Our online resources provide invaluable learning aids for your preparation for the Core Surgical Training interview. With short tutorials, model answers and an array of scenarios, this is your guide to self-preparation. We will be uploading further videos and scenarios each month to continue to give you new material as you prepare for the course. Feel free to submit suggestions for video tutorials and scenarios for us to help you
Example Management Scenario
You are the Urology SHO on call overnight and your patient has a testicular torsion. You have informed Urology registrar who has agreed the patient needs an operation. You believe that the registrar is not competent to perform this procedure unsupervised. What do you do?
Answer: The key issue here is patient safety. Any answer you give must have this key piece of information. Your patient needs an urgent operation and it is important that this happens as soon as possible. Your job is to make sure this happens safely. Doubts about this should be discussed with the registrar
Is there anyone else you can discuss this with overnight?
Answer: This is testing your knowledge of your “out of hours” support system. These include: Senior nurses, anaesthetic team, escalate if necessary – consultant
The registrar proceeds with the procedure and you are in the middle of the operation. You notice they are about to perform something unsafe, what do you do?
Answer: Again, patient safety is your primary concern. If you believe the operating surgeon is about to cause harm you must clearly and firmly ensure they stop. You then speak to your registrar and explain why you asked them to stop. Your patient remains anaesthetized and potentially compromised due to their diagnosis. You must speak to your anesthetist and, at this point, either ask your registrar to speak to the consultant or ask if you can descrub to discuss with them.
Your consultant comes in and completes the operation. Your registrar thanks you for your assistance and for preventing a complication. Over the next few weeks is there anything that you would like to do?
Answer: This is an opportunity for you to show your knowledge of how to act after an event has occurred. This is something that you should reflect on – informally with your Supervisor and formally on your ISCP/ Datix (if required). To prevent this happening in the future, it may be useful for you to perform an audit into what registrars feel comfortable with doing/ not doing overnight. Procedures highlighted as requiring improvement can be discussed in the audit meeting with teaching sessions arranged to bring all the registrars up to a required level.
Example Portfolio Question
Tell me about an audit you have done
Answer: “The audit I am most passionate about is…In this audit we performed a closed-loop audit that we presented locally/ regionally. What I learnt from this audit …” To answer these questions using our methods, please see the tutorial in our members area.
Example Clinical Question
You are the Surgical SHO on call. You are called to see a 28-year-old woman in the Emergency Department who has been referred with right iliac fossa pain and a temperature. How do you proceed?
Answer: It is important to assess this patient using the method discussed in the critically ill surgical patient tutorial. Your initial assessment will be ABCDE, as per the tutorial, and should be in the format to get as much information while you’re ticking the boxes. The observations are critical, knowing they have a temperature, its important to see if they are septic.”
What is your differential diagnosis?
Answer: This should be structured as per the “differential diagnosis tutorial”. Ruptured ectopic pregnancy, ruptured ectopic cyst, appendicitis, diverticulitis, infected ureteric calculi. Be sensible.
Are there any further investigations you would like for your patient?
Answer: This should be answered as per the “investigations” tutorial. The key is to split these into bedside and radiological. They should help exclude your differentials so you should say what you are looking for with each investigation. When you ask for the investigation, you should be prompted with what is relevant. Bedside investigations: Observations (already given), Bloods tests including full blood count (WCC 12 Hb 120), urea and electrolytes (NAD), CRP (250) and HCG (negative), ABG (Lactate 2.6), Urine dip (Nitrites ++, Blood, ++).
Radiological investigations: Chest X ray (no air under diaphragm), abdominal ultrasound (possible stone in the right ureter).
You believe this is an infected obstructed ureteric calculi. How would you definitively diagnose this?
Answer: CT KUB
How would this be definitively managed?
Answer: This is a bonus question. Although you should know the answer to the management of surgical emergencies, if you have reached this point it means you have appropriately initially managed and investigated this patient. This is one of the few Urological emergencies and it requires urgent intervention. As the on call SHO you should inform your senior (it is likely you will have done this earlier) and inform appropriate other specialties. This includes the anesthetist if it is managed operatively but also the interventional radiologist incase they require a nephrostomy. You should inform the theatre staff and ensure the patient is Nil by Mouth.
Your patient has a heart rate of 109, a blood pressure of 95/60, oxygen saturations of 97%, a respiratory rate of 25 and a temperature of 38.2. How would you proceed
Answer: This may have been assessed in your initial assessment. This patient is septic and should be resuscitated as per the Sepsis 6 protocol: Give oxygen, intravenous fluids, broad-spectrum intravenous antibiotics, Take: Blood pressure, lactate measurement, urine output.