, you may think some are very similar in content, and indeed they are, but we have included them all to give you a feel for how different individuals word questions slightly differently. In Chapter 10, which looks at specialty-specific interviews, there are examples of specialty-specific general and ethical questions. All that said, if you decide to ignore the advice on where to start and go straight to question practice, remember these key points: • Practise your answers out loud (most of us waffle when we go through answers in our head) • Pause before answering the question and think about what you want to say, in particular how you will use this answer to promote yourself as the best candidate for the post • Divide your answer into three parts: • Start with a short, sharp answer during which you tell the panel what you are going to tell them • Back the answer up with your evidence and examples • Tell the panel what you have just told them and why it will benefit their organization • Spend no more than 2–3 minutes answering any one question • When asked for an opinion, recognize both sides of any debate/ discussion, but ultimately come off the fence with a distinct answer, backed up by sensible reasoning • Talk in the first person and in the present tense, i.e. use ‘I do’ rather then ‘We should’ • Tell me about your CV • Tell us about yourself • Describe your clinical training • Tell me about the gaps in your CV