How to Succeed in the Academic Clinical Interview [1st ed.] 9781108708715, 1108708714, 9781108849654

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Table of contents :
Cover......Page 1
Title......Page 4
Copyright......Page 5
Contents......Page 16
Preface......Page 18
Acknowledgements......Page 20
1 UK Academic Career Pathways......Page 22
2 Preparing to Apply......Page 35
3 The Application......Page 52
4 The Interview......Page 60
5 Practice Interviews......Page 114
Appendix 1: White Space Questions......Page 118
Appendix 2: Useful Resources......Page 124
Index......Page 125
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How to Succeed in the Academic Clinical Interview

How to Succeed in the Academic Clinical Interview Wei Keith Tan MBChB, BSc (Hons), MRCP (London) NIHR Academic Clinical Fellow in Gastroenterology and Hepatology Department of Gastroenterology, Addenbrookes Hospital University of Cambridge

Rory J. Piper MBChB, BMedSci (Hons), MRCS (Ed) NIHR Academic Clinical Fellow in Neurosurgery Department of Neurosurgery, John Radcliffe Hospital University of Oxford

University Printing House, Cambridge CB2 8BS, United Kingdom One Liberty Plaza, 20th Floor, New York, NY 10006, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia 314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre, New Delhi – 110025, India 79 Anson Road, #06–04/06, Singapore 079906 Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning, and research at the highest international levels of excellence. www.cambridge.org Information on this title: www.cambridge.org/9781108708715 DOI: 10.1017/9781108769891 Cambridge University Press © 2020 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2020 Printed in the United Kingdom by TJ International Ltd, Padstow Cornwall A catalogue record for this publication is available from the British Library. ISBN 978-1-108-70871-5 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. ....................................................................................................................................................... Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

How to Succeed in the Academic Clinical Interview

How to Succeed in the Academic Clinical Interview Wei Keith Tan MBChB, BSc (Hons), MRCP (London) NIHR Academic Clinical Fellow in Gastroenterology and Hepatology Department of Gastroenterology, Addenbrookes Hospital University of Cambridge

Rory J. Piper MBChB, BMedSci (Hons), MRCS (Ed) NIHR Academic Clinical Fellow in Neurosurgery Department of Neurosurgery, John Radcliffe Hospital University of Oxford

University Printing House, Cambridge CB2 8BS, United Kingdom One Liberty Plaza, 20th Floor, New York, NY 10006, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia 314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre, New Delhi – 110025, India 79 Anson Road, #06–04/06, Singapore 079906 Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning, and research at the highest international levels of excellence. www.cambridge.org Information on this title: www.cambridge.org/9781108708715 DOI: 10.1017/9781108769891 Cambridge University Press © 2020 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2020 Printed in the United Kingdom by TJ International Ltd, Padstow Cornwall A catalogue record for this publication is available from the British Library. ISBN 978-1-108-70871-5 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. ....................................................................................................................................................... Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

How to Succeed in the Academic Clinical Interview

How to Succeed in the Academic Clinical Interview Wei Keith Tan MBChB, BSc (Hons), MRCP (London) NIHR Academic Clinical Fellow in Gastroenterology and Hepatology Department of Gastroenterology, Addenbrookes Hospital University of Cambridge

Rory J. Piper MBChB, BMedSci (Hons), MRCS (Ed) NIHR Academic Clinical Fellow in Neurosurgery Department of Neurosurgery, John Radcliffe Hospital University of Oxford

University Printing House, Cambridge CB2 8BS, United Kingdom One Liberty Plaza, 20th Floor, New York, NY 10006, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia 314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre, New Delhi – 110025, India 79 Anson Road, #06–04/06, Singapore 079906 Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning, and research at the highest international levels of excellence. www.cambridge.org Information on this title: www.cambridge.org/9781108708715 DOI: 10.1017/9781108769891 Cambridge University Press © 2020 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2020 Printed in the United Kingdom by TJ International Ltd, Padstow Cornwall A catalogue record for this publication is available from the British Library. ISBN 978-1-108-70871-5 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. ....................................................................................................................................................... Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

To our families, who have supported us in every step of our careers

Contents Preface ix Acknowledgements xi

1 UK Academic Career Pathways 1 1.1 Academic Foundation Programme 1 1.2 Academic Clinical Fellowship 5 1.3 Academic Clinical Lectureship 9 1.4 Alternate Academic Pathways 12 2 Preparing to Apply 14 2.1 Choosing a Programme to Apply For 14 2.2 Building an Academic Portfolio 17 2.3 The Curriculum Vitae 28 2.4 Portfolio 30 3 The Application 31 3.1 The Online Portal 31 3.2 The White Space Questions 31 3.3 Publications 36 3.4 Presentations 36 3.5 Awards and Prizes 37 3.6 References 37 4 The Interview 39 4.1 Before the Interview 39 4.2 How to Answer Any Question 40 4.3 Structure of the ‘Generic Academic Interview’ 42 4.4 Career and Portfolio Questions 44 4.4.1 Tell Me About Yourself 44 4.4.2 Why Do You Want to Pursue This Specialty? 46 4.4.3 What is Your Greatest Achievement? 48

4.4.4 What is Your Greatest Strength? 49 4.4.5 What is Your Greatest Weakness? 50 4.4.6 Where Do You See Yourself in Ten Years’ Time? 51 4.4.7 Describe Your Teaching Experience 52 4.4.8 Describe Your Experience in Leadership 54 4.4.9 Describe an Example of When You Worked Well in a Team 55 4.5 Research Questions 56 4.5.1 Why Do You Want to Be an Academic Clinician? 56 4.5.2 Tell Us About Your Research Experience 57 4.5.3 Which of Your Research Projects Are You Most Proud of? 59 4.5.4 Why Do You Want to Apply for This Particular Academic Post? 61 4.5.5 What Steps Need to Be Taken Before Commencing a Research Study? 62 4.5.6 Whom Would You Do Your Academic Time with if You Were to Get This Academic Post? 64 4.5.7 What Are Your Long-term Research Goals? 66 4.5.8 How Do You Balance a Clinical and Academic Career? 67 vii

viii

Contents

4.5.9 How Do You Go About Getting Funding for Research? 68 4.5.10 Can You Tell Us About a Research Paper You Have Read Recently? 68 4.5.11 Critical Analysis of an Abstract or Paper 72 4.5.12 Should All Trainees Be Involved in Research? 72 4.5.13 What is Evidence-based Medicine? 74 4.5.14 Tell Me About the Different Levels of Evidence 75 4.6 Clinical Questions 77 4.6.1 How Would You Deal with [this particular clinical scenario]? 77 4.6.2 Can You Describe a Time When You or Your Team Made a Clinical Mistake? 80 4.6.3 What is Informed Consent? 81 4.6.4 What is Clinical Governance? 82 4.6.5 What is the Difference Between Audit and Research? 83

4.7

4.8 4.9 4.10

4.6.6 Describe Your Experience in Audit or Quality Improvement Projects 84 Miscellaneous Questions 86 4.7.1 If You Were Given a Blank Cheque What Would You Do with It? 86 4.7.2 Tell Me About a Person You Admire 87 4.7.3 Academic Ethical Scenario 89 4.7.4 Other Questions to Think About 90 How to Deal with the ‘Nasty’ Interviewer 90 Ending the Interview 91 After the Interview 92

5 Practice Interviews 93 Interview 1 93 Interview 2 93 Interview 3 94 Interview 4 95 Interview 5 95 Interview 6 95

Appendix 1: White Space Questions 97 Appendix 2: Useful Resources 100 Index 101

Preface A career in clinical academia offers doctors the opportunity to work at the bidirectional interface between the research frontier and treating patients. The opportunity to work from bench to bedside is an exciting and rewarding prospect that allows us to improve patient care. While it is an inspirational career choice, a career in academic medicine is a challenging one. One of the first challenges is securing a competitive position as a clinical academic and then retaining it. How to Succeed in the Academic Clinical Interview is intended as a compendium for applicants to academic clinical positions in the UK and is therefore aimed primarily at medical students, foundation doctors, and trainees. Through personal experience when applying for these positions, we noted a lack of resources surrounding the application process. Spurred on by the requests from medical students and trainees for advice on the academic application and interview, we have been led to the idea that we should incorporate our thoughts and experiences into the form of a book. The objectives of the book are: 1. To give guidance on the generic UK academic pathways and posts, including the Academic Foundation Programme (AFP), Academic Clinical Fellowship (ACF), and Academic Clinical Lectureship (ACL), and how applicants may wish to navigate their career path 2. To give guidance on how to build an academic portfolio 3. To give guidance on how to prepare the typical clinical academic application form 4. To give guidance on acing the clinical academic interview In this book we choose to act as a guide to the generic academic application and interview, rather than focusing on the AFP or the ACF (and so on) separately. The general principles and foundations covered here should also largely hold true for PhD and grant applications. Although there clearly is a difference in criteria required between posts, in our experience these applications and interviews follow a remarkably similar format and require a similar preparatory approach. After all, by preparing at an ACF standard, this can only make the possibility of success at the AFP level more promising. This book is used effectively when combined with (1) identifying a good mentor(s) and (2) speaking to many other established academic trainees. We wish to emphasise that the contents of this book are heavily influenced by our personal experiences and stress that the nature of the contents are at risk of subjectivity. As we have not applied and interviewed for every post in the country, the contents listed in the book do not reflect the interview structures of all deaneries, but may be biased towards deaneries to which we have applied. We therefore urge you to speak to as many clinical academics as possible to get wellrounded advice. The general principles, however, for preparing for the academic interview described here are the same and will hold true wherever you are. In this book we try to provide a high-quality answer to each question, and this naturally draws on examples of high-flying achievements and outcomes. Do not be discouraged if your curriculum vitae, application form, or interview answers are not at the standards seen in this book. Everyone (including us!) is different, and each of us has our stronger and ix

x

Preface

weaker elements. This book aims to maximise your chances of success by capitalising on your strengths and achievements. We are passionate about clinical research and hope that future generations will be too. We would like to emphasise that there should be no barriers in the way of keen junior doctors and medical students pursuing research. Equal opportunities should be provided for all. A recent survey of 1,625 medical students from 38 countries revealed that respondents thought that key barriers to pursuing research were lack of time as well as difficulty finding projects and mentors.1 We will spend time in this book discussing how these barriers, and others, can be overcome. Also, it was noted in the aforementioned study that female students (60 per cent of the cohort) were more likely to report barriers to research involvement. In this book, we use the feminine pronoun in the first half of the book, and the masculine pronoun in the second half, with the intention of (besides avoiding the passive tense) encouraging young clinical academics, both male and female. The building blocks of this book are inherited from the help, wisdom, and advice from our mentors and colleagues. We are indebted to those who have guided us and we hope to pass some of this knowledge and experience on to you. Lastly, we would greatly appreciate if you could send us your feedback on this book, as well as any new interview questions you encounter, to [email protected] so as to allow us to stay up to date with the current interview process and to update the contents in subsequent editions of this book. We wish you every success in your academic clinical career! Keith Tan Rory Piper 1

Funston G, Piper RJ, Connell C, et al. Medical student perceptions of research and research-orientated careers: An international questionnaire study. Med Teach 2016;38:1041–8. DOI: 10.3109/0142159X.2016.1150981.

Acknowledgements We thank Cambridge University Press for giving us the opportunity to publish our experiences and hopefully to help others pursue their academic clinical career. We thank Dr. Vian Azzu for writing the section on the Academic Clinical Lectureship. We thank the following academic clinicians for reviewing our book chapters: Medical Students: Soham Bandyopadhyay (University of Oxford) Sanskrithi Sravanam (University of Oxford) Susan Honeyman (University of Oxford) Academic Foundation Doctors: Saeed Kayhanian (Neurosciences, University of Cambridge) Hugo Layard Horsfall (Neurosciences, University of Cambridge) Michelle Law (Medicine, University of Cambridge) Mae-Yen Tan (Medicine, University of Cambridge) Academic Clinical Fellows: Mathew Vithayathil (Gastroenterology, Imperial College London) Gareth Matthews (Cardiology, University of Cambridge) Maria Prasinou (Nephrology, University of Cambridge)

xi

Chapter

UK Academic Career Pathways

1 The Walport Report in 2005 identified the need to improve the training and fostering of academic clinicians.1 To this purpose, an Integrated Academic Training Pathway (IATP) was designed – a model that has been adopted in various forms throughout the UK (Figure 1.1). More than a decade later, the Academic Foundation Programme (AFP), Academic Clinical Fellowship (ACF), and Academic Clinical Lectureship (ACL) posts remain fiercely competitive. The IATP proposes a step-based academic progression that is an accompaniment to clinical training rather than a string of academic interruptions. The academic components are built into the clinical training (hence ‘integrated’) model and thus avoid slowing clinical training down. The following situations are two exceptions to this principle: (a) a PhD is typically not built into training and trainees will have to apply for an ‘Out of Programme Research’ (‘OOPR’) status; and (b) some ACF posts (e.g. some of those offered in general practice) and ACL schemes will slow down (but not stop) the pace of training. The IATP is somewhat flexible. You can step on and off the academic pathway as per your needs without fear of being left out in the future. Also, there is no one academic post that is a prerequisite for another and you can still obtain higher posts regardless of whether or not you have held one of the earlier posts. In this chapter, we will discuss the various components of the IATP (the AFP, ACF, and ACL) as well as some other ways of pursuing an academic career.

1.1 Academic Foundation Programme 1.1.1 What Is the AFP? The AFP is a two-year training programme in the UK that offers academic training as an integral part of the clinical Foundation Programme (FP). This usually incorporates dedicated and protected time for the AFP doctor to conduct research or other academic activities. The AFP is an excellent opportunity towards building a career in academia, but it is by no means a prerequisite towards an academic career and there are many other opportunities in a standard FP to pursue academic work. Nor is the AFP a point of no return for those who

1

Medically and dentally qualified academic staff: Recommendations for training the researchers and educators of the future. Report of the Academic Careers Sub-Committee of Modernising Medical Careers and the UK Clinical Research Collaboration March 2005. Available from: www.ukcrc.org 1

2

UK Academic Career Pathways

Figure 1.1 The Integrated Academic Training Pathway (IATP) in England. The academic programmes available in Northern Ireland, Wales, and Scotland offer variations on this structure (see Section 1.4.1).

later decide not to pursue academic medicine. On the contrary, the AFP may offer those who are undecided a ‘taster’ opportunity in academia. There were 562 available AFP posts in the 2019 AFP round, which constituted approximately 8% of the total number of FP jobs in the UK. There was an overall applicant/job ratio of 4.94 and a post fill rate of 99%. A breakdown of the number of AFP jobs previously available in each deanery can be found in Table 1.1. AFP posts are usually supported by a partnership between the National Health Service (NHS) deanery and the respective affiliated university, allowing shared communication, supervision, and resources between the two. The allocated academic time for research varies across different deaneries; however, the most common programme structures are (Table 1.2): • One four-month research block during foundation year 2 (FY2) • One day release per week for a year (usually during FY2) • No protected time (e.g. in some programmes in Scotland) Although most AFP posts focus on research, some AFP programmes offer training in other ‘academic activities’, such as medical education or leadership and management. It is therefore critical to investigate each programme to gain a clear understanding of what you are signing up to, in terms of both the structure of the programme as well as its focus. Regardless of the programme structure and dedicated research time allotment, an important point to emphasise is that the AFP does not slow down your training and you will be expected to match the clinical competencies of those in the FP. Some of the notorious interview questions, which we will tackle later, are centred on this predicament.

1.1.2 Application Process In the most recent cycles, the AFP application has been made during the same application window as the standard FP (usually a two-week period) using the same portal (www .oriel.nhs.uk). Compared to the FP, the AFP application form requires additional evidence including academic achievements (e.g. publications, presentations, prizes, and degrees). The form also includes a separate section for ‘white space questions’ in which the questions vary between those of the different deaneries. The general process for FP and AFP applications is shown in Figure 1.2. AFP applicants have usually been allowed only to apply to a maximum of two ‘Academic Units of Application’ (AUoA, i.e. body that organises the AFP in each deanery). The AUoAs of each deanery to which you are applying will be blinded from each other.

1.1 Academic Foundation Programme

3

Table 1.1 Applicants and posts for the AFP per deanery (AUoA) for the 2018/2019 intake.

Deanery (AUoA)

Posts available

Applicants

Applicant/post ratio

East Anglia – Cambridge

24

170

7.1

East Anglia – Norfolk

12

25

2.1

East Midlands

48

129

2.7

Essex, Bedfordshire, and Hertfordshire

22

108

4.9

London and South East

124

832

6.7

North West of England

57

39

0.7

Northern

21

280

13.3

9

79

8.8

Oxford

24

228

9.5

Scotland

60

179

3.0

South West

25

177

7.1

Wales

12

53

4.4

Wessex

13

74

5.7

West Midlands

45

133

3.0

Yorkshire and Humber

66

272

4.1

562

2778

4.94

Northern Ireland

Total

AUoA, Academic Unit of Application. Source: Adapted from the UK Foundation Programme 2019: Recruitment Stats and Facts.

Figure 1.2 The general process for both the FP and AFP applications.

Once the application has been submitted, each AUoA will score the application separately according to its own internal shortlisting criteria and, if the candidate is shortlisted, the applicant will then be invited for a local interview. If applicants fail to meet the shortlisting requirement, they will automatically be enrolled back to the standard FP.

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UK Academic Career Pathways

Table 1.2 AFP job structure according to the AUoA

Deanery (AUoA)

Allocated and protected academic time

East Anglia (Cambridge)

FY2: 4 months

East Anglia (Norfolk and Norwich)

FY2: 4 months

East Midlands

Mixture of one-day release and 4-month research block across FY1 and FY2

North West

Varies depending on the hospital (FY1: 5-week block, FY2: 4 months or day release)

Northern

FY1 and FY2: 4 months in both FY1 and FY2 (new structure)

Oxford

FY1: one-day release, FY2: either 4-month block or split

Scotland

East: 4 months in FY2 South: no dedicated time West: no dedicated time North: no dedicated time

Severn

FY2: one day release or 4-month block

South West

FY2: 4-month block (with day release for the other 2 × 4-month block)

Thames

FY2: 4 months

Wales

FY2: 4 months

Wessex

FY2: 4 months

West Midlands

FY2: 4 months

Yorkshire and Humber

FY2: 4 months

AUoA, Academic Unit of Application. Source: Adapted from Ologunde R, Sismey G, Kelley T, et al. The UK Academic Foundation Programmes: Are the objectives being met? J R Coll Physicians Edinb 2018;48:54–61.

While there may be some variation in the timeline in the future, an example AFP timeline for 2019/2020 is shown in Table 1.3.

Do You Need to Sit the SJT if You Are Applying for the AFP? Yes! The job offer of an AFP is usually made after the SJT exams have taken place (but before the SJT results are released); therefore, at the time of the SJT exam, AFP applicants will not be aware of whether they have been appointed to an AFP job. Applicants should therefore strive to do well on the SJT, since those who are unsuccessful in their AFP application will be automatically ranked and allocated FP posts according to their SJT scores. If you have been awarded an AFP position, you will still need to score satisfactorily (i.e. pass a threshold mark, usually >30) on the SJT, but having a close-shave pass versus a high score on the SJT will usually have no bearing on the outcome of the AFP application. More information is available on the official FP/AFP website: www.foundationprogramme .nhs.uk

1.2 Academic Clinical Fellowship

5

Table 1.3 Timetable for Academic Foundation Programme application for the 2019/2020 intake

Timeline

AFP milestones

19 August 2019

AFP programmes available to view

23 September 2019

Open for registration

30 September 2019

Open for application

11 October 2019

Application deadline

14 October–6 December 2019

Local shortlisting and interviews

15 January–12 February 2020

AFP offers

1.2 Academic Clinical Fellowship 1.2.1 What Is the ACF? Following the AFP, the ACF is the next step on the IATP. Although having completed the AFP beforehand will most certainly be beneficial when submitting an ACF application, this is not a requirement and should not dissuade you from applying. ACF positions are highly competitive, as they guarantee an academic national training number (NTN[A]) in the desired specialty (i.e. run-through training). The ACF is a three-year (or four-year for general practice) programme that typically offers 25% protected research time alongside clinical training. In theory, this gives ACFs nine months of protected academic time over three years, but practically this may be spliced according to how the programme is managed locally. For example, some programmes offer three months per year for research and the remaining nine months for clinical training while other programmes may offer weekly academic protected time over a longer duration. In most deaneries, however, the distribution of time is flexible and can be customised or negotiated to suit your needs. As for the AFP, the ACF does not slow down the pace of clinical training (with the exception of the general practice ACF) and the same clinical competencies must be met within the duration of the post. The ACF is a clinical academic training post that was originally designed for candidates without a higher degree such as an MD or PhD. The intention was for ACFs to use their academic time to explore further academic interests, gain experience and research skills, and generate pilot data to prepare for a competitive PhD application. It is not mandatory to pursue a higher degree after the ACF. If an ACF finds that the academic path is not suited for her, she can always move back into the clinical training pathway (she does not typically need to reapply for clinical training because she already holds an NTN). Most ACFs will pursue a PhD after completion of the ACF programme, but this is flexible. Candidates with PhDs (including MBPhDs) are also eligible to apply for an ACF. For those who already have a PhD, the dedicated academic time in the ACF may be used to ensure there will be no large breaks in research activity and without having to extend clinical training. Most post- PhD ACFs will use the protected research time to generate more data to put forth an application for an ACL position. On the face of it, candidates with a PhD may seem to be at an advantage compared to candidates without a PhD because of their more extensive research experience. We would argue, however, that your research aptitude and

6

UK Academic Career Pathways

productivity will be weighed against how many research opportunities you have had. A prePhD candidate who has been productive without as much dedicated research time is equally impressive as a candidate who already holds a PhD. The ACF is run slightly differently between deaneries, but there will usually be an academic training school or organisation (e.g. Oxford University Clinical Academic Graduate School [OUCAGS] in Oxford, or Clinical Academic Training Office [CATO] in Cambridge) that supports the ACFs. Support may come in the form of designation of an ACF programme supervisor, a mentorship scheme, academic forums, or structured courses. ACFs are usually given a modest academic bursary, usually somewhere in the region of £1,000 per academic year. Some programmes allow ACFs to pursue a part-time master' s degree alongside the three-year ACF programme and often will provide some funding opportunities towards this degree (e.g. up to £2,000 for the Cambridge ACF and up to £4,500 for the Imperial ACF).

1.2.2 Application Process ACF positions are usually offered as three-year posts (or four years for general practice) and are usually offered at the CT1/ST1, CT2/ST2, or ST3 level. The ACF may be offered to a particular grade or may be open to a range of grades. Approximately 250–300 National Institute for Health Research (NIHR) ACF positions advertised each year in the UK,2 plus others from non-NIHR funding streams. The number of posts available in each region are somewhat dependent on funding and capacity within the host institution. While in any one region or year there may be some posts dedicated to a particular specialty, on other occasions the funding for a post may be open to competition between multiple specialties (e.g. one ACF position at IMT/ST 1 level for gastroenterology, nephrology, or cardiology). For an ACF post starting in August, the online application portal opens around October the year before, and similarly to the AFP, the application is usually opened for a few weeks. The application itself contains a series of matter-of-fact questions (e.g. personal details, qualifications, and prior employment), ‘white space questions’ and requires other ‘supporting information’. Unlike for the AFP, there are no restrictions in the number of ACF positions a candidate can apply for. Those seeking an ACF post will apply directly to a specific deanery. If shortlisted, they will then be invited to attend the ACF interview at that deanery. Applications have previously been made through the online platform (currently the Oriel platform; www.oriel.nhs.uk) and the submission portal usually becomes available in midOctober and closes around four weeks later. An important aspect to note is that, at least historically, under the ‘supporting information’ section of the ACF form, the applicant may be asked to choose whether she is applying for an: • •

2

ACF programme only or ACF and clinical programme

NIHR website: www.nihr.ac.uk/explore-nihr/academy-programmes/integrated-academictraining.htm

1.2 Academic Clinical Fellowship

7

Applicants who choose the ‘ACF programme only’ should already have their NTN (i.e. applying for ACF ST1 as an ST1 having already secured an NTN at ST1 e.g. obstetrics, paediatrics, GP or run-through surgical specialties or applying for an ACF ST3 having already secured an NTN at ST3 level) or be within their core medical or surgical posts. Applicants without an NTN (i.e. those applying for ACF ST1 as a FY2, or those applying for ACF ST3 as an IMT or CST), must choose the ‘ACF and clinical programme’ option, which involves applying for the ACF position, as well as the clinical (non-academic) training pathway. Applying to the ‘ACF and clinical programme’ is important, because, if a candidate is offered an ACF job, she will need to attend ‘clinical benchmarking’ (described in Section 1.2.3), but you are allowed to attend the benchmarking only if you apply to the ‘ACF and clinical programme’. It is important to note that if a candidate who requires ‘clinical benchmarking’ but applied to the ‘ACF programme only’, should she be shortlisted for the ACF interview, she will not be eligible to attend the interview. The following are examples of situations requiring either an ‘ACF and clinical programme’ or ‘ACF programme only’ (Note: Due to the recent introduction of the three-year IMT training in the year 2019/2020, it is not yet entirely clear if ACF positions will be offered at the IMT3 level. In prior years, ACF positions were available at both CMT1 and CMT2 level): •



Applying for an ACF IMT1/CST1/ST1 as an FY2: You will be required to apply to the ‘ACF and clinical programme’. Since you have not yet secured an IMT1/CST1/ST1 position. If you were to apply to the ‘ACF programme only’, should you be shortlisted for the ACF interview, you will not be eligible to attend the interview (bear this in mind, as this was an actual mistake made by an ACF candidate in 2019). Applying for an ACF IMT2/CST2/ST2 as an IMT1: You will be required just to apply for the ‘ACF programme only’, since you are already in training.

The ACF interviews usually take place between December and January, and offers are typically issued by the end of January. For those applying for an ACF during their AFP post, interview questions will likely focus on what you are doing with your AFP project. Since the ACF interview often takes place around December to January, only a third of candidates would have completed their four-month AFP block. We would argue, however, that there is no clear advantage of having already completed the four-month academic rotation prior to the ACF interview. On the contrary, for candidates who have already completed their research rotation, the pressure is on, since you will need to defend the good work you have just finished doing! If it turns out, however, that you have not generated much output from your academic rotation, then this can reflect badly on you. Candidates who have just started, or are yet to start their AFP rotation, need to have at least an outline of what they will be working on or have at least an idea of specific skills or techniques that they would like to acquire during their research block. Planning ahead and having an idea of what you want to do will reflect well on you. Candidates who miss out on the first round of offers may be placed on the reserve list, and subsequent offers will be given out one to two weeks later to those on the list depending on whether other candidates accept or reject their initial offers. So, do not give up even if you miss out on an offer during the initial period. If at first you are unsuccessful, be aware that there will be a second round of ACF positions available (depending on job uptake and funding distributed from the first round) and the advertisement will go out around mid-February or later. Be sure to look out for

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these jobs, as many applicants may not be aware of this second round of job advertisements, and competition may be less stiff than during the first round.

1.2.3 Clinical Benchmarking Candidates who are offered an ACF position will still need to reach a threshold mark at the national selection interview for the specialty that they are applying to, to be considered ‘appointable’. For training programmes that are already ‘run through’ (i.e. no further interview for ST3 once you get a number at ST1), the process is relatively straightforward. If you are applying for an ACF at ST1 level (i.e. you do not yet have an NTN) then you need to pass the clinical benchmark, but if you already have an NTN then you do not (your NTN will be converted to an NTN[A]). The process is a little more complex for the IMT and Core Surgical Training (CST) training programmes. Due to the recent introduction of the three-year IMT programme, which replaces the two-year CMT programme, the ACF IMT application is slightly more confusing. In this section, we try to describe the ACF IMT application to the best of our current understanding, although we appreciate that the IMT process is new and at the time of writing this book, many academic institutions are still in the process of figuring out how to accommodate the additional IMT3 year within the curriculum. In the following examples, we use ‘ST’ for specialist training (i.e. those with a run-through position which comes with a training number in your specialty) and IMT/CST for non-run-through jobs (i.e. without training number). The following are a few scenarios that illustrate this point: 1. Applying for an ACF ST1 from FY2 (or those without a training number, i.e. those taking a year out after FY2). For example, let us say you are an FY2 who applies for an ACF in gastroenterology at ST1. This post will come with a run-through NTN in gastroenterology. Note that this ‘run through’ NTN[A] in gastroenterology means that no further interview is required between IMT3 and ST4. If you were successful and were offered the ACF at ST1 level, the offer is conditional on your passing of the clinical benchmarking for IMT. This means you will still need to attend the ‘national selection interview for IMT’ and will be required to achieve a threshold pass mark to be deemed appointable. If you fail to reach this threshold then you will be deemed not appointable and you will not be allowed to take up the ACF position. For example, if you are applying for an ACF in Cambridge, but also applied for the usual IMT (non-academic) position for which you ranked the London deaneries as your top choice, should you do well in the ACF interview and be offered a conditional offer, you still need to attend your clinical benchmarking interview, which will take place in London (not Cambridge), and you are required to ‘pass’ the interview. In this situation, ‘pass’ just means that you need to reach a specific threshold pass mark for the specialty you are applying for. 2. Applying for an ACF at ST3 or ST4 level from IMT2, IMT3 position or CST2 level. If you are an IMT2 and are applying for an ACF at ST3 level in group 2 specialties (i.e. specialties which do not require dual training in internal medicine such as allergy, haematology, immunology, clinical genetics, etc.) and you are awarded a conditional offer for the ACF ST3, you will need to attend the ‘Clinical Benchmarking’ interview for the ST3 level (i.e. registrar level benchmarking interview) for that particular specialty because you are already in IMT training. If you are an IMT 3 and are applying for an

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ACF at ST4 level in group one specialties (i.e. specialties which require dual accreditation in internal medicine, such as cardiology, gastroenterology, neurology, renal medicine, respiratory, rheumatology, acute internal medicine, endocrinology, geriatric, palliative care, clinical pharmacology) similarly, you will need to attend the ‘Clinical Benchmarking’ interviews at the ST4 level (i.e. registrar level benchmarking interview). For surgical trainees at the CST2 level applying for ACF at ST3 level, similarly, you will have to attend the ‘Clinical Benchmarking’ interview at the ST3 level (i.e. registrar level benchmarking interview). 3. Applying from IMT1/CST1. If you are currently an IMT1 and you are awarded an offer for an ACF at ST2 level in nephrology, you are not required to attend the ‘Clinical Benchmarking’ interview for IMT, as you would have already passed the IMT interview. Note that in this circumstance you would also not need to attend the national selection for nephrology and can proceed straight into registrar training in nephrology following completion of IMT. 4. Applying as a registrar. If you are a non-academic ST4 with an NTN in respiratory medicine and are applying for an ACF academic ST4 (yes, you can apply for an academic ST4 even if you have started an ST4 position, although some specialties may not allow this), you are not required to demonstrate clinical benchmarking a second time because you would have already passed the ST4 interview. Your NTN would turn into an NTN[A]. Essentially, clinical benchmarking just refers to the ‘national selection interview’ that all applicants, academic or not, must attend and meet the threshold of appointability before being considered appointable for their desired higher training positions.

1.3 Academic Clinical Lectureship By Dr. Vian Azzu Academic Clinical Lecturer in Hepatology, University of Cambridge

1.3.1 What Is the ACL? An Academic Clinical Lectureship (ACL), alternatively named a Clinical Lectureship (CL), is a post within the Integrated Academic Training Pathway that offers the candidate up to 50% protected time on research. The remaining 50% of the post is spent on clinical training, during which clinical competencies must be met. This significant reduction in clinical time has implications on the pace of clinical progression, making it an important point to consider in terms of timing of application. Applicants for an ACL are not required to have previously completed a clinical academic position (AFP or ACF), although having completed these academic positions may be beneficial when applying. However, applicants for an ACL must have completed a higher research degree such as an MD or PhD or nearing completion with the thesis submitted. An additional requirement is that candidates must have an NTN at the time of application (i.e. already enrolled in a higher training programme), which will be converted to an NTN[A] on securing the post. ACL posts are usually funded by the NIHR (about 100 annually for medicine and 10 for dentistry), local universities, or partner institutions, typically for a maximum of four years

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or until the individual acquires their Certification of Completion of Training (CCT) (with the possibility to apply the grace period like any other higher specialty trainee). The ACL is designed to provide the opportunity for an individual to continue her academic development alongside her clinical training and to encourage candidates to emerge as independent researchers with a strong interest in academic medicine. The expectation is that most ACLs will apply for a post-CCT research fellowship, e.g. an Intermediate Fellowship, a Clinician Scientist award (funded by NIHR, Medical Research Council [MRC], or Wellcome Trust), a personal fellowship, or other research grants on completion of her training. ACL jobs are highly competitive and should be applied for by dedicated academics who wish to pursue an academic career. Remember that spending 50% of your higher specialty training on research necessarily means that you are unlikely to be able to develop other skills in that training programme that might influence your future career or trajectory as a clinician. An example of this in gastroenterology would include being unable to spend time doing advanced endoscopy if your research focuses on the use of stem cells in treating pancreatitis. As part of higher specialty training, an ACL will often be expected to partake in educational activities such as medical student teaching as well as gaining leadership and management skills. Most programmes these days do not expect ACLs to do this specifically within the remit of their ACL, unless the ACL position is a position that focuses on management or leadership or education. All ACLs must be affiliated with a university, which is recognised as their primary employer. Therefore, by definition, ACLs will require an honorary NHS contract where clinical training can be undertaken. ACL pay scales by the university mirror the NHS pay scales for higher specialty trainees, including any on-call supplement which is typically paid by the lead employer (the university) and charged back to the NHS clinical site. The annual leave arrangements also mirror those for higher specialty trainees. In general, ACLs will be enrolled on the Universities Superannuation [pension] Scheme (USS), unless they opt to not do this and remain paying into the NHS pension scheme – you need to anticipate this and act accordingly. An ACL is also usually entitled to an academic bursary of about £1,000 (varies across deaneries), but applicants should enquire whether this is to support clinical or academic activity or both.

1.3.2 Application Process The application process for the ACL is similar to the that for the AFP and ACF, and involves an online application which includes the white space questions (see Chapter 3). Unlike for the ACF, however, the release dates for the application varies, and depends on whether there is a vacancy that has appeared (e.g. a previous ACL has vacated the position and has become a consultant elsewhere, or a previous ACL has attained higher funding [e.g. an intermediate fellowship] and therefore vacated their ACL post). All ACL positions will be advertised both locally and nationally; therefore be sure to look out for them. For an ACL post, it is often a prerequisite that the candidate approaches the head of department before applying because most shortlisted ACL candidates are often predetermined, and the institution may already know who they want to appoint or interview.

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Box 1.1 Example of NIHR Checklists for ACL Applications3

Checklist of Information to Include When Submitting an NIHR Stage 1 Research Application A good quality plain English summary A clear explanation of the problem being addressed A clear demonstration of the need and importance of the research A review of existing literature (primary research) A clear research question/aim(s) and objectives A clear project plan summarising the study design and methods Appropriate and relevant involvement of patients and the public A clear, appropriate, and relevant plan for dissemination

Checklist of Information to Include When Submitting an NIHR Stage 2 Research Application Details of how patients and the public will be involved in research A detailed budget breakdown Details of participants and signatories

Prerequisites for the ACL programme are: • • •

Candidate has a higher degree, e.g. MD or PhD, or be close to achieving these (thesis submitted). Candidate already has a national training number. Candidate shows outstanding potential for continuing a career in academic medicine.

The timing of ACL applications may vary according to the funding body and by the availability of the posts. The timing of the ACL start date is also not as standardised as it is for the AFP or ACL. For example, the 2019 round allows applications from March 2019 to March 2020 and requires ACLs to take up their post before 31 March 2020. The funding for each ACL may be specifically for a particular specialty or may be open to applications for trainees from a number of specialities (e.g. ACL in Cardiology, or Gastroenterology, or Nephrology). Despite having an NTN in your first deanery, some trainees choose to move deanery to take up an ACL and this is entirely permissible. NIHR applications are currently made through the NIHR website, but university applications are usually made online through the university’s platform. The application process for ACLs occurs in several stages for both NIHR and local posts, but you should make sure you know the precise details (Box 1.1). Typically, in the first stage, applicants must have identified a host organisation (academic host) and a partner organisation (clinical host) and be able to provide details of support for the applicant during the 3

www.nihr.ac.uk/our-research-community/NIHR-academy/nihr-training-programmes/integratedacademic-training-programme/clinical-lectureship-cl.htm

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clinical lectureship. Additionally, they must complete CV-related information, details of their proposed project in the context of what is known in the field, costing for the project, and references and statements from relevant signatories. A shortlisting process then occurs, and if selected for an interview, candidates complete stage two of the application to finalise project details. Applicants who are successful in being selected for an interview will be required to deliver a 5–15-minute presentation of their research to the selection committee, which will be followed by 20–30 minutes of questions about the proposal. In general, local ACL posts will additionally interview but will also have a larger committee interview. Be prepared to answer questions about your academic progress and how you will ensure you can sign off on your clinical competencies within the timeframe of the ACL post.

1.4 Alternate Academic Pathways The Integrated Academic Training Pathway (IATP) offers a structured approach to academic development in medical training. It is not, however, the only way to become an academic and there are countless variant paths through which aspiring academics can reach their goal. The IATP has been adopted to varying degrees across the UK. While England has adopted the model fully, there are more marked differences in other countries. 1. Northern Ireland. Northern Ireland has some adopted components of the IATP. There is an AFP programme that is essentially the same (four-month academic block within FY2), an ACF programme (two years; 75:25 split, pre-PhD), and an ACL programme (three years; post-PhD). In Northern Ireland both the ACF and ACL require the candidate to be ST3 or above (or ST2 in general practice). These posts, at least in 2019, require the candidate to already have an NTN in Northern Ireland. 2. Scotland. Academic training in Scotland is different, and there are regional differences in the Scottish academic training schemes. The AFP exists but there are no ACF equivalent posts. Academic training is managed through a system called SCREDS (Scottish Clinical Research Excellence Development Scheme). Post-foundation applicants typically apply after securing their NTN in their specialty in Scotland. A key difference is that the posts are not specialty specific, but rather the funding for each post available goes to the strongest candidate regardless of specialty interest. The first year of the programme offers a small amount of protected time that is aimed to prepare for an OOPR PhD project. On return from their PhD project, SCREDS trainees will be guaranteed a clinical lectureship position that will carry them through to CCT, which typically offers 20% academic time alongside clinical training. Each associated region offers its own programme and there is variation across the board, so look into these carefully: a. Aberdeen Clinical Academic Training (ACAT) b. Dundee Clinical Academic Training (DCAT) c. Edinburgh Clinical Academic Training (ECAT) d. Glasgow Academic Training Environment (GATE) 3. Wales. The Welsh Clinical Academic Training (WCAT) programme resembles the Scottish system in that there is a pre-PhD preparatory year followed by a guaranteed run through clinical lectureship for successful candidates.

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Of course, there are endless options for pathway variation and moving away from the UK will take you down a completely different route. Although it is not commonly done, there is nothing to stop you and there is nothing wrong with doing your PhD or other components of your academic training abroad. Lastly, while academia is better promoted now and medical students are getting streamed into research activities such as the intercalated degrees, projects, and then the AFP, there is no such thing as being ‘too late’ to venture into an academic career. For example, the flexibility of undertaking an OOPR PhD may give you the jumpstart to your academic career even if you are most of the way through your clinical training.

Chapter

Preparing to Apply

2 2.1 Choosing a Programme to Apply For Choosing which programme to apply for may be a very easy decision, or it may be a fiendishly difficult one. The big question, however, is the same: ‘Where is the best place for you to develop as (a) a clinician and (b) an academic?’ Consideration should be given to both factors. When you (and your interviewers) are considering where you best belong, the following crucial components need to align: • • •

The person (you) The place The project

Being able to defend your person–place–project rationale is key to not only deciding which post to choose from, but also to convince the interview panel that you are a perfect fit for the job. In our opinion, this is the most important aspect of your application and you need to get it nailed down. Everyone is in a different situation, so seek some personal advice from your fellow colleagues and mentors who have experience in academic positions.

2.1.1 The Person First, consider what you want your career to look like and what you want to achieve. The relevant questions that you should be asking yourself, and what the interviewer will be asking you are: • • • • • •

What sort of clinical career do I want to pursue? Do I want to be an academic? What are my short- and long-term academic goals? What are my academic skills? What research experience and skills have I acquired that would strengthen my application? Do I have any pilot data that could strengthen an application for a particular project?

The last point is particularly important for the Academic Clinical Fellowship (ACF) and Academic Clinical Lectureship (ACL) interviews. Of course, learning new techniques is part of starting a new academic post or project. Consider, however, that interview panels will look favourably on any prior research skills or experience that you can bring with you and that you can contribute once you arrive. 14

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2.1.2 The Place After considering what area of clinical medicine you want to pursue, ask yourself: Where is the best place for me to acquire clinical training in that particular field? If you are applying for an Academic Foundation Programme (AFP), consider choosing a programme that gives you a rotation in that particular specialty. If you are applying for an ACF then you need to think very carefully about this point, since the training programme at your academic institution you are applying for could shape your training significantly. For example, choosing to train in a particular location could maximise or limit your exposure to a particular subspecialty within your field. On the other hand, consider where the best place is for you to achieve your research goals and to develop as an academic. How does one determine that? There is no one correct answer, but some of the relevant questions are: 1. Does the place offer the expert supervision you require? For example, if you want to pursue a career in pancreatic stem cell transplantation, does the deanery have the expertise in this field of research, or would you benefit from applying to another deanery? Regardless of the level of the post you are applying for, you will need to prove to yourself and to the interview panel that you will be supported in your new post and that you will have the necessary supervision to steer you towards success. 2. What is the academic track record of that place? You need to have a good look at the academic outputs of your potential department, lab, or supervisors. Have a look at their publications on PubMed (www.ncbi.nlm.nih.gov/pubmed) and ResearchGate (www .researchgate.net), and funding sources on their university profiles. By all means, look at your potential supervisor, but what is perhaps more helpful is to look at the track record of clinical academics who have previously held the post that you are applying for. Number of publications is one, but not the best measure of track record. Have a closer look at the quality of work produced. 3. Does the place do research that you want to do? This is the most important question. If the place offers excellent supervision and has an incredible track record but you would be miserable doing research that you do not want to do, then do not even consider it! If your supervisor works on a theme of research that is not compatible with your career aspirations, then maybe she is not the right fit for you, and you, should be looking elsewhere. In this day and age, a great deal of this place searching can be done from afar, but we would iterate the value of physically going to visit the place, supervisor, or group, you want to work with. Although it is not compulsory to have met a potential supervisor beforehand, it is imperative that a candidate at least research whom they would want to work with should they get the job. If you are not able to speak to your potential supervisor, try meeting a member of the laboratory you wish to work with to get a feel of how the lab runs as well as her feedback on the supervision she received. It will not look good during the interview if you have not identified a potential supervisor to work with (more on this later in the interview chapter). Lastly, it is possible that you may not be successful in your application to your top choice of AFP or ACF. You need to consider choosing a ‘plan B’ . . . perhaps even a ‘plan C’.

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2.1.3 The Project For the AFP, it is not absolutely necessary to have your project nailed down by the time of your interview, but it undoubtedly reflects well to have made steps towards achieving this. On the other hand, having a ‘bulletproof’ project would make you a front-running candidate. For any higher level posts (i.e. the ACF and beyond), being able to defend your project down to the small details is essential. What makes a job-winning project proposal? Our opinion is that such a project is one that: 1. Addresses an important clinical problem. You essentially need to convince the panel that your project will have an output that will increase our knowledge and, more importantly, have positive implications for patients. It is not enough to want to know more about ‘gene x’ . . . you need to show, for example, that gene x is important for our understanding of potential therapeutic targets for patients with the condition. 2. Is novel and captivating. The project that you are proposing needs to be something that no one has ever done before. Otherwise, why bother? You need to be sure that no one has beaten you to the finish line, so do a thorough check of the literature and speak to your potential supervisor. 3. Is ambitious, yet achievable. This is a fine balance, one which is difficult to strike. While it is important to propose an impressive project, you need to convince the panel that what you propose to do is deliverable. Despite your best intentions, you will not be able to cure cancer in a four-month AFP research project. Similarly, the panel will be wary about ‘high-risk’ projects that may be designed on some leaps and assumptions or have various dependents. If you have ‘pilot data’ (data that prove or give evidence in support of the concept) then this is highly respected, since it shows project feasibility, but also demonstrates preparation. Much of the work and considerations of designing an academic project follow the same principles of writing a grant application. You need to be able to defend your project proposal down to every fine detail. Generic questions about your project may relate to: • • • • • • • • • • •

What is the clinical problem you are trying to address? What are the aims of the project? What methods will you use? Who would supervise the project? Where would you do the research? How much will it cost? How would you fund the research? How long would it take you? Is it possible in the time frame that you would be given? How many patients/subjects would you need? (Have you done a power calculation?) What you would do if part of the project went wrong, and what would be the contingency plan?

As stated, these answers should roll off the tongue for those applying for an ACF post or higher. For the AFP application, although having a solid research project or proposal or even visiting the potential supervisor’s department would be very impressive, it is not necessary to

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have done these by the time of the interview. It would be prudent, however, for a candidate to have at least identified and researched a supervisor she would like to work with in that deanery. Identifying a supervisor and understanding the theme of her research, and perhaps reading one or two of her latest publications will be good talking points during the interview.

2.2 Building an Academic Portfolio The thought of applying and competing for an academic post can seem daunting to begin with. If you are convinced that you want the job but have no idea how to go about getting it, then this section is written for you. Here is some general advice that may sound trivial but is too often forgotten: 1. Start early. To hazard a cliché, time flies. You should aim to do as much of your portfolio building in one to two years prior to your application deadline. Take the ACF application and interview, for example, which occur only less than 18 months after graduation from medical school. The majority of your experience that you will discuss in the ACF interview will be what you did in medical school, not your FY1 or FY2. 2. Use your time wisely. For example, make the most of your spare time between medical school terms. The summer holidays between medical school years are a substantial amount of time (three to four months in most institutions), and this is more than enough time to complete a modest research project in the midst of enjoying your time off. Using your own time to do research demonstrates enthusiasm and commitment. Importantly, to enable this, there are several sources of summer project funding for medical students. If all of your summer holidays are gone, consider using your medical school elective, ‘student-select modules’, FY1, or FY2 taster week (or even annual leave, if you have to) for research. 3. Stay organised. Create a CV early, and keep it updated along every step of the way. A CV can be requested by potential research supervisors and needs to be available quickly. The contents of your CV require evidence, which essentially becomes the contents of your portfolio. If you cannot prove it, it did not happen! It is therefore imperative to collect evidence along the way rather than spending your valuable last-minute preparation trying to find documents. This includes abstract books from conferences, course certificates, feedback from teaching, or a reference letter from the leader or chairperson of the society you were a part of. 4. Do not jeopardise your clinical career. Excelling across the board of clinical experience, research, audit, teaching, and leadership is crucial. It will not matter that you have 20 publications if you are clinically inept. Your clinical acumen will also be assessed via one or two clinical scenarios during the interview, so you need to be as good, but preferably better than the other candidates in this arena as well. Your clinical skills will be further tested in practice once you get the job, as academics are required to achieve the same clinical competencies, albeit in a shorter period of time than your non-academic colleagues. 5. Stay competitive. What does it mean to be a competitive candidate? A competitive candidate is one who has achieved more than what is expected of her at the present stage. Essentially, you need to prove to the interview panel that you are better than the other candidates. It is important to ensure that your success is robust to quantitative (i.e. it is measurable and you have got lots of it) and qualitative (i.e. what you have done is worth something) scrutiny.

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2.2.1 Clinical Experience Going to medical school is obviously not a unique factor to your portfolio. So, what else can you do to excel in clinical experience? For those who are certain of their career choice, this part comes easier because the CV and portfolio of experience can be tailored accordingly. Those who remain uncertain of which clinical career to pursue will need to think about how to make experiences translatable across different fields. Maximising your medical school elective or ‘student-selected component’ is an excellent opportunity to demonstrate not only interest but also a commitment to your specialty of choice. Consider spending your elective in a world-class institution of your desired specialty. This allows for good talking points during the interview and would certainly set you apart from other candidates during your application and interview process. Furthermore, if you are extra keen, a summer holiday can be used as an extra elective. For Foundation Programme doctors (FPs) and AFPs working towards the ACF, most programmes offer ‘taster weeks’ in which you can take time out of your clinical rotation to experience a field that you would otherwise not encounter. Taster weeks can even be done in a different hospital. For example, if you have a clinical inclination towards a career in infectious diseases, a specialty which is usually seen only in large tertiary institutions, and if you are currently working in a district general hospital, you could still apply to do a taster in a tertiary institution. For those surgically inclined, it is important to start recording procedures that you have encountered as early as possible (yes, even as a medical student!). Even if you have only watched the procedure as a student you can record it as ‘observed’. This may seem pointless, but recording your clinical experiences shows attention to detail, organisation, and most importantly, an interest in one’s surgical and procedural development. Various online and automated logbooks are available. A sensible choice may be www.elogbook.org, since it is currently the logbook used by UK surgical training programmes. Attending courses demonstrates your clinical interest and development. Examples of undergraduate courses include: • • •

Basic Life Support (BLS) Intermediate Life Support (ILS) START Surgery (Systematic Training in Acute Illness Recognition and Treatment for Surgery)

Postgraduate courses include: • • • • • • • • •

Advanced Life Support (ALS) Acute Life-Threatening Events Recognition and Treatment (ALERT) Advanced Trauma and Life Support (ATLS) Basic Surgical Skills (BSS) Care of the Critically Ill Surgical Patient (CCRISP) Medical registrar on call (Hammersmith) Chest X-Ray interpretation workshop Procedural skills workshop Point of care ultrasound course

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These courses are upsettingly expensive,1 especially the surgical courses (ALS, ALERT, ATLS, BSS, and CCRISP), but most applicants will have completed all of them, so it is best to not be left out. Usually, candidates can partially claim for these courses through the trainee educational budget, although the yearly education budgets for junior doctors are quite small (~£600) and vary according to deanery. Furthermore, these courses compound the core competencies needed to be a clinically astute trainee and help facilitate how to think like a higher specialty registrar. This, of course, is a good reminder that we attend courses to increase our clinical knowledge and to be more effective practitioners – it is not purely a ‘tick box’ exercise. Following graduation, you can show clinical commitment to your specialty by starting to sit the various steps of the postgraduate exams, for example the Member of the Royal College of Physicians (MRCP) or the Member of the Royal College of Surgeons (MRCS) exams.

2.2.2 Research Experience This section goes through some ideas of what you could do to build your research portfolio.

2.2.2.1 Research Projects Research, as a broad term, takes many forms, including: • • • • • • • •

‘Wet lab’ research (‘bench’ or ‘basic science’, e.g. animal models, genetics) ‘Dry lab’ research (e.g. imaging) Clinical trials Epidemiological studies Clinical cohort studies Systematic reviews and meta-analysis Narrative reviews Case reports or case series

An attractive feature of clinical academia is that there are many forms of research in every field of medicine, so there is bound to be something in some field that will interest you. Some clinical academics revel in the opportunity to perform Western blots, whereas others would rather be combing through the literature. In your early years, it is not a bad thing to experiment in different forms of research to broaden your skills and to perhaps surprise yourself as to what you may enjoy. Importantly, having a broad base of academic training is helpful when it comes to your interviews, since if you are a ‘one-trick pony’ and they do not care for your trick, then you are in a precarious position. Furthermore, many of the generic academic and research skills are wholly transferrable: submitting a paper, a systematic literature review, and core statistical concepts are all part of the same process regardless of the subject. The key at an early stage is approaching all

1

O’Callaghan J, Mohan HM, Sharrock A, Gokani V, Fitzgerald JE, Williams AP, Harries RL. Council of the Association of Surgeons in Training. Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland. BMJ Open 2017;7(11):e018086.

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research opportunities with enthusiasm and with the mindset to learn and develop yourself as much as possible. When searching for a new research project, time is an important factor to consider, regardless of your stage of academic training. Although having a large number of highquality projects in your portfolio would be best, the level of time commitment these require may be difficult or even impossible depending on your circumstances. If you have protected research time (e.g. an intercalated degree project, a summer project, or an AFP project) then you have some scope to think big, but if you are trying to do things on your own time then be careful not to commit to what you cannot finish. Laboratory work takes many forms. The terms ‘basic science’ and ‘wet lab research’ are often used by medics (and not often by scientists) to describe ‘pre-clinical’ research. Examples of ‘wet lab projects’ include those that use mouse models, ex-vivo analyses of tissue and. ‘Dry lab research’ is another invented term that often is used for projects using computational methods such as radiological analyses and statistical modeling. Regardless, laboratory (particularly wet lab) work is often very time consuming compared to clinical research and takes a long time before it is published. These lab projects often demand a proximity with you and the lab in order to keep both your research going . . . and your animals or cells alive! If you are a medical student or junior doctor and do not have dedicated research time, pursuing lab work may be difficult (but not necessarily impossible). Medical students can often pursue lab work during an intercalated degree, student-selected component (SSC), summer holidays, or an elective. Often, lab work projects that you work on during intercalated degrees will not be published by the time you apply for AFP and, because of the nature of the work, some projects are never published at all. Nevertheless, even if you do not achieve a publication for lab research projects (which is common in many cases!), developing lab skills (e.g. immunofluorescence or image analysis, mass spectrometry, flow cytometry, or whole-genome sequencing) is important and these should be listed on your CV. Even if you do not want to do wet lab research, some institutions are often lab-research heavy, and having lab skills may be helpful for the application and interview process. Clinical research projects are more focused on the data derived from clinical practice and includes clinical trials, prospective or retrospective cohort analyses. There is clearly a wide scale of undertaking here. A good starting point may be a retrospective analysis of a particular cohort or paradigm. It is often difficult to be original with these cohort studies, but cross comparison with others in the literature can be seen as a benefit. It is always sensible to approach a senior clinician (ideally a consultant) to seek ideas and gain approval for these studies. Not to mention, if a database of patient data already exists for a specific cohort, then perhaps a great deal of the laborious data collection has already been completed. Often, creating a new database may be quite tedious and time consuming; however, it can often lead to others using your work and may lead to further recognition down the line. A systematic review is defined by the Cochrane Collaboration as a review that ‘attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question’.2 Systematic reviews are intended to answer a specific question and should be scientifically rigorous in order to minimise bias. The general process involves asking a question, searching for all of the literature (the ‘systematic search’) that could potentially answer that question, and reporting the data or findings. The systematic search 2

Cochrane collaboration. Cochrane Handbook for Systematic Reviews of Interventions. Section 1.2.2: What is a systematic review?

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should be performed by two researchers, independently. If there are quantitative findings to be reported (e.g. outcomes from multiple clinical trials), then a ‘meta-analysis’ can be performed. Some good sources of help for writing systematic reviews are the Cochrane Collaboration, National Student Association for Medical Research (NSAMR: www .nsamr.ac.uk/guides/), and also your local medical librarian. A review article is a synthesis and summary of the literature in a particular field. A ‘review’, rather than a ‘systematic review’, usually refers to a narrative of the literature from the author’s perspective, and the choice of papers cited is at the discretion of the authors. For these reasons, narrative reviews are prone to bias. These authoritative reviews can be time consuming, especially if you are new to a particular topic. Furthermore, they may be challenging to publish. The exception is the ‘invited review’, in which journal editors will ask eminent researchers to write a review for their journal. It is worth asking your supervisor if she has received any invites lately, since you may be able to contribute to these. Case reports are arguably not ‘research’ but may infringe on the border between clinical practice and research. For example, if you see a particularly interesting, rare, or educational case on the ward round, perhaps enquire with the responsible consultant on whether you could write it up. If you have multiple similar interesting cases, you could always write them up as a case series. A letter to the editor is usually a one- or two-page article which discusses the strengths, limitations, or clinical applications of a recently published research paper, usually reported in the same journal. Letters to the editor are often considered publications in the ‘real world’, but currently not at the AFP application. Writing these letters, however, can be a good exercise, since it fosters understanding and critique of others’ research, and also offers experience in writing.

2.2.2.2 Publications While some consider that publications are the ‘currency of research’, this certainly is not the only measurable output of research experience. It is imperative to show that what you have done is quality work. Ten mediocre publications are not as impressive as one excellent publication. Although there is no requirement to have a publication at the AFP level, it certainly helps to have one or more. For those applying for ACFs or ACLs, the level of competition is clearly higher, and multiple publications will be required to convincingly put you in the running for a post. Rank of authorship is a factor that some will take into account. To be first author is considered by most to be the most impressive rank, but most sensible interviewers will recognise that middle authors have worked hard and learned a great deal from a project they have contributed to. As already discussed, time (or lack thereof) is hugely important. Research can take a long time to finish, but another consideration is that it takes even longer to publish! How long does it take to take a research project from conception to publication? This is influenced by the size of the project, the nature of the research, the target journal, and of course your efficiency and that of your co-investigators. Even once you have finished your experiments and personal write up, your paper will be sifted through by your co-investigators (more investigators ∝ more time required) and will have several rounds of edits. Some groups like to have their work presented either regionally or wider prior to submission. The ‘big journals’ usually have a fast turnaround time, especially if it is a rejection! ‘Smaller journals’

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can be much slower. Reviewer comments can take several weeks and there is often a rebuttal stage during which you are required to make changes (which takes even more time) followed by a need for re-review (taking even longer). It can therefore take several months for a paper to get through the publishing pipeline, and if it is rejected at any point then you need to start all over again. Do not be fooled into thinking that you will have a publication popping up on PubMed on the last day of your research project. Considering this pessimistic yet realistic timeline, for prospective ACF candidates, leaving publishing until your postgraduate years is not an option. Plan accordingly by starting early and by choosing research projects that have an achievable output within your given time frame. When choosing a journal to publish your work, check whether the journal is indexed in PubMed. Journals which are indexed in PubMed certainly look more favourable than journals that are not, however, this often does not matter too much for the AFP application, since having any sort of publication looks good. However, for the standard FP (nonacademic post) publishing in a journal not indexed in PubMed does not score you points during the FP application. What if a journal rejects your work? Do not give up! Discuss the editor’s decision with the senior author on your paper, who will often have further suggestions. Another option would be to search for another journal, but be sure to reformat your work according to the journal requirements. An under-recognised benefit of being rejected by a journal is that you may get expert advice from your reviewers on how to improve your manuscript prior to your re-submission. Any good work is publishable, it is just a matter of when, and how patient you are . . . so do not give up! One tip is to email the editor of the journal prior to submitting the work, highlighting the key points of the paper and what relevance this has to the particular field. This saves a tremendous amount of time because if the editor totally rebukes the paper there and then, there is no wasted time editing and formatting it specifically for the journal, or waiting for a decision. Having said that, even when an editor says that ‘the paper would be best placed elsewhere’, it can still be worth submitting, since it might be accepted!

2.2.2.3 Presentations Presentations are an important demonstration of research output. Presenting at conferences allows early dissemination of work and facilitates an interactive forum with those in your field. In this way, prior to submitting for publication, presenting your work at a conference (be it local, regional, or international conferences) will allow some early feedback and may increase your chance of success in getting into your target journal. Presentations can be arbitrarily categorised into poster presentations and podium/oral presentations. They may also be categorised geographically as those being presented at local, regional, national, or international conferences. Although all types of presentations are important, the podium presentations delivered at an international conference are typically considered the most impressive. For the AFP, presentations will be weighted or discounted on the basis of these factors. Furthermore, most conferences will award a prize(s) for the best presentation(s), so do not underestimate the potential for conferences to do great things for your portfolio! Going to conferences, especially abroad, can be an expensive business once all the costs are included (e.g. registration, travel, hotel, etc.). It is imperative to have a good look at the conference website to see if the organisers are offering travel bursaries for young investigators, trainees, or medical students. Also, do not forget to use your NHS study budget. If you

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are still a medical student, enquire from your medical school if they have any funds to support students presenting their work. You might be pleasantly surprised!

2.2.2.4 Prizes Prizes are an impressive item on your portfolio, as they can be very competitive . . . and sometimes prestigious! Points are often awarded specifically for prizes on application forms (and also on the applications for non-academic posts). • • • • • • • •

Examples include: Distinction in degree Best poster presentation Best podium presentation Young investigator award Best dissertation Essay prize Scholarship Bursary

To hazard another cliché, one man’s trash is another man’s treasure. It is important to note that some prizes are valued by some interviewers and not others. For example, a ‘best poster prize’ may be considered to be a true prize by some, but not by others. The definition of a prize is listed on the Internal Medicine Training (IMT) website as ‘national prize that is eligible for all undergraduates, postgraduates in the country of training’, which is subject to interpretation. Nevertheless, if you are unsure as to what prize category (or points) you are entitled to, go ahead and list your prize in the highest category to which you think your prize corresponds to. The worst thing that can happen is that they do not award you fully all the points you declared for. Do not be afraid to sell yourself well, but not to the extreme of falsely over-declaring your achievements. Do not assume that the person marking your application form will appreciate the gravity of your achievement. It is helpful to be quantitative and specific. Specify whether it was a local, regional, national, or international competition; how many winners there were; and how many applied for the prize. As you may have noticed by now, a single project can go a long way in getting you points on an application form (including publication, presentation, and prize), so make sure you maximise the outputs from your efforts. Bear this in mind if you are currently working on a research project. As a final point to mention on prizes, be sure to compete for both undergraduate and postgraduate prizes, as most applications will have separate marks available for your undergraduate and your postgraduate achievements.

2.2.2.5 Additional Degrees For those still in medical school, an intercalated degree is an excellent opportunity to gain formal training in medical sciences and research. In most universities, the intercalated degree programmes offer a mixture of classroom learning, online learning, and one or more research projects. Although this time out of medical school requires an additional year at university and has financial implications, these concerns should be balanced against the

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benefits of an additional degree (e.g. an intercalated bachelor’s or master’s), scientific training, development of research skills, and the optimistic outputs that come from a research project. Some medical students may choose to do an MBPhD, in which their medical degree is coupled with a PhD. For those who have found their academic niche and are 100% passionate about their field, why wait? For others, it is also perfectly valid, and perhaps advantageous, to wait until later in their training to take time out to do a PhD. Other options for attaining a degree include those that can be done part-time, alongside clinical practice. More and more master’s degree programmes are becoming available that are taught solely online. Another popular option is to complete a diploma or certificate in medical education.

2.2.2.6 Research Societies Most medical schools have undergraduate medical research societies. There is also a national research society called the National Student Association of Medical Research (NSAMR; www.nsamr.ac.uk). You may want to consider joining a society . . . or at least attending the events. This will give you an early exposure to critical appraisal and may help you cross paths with inspiring clinician scientists or even mentors. Becoming part of a committee may also offer an additional management or leadership role for your CV or provide you the opportunity to organise events or conferences. Holding a leadership or managerial position in societies will now score you additional points during clinical job application.

2.2.2.7 Research Courses Research skills courses are also a good way to learn about a new statistical concept or methods. A few examples of research skills courses are as follows: • • • • • • •

Essentials of Clinical Trials (London School of Hygiene and Tropical Medicine [LSHTM]) Cancer Survival: Principles, Methods and Applications (LSHTM) Introductory course in Epidemiology and Medical Statistics (LSHTM) Introduction to R or Stata (University of Bristol) Systematic Reviews and Meta-analysis (University of Bristol) Clinical Trial Management (University of Oxford) Randomised Controlled Trials Course: A Guide to Design, Conduct, Analysis, Interpretation, and Reporting (University of Oxford)

2.2.3 Clinical Audit and Quality Improvement Projects Audits and quality improvement projects form one of the ‘pillars’ of clinical governance, the purpose of which is to continually improve the care and service we deliver to patients.

2.2.3.1 Audits An audit is an exercise that is used to determine if a clinical practice is meeting a set standard.3 A ‘standard’ is a level of performance that should be met, and this ‘standard’ can be defined by local hospital guidelines, societal guidelines (e.g. British Society of Haematology 3

Benjamin A. Audit: how to do it in practice. BMJ 2008;336:1241.

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guidelines), or national guidelines (e.g. the National Institute for Health and Clinical Excellence (NICE)). This allows clinicians to be informed whether their practice or service is meeting this performance threshold and if there are areas for improvements. A clinical audit consists of a cycle with five stages (Figure 2.1). We will use an example to demonstrate the cycle. 1. Identify the problem. A doctor in the emergency department of Hospital X suspects that patients with acute upper gastrointestinal bleeding secondary to varices have not been receiving intravenous antibiotics. 2. Define the standard(s). The local guidelines at Hospital X recommend that all patients with suspected upper gastrointestinal bleeding secondary to varices should be treated with empiric broad-spectrum antibiotics. 3. Collect and analyse the data. The auditing doctor collects data on all patients who presented to the emergency department with suspected variceal bleeding over the past four weeks. Only 65% of these patients were administered intravenous antibiotics. 4. Implement change. The auditing doctor presents the results at the local departmental audit meeting and runs a training session for emergency doctors to educate them on the treatment of variceal bleeding. 5. Re-audit (‘closing the loop’). The auditing doctor repeats steps 1 to 4 after four weeks to assess for an improvement. A relatively new phenomenon within audit has been the boom of collaborative, multicentre audit groups. An example is the Student Audit and Research in Surgery (STARSurg) group (www.starsurg.org), which produces UK-wide audits on surgical outcomes through a group effort of medical students. The group welcomes the involvement of all medical students from across the UK, provides a supportive platform for students wanting to get involved in audit, and offers all participating students PubMed-citable collaborator status recognition on the outputs (not authorship). Many specialties have now launched collaborative groups of similar design (for example, the UK Audit and Research Collaborative in

Figure 2.1 The five stages of the audit cycle.

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Obstetrics and Gynaecology [UKARCOG] or the British Neurosurgical Trainee Research Collaborative [BNTRC]).

2.2.3.2 Quality Improvement Projects Quality improvement projects (QIPs) are in some ways similar but are not the same as audits. A QIP implements a systematic change in order to improve the experience or outcomes for patients (and/or staff).4 For example, a QIP could be conducted to improve junior doctors’ experience in cardiac arrest scenarios. A QIP is conducted using the plan, do, study, and act (PDSA) framework and is an iterative process. Multiple cycles can be performed quickly and within a short space of time. 1.

2. 3.

4.

We explain the QIP cycle here with an example: Plan (Identify a problem and plan for a change). An FY1 doctor feels that she does not have confidence in being a member of the cardiac arrest team. She decides to perform a survey among the other FY1 doctors to determine how confident they are with being on the team. A questionnaire was given out to all FY1s to obtain a baseline. Do (Make the change). The doctor creates a rota-based system where FY1 doctors take turns weekly to be supernumerary members of the cardiac arrest team. Study (Measure the impact of the change). After eight weeks, she re-evaluates these FY1 experiences with the same questionnaire in order to gauge whether or not their confidence in managing cardiac arrest scenarios has increased. Act (Plan the next change or introduce a larger scale implementation). This doctor noted that other FY1 doctors found the exercise to significantly improved their confidence in managing life-threatening situations. She now wants to introduce this arrangement as part of the mandatory curriculum for FY1s in her hospital.

2.2.4 Teaching Experience Teaching is an important component of academia and is often a formal expectation of clinical academics by their employing university. It is important to note that teaching can come in many forms, ranging from bedside teaching of medical students to delivering tutorials, lectures, simulations, skills-based sessions, or even online teaching such as writing for medical websites. Again, the assessment of teaching experience is graded both quantitatively and qualitatively. Of course, the amount and duration of teaching you have delivered will influence the number of points you score on your application. Additionally, however, organising and designing your own teaching materials and sessions will gain you more points than joining a teaching activity hosted by others. An important aspect for both improving your ability as a medical teacher and for proving this to others (i.e. an interviewer) is formal feedback. Feedback could be in the form of a questionnaire which is distributed at the end of your teaching session. If your deanery or hospital does not have a formal feedback questionnaire, then we would advise that you create your own questionnaire and be sure to bring it to all of your teaching sessions, and to make sure all your students fill out the questionnaire before they leave your session. Highlighting what was good about your teaching session can be incorporated on the 4

Tasker F. How to lead a quality improvement project. BMJ 2013;346:f113.

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white space questions for job applications, but identifying ‘areas for improvement’ will also serve you well when designing future teaching sessions. There is an increasing recognition of, and additional credit given to candidates who have, formal training in teaching. This can be achieved by undertaking a Master’s (MSc) in Medical Education, or Postgraduate Diploma in Medical Education. Some academic programmes offer these courses to academic trainees for free and use them as a component of academic training. There are also formal teaching courses (e.g. Tomorrow’s Teachers or Training the Trainers). Most deaneries will often conduct formal teaching courses for interested candidates; therefore, be sure to sign up early for these courses, as they get filled quickly. For those who are passionate about medical education, there are some academic posts designated specifically for this purpose. For example, in the 2019/2020 intake, AFP jobs focused on medical education were available in London (n = 5), Essex, Bedfordshire and Hertfordshire (n = 22), North West Deanery (n = 14), South West Deanery (Severn and Peninsula, n = 6), Wales (n = 6), West Midlands (n = 3), and Yorkshire and Humber (n = 12).

2.2.5 Leadership and Management Experience Nowadays, having held leadership or managerial positions during your medical career is almost a requirement and will often score you points in the application. This is not limited to academic applications. Leadership and management . . . what is the difference? If you search the internet for definitions, you will find widely different results and opinions. We consider leadership to be the ability of a person to motivate and influence a group of other people in order to achieve an output. A manager, in contrast, is a person who directs other people and/or resources in order to achieve an output. Of course, there is some overlap and perhaps it is even possible to have both roles. An analogy may be that of a football team in which you have a leader (the captain) who is actually playing the game as well as spurring their team on and making onpitch decisions. This is in contrast to the team’s manager who stands at the sidelines and directs players. In summary, leadership is to encourage others to ‘do as I do’, whereas management is to tell others to ‘do as I say’. Being either a good leader or a good manager is extremely important in any profession. We all have seniors from our past whom we remember as either good or bad leaders, good or bad managers . . . or leaders who acted more like managers! There is, however, an increasing appreciation for the art and science of leadership in medicine, and this applies to academic medicine also. Leadership and management come in many different forms, ranging from leading a team of researchers to organising fund-raising events, fronting the #MeToo movement, campaigning for gender equality, or leading a sports team to success. Other specific opportunities to demonstrate leadership or management include being a member of a society (e.g. a surgical society or an academic society), a representative to your cohort on either a local (e.g. doctors’ mess representative) or regional or national (e.g. British Medical Association representative) level. For those with a particular interest in leadership and management in medicine, there are some AFP posts that are specifically geared for this, although the number of available jobs in the UK is small. The number of posts in the most recent AFP intake were: East Midlands

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(n = 10), London (South Thames, n = 6), North West England (n = 4), South West England (Severn and Peninsula, n = 2), Wales (n = 6), and West Midlands (n = 3). There are an increasing number of courses on ‘non-technical skills’ which covers leadership, team working, and communication skills. Having these courses and skills in your portfolio would certainly be beneficial.

2.2.6 Mentorship Put simply, mentorship is the process by which an experienced person gives guidance to a less experienced person. Mentorship is incredibly important within clinical academia, since the training pathway is often tortuous and filled with career-defining decisions. A good mentor is one who is impartial (not trying to feed her own gain), genuinely interested in your success and development, and has an inspiring track record of her own that one day you would hope to emulate. Your mentor does not need to be in the same field as you or reside in the same university or hospital. The important thing is that the mentorship should work for you and should be fruitful to your development. You do not need to have only one mentor. You may require different mentors for particular domains of your career, and your mentors may change over time as your needs transition. Mentorship is often found naturally by fortuitously meeting good mentorship candidates. If not, there are local, regional, and national schemes that can help. For example, the National Student Association of Medical Research (NSAMR) offers a pairing scheme between medical students and early-year academics (http://www.nsamr.org/mentorship/). For ACLs, there is a mentorship scheme hosted by the Academy of Medical Sciences (https://acmedsci.ac.uk/grants-and-schemes/mentoring-and-other-schemes/mentoringprogramme).

2.2.7 Non-medical and Non-academic Skills As doing all of the foregoing was not already enough to ask, it is fiendishly important that you have interests and attributes outside of work. Strangely enough, this can be what interviewers like to talk about the most. While sport and music are common examples, outside interests can include whatever you want. Being a well-rounded candidate makes you interesting, but also reassures recruiters that you are resilient to burnout and stress. If we have not already convinced you that having hobbies is a good thing, application forms and interview questions specifically give credit towards these things, so do not neglect this part of yourself.

2.3 The Curriculum Vitae A physical curriculum vitae (CV, a.k.a. résumé) is often not required at the online application stage, since all information is uploaded to an electronic portal. However, unless specifically advised not to bring one, it would be wise to have it to hand on the day of the interview. We have included the CV section here because having it prepared well in advance will allow you to have your achievements presented in a well-structured way and will prevent a last-minute preparation frenzy. Writing the Perfect Curriculum Vitae (CV) should be a book of its own, but here is some pertinent advice:

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1. Structure. The CV should follow an ‘acceptable’ structure (i.e. a structure similar to what most candidates use), but there is a little wiggle room for advantageous adaptation. The CV structure usually follows something like: a. Personal information i. Your name (including titles, e.g. MBBS or BSc) ii. Contact information (address, email, phone) iii. General Medical Council (GMC) number b. c. d. e. f. g. h. i. j. k. l. m. n.

Academic qualifications Employment Elective placements or sub-internships Awards Competitive grants Publications Presentations Research experience Audit Positions of responsibility Logbook or procedural skills Outside interests Reference(s)

2. The CV should not look ‘good’; it should look professional. Keep to black and white. Do not include superfluous pictures or decoration. 3. Use a simple, plain type font. (e.g. Arial or Calibri or Times New Roman). Flowery texts are difficult to read and distracting. For similar reasons, try not to over-format your CV (i.e. multiple fonts, boldness, underlining, or italics). 4. Accept that the entire CV may not be read. Cut out anything that is not impressive. Make sure that your most impressive content is on the first two pages. 5. Get rid of any pre-medical school content. It might be hard to delete your valedictorian award from high school from your CV, but, sorry, it is irrelevant now. 6. Do not use abbreviations. Do not assume that the person looking at your application knows what the acronyms stand for . . . for example, ‘RCOG’ (Royal College of Obstetricians and Gynaecologists) or ‘NSAMR’ (National Student Association of Medical Research). If you are going to use the name multiple times, at least spell it out the first time. 7. Should I include my exam results? Some people include their exam results in their CV, but they are often not required. Our advice would be that unless they are exceptional results that you would like to show off, they are best omitted. 8. Should I include a portrait picture? Unless specifically requested, we would suggest not to. 9. Know your own CV and its contents. Anything you include on your CV (or in your portfolio) is fair game for scrutiny during the interview, so you should be able to discuss (and defend!) it all. For research projects and outputs, you should be able to describe the techniques you have used, the methodology, the results, the strengths and limitations of your work, and the future directions of your work.

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2.4 Portfolio The portfolio can be a source of great anxiety for some, but it does not have to be. Here are our top tips: 1. How much to include? A good portfolio is engaging, impressive, and streamlined. There is no need to include everything you have ever done. Your interviewers will not read it all. The portfolio should be a showcase of your greatest achievements and therefore every page they look at should be something worth looking at. Do not bury your best work among formality documents and nonsense. 2. Structure your portfolio according to your CV. Everything should be readily found in the portfolio, especially if it is large. Having a contents page and labelled dividers helps. The CV should be at the front of your portfolio to act as a summary of your portfolio and should therefore match the order of content. 3. Be prepared. Your portfolio should be prepared well in advance. This should come naturally if you adhered to the advice thus far by collecting all evidence required along the way and having a good-to-go CV at your fingertips. On the night before, you do not want to be scrambling for materials and tied to a computer and printer. This last-minute time is golden and should be spent on preparing for the interview itself. 4. Dress to impress. Right or wrong, appearance is everything when it comes to the portfolio. A ring-binder with hole punched work or scrunched-up plastic pockets will be off-putting to the assessor. Again, like the CV, the portfolio should appear professional and slick, not ‘fancy’. Either invest in a professional portfolio book or use a smart binder with high-quality pockets and dividers. All documents should be originals where possible, and printed documents should be in colour and on high-quality paper.

Chapter

The Application

3 3.1 The Online Portal Most academic posts are currently applied for through an online portal called Oriel (www .oriel.nhs.uk). Although it may seem obvious, note that online submission portals are timed down to the second. There is no mercy or defence for late submission – it will not be accepted. Submission of the online application is time consuming, especially if you are applying to more than one academic unit. We would recommend submitting the online application at least 24 hours ahead of the deadline to avoid the fallout of any potential technical meltdown. Also, as a word of caution, you should present your achievements well, but being untruthful is wrong and is a General Medical Council (GMC)-notifiable offence. Many of the initial sections of the application form ask for matter-of-fact information: • Applicant details (name, DOB, address . . .) • GMC credentials • Language skills • Right to work in the UK • Fitness to practice • Medical school information • Employment history The remaining sections require completion of the ‘white space questions’ and listing of achievements. In this chapter we will work through how to approach these sections.

3.2 The White Space Questions The ‘white space questions’ are used to narrow down the candidate shortlist. White space questions are typically open-ended questions intended for candidates to demonstrate their achievements, skills, and experience. The white space questions in the past have contained approximately 4 to 6 questions for the AFP, 10–12 questions for the ACF, and a variable number of questions for the ACL. The word limit for the answers to these questions is highly variable (usually 200 words) but can be surprisingly long for some deaneries (up to 600 words). White space questions are semi-objectively marked. The marker will have a scoring sheet to assign points fairly. There is, however, an art to writing these answers to highlight your very best academic achievements, demonstrate your commitment to a career in academia and, most importantly, to score those most precious points. 31

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The principles of answering these white space questions are, in our opinion, essentially the same as answering questions at the interview. There is a great deal of overlap and we therefore refer you to Chapter 4 for advice on how to answer these. For the time being, here is some general advice on how to avoid some costly blunders: 1. Do not be modest. While modesty is usually a virtue, it can sink your application or interview. Sell yourself and be sure to list all your credentials as appropriate. 2. Be specific. Do not give vague or generic statements, but rather strike the almost impossible balance between an adequate explanation and conciseness. 3. Keep to the word count. It is not worth losing points by trying to win more. This will only count against you. 4. Answer the question. You will not get bonus points for going off on a tangent, even if what you ramble on about is impressive. You need to give them what they want (i.e. what they can assign you points for!). 5. Provide personal examples. It may be effective to use evidence from your portfolio to demonstrate competence in a particular domain. For example, when asked about teaching, use an example of good feedback you received from a course you have taught. 6. Ask a successful candidate or more senior academic to read your answers. They should definitely not write the answers for you, but they may give you some general advice about your style or approach. 7. Do not be stung by bad grammar. Get your answers proofread. 8. Remember what you have written. You will be asked about your answers during the interview. Anything you have written is fair game for scrutiny. 9. No abbreviations are allowed. Again, just as for the CV, do not assume that the person(s) reading your CV will understand your abbreviations or acronyms. 10. Assume nothing. Do not assume that the persons reading your answers know the significance of something. Make it crystal clear. For example, if the prize you won was an international prize and you ranked first out of 2,000 candidates . . . then tell them! How else would they ever know? In case you have not yet noticed the trend, hear this: assumptions will bring you down. Assume nothing.

3.2.1 Typical AFP White Space Questions Historically, the AFP applications have asked four to six white space questions. For the most recent application (2019/2020 application), the UK Foundation Programme released all the white space questions for each deanery on its website. Not every deanery uses the white space questions to shortlist candidates; for example, the London deanery and the Yorkshire and Humber deanery no longer have white space questions. A selected few examples of the white space questions are listed here (see the Appendix for the full list of questions for every deanery). Again, we deal with answering these questions in the interview section on Chapter 4.

East Anglia (Cambridge) 1. What are your specific reasons for applying to the Cambridge Academic Foundation Programme? Please highlight how the programme will contribute to your clinical or research career plans and briefly outline these. (225 words)

3.2 The White Space Questions

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2. What is your single best clinical or research achievement (paper, presentation, or prize) and why? (225 words) 3. Academic medicine requires an individual to work successfully in a team. Describe a time that is relevant to your foundation training when you have worked as a successful member of a team, and identify your role and contribution to this success. (225 words) 4. Understanding the nature of dark matter is an example of an unanswered high-priority challenge in cosmology and astrophysics. Please give an example of an unanswered highpriority challenge in medicine, and explain the reasons for your choice. (225 words) 5. Please outline your research interests and how they relate to the academic programme and choices available. If you have selected ‘Choice A, B, C, or D’, please identify your first preference academic rotation (from the eight in the prospectus) if you have already made a decision. (225 words) 6. Please list below any achievements that are relevant to the application that have not been captured elsewhere in your application. (225 words)

Oxford 1. How would training in this Academic Foundation Programme contribute to your overall career plans? 2. We recognise that applicants will have had varying levels of research and teaching experience. Please give one example in your medical student career to date of a research project or teaching experience and its significance to your application for an Academic Foundation Programme. 3. Academic medicine requires an individual to work successfully in a team. Describe a time relevant in your foundation training when you have worked as a successful member of a team and identify your role and contribution to this success. 4. What are the teaching and research skills (maximum three) that you would like to take away from the Oxford Academic Foundation Programme, and that you do not already have? Briefly outline your strategy for acquiring or developing these skills. 5. Describe how you would set out to answer a research question that has arisen from a specific clinical case that you have been involved in.

Scotland 1. How would training in this Academic Foundation Programme contribute to your overall career plans? 2. We recognise that applicants will have had varying levels of research and teaching experience. Please give one example in your medical student career to date of a research project or teaching experience and its significance to your application for an Academic Foundation Programme. 3. What are the teaching and research skills (maximum of three) that you would like to take away from the Scotland academic programme, and that you do not already have? Briefly outline your strategy for acquiring or developing these skills. 4. Describe how you would set out to answer a research question that has arisen from a specific clinical case that you have been involved in. 5. Academic medicine requires an individual to work successfully in a team. Describe a time that is relevant to your foundation training when you have worked as a successful member of a team, and identify your role and contribution to this success.

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The Application

3.2.2 Typical ACF White Space Questions The types of questions for the ACF are usually similar to those for the AFP, but there are usually more of them to answer, and they have a larger word count. Examples include: 1. Please give details of your previous and/or current research projects. Please include the methods that you have used. Please specify your role and contribution in each project. Please specify when this research work took place. If this project took place as part of a higher degree, this must be detailed accordingly. (600 words) 2. Please provide in detail a research project that you are particularly proud of. (300 words) 3. Please specify why you want this post. Please list your medium- and long-term academic career goals should you be awarded this position. (300 words) 4. Please provide details of any teaching experience that you have. Have you undertaken a teaching skills course or do you have a formal qualification in medical education? (600 words) 5. Please provide details of any audit or quality improvement projects that you have completed. Please include a statement about your personal contribution to the work and the impact that resulted from your project. (600 words) 6. Describe how you meet the person specifications for this programme that you are applying for. Please include all the particular skill sets and attributes that you have which make you a suitable candidate for this specialty. (200 words) 7. Please describe your previous activities and achievements that demonstrate your commitment to this specialty. (200 words) 8. Please describe your achievements in management, leadership, team working, and communication skills as relevant for a career in your specialty of choice. (200 words) 9. Please give details of any outstanding achievements outside the field of medicine (100 words).

3.2.3 Typical ACL White Space Questions Personal Questions 1. Please describe any clinical experience of particular relevance to this specialty. (250 words) 2. Please provide evidence of activities and achievements which demonstrate your commitment to a career in this specialty and/or which have led to the development of skills relevant to a career in this specialty. (250 words) 3. Give details of outstanding achievements outside the field of medicine. (250 words)

Teaching and Audit 4. What experience of clinical audit do you have? Please state clearly where and when this was undertaken and indicate specifically your role. Please give full details including a statement about your personal contribution to the audit work. (250 words) 5. What experience do you have of delivering teaching? Have you undertaken a teaching skills course or a formal qualification in teaching? (250 words) 6. Please describe an example from your own experience where issues relating to clinical governance have been of particular importance. (250 words)

3.2 The White Space Questions

35

Management, Leadership, Teamwork, and Communication Skills 7. Please provide evidence of activities and achievements which demonstrate your skills in the above, relevant to a career in the specialty. (250 words) 8. Please describe your experience of managing resources. You may give examples from both inside and outside medicine. (250 words)

Academic Achievements 9. Prizes or other academic distinctions. Please state awarding body, date of award, and any relevant additional information. (250 words) 10. Presentations/posters at national or international conferences (indicate whether national or international). (250 words) 11. Publications (shortlisted candidates will be asked to bring copies of all peer-reviewed publications to interview). (250 words) 12. Describe your PhD research. Include a brief description of your main findings, their impact, and the research methods you used. Please confirm the date of submission of your PhD, MD (original research) thesis. (750 words) 13. Please explain how the hosting research department will support your research aims and career objectives, and outline your plans for research in this post. (250 words) 14. Please describe any research training that you have received to date, for example training courses in research methods. (250 words) 15. If you are successful in gaining a Clinical Lectureship, please describe how you will manage the completion of your clinical training. (250 words) 16. Please indicate your medium- and long-term career goals in relation to an academic career. (250 words) 17. Explain how you have developed your interest in becoming an academic medical specialist and how this illustrates your potential for the development of a career in research. (150 words) 18. Please indicate your level of familiarity with information technology. (250 words)

Personal Skills 19. Please describe a challenging situation you have experienced and how you dealt with this. (200 words) 20. How does this demonstrate your communication and interpersonal skills? (150 words) 21. How does this demonstrate your drive and initiative? (150 words) 22. How does this demonstrate your problem-solving skills? (150 words)

Other Information 23. Please list any additional completed undergraduate qualifications with dates. Include intercalated BSc/equivalent degree here, if you have one. Do not include details of your pre-university school education/exam results. (250 words) 24. Please give details of any completed postgraduate medical qualifications/other degrees/ diplomas/certificates (e.g. MD, MRCS, MRCP, etc.). Where a qualification is partly completed please state your exam status, e.g. MRCP (Part 1) etc. For an MD please state whether this is linked to your primary medical qualification or the result of an

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The Application

independent research thesis. Please include here any relevant qualifications listed as desirable on the person specification. (250 words) 25. Please confirm any additional qualifications that you have obtained such as MSc, MD, or PhD. Please give details and dates of qualifications. (50 words)

3.3 Publications Publications listed either in your CV or on the online application form must appear organised, consistent, and professional. Choose a way of listing these systematically, which is usually done by ordering from most to least recent. Be consistent with the referencing format (e.g. Harvard or Vancouver style). It is important not to ‘over-format’ your application form, but it may be worth indicating where your name is within the list of authors by underlining or bolding it. Include the PubMed ID at the end of each paper. The following are two examples: Peer-Reviewed Publications 1. Federer RS, Murray AB, Ecclestone CD, et al. Extramammary Paget’s disease of the scrotum: Case report and review of literature. (Accepted for publication by BMJ Case Report). 2. Leon MB, Kayhanian AB, Federer RS et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. New England Journal of Medicine. 2016 Apr 28;374(17):1609–20. PMID: 27040324. Do I list the papers that are currently being reviewed on my job application form? This is a frequent topic of debate. You can list these, but only as long as you make it transparent on your application form what the status of these submissions is. Our suggestion would be not to, since after all you can submit a blank page to the Lancet and just be waiting on the inevitable response . . . so writing that you have made a submission to a journal does not warrant any points or recognition. Some, however, would argue that although it may not score you points in the application, this will still be evidence that you have had research or writing experience. A candidate who has written and submitted a paper would stand out more compared to a candidate who has significant research experience but no research output to show. Your article being ‘in press’, however, is different because it has been accepted but just has not reached PubMed yet. These ‘in press’ papers should definitely be listed on your application, but, well signposted in their status. It would be embarrassing to be called out for wrongfully listing a publication that is in press that could not be found anywhere on the internet.

3.4 Presentations Presentations listed in your application form (and CV) should appear as a formal reference. For consistency, use the same style as that used for your publications. Signpost whether your presentations were delivered via podium or poster and whether these were delivered to an international, national, or regional audience. This may serve to bring your most impressive presentations to the top of the list and will draw the panel to these achievements. If you have multiple presentations in each category, a good way of doing this is just by having headings to separate these different types. If you only have a few

3.6 References

37

presentations, then indicate their type in brackets after the reference. Otherwise, list all presentations again in reverse chronological order (most recent at the top). Remember to list your name in bold characters or highlight it if using some other formatting method regardless of whether you are the first or middle author. The following are a few examples: Presentations 1. James LB, Johnson CB, Smith AR et al. Fluorescence In-Situ Hybridization (FISH) – A possible substitute for invasive examination in patients at risk of urothelial cancer or dysplasia. 11th Asian Congress of Urology, August 2019, Pattaya, Thailand. (Delivered podium presentation at an international conference) 2. George AR, James LB, Radcliffe P et al. A survey of patient satisfaction following a trial of watchful waiting for the ‘common cold’. National Conference of the Royal College of General Practitioners, December 2018, London, UK. (Delivered podium presentation at a national conference) 3. Roberts MB, Murray AB, James LB et al. Comparative outcomes of radiofrequency ablation for Barrett’s oesophagus with different baseline histology. The Annual John Radcliffe Hospital Gastroenterology Symposium, April 2017, Oxford, UK. (Delivered poster presentation at a regional conference) For candidates who do not have many presentations, remember, you could also include presentations given at local and departmental audit meetings.

3.5 Awards and Prizes When listing your awards, it is critical to ensure that the reader is able to understand and quantify the significance of an award. For example, did you win a regional, national, or international competition? It is not always possible to know the number of applicants, but if you do know that you placed first out of 1,000 people . . . say so, it’s impressive! The following are two examples: Awards 1. Young Investigator Award. International Association of Ophthalmologists. Awarded 6 July 2019. (Awarded for the best trainee presentation at the International Ophthalmology Symposium) 2. Medical Student Essay Competition. The British Association of Urological Surgeons. Awarded first place (£750). August 2017. (National competition, open to all UK medical students.)

3.6 References For any post, academic or not, one or more referees will be required. These referees tend to be contacted only if the job is offered to you. Choose your referee(s) wisely. It is not necessary to have an esteemed doctor or eminent professor of your field as your named reference. A good referee is one that (a) will respond to the reference request (i.e. someone who has a good track record of responding to correspondence) and (b) will say good (preferably excellent) things about you rather than just a bland or generic reference.

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The Application

For an academic interview, good choices for referees tend to be academics, since they are well tuned to the practice of this. Think about who has genuinely got your best interests in mind. It is common courtesy to inform your referees that the request will be heading their way. Giving them notice will allow them some time to think about what they might write.

Chapter

The Interview

4 In this chapter we will guide you from the beginning to the end of your interview process. We start by giving some advice about preparing for the interview and what to do on arrival at the interview centre. We then discuss how to answer interview questions in general and discuss in detail how to answer the high-yield academic clinical questions. Lastly, we talk about what to expect following the interview and what to do with the result.

4.1 Before the Interview 4.1.1 Preparation The content of this section might seem obvious, but the consequences of getting these simple, practical things wrong are disastrous. Do not let your interview day turn into something that resembles a nightmare. 1. Do not delay interview preparation until you have an invitation. It is important to bear in mind that you will likely receive the interview invitation around one to two weeks before the interview day itself. This is not much time! 2. Read the interview invitation and guidance documentation carefully. Know what documents you are required to bring with you. Copies are often required. As per the CV or portfolio, do not leave anything until the last minute. 3. Prepare for every imaginable question. We think that there is actually a limited core of possible questions for any academic interview, and it is possible to prepare for almost all of these. An important point to realise, and one that will make the preparation easier, is that one question can take many forms. Take the example ‘Tell me about yourself’. This might be also be rephrased as ‘Talk to me about your CV’ or ‘Tell me about your portfolio’, and the answer essentially would be the same. Realising this allows you to streamline your preparation and reduce the need for preparing or memorising a vast number of answers. In the example questions section, we point out some of these related questions along the way. 4. Practice, practice, practice. Mock interviews are imperative in preparing for the real interview. You need to find someone, ideally an academic, whom you trust to do this exercise with you. Failing that, practice in front of family or a friend . . . or talk to the mirror. Writing down answers is not sufficient preparation – you need to use your voice! See Chapter 5 for some sample mock interviews for you to try. We recommend undertaking a mock interview at least one week before the interview and another one two to three days before the interview. The first mock interview is to ensure that you have attempted to speak out your answers. Most people will probably find that they perform quite poorly on the first mock, but do not worry! For most people, this will be 39

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The Interview

their first interview since medical school and therefore they may feel quite rusty. Once you have identified areas for improvement, work on these over the next week and have another mock two to three days before the interview. By the second mock, you would have noticed drastic improvements. Finally, use the last few days to fine tune your answers.

4.1.2 Practical Considerations 1. Make sure that your clothes are sorted well in advance of your interview. To state the obvious but perhaps neglected thoughts in the stress of preparing for an interview: you cannot get a suit dry-cleaned the day before and you cannot shop for new clothes the day before without being horrifically stressed. 2. Ensure personal homeostasis. Make sure you eat and drink something (but not too much) on the day of your interview. Your physiology needs to be maintained to rise to the challenge (and stress) of the interview. 3. Avoid any travel fiascos. Do not let traffic, frozen train lines, cancelled flights, or noshow taxis stop you from being at your interview. This is of particular importance for early morning interviews or if you are travelling from far away. If necessary, travel the day before and stay in a hotel, since this will allow you to arrive, get a good night’s sleep, and remove the anxiety of the commute to the interview. Make no mistake, interviewing is an expensive business. However, some recruiting centres will offer travel expenses, so be sure to enquire about these in advance.

4.1.3 On Arrival Arrive early. Locate the interview room. Locate the toilets. Locate a glass of water. Before entering the interview room, you will likely spend some time with an administrator checking and submitting documents. This is to ensure that you are who you say you are and that you have the basic personal specifications for the job you applied for (e.g. you have enrolled in or have graduated from medical school, or you have the right to work in the UK). The administrator may also take various documents such as certificates for college memberships or Advanced Life Support (ALS) courses to give these to the deanery if you were to be successful in your application. You will be asked to wait until called in for your interview. Make sure that you are looking presentable for when you are called. Sit up straight, do not fidget, and keep your hands together.

4.2 How to Answer Any Question You may be the best candidate for the job, but the trouble is . . . you need to prove it . . . in person! Whether or not you are naturally an extrovert or performer, you need to put on a good show and present yourself in the best possible way. This section offers some basic principles to deliver answers in the best way. 1. Structure your answers. Having a predefined way of answering a question will help you to prepare, deliver, and remember your answers. More importantly, perhaps, it will give your interviewers some direction in where your answers are going. It will give them some reassurance that your answer has an end, and they will be more inclined to let you

4.2 How to Answer Any Question

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reach the end of your answer before interrupting. There are various methods to do this. A good example is the CAMP structure described by Picard et al., which orders answers to portfolio questions by clinical, academic, management, and personal content.1 This particularly applies to the portfolio questions (e.g. can you give us an overview of your portfolio?) Another good tip is to use ‘the power of three’ – i.e., giving three reasons for an argument, which sounds punchy. 2. Be confident. Wake up the panel! You need to stuff every question full of enthusiasm. You need to be fierce and dynamic to prove that you really want the job and that you are more passionate than the other candidates. With the competition being so high for these posts, you cannot afford to let the interviewers think that you are one foot in, and one foot out. 3. Sell yourself. There is an element of salesmanship in the interview. Answer questions in a way that is going to show off your best achievements. Ideally, list your notable achievements at the start of the answer to try to catch the interviewers’ attention. The attention span of most interviewers listening to an answer is probably 30 seconds to a minute before they lose interest. You do not want to be in a situation where you were cut off half-way through your answers and had not yet talked about all your notable achievements. No one is going to stick up for you. You need to sell yourself . . . a task hard for the humble but swallow your pride . . . actually no; pour it out and display your pride in front of the examiners. 4. Do not use jargon. You should pitch your answers on a level such that any doctor in any field would be able to understand what you are talking about. Consider also the fact that there may be a layperson on the interview panel and that his vote for the successful candidate is equally valid. On a similar note, do not use abbreviations (e.g. DTI for diffusion tensor imaging, PCR for polymerase chain reaction, etc.), since, unless your interviewers are very familiar with your field, they will quickly get lost and lose interest. 5. Do not try to outsmart the interviewers. Clever people are not those who can make simple things sound complex. Clever people are those who can make complex things sound simple. 6. Control yourself. Do not let your ‘body language’ be distracting, so keep your hands together on the table in front of you. Use non-verbal communication to your advantage. Sit up straight to show that you are enthusiastic and interested. 7. Assume nothing. Do not be falsely under the impression that because they have a copy of your CV and/or portfolio, your interviewers have (a) even read it or (b) taken it all in. The more you can mention and reiterate, the better. Also, do not assume that they understand the gravity of an achievement – for example, they might not appreciate how hard it is to get a certain award from a particular organisation . . . tell them! 8. Be efficient in your answers and content. Do not repeat the same achievement again and again; use a different achievement with each question. 9. Be open to suggestions from the interviewers. You do not need to fight them on everything. If they suggest that you have a look at working with a particular researcher or seeking them out as a potential supervisor, they are more likely to be genuinely trying to help you rather than trying to pick a fight. 1

Olivier Picard, Dan Wood, Sebastian Yuen, and Luke Dunn. Medical Interviews: A Comprehensive Guide to CT, ST & Registrar Interview Skills. ISC Medical.

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The Interview

10. Give balanced opinions. If asked a question on your opinion of a matter, give a balanced view. This will bring out more of the conversation and score more points. For example, most arguments (e.g. ‘Is Brexit going to be a good thing or a bad thing for clinical academia?’) can be split into the advantages and disadvantages. 11. Know what you are applying for. Before the interview, be sure that you have thoroughly researched the programme and know how each deanery schedules its protected academic time. It will be foolish and frowned upon in the interview if you do not know how the programme is shaped.

4.3 Structure of the ‘Generic Academic Interview’ Although there are clearly different expectations of standards, the structure and general content of the interviews for academic posts (be that Academic Foundation Programme [AFP], Academic Clinical Fellowship [ACF], and Academic Clinical Lectureship [ACL], or others) are remarkably similar. A typical interview panel for an academic post will consist of three to seven interviewers and also varies depending on how many specialties are eligible for a particular post (i.e. each specialty will typically be represented by a panel member). The panel typically includes a senior member of the academic clinical programme, academics from each specialty, specialty clinical training director(s), and also a layperson. The total duration of most academic interviews is often around 30 minutes. You may be called into the interview room by an administrator, although sometimes one of the interview panel members may come out and invite you into the room. When you are called, stand up straight, smile, and offer a professional greeting (‘good morning/afternoon’). Do not try to start the interview early by schmoozing or asking questions. You will be shown to the room, and upon entering, do not offer a handshake unless one is offered to you. After sitting down, usually the designated chair of the interview will start introducing himself. The chair may introduce the whole panel, although sometimes, if the panel is large he will not introduce the whole panel and each interviewer will briefly introduce himself when it is his turn to ask you questions. If so, smile and acknowledge each person. The first few questions in the interview are usually intended to help you settle down. For example: 1. How was your journey here? When did you arrive? 2. Where are you in terms of membership exams? (ACF level question) 3. Where are you currently working and on what rotation? These questions are not designed to catch you out. They are just to help you settle in. Do not overthink these questions. They should need just a one- or two-line answer – do not get too ‘chatty’, since you will want to get down to business promptly in order to use the time efficiently. The actual interview then commences. Usually, the questioning will start from interviewers on one end of the table and gradually progress towards those at the other end, with each interviewer taking turns to ask questions (although in some interviews, the

4.3 Structure of the ‘Generic Academic Interview’

43

interviewers can ask questions in random order). Often, the line of questioning will follow a specific theme, as follows: •

Career and portfolio (Section 4.4). Examples include: ○ ○ ○ ○ ○ ○ ○ ○ ○



Research (Section 4.5). Examples include: ○ ○ ○ ○ ○ ○

○ ○ ○ ○ ○ ○ ○ ○



4.5.1 Why do you want to be an academic clinician? 4.5.2 Tell us about your experience in research. 4.5.3 Which of your research projects are you most proud of? 4.5.4 Why do you want to apply for this particular academic post? 4.5.5 What steps need to be taken before commencing a research study? 4.5.6 Whom would you like to work with during your academic time should you get this post? 4.5.7 What are your long-term research goals? 4.5.8 How do you balance a clinical and academic career? 4.5.9 How do you go about getting funding for research? 4.5.10 Can you tell us about a research paper you have read recently? 4.5.11 Critical analysis of an abstract or paper 4.5.12 Should all trainees be involved in research? 4.5.13 What is Evidence-Based Medicine (EBM)? 4.5.14 Tell me about the different levels of evidence.

Clinical (Section 4.6). Examples include: ○ ○ ○ ○ ○ ○



4.4.1 Tell me about yourself. 4.4.2 Why do you want to pursue this specialty? 4.4.3 What is your greatest achievement? 4.4.4 What is your greatest strength? 4.4.5 What is your greatest weakness? 4.4.6 Where do you see yourself in ten years’ time? 4.4.7 Describe your experience in teaching. 4.4.8 Describe your experience in leadership. 4.4.9 Describe an example of a situation where you worked well in a team.

4.6.1 How would you deal with [this particular clinical scenario]? 4.6.2 Can you describe a time at which you or your team made a clinical mistake? 4.6.3 What is informed consent? 4.6.4 What is clinical governance? 4.6.5 What is the difference between audit and research? 4.6.6 Describe your experience in audit or quality improvement projects.

Miscellaneous (Section 4.7). Examples include: ○ ○ ○ ○

4.7.1 If we were to give you a blank cheque, what would you do with it? 4.7.2 Tell me about a person you admire. 4.7.3 Academic ethical scenario 4.7.4 Other questions to think about

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The Interview

We will next dissect these common questions asked in clinical academic (and also often at clinical) interviews. We would strongly encourage you to have a well-prepared answer to all these questions, and more. As mentioned, to prepare in an efficient way, we apply the technique of clustering similar questions together and prepare common stem answers which can be used to answer multiple questions within the same cluster. The purpose is to avoid having to remember copious amounts of information and prepare multiple answers for the same question. This technique will allow you to have a core bank of A+ answers up your sleeve to deal with a range of questions within the same cluster. We demonstrate some examples in this book to help you with this clustering method. The answers to these questions are dependent on each candidate’s own experiences, skill set, and achievements. Each answer should therefore be tailored to your personal achievements, and thus the example answers listed in this section may not be pertinent to everyone. However, the structure and general approach to answering these questions could be applicable to anyone. As mentioned earlier, the example answers given in this book are based on examples of ‘high-flying’ candidates. You, like everyone else, including the authors, should not be discouraged if you cannot match these levels of achievement for every question and answer. Each candidate has his strengths and weaknesses and therefore there will be natural variation in answer strength throughout one’s application form and interview. Regardless, in this section we help you to represent your achievements and credentials in the most impressive way.

4.4 Career and Portfolio Questions 4.4.1 Tell Me About Yourself Similar Questions • • • •

Take me through your CV. Talk to me about your portfolio. Talk me through your academic career to date. How have you shown commitment to your specialty?

This question (technically a command) is a gift. Why? Because you get to pitch your greatest achievements directly to the panel. This is often the first question of the interview and is your chance to make a good first impression, so make it count. Do not be fooled by what may first appear as a casual ‘tell me about yourself’ request. It is not a speed-dating exercise. They are not interested in your nickname, family tree, pets, or favourite hobbies. You are applying for a career as a clinical academic and the answer needs to convey that you mean business . . . and that you want the job! In all likelihood, the interviewer will stop you before the end of your answer, so making sure each sentence is efficient is crucial – i.e. make sure that your answer is stuffed with impressive and objective evidence for why they should hire you. Of course, everyone has a different cocktail of achievements, and you should tailor your answer to show these off as required.

4.4 Career and Portfolio Questions

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Since this is an academic interview, the answer should heavily focus on the ‘A’ of the CAMP structure.2 Here we give an example of both ineffective and effective answers from a single fictional candidate. Example of an Ineffective Answer I am currently an AFY21 at the JR.1 I am keen to be an ophthalmologist2. My portfolio shows I have been involved3 in research, audits, and have done some teaching as well. . . . 4 Dissecting the Answer 1. Do not use abbreviations. The interviewers may have no idea what they mean. 2. This states no intent to be an academic. 3. While intended as modesty, it could be interpreted as passive involvement. 4. This candidate fails to realise that this question is a golden opportunity to showcase his achievements. It is not a simple introduction scenario.

Example of an Effective Answer I am currently an Academic Foundation Doctor at the John Radcliffe Hospital in Oxford. My portfolio demonstrates my commitment towards a career in academic ophthalmology. I have demonstrated this commitment through clinical, academic, teaching, and leadership activity.1 Clinically,1 I am a graduate with honours2 from Imperial College London and spent my elective module in a joint clinical and academic2 placement at the Department of Ophthalmology at Stanford. I then was selected onto a competitive2 Academic Foundation Programme at the University of Oxford. I have used every opportunity3 to engage with clinical ophthalmology and my clinical knowledge has been proven by coming first place in the Duke Elder exam last year. In terms of academic output,1 I have a First Class2 intercalated degree in physiology and, despite being pre-PhD,3 I have a peer-reviewed publication in the Journal of Ophthalmology for which I am the first author.2 I have presented my work at both national and international2 conferences and recently won the prize for the best oral presentation at the National Student Association of Medical Research conference. I have been active in clinical governance and audit.1 In my academic foundation year, I closed the loop on an audit aiming to improve the efficiency of discharge following cataract surgery. I have been formally trained in teaching1 by enrolling in a postgraduate diploma in medical education and have designed a fundoscopy skills course for medical students. Dissecting the Answer 1. Signposting the structure of the answer to the interviewers. 2. Details not to be missed when describing your achievements. 3. Indicates early commitment to an academic career.

2

Olivier Picard, Dan Wood, Sebastian Yuen, & Luke Dunn. Medical interviews: A Comprehensive Guide to CT, ST & Registrar Interview Skills. ISC Medical.

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The Interview

4.4.2 Why Do You Want to Pursue This Specialty? Similar Questions • • •

What has been your experience in [field of medicine]? Why do you enjoy [field of medicine]? What makes [field of medicine] an interesting specialty?

An applicant will choose, knowingly or not, a specialty based on a number of different reasons. These include clinical, academic, and personal factors. As this is an academic interview, particular emphasis should be on the academic reasons, but a well-structured and prepared answer may incorporate each of these interests. Each candidate will have his individual reasons for his choice of specialty, and an individual or unique answer would be preferable. To get you started, here are some examples of factors of why you may have chosen your particular specialty: • • • • • • • • • •

[Specialty] allows you to treat a diverse patient population, ranging from young adolescents to elderly patients. [Specialty] allows one to retain a generalist practice. [Specialty] offers a balance and interplay between medicine and surgery or the opportunity to perform invasive procedures. [Specialty] offers continuity of care with patients. [Specialty] offers an exposure to managing both acutely unwell patients as well as those with chronic diseases. I enjoy the holistic approach to patient care offered by [specialty]. [Specialty] involves screening and prevention of cancers. I appreciate the importance of effective communication in [specialty] and dealing with sensitive issues. [Specialty] offers the potential to have an immediate impact on acutely unwell patients. The field of [specialty] is rapidly advancing and offers many areas for research.

A candidate should have two or three examples when structuring his answers and by no means does this have to include one example from every category. Including two clinical and one academic answer is perfectly fine, although, as this is an academic interview, we would argue that you must have an ‘academic reason’ for pursuing your specialty. Giving a bunch of generic answers will not catch the attention of your interviewers. A crucially important factor in your answer is how personal it is to you. A good way to achieve this is to provide answers with personal examples which will allow you to confirm that your career interest is genuine and strong. Example of an Ineffective Answer I want to pursue a career in respiratory medicine since I enjoy seeing and managing the acutely unwell patient.1 Pharmacological interventions can result in dramatic improvements in patients.1 There is also a wide scope of research areas which I find interesting2 and I would like to investigate pulmonary fibrosis, asthma, and pneumonia.3

4.4 Career and Portfolio Questions

Dissecting the Answer 1. Not specific to specialty. Generic and impersonal reasons. Giving a personal example would make these more meaningful. 2. There is no weight behind this statement, since it is not clear why the candidate is ‘interested’ . . . which is a word that is not very convincing. 3. This statement is too broad. It would be more feasible to focus on one condition and convince your panel of your interest in it rather than a few conditions. It gives the impression that you are either unfocused or trying to bite more than you can chew. Overall, this question is too short and there is much more opportunity here to convince the panel that you are determined to pursue the [specialty] in question.

Example of an Effective Answer Respiratory medicine is a fascinating specialty which I first discovered in my medical school attachment and I have been pursuing it as a clinical academic career since. From a clinical perspective,1 I have particularly enjoyed dealing with critically unwell patients1 and that my intervention can have the potential to have immediate life-changing results for the patient. For example,2 when I was shadowing a respiratory registrar during my medicine rotation we reviewed a patient with life-threatening asthma exacerbation with a peak flow of 50 L/min. With just a few interventions we were able to stabilise and relieve his respiratory distress, avoiding the need for intubation. What I find particularly exciting about respiratory medicine, however, is the academic prospect1 this specialty has to offer. I have an interest in interstitial lung disease, especially idiopathic pulmonary fibrosis (IPF).3 My interest is in trying to understand the genetics of this condition, in particular, how genetic mutations of proteins involved in the inflammasome, such as NFκB, lead to IPF, since it has been increasingly elucidated that the process leading to IPF is subclinical epithelial injury secondary to underlying inflammation. My previous research during my intercalated BSc working on IPF showed that inhibition of NFκB in rat models prevented the development of pulmonary fibrosis and that overexpression of this gene with a hyper-expressed promoter led to fibrotic changes in the mouse lung after three weeks. I presented4 my work at the American College of Chest Physicians conference in 2019, and I also co-authored an article on the work which was published4 in the Journal of Respiratory Medicine. I am determined to continue my pursuit of a career in academic pulmonology by acquiring this Academic Clinical Fellowship. Furthermore, I have also learned that Professor Davies is a pioneer in research investigating inflammation and IPF,5 and if given the opportunity, I would like to work in his lab. Dissecting the Answer 1. Signposts the answer and provided structure. 2. Provides clinical reasons with personal examples. 3. Provides a specific research interest with a clear intent of academic pursuit 4. Uses the opportunity to highlight your achievements. 5. Demonstrates that you have insight into the place you are applying to and have already made provisional plans for your research there.

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As per other questions, it is typical to be interrupted half-way through your answer. If you have given an interesting answer, however, you will likely have some follow-up questions, such as: • • • •

You mentioned a project that you previously worked on. Can you describe this in more detail? What techniques did you use in your research project? You mentioned that you worked in / visited [hospital/lab]. Please can you tell us more about that? Why do you want to pursue [specialty] here?

By inserting specific experiences and achievements into your answers, you are often able to ‘steer’ the interview towards questions that you are much more comfortable answering.

4.4.3 What is Your Greatest Achievement? Similar Questions • What is your greatest academic output? • Which research project are you most proud of ? This question is somewhat similar to ‘what project or paper are you most proud of?’ (covered in Section 4.5.3) but instead leaves scope for you to choose another type of achievement. Sometimes, however, the questions may be phrased as ‘what is your greatest non-medical achievement’? It is therefore important for you to think of both a medical and a non-medical achievement in your preparation for the interview. Examples of Medical and Academic Achievements • • • • • •

Medical school or university distinction or merit Essay prize Surgical skills competition Young investigator award Successful grant application Publishing an important paper

Examples of Non-medical Achievement • • • •

Leading a sports team to victory Representing your university in [activity] Publishing a piece of music Scaling to the peak of Mount Kilimanjaro

The more personal and the more unique your answer can be, the more the panel are going to be interested in your achievement. Adding quantitative information to your answer, such as competition ratios or describing the scope of the competition, will also add to the wow-factor of your greatest achievement.

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Example of an Effective Answer Regarding a Medical or Academic Achievement During my third year of medical school, I won a young investigator award from the Royal College of Radiologists for my research on liver ultrastructural imaging. The award was contended for by medical students from around the UK,1 and my abstract ranked first out of 87 submissions.2 As well as winning the award, I was particularly proud of this achievement, since this was a project in which I developed myself and had pitched an original study idea3 to my supervisor. This demonstrates that I can develop original research questions and that I have shown early independence as a young academic clinician.3 Dissecting the Answer 1. Describes geographical scope of competition. 2. Provides a quantitative summary of competition level. 3. Demonstrates a deeper level of worth behind the achievement.

As well as preparing to answer this question with a medical or academic answer, it is certainly worth having a non-medical or non-academic example as well. This may be the interviewers’ way of asking about ‘extracurricular interests’. Example of an Effective Answer Regarding a Non-medical or Non-academic Achievement In my second year of medical school, I captained the Dundee University Men’s Rugby team. Together we won1 the Scottish University Rugby League in that year, by ranking first out of 16 regional teams. As well as winning the league, this was a hugely rewarding experience because I was able to demonstrate leadership, resilience, and determination2 in reaching our goal. In addition to being great fun, rugby has been motivational in all of my pursuits, including academia,2 and demonstrates that hard work does pay off. Dissecting the Answer 1. Shows humility where possible. 2. Brings the answer back around to being relevant for the interview.

4.4.4 What is Your Greatest Strength? This question is typical of all interviews, including those of the clinical and academic posts. It is often asked in tandem with the contrasting ‘greatest weakness’ question, covered in the next section. There are some generic examples of ‘strengths’ that applicants use, for example those that focus on organisation, teamwork, leadership, and time management. These examples, quite frankly, are boring. In the clinical academic interview, we would instead argue that a strength focused on your academic abilities is a more relevant answer. Describing your greatest academic strength followed by a key example and an impressive outcome would be an effective answer. Some examples would be being an avid collaborator, being able to ask original research questions, or being able to carry projects through to completion.

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Example of an Effective Answer My greatest strength is my passion for and effectiveness in collaborative research.1 I have worked on three collaborative projects2 with the Student Audit and Research in Surgery (STARSurg) collaborative, which is a UK-wide collective of medical students who are passionate about surgery and want to generate high-impact work together. There is an increasing ethos of collaboration within UK surgical research,3 and by being an excellent collaborator I have demonstrated that I am able to remain at the forefront of research methods. My collaborative efforts have yielded three publications; I was a co-author in the writing group on two of them and collaborator on the other. If I were to be successful in securing this post,4 I plan to continue in my nationwide collaborative work, in which I would like to develop a UK-wide study of the outcomes and complications of inguinal hernia repair in the UK. Dissecting the Answer 1. 2. 3. 4.

Not a cliché choice of strength. Shows an example of how this strength has been proven. Explains why the strength is relevant to an academic clinical career. Brings the answer back around to the post.

4.4.5 What is Your Greatest Weakness? Similar Questions • Is there anything about yourself that you want to improve on? • What skills would you like to improve on? This is what we would call a ‘shoot-foot’ question – meaning, it is possible to do yourself a tremendous disservice by answering this question poorly. It is a very difficult question to answer, since you need to tread a fine line between describing a weakness yet portraying yourself in a good light. Saying you do not have weaknesses at all appears arrogant. Even if you tried to tell your interviewers this, they would probably push you to state an example. On the other hand, your answer should not include anything that makes you appear incompetent, unsafe as a doctor, or undesirable as an employee. For example, you can’t say something like ‘bad communicator’, ‘bad at suturing’, or ‘unhealthy eater’. There is no positive spin that you can bring to these examples. Common (and cliché) answers to this question include: • I am a perfectionist. • I find it hard to delegate. • I take on too much responsibility. • I am a workaholic. A way to get through this question is to choose something that you would like to achieve soon, but perhaps is just a little ahead of your time. As for other questions, an answer can come alive if you make it personal and less mundane.

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Example of an Effective Answer A personal weakness that I wish to work on is my ability to ‘sell myself’.1 In preparing for this interview I have been told that I often fail to mention some of my best achievements. While modesty is generally a good quality,1 it could become a weakness in certain competitive academic situations,2 such as interviews, grant applications, and beyond. I do hope that I have managed to represent myself as well as possible today and will strive for a good balance between salesmanship and modesty going forward.3 Dissecting the Answer 1. A ‘weakness’ that will not ‘shoot you in the foot’. 2. Academic relevance. 3. Shows determination to work on one’s weaknesses.

Keep this answer short and sweet. Do not spend a large chunk of your precious interview time talking about your ‘weakness’!

4.4.6 Where Do You See Yourself in Ten Years’ Time? Similar Questions • What is your long-term career goal? • Where do you see yourself in the future? • Where do you see yourself in five years’ time? This question tests whether you have academic aspirations beyond the programme you applied for and whether you know how to plan your career to achieve those aspirations. The key is to understand both the final destination and the route towards it. It is important to have an answer for the ‘Where do you see yourself in five years?’ question, since this is also commonly asked. As most people often prepare answers for five or ten years, occasionally, interviewers will try to catch you out by asking, ‘Where do you see yourself in seven years’ time’? In fact, this was an actual question at the ACF level. To be able to answer this question, it is important to have thought about this beforehand. A few key points to think of are: • What career stage will you be at in ten (or five) years’ time? • When are you planning to take time out for a higher degree (MSc, MD, or PhD)? • What do you want to do after getting a higher academic degree? Apply for a postdoc position? Apply for a lecturer position? Apply for an intermediate fellowship position? • Are you thinking of spending some time overseas? • When will you achieve your certificate of completion of training (CCT)? Example of an Ineffective Answer Well, let me work it out.1 In five years’ time I think1 I will still be a registrar. I will have done my PhD by then and hopefully I will consider2 applying for an Academic Clinical Lectureship. It is

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quite difficult to know what I will be doing after that,3 but I plan to be a consultant2 in general surgery at a teaching hospital. Dissecting the Answer 1. Question and answer not anticipated. 2. No clear commitment to an academic career. 3. No obvious ambition or foresight.

Example of an Effective Answer In ten years’ time I am determined to be an Academic Clinical Lecturer1 and Senior Trainee in General Surgery. I plan to get there by2 acquiring this ACF, completing a three-year competitively funded PhD1 after finishing ST3, and hopefully, acquiring a Clinical Lectureship post-PhD. At this stage in my career I plan to be striving towards my goal to understand more about the genomics of colorectal cancer3 with the laboratory techniques and insight I have gained from my prior posts. After this,4 I will be looking to acquire CCT as well as an intermediate fellowship from the Wellcome Trust or MRC. I also intend to complete a one-year advanced fellowship in colorectal surgery at the Massachusetts General Hospital and then compete for a Clinician Scientist position.5 Dissecting the Answer 1. Shows commitment to academia. 2. Insight to the academic pathway and pre-planning. 3. Leads the interviewer towards a desirable topic of discussion – one that will draw out the candidate’s field of research and/or expertise. 4. Academic aspiration even further than the ten years asked. 5. Career destination known.

4.4.7 Describe Your Teaching Experience Medical education is changing such that teaching is recognised as a discipline that must be refined. It is increasingly expected that medical educators should be trained in their role. Try, therefore, to incorporate into your answer any courses (for example, ‘Tomorrow’s Teachers’ or ‘Training the Trainers’) or degrees (for example, a Postgraduate Diploma in Medical Education) that you have completed or are enrolled in. Being simply ‘involved’ in teaching is only so impressive, since many applicants will be loosely involved in teaching. To catch the attention of the panel you need to show them something that others have not done. Some ways to set yourself apart are: • Designing a curriculum. • Running your own course. • Organising mock examinations. • Winning a prize for medical education. To answer these questions, you need to think about these key points: • What teaching sessions have you delivered?

4.4 Career and Portfolio Questions

• • • • • • • •

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What was the format of the teaching? (e.g. bedside teaching or classroom teaching) Who was/were the audience? (e.g. pre-clinical or clinical medical students, or junior doctors) Were they regular sessions? (i.e. a long-term commitment) Do you have any formal feedback from your teaching? Have you been recognised for your teaching? Did you win a prize? Have you attended any teaching courses to refine your teaching abilities? Are you planning to enrol yourself into a higher degree for medical education?

Example of an Effective Answer 1 During my Foundation Year 1,1 I designed and organised a six-week teaching programme1 called ‘High-Yield Cases for Medical Finals’ for medical students approaching their final examinations1 at Imperial College London. I focused on the management of medical emergencies1 with an emphasis on guidelines and evidence-based medicine.1 This programme concluded with a 60 Multiple Choice Questions mock exam that I wrote2 to simulate the experience of the students’ upcoming exam. The feedback3 I received for the course was overwhelmingly positive and motivating and 95% of students recommended my course to other students. The positive feedback I received led to me being nominated for medical school Educator of the Year in 2016. The success of this course also led it to being introduced as part of the final year curriculum at Imperial College London. To continue my pursuit of medical education and to further refine4 my teaching methods, I wish to enrol onto the Imperial College London’s Clinical Educators scheme,4 where I could deliver weekly bedside teaching for final year medical students. Dissecting the Answer 1. Explains what, where, when, and who of the teaching sessions. 2. An example of going ‘above and beyond’. 3. Feedback received supporting the value and quality of the teaching. 4. Demonstrates willingness to develop as a medical educator.

This is an example of a good answer for the ACF application. Most candidates for the AFP will not have such extensive teaching experience. However, AFP applicants could still apply the framework and general principles discussed here. Example of an Effective Answer 2 During my final year of medical school, I organised a ‘mock objective structure clinical examination (OSCE)’ for third-year medical students to prepare them for their end-of-year OSCE exam.1 I worked with a team of three other senior medical students to design, organise, and coordinate the mock examination.2 This was a challenging exercise that required me to write clinical scenarios that would challenge the students at the correct level. This experience also improved my organisational skills,3 since I was responsible for2 booking suitable venues, recruiting junior doctors and consultants to act as mockexaminers, and advertising the course to the students. Students were also provided with feedback and areas for improvement.1 In particular, we noted that students found the cranial nerve station particularly difficult, and therefore we concluded the feedback session

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by inviting a neurologist to perform a step-by-step illustrations of the cranial nerve exam. The feedback from the course was excellent,4 and the students specifically praised the patient selection and the relevance towards the medical school curriculum. Ninety-five per cent of students who attended the course passed their year three exam.5 Dissecting the Answer 1. Teaching tailored to educational need. 2. Specific involvement stated. 3. New skills developed. 4. Feedback acquired. 5. Objective outcome stated.

Answers such as these could easily be adapted and used to answer the white space questions on teamwork. Of course, if doing so, then the answer should be framed towards applying skills involved in team working such as delegation, coordination, providing clear instructions, and meeting timelines. Most medical school graduates would have delivered some sort of teaching. As previously mentioned, teaching can come in many forms, such as bedside teaching, tutorials, lectures, educational presentations, journal club, simulations, or skills-based sessions. For those who do not have much experience, describing bedside teaching experience, feedback received, and what you have learned from it would certainly be better than nothing.

4.4.8 Describe Your Experience in Leadership Similar Questions • Tell us about a time you demonstrated leadership. • Tell us about a situation in which you have acted as a leader. • Give us an example of a situation in which you took the role of a leader. Typical clinical academic answers include those that revolve around: • Leadership of a committee or society. • Leadership of a study team on a project. • Organising a conference. • Managing a rota. • Leading a clinical team (e.g. a medical registrar leading the cardiac arrest team). An effective leader: • Establishes a clear goal or vision. • Is able to steer the team, group, or committee towards the end goal. • Motivates the team. • Works for the team’s or organisation’s benefit rather than his own. • Understands his team and helps them to draw out their best qualities or skills. • Makes difficult decisions when required on behalf of the team. • Puts faith in team members and is able to delegate. • Supports team members through individual challenges in completing a task.

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Leadership qualities are also relevant in non-medical activities that you may take part in. If you do not have an academic example, it may be perfectly valid to give a non-academic example. For example, have you led a sports team? Did you represent your university in a club? Did you lead a fund-raising campaign? When answering these questions, it is important to consider if, in your given answer, whether you are describing an example of leadership, management, or both (refer back to Chapter 2, Section 2.2.5 for guidance on this). Be sure to explain the nature of the leadership role you played. Even more importantly, however, is that a strong answer should demonstrate that you were effective in your role. For example, what was the output (e.g. publications, presentations, etc.) from the research that your team did? Or, how successful was the conference your team organised? Or, how much money did your fundraising campaign raise for charity? Or, how well did your cardiac arrest team perform? Example of an Effective Answer During my final year of medical school I led the Warwick Medical Student Research Society where we promoted undergraduate research, held regular journal clubs, and hosted a national undergraduate research conference,1 of which 120 students from 25 medical schools attended.2 In addition, we established and launched an online resource on our website for students to find landmark and recent clinical trials where members could easily identify and incorporate evidence-based medicine into clinical practice. The society website now has 80 hits a day compared to 20 hits per day2 recorded in the year prior. Leading the committee was sometimes challenging due to differing opinions and it was sometimes hard to make a decision when there was a lack of consensus. Nevertheless, this was a useful experience going forward, since academic clinicians often find themselves in leadership positions within a research team and are required to make progress in the face of discord.3 Dissecting the Answer 1. Specific goals and responsibilities stated. 2. Quantitative measures of success. 3. States how leadership experience is important for an academic clinical career.

4.4.9 Describe an Example of When You Worked Well in a Team Similar Questions • Tell us of a time when you worked as a good team member. • Describe a situation in which your contribution as part of a team led to a valuable achievement. There may be some overlap between your leadership and team working experiences, but there is an individual skill set for being a good team player, which includes: • Putting the best interests of the team and goal ahead of one’s own. • Respecting the views of others. • ‘Actively’ listening to others on the team. • Showing commitment and taking on an equal burden of responsibility. • Reliably fulfilling your duties to the team or goal.

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• • •

Showing the ability to learn from one another. Showing the ability to receive and give constructive criticism. Supporting other team members. Effective answers to this question could either be a medical, academic, or ‘extracurricular’ achievement. Example of an Effective Answer During the first year of my Academic Foundation Programme I worked with a team of junior doctors at the Queen Elizabeth Hospital in King’s Lynn to conduct a hospital-wide audit of vancomycin prescriptions and dosage monitoring.1 Following a hospital teaching session on prescribing, a group of us were interested in determining our hospital’s performance against our local antibiotics prescription guidance. We discussed among ourselves how to define our audit purpose (which required us to actively listen to and respect each other’s ideas)2 and develop a plan of how to conduct the audit and divide the work equally between the members of the group. Our group effort was successful, since we presented our findings to the hospital seniors and we implemented a new prescription chart that improved our performance from 69% to 86% compliance.3 As well as this good outcome for patients, we showed that we could work effectively as a team to achieve a common goal. Dissecting the Answer 1. Uses a team working example that also serves as an example of achievement. 2. Describes qualities of a good team worker. 3. Objective measure of success.

4.5 Research Questions This is arguably the most important, and likely the most time consuming, section of the clinical academic interview.

4.5.1 Why Do You Want to Be an Academic Clinician? Similar Questions • What made you pursue academia? • Why do you want to pursue a career in academic [specialty]? • Why do research? This question has some overlap with the ‘Why do you want to be a [type of doctor]?’ question (Section 4.4.2) but is intended to be much more specific on the academic component. Use the valuable time given here to focus in on why combining your clinical career with academia is going to make your career and daily work even more exciting. There are some generic statements that are often regurgitated by candidates. Using some of them may show some insight into the career, but it would be important to add something 3

British National Formulary. Prescription writing. https://bnf.nice.org.uk/guidance/prescriptionwriting.html

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novel to this answer to wake up some of the dozing interviewers. One way to achieve this would be to use a personal example to illustrate how an experience has made academic medicine come alive to your eyes. This question will be used to decide how dedicated you are to a career in academia, so giving an answer with enthusiasm and confidence to academia is critical. Example of an Effective Answer I am dedicated in my pursuit of a career in academic oncology.1 During my medical school respiratory module I encountered patients with metastatic lung cancer for whom the prognosis was dismal.2 I was surprised to learn that there are very few options for effective therapy, and this sparked my interest in understanding and trying to develop novel treatment options for patients with lung cancer.3 I have already made early progress in academic pursuits by undertaking an intercalated BSc in Cell Biology.4 I worked on a project utilising gene therapy in lung cancer in which I transfected mice with a lentivirus vector carrying the PD-L1 gene to increase its expression, and to then determine whether T cells could mount a response towards the cancer. My results showed that this therapy led to regression of tumour size by 20% after three days. However, the tumour was able to develop resistance to treatment after two weeks. My work was presented at the American Thoracic Society and will be submitted for publication to the Journal of Thoracic Oncology.4 To further my interest in immunotherapy, I then undertook a combined clinical and research elective in Pulmonary Oncology at Memorial Sloan Kettering Cancer Center in New York, working on similar methods in human lung cancer cells in vitro.5 This early experience in translational research has confirmed that combining clinical work with academia is both stimulating and rewarding. Attaining this post would be a crucial step towards continuing my road towards being a clinician scientist and towards developing effective therapies for patients with lung cancer. Dissecting the Answer 1. Enthusiastic opening line that confirms commitment. 2. Personal example giving rationale of career choice. 3. Patient-centred academic goal. 4. Using opportunity to describe previous research experience, results obtained and associated achievements. 5. The interviewers will most certainly quiz you on this further; thus you are steering the interview towards something you are comfortable talking about.

4.5.2 Tell Us About Your Research Experience Similar Questions • Tell us about your research career to date. • Tell us about the different research projects that you have worked on.

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This question is almost always asked at every academic interview and is a golden opportunity for you to showcase all of your academic abilities and achievements. This question is similar to the academic component of the question ‘Tell me about yourself’, but it gives you the opportunity to expand on your prior research projects and outputs in more detail. Before answering this question, remember that candidates will need to know in detail all of the research work listed in their answer for the ‘white space’ questions. Important aspects of your previous work that you should have memorised include, but are not limited to, your role in the project, the methods used, results, limitations, potential for future work, and skills you developed. Knowing your work in detail is important because this question will often lead to a follow-up question such as ‘Tell me about one of your research projects in more detail’ or ‘Tell me about a research project that you are proud of’ (Section 4.5.3). It is also imperative to understand the techniques that you have used in your research projects. For example, it would be suspicious if you have published a paper describing an experiment that used Western blots but you have no idea how the technique works! With that said, in your answer you do not need to describe everything you have ever done. For example, if you are applying for an academic psychiatry position and have five previous psychiatry projects and one project on tonsillectomies, then taking out the tonsils is probably the right thing to do. Important Points to Consider for this Question • • • • • • • • •

How many projects have you been involved in? What types of projects have you done? Were these basic science research or clinical projects? When were these projects undertaken? Did you do an intercalated BSc or MSc? Did you get honours or were you nominated for the Dean’s List? Have you conducted any projects in a prestigious institution or lab? How many papers and abstracts have you produced? How many presentations have you delivered? Were these oral or poster presentations? Have you won any grants, bursary, or prizes? Example of an Effective Answer Throughout my early career in academic medicine I have developed experience and skills in research by completing four basic science project(s) as well as two clinical project(s).1 During my intercalated degree in Molecular Biology, in which I achieved First Class Honours, I undertook a basic science project on the use of gene therapy to prevent diabetic cardiomyopathy in type 1 diabetic mice. As part of this project, I learned to perform histological analysis including immunohistochemistry, immunofluorescence, and paraffin processing with the microtome.2 My experiments showed [brief summary of results]. I was nominated for the Dean’s List, published my results in the journal Diabetes and presented the work at the World Congress of Diabetes.3 In the final year of medical school, I was awarded a travel grant by the Royal College of Surgeons to undertake a research elective at the Wake Forest Institute of Regenerative Medicine in North Carolina, USA, where I worked with [Professor] on 3-D printing of kidneys for transplant. As part of this work, I developed skills in automated image segmentation and

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showed [brief summary of results].2 I also presented my work at the hospital’s Grand Round and was also a co-author on an article in the Journal of 3D Printing.3 In addition to these works,4 I have published three clinical research papers, one of which I was the first author. I have also published four abstracts, three of which I was the first author and presented as oral presentations at international conferences. Dissecting the Answer 1. Signposts and gives structure to your answer so the interviewers know what to expect. 2. Each project listed includes a succinct summary of the techniques used, skills developed, and results obtained. 3. Each project mentioned is accompanied by notable achievements. 4. The answer concludes with a list of other achievements. If you still have time, use it to showcase your achievements.

As stated previously, this will not be a standalone question, but it will open the door to multiple follow-up questions through which you can talk in more detail about a particular project. It may even be that you are interrupted mid-answer. In the aforementioned example, the interviewers will most probably focus in on your elective work and would ask you to expand on this. As this is predictable, having a polished answer for this work is critical.

4.5.3 Which of Your Research Projects Are You Most Proud of? Similar Questions • Please describe one of your research projects in more detail. • What is your most significant research output? • Which of your research projects has had the biggest impact? This question is a golden opportunity to showcase your research, demonstrate the skills that you have developed, and highlight some of your best achievements. This question could be answered by giving a brief overview of the project: • Where was this work conducted? Was it in a lab? Was it in another country? • When did you complete this project? Was it part of your intercalated degree, or was it done as part of your student-selected component? Or was it done over the summer holidays? • What was the aim of the study? • What was your role? Did you help design the study? • What techniques did you learn? • What did your results show? • What was the outcome or implications of the work? The remainder of your answer should explain why you are most proud of your selected project. There are no rules here on what constitutes an ‘impressive’ project. For example, it does not necessarily have to have led to a publication or prestigious award. It also does not

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even need to be a project that you have completed. The project that you select could very well be an ongoing project you are working on. Here are a range of good reasons for which you may be proud of your project: • You had a significant role in the design. • You had a significant role in conducting the research. • The research led to a publication, presentation, or award. • You learned a new skill or technique. • The output had a significant impact (e.g. changed clinical practice). For a project you have published, it is important to bear in mind that being middle author in a high-impact publication does not necessarily make you look better than a paper in which you are the first author, but in a low-impact journal. In fact, you probably learn more by being the first author in a smaller publication, since the first author is often the person who collects most of the data, analyses the data, drafts the whole manuscript, submits the paper, addresses the reviewers’ comments, and makes the necessary corrections to the paper.

Example of an Effective Answer I have undertaken a range of different research projects throughout my medical career, ranging from laboratory research to epidemiological studies.1 The project I am most proud of, however, is a study aiming to determine the health outcomes of children and adolescents with acute lymphoblastic leukaemia (ALL) in Northern Ireland.2 This was a project I undertook with the Cancer Survival group in Northern Ireland during my medical school summer holiday after completing an intercalated bachelor’s degree in Public Health in Bristol. I analysed the Northern Ireland Cancer Registry for all ALL patients between 1980 and 2018. I independently generated a data collection proforma3 to obtain data on the age at diagnosis, ethnicity, gender, blood results, and five-year survival. I learned to independently perform complex statistical analysis using Stata such as the Pohar–Perme estimate.4 My results showed that the five-year survival had improved from 25% in 1980–1990, to 85% in 2001–2010, with a median of three-year survival advantage.5 We also identified that age at diagnosis, degree of anaemia at the time of diagnosis, and lymphocyte count at diagnosis as predictors of poor prognosis in ALL. My work from this project has been accepted for an oral presentation at the National Cancer Research Institute (NCRI) conference in Glasgow 2020. I have also drafted a manuscript on which I am the first author, which is currently being peer-reviewed by the British Journal of Hematology .6 Dissecting the Answer 1. Shows the breadth of your prior research work, both clinical and basic science. 2. Straight to the point, stating the aim of the work. 3. Lists your role and your contributions to this work. 4. States what you have learned. 5. Succinct summary of results and significant findings from the work. 6. Rewards and outputs from your work.

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4.5.4 Why Do You Want to Apply for This Particular Academic Post? Similar Questions • Why should we hire you? • Why apply to this deanery? ‘Why here?’ is essentially the question. This is a classic interview question at every level of either the clinical or academic ladder. The answer to this question needs to convince the panel that the job is best suited for you, and, conversely, you are best suited for the job. Thus, essentially, the ‘why here?’ (or ‘why us?’) question is the same as the ‘why you?’ question. A good answer to this question is a multifactorial one that incorporates both clinical and academic factors. As we mentioned in Chapter 2, Section 2.1, the stars need to align to enable both clinical and academic progression for you to excel in that particular post. Example of an Ineffective Answer Edinburgh is a beautiful city1 that has excellent hospitals2 and an excellent Department of Oncology. I think3 that I would get a good level of training2 here and an opportunity to get involved4 with the research that they are doing at the Western General Hospital. I would be looking for a project5 in the field of genetics and breast cancer, and I would like to learn more about the CRISPR-Cas9 technique.6 Dissecting the Answer 1. Not particularly relevant and a poor opening argument. This is an academic clinical interview. 2. Not specific. Many places and departments are excellent. 3. Never say ‘I think’ in an interview. 4. ‘To get involved’ is a passive statement. 5. ‘Looking’ infers that you have not done your homework into what projects are available, have not identified a supervisor or lab, and have not put any plans in motion yet. 6. Never use an (unexplained) abbreviation/acronym or jargon in an answer.

Example of an Effective Answer Edinburgh is the best place for me to continue my pursuit of a career in academic oncology.1 My research focus is on the genetics of breast cancer and I have identified2 that the work that Professor Singh’s lab at the Institute of Genetics and Molecular Medicine is conducting is groundbreaking, especially in regards to identifying molecular targets for pharmacological agents. I have already approached Professor Singh2 about a project using CRISPR (which stands for Clustered Regularly Interspaced Short Palindromic Repeats)3 for gene editing and to identify immunotherapy targets for breast cancer.3 This project would be an excellent extension of my previous academic work, since in my undergraduate research project which I published in the British Journal of Cancer, I used some of these techniques to study molecular targets in lung cancer. This previous research experience4 could act as a springboard towards a doctoral project in the future.

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Coupled with the excellence in research training that Edinburgh would offer me, the Oncology Department at Edinburgh would offer me an excellent standard of clinical training. I have visited the department and spoken to the oncology trainees5 in Edinburgh. I have been informed that the department provides a broad-based oncology service, yet allows trainees to progress towards their subspecialty interest by allowing the option to rotate in a subspecialty field in the senior years of training. Dissecting the Answer 1. Career destination defined. 2. Demonstrates that the applicant has made the effort to research the place and has already approached a potential supervisor for a project. 3. Jargon explained. 4. Prior experience shows the feasibility of the project, but also shows that the applicant is bringing some experience with them to contribute to the research group. 5. Shows initiative and active interest.

4.5.5 What Steps Need to Be Taken Before Commencing a Research Study? Similar Questions • How would you approach designing a new study? • How would you design a clinical trial? Having an idea for a research project is one thing, but taking it from an idea to a real research study is a very difficult and lengthy task. There are some variations in the process of setting up a research study and differences occur according to the type of research (e.g. human versus animal research) and geography. Here, we outline the general steps involved in designing a clinical trial. 1. What is the question? The first step in designing a research study is to have a good question that you want to answer and, ideally, a hypothesis that you want to test. In clinical academia, a good question will come from identifying (and solving!) a problem that is ultimately meaningful to patients. 2. Design of the study. The next step is to design a study that will answer your question(s) and test your hypothesis(es). This often involves writing a ‘study proposal’ that details: a. Rationale b. Aims and objectives c. Project design i. Overall design (e.g. randomised controlled trial) ii. Methodology 1. Study subjects (inclusion and exclusion criteria) 2. Study procedures (randomisation, blinding) 3. Outcomes variables (primary and secondary endpoints) 4. Statistical analysis, including power calculations

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iii. Data management and quality control (steps to ensure data are properly managed as well as reporting of any adverse events) iv. Timetable of study events, such as recruitment time (i.e. accrual time), follow-up duration, and time intervals between each follow-up d. Ethical considerations (steps taken to ensure the safety of each participating individual and ethical issues raised by the study and how are they addressed) e. References 3. Study protocol. The study protocol is a detailed written plan for the study and provides a rigid step-by-step walkthrough of what the investigators plan to do at each timepoint. It will include a standardised protocol of how each variable will be measured (standard operating procedures [SOPs]) as well as how each outcome will be determined. The protocol is important to ensure that the study is carried out in a standardised way, and this is particularly important when conducting a multicentre study. 4. Funding. Once you have formulated the research question and hypothesis, the next step is to apply for a grant so that you have the necessary funding for the research. This is where you would write the dreaded ‘grant proposal’, which is an iteration of the study proposal that conforms to the requirements of each particular funding body. Different funding sources have different requirements of what needs to be included in a grant proposal. At this point you will need to calculate the required funds necessary and to justify these (usually each institution will have a clinical research team to help you with this). Also, a brief biosketch (two to four pages) of each investigator is required, since funders will be looking to fund researchers with a good track record of publishing or who have completed large-scale studies in the past. 5. Sponsorship. A body, such as your NHS Trust or your university, will take overall and legal responsibility for your research. The sponsor will perform their own independent review of the study, which can take weeks to months to complete depending on the nature of the proposed study. 6. Health Research Authority (HRA) and ethical approval. Approval from the HRA is required for all research carried out in the NHS in England and Wales. The HRA application is now paired with the application for ethical approval (the ‘Integrated Research Application System [IRAS]’) which means you apply for ethical review simultaneously. A favourable opinion is required from an ethics committee for any study that involves either patients or animals. 7. Study set-up. Prior to recruiting patients to your study, all of the necessary provisions are to be made: a. b. c. d.

Infrastructure Equipment Materials Training and induction of staff

8. Beginning the study. You are finally able to begin your study! A helpful resource for the planning of clinical studies is given by Good Clinical Practice (GCP) by the National Institute for Health Research (NIHR).4 It is a requirement for clinical 4

Good Medical Practice. National Institute of Health Research. www.nihr.ac.uk/health-and-careprofessionals/learning-and-support/good-clinical-practice.htm

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investigators to have an up-to-date GCP certification, particularly for interventional studies such as trials.

4.5.6 Whom Would You Do Your Academic Time with if You Were to Get This Academic Post? Similar Questions • What are your short-term research goals? • Whom do you want to work with if you were to get this job? • What research project will you conduct if you get this job? This question is a little bit like the ‘why here?’ question, but instead pushes you further on the specifics of your potential research project. This is a classic and crucial question of the academic interview which tests whether the applicant has done the groundwork about the institution he is applying to. As we have covered in Chapter 2, Section 2.1, the most important concept is perfecting the trio of person, place, and project. In short, you need to prove that you are the best person to conduct that particular project in that one place. As an extension of Chapter 2, Section 2.1, here is an approach and a summary of how to design the answer to this question: 1. Identify a potential supervisor whose work align with your research interest. If you are unsure on where to start, search the associated university or department website for academics within that field of research. Look through the research themes of different academics and find one that is compatible with your interest. Once you have identified someone, we advise that you look up his most recent publications to understand his most recent work and direction of research. You may want to reach out to him over email or in person prior to your interview to discuss potential projects to work on. Of course, meeting a supervisor in person may be difficult if you are working or studying in a different city; however, if you are applying for an academic job in your proximity, then it really should happen. This is the most reliable way to confirm that you like his project and . . . him as a supervisor! 2. Identify a potential project. Some supervisors may assign you to or steer you strongly towards a particular project. If not, it may be up to you to design a potential research project and pitch it in your interview. A good place to start is reading the recent work of your potential supervisor and research lab. Focus on the clinical implications of the studies, what new questions they raise, and how new studies could arise from them. You will then need to design the project according to the steps we suggested in the previous question on ‘what steps need to be taken before commencing a research study?’ The expectation for your answer to this question will be higher when applying for the ACF and above, compared to the AFP. In the AFP, having prepared for this answer shows that you have done some background research on whom you want to work with. For the ACF and above, it is essential to have found a potential supervisor and planned a provisional project.

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Example of an Effective Answer I have provisionally reached out to Dr. Fitzpatrick1 in the Cancer Research UK Institute and we have discussed working on a project that will identify new targets for immunotherapy in pancreatic cancer. Recent efforts in the field of immunotherapy are attempting to prime the cytotoxic T cells to track down cancer cells which have evaded the immune response.2 In a recent publication by Dr. Fitzpatrick’s lab that was published in Science, the authors showed that, despite the presence of anti-tumour T cells which were successfully isolated from the blood of the murine model using magnetic beads cell isolation, the cytotoxic effects of these T cells were ineffective in destroying the tumour, due to evasion of the tumour from the immune system. More specifically, these T cells were found in the peripheral blood but were absent from regions of the tumour tissue. The team then showed that downregulating expression of the PD-L1 gene with Avelumab (a humanised monoclonal antibody to PD-L1 ligand) led to immune activation of these cytotoxic cells and to a shrinkage of the tumour size by 50% within three days.3 I would most certainly like to build on this excellent work as part of the Academic Clinical Fellowship.4 Although the described experiment was tested in murine models, I would like to take this project to the next step by validating the work in larger mammals, such as the swine model. The end goal of this work is to be able to translate this research into clinical practice, and to validate our work in the form of Phase I clinical trial.5 Dissecting the Answer 1. Candidate has identified whom to work with and has already taken steps to make it happen. 2. Provided a brief one-sentence background to put the research into perspective as well as a layperson’s description of the work. This is important, since the interview committee may have a layperson in the panel who will have equal say in the vote on whether you get the job. 3. Briefly explains the results. 4. Intent for ACF described. 5. Sets the interviewers up to ask further questions about the work.

The foregoing example answer can be given in one to two minutes at a normal pace and is easily understood. It includes a brief background, summary of previous work, and potential future work. You will not need to know about the minutiae of the techniques used in the experiment, but it would be good to know about the general concepts of the techniques used. This question, as per others, sets you up for scrutiny, so be prepared for the inevitable interrogation on the design of your project. In a similar vein, it is important not to shoot yourself in the foot here. Do not launch into the minute specifics of your potential project. Do not give the interviewers ammunition to rip apart your project from the get-go. First, give them an overview and big-picture introduction and then wait for the interrogation to begin. For example, they may then follow with ‘What will your hypothesis be?’ or ‘How are you going to design an experiment to look at that?’

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It is also important to know that, should you be appointed to the job, you are not handcuffed to that particular project or to the academic whom you talked about during the interview. Once you have started work within the deanery, you will get to know more about the different research within that institution and you may be able to find someone whose research aligns with your interest. For some, your clinical experience may spark a different research interest.

4.5.7 What Are Your Long-term Research Goals? Similar Questions • What do you want to achieve in your career as a clinical academic? • What is your overall research aim? This question tests your foresight, your willingness to think big, and your ability to understand the final destination of your academic career. While in the ‘short-term research goal’ question you need to have a water-tight plan of an achievable goal, you can afford to be a bit more ambitious in this statement. Keep your answer broad and not confined to conventional methods, since one particular approach or technique in the current vogue may be rendered redundant or superseded in 30 years’ time. Example of an Effective Answer My long-term goal as an academic urologist is to develop rapid, non-invasive, and accessible diagnostic methods for urological cancers, such as bladder cancer.1 Currently, patients who present to the urology clinic with haematuria must undergo imaging studies and invasive cystoscopy. While these diagnostic methods are effective at detecting bladder cancer, diagnosis is dependent on the speed at which they can be delivered. What I want to achieve in the long term is a clinicbased diagnostic test that can reliably indicate to the surgeon and patient: (a) whether or not the patient has cancer, and if so, (b) what type of cancer it is, and (c) the molecular profile of the cancer.2 In this way, patients who do have bladder cancer may receive a more efficient diagnosis and tailored molecular-guided approach to their care, and patients who do not have bladder cancer can be reassured without undergoing invasive tests. This goal I have set out to achieve is challenging, but this Academic Clinical Lectureship at King’s College London has a leading research expertise in molecular profiling in cancer and will give me the best possible chance of progressing towards my goal.3 Dissecting the Answer 1. Overall goal. Not solely dedicated to specific technique or disease. 2. Provides clear overall aims of the project. 3. Brings answer back around to why you want this particular job and why you are the right person to do it.

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4.5.8 How Do You Balance a Clinical and Academic Career? Similar Question • How are you going to meet your clinical competencies if you take time out to do research? This is a classic question in the academic clinical interview. There is a wide variance of opinion on this topic, so do not be surprised to have a bit of an argument with the interviewer. Mundane and common answers to this question include examples like ‘good time management’. Our advice to set yourself apart in this question is to personalise it by drawing upon previous experience and by demonstrating that you are already able to do this. This shows your pre-formed ability to be a clinical academic, as well as another opportunity to do a bit of salesmanship! Generally, interviewers do not get on board with answers that involve you ‘working harder’ than non-academic trainees. Do not dig a hole in an argument about the European Working Time Directive by suggesting that you are going to work 120 hours a week, work moonlight shifts, or do all your research at night. Another piece of advice would be to acknowledge the difficulty of balancing these two different strands of your career. This is a big challenge, regardless of how good you are as a clinical academic. Demonstrating to the interview panel that you understand this struggle will show insight into the profession. Example of an Effective Answer for ACF Interview While I have thus far immensely enjoyed combining my clinical and academic careers, I can already appreciate that being successful in both is very challenging.1 An academic clinician’s ability to balance both elements of their career is dependent on their particular clinical and academic situation and requirements. To maintain one’s academic career, having protected academic time for research is essential in order to have the means to be focused and productive. The UK Integrated Academic Pathway has helped me to achieve this so far,2 since my Academic Foundation Programme post at the University of Liverpool allowed me to spend four months away from the wards and to be immersed in a rich academic environment. Going forward,3 I plan to retain dedicated research time by attaining this Academic Clinical Fellow position, taking time out of the programme to complete a PhD and then to apply for a Clinical Lectureship. On the other hand, achieving my clinical competencies for my FY2 year was made more challenging because of restricted time. I therefore opted to continue doing on-calls shifts during my research block to allow me to achieve the required clinical competencies for the foundation programme.3 In addition, I have recently obtained my MRCS to stay ahead of my clinical requirements heading into my surgical training.4 Dissecting the Answer 1. Acknowledges the difficulty and shows insight. 2. Uses personal example. 3. Uses answer to demonstrate academic ambition. 4. Be ahead of expected clinical goals.

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4.5.9 How Do You Go About Getting Funding for Research? The answer to this question will be quite different depending on the academic post you applied to and the circumstances of the research discussed. While for the AFP there is rarely a demand for the selected AFP candidate to find his own research funding, this expectation for the candidate to identify and apply (or co-apply) for their own grants increases as the academic pathway progresses. The first step in writing a grant proposal for a clinical study is to identify which funding agencies you are planning to apply to. For example, the usual ‘big four’ funding bodies are the Wellcome Trust, Medical Research Council (MRC), Cancer Research UK (CRUK), and National Institute of Health Research (NIHR). The Wellcome Trust usually funds basic science or translational work but does sometimes fund clinical or epidemiological research. The MRC and CRUK fund both clinical and basic science work and the NIHR only fund clinical research. There are other smaller funding agencies available which are usually specialty specific or other charitable trusts such as the Urology Foundation, Epilepsy Research UK, or GUTS UK which offer funding for salaries and research costs. Each funding agency will have its own set of requirements (including a standardised application form) when applying and we would advise you to take a look at these requirements early on if you are considering putting in an application.

4.5.10 Can You Tell Us About a Research Paper You Have Read Recently? Similar Questions • Can you tell us about a major development in [your field of interest]? • Tell us about a paper you have read recently that is outside [your field of interest]. This is a common question in academic interviews which aims to assess whether (a) you are interested in and up to date with the literature; and (b) you are able to communicate and talk about research. If prepared for properly, this question is a ‘gift,’ as it allows you to talk about any topic you are comfortable with. For these questions, we would advocate that you prepare to talk about two separate papers, one from the specialty you are applying to, as well as a second paper from a different specialty, since, on some occasions, the interview panel will ask you about a research paper outside your field of interest. When preparing for this question, what you need to remember is that the panel will likely not have read the paper that you have selected (unless of course, if the paper you selected is a ‘breakthrough paper’) and, therefore, you will not need to go deep into the minutiae of the paper. The more important goal is to be able to explain the message the paper is trying to convey. Another tip to avoid duplication in interview preparation is that the paper you choose could relate to your academic field of interest and can be a study published by your prospective lab or supervisor. This relates to preparing for the question on ‘Whom would you do your academic time with if you were to get this academic post?’ in Section 4.5.6.

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The second paper that you choose can be any paper that you found interesting, but should not be related to your specialty. This will show that you have kept an eye on the general medical literature. Keeping a structure for this answer is important. You may get the interviewers chipping in with comments or questions, but having a structure to rely on is a good way to avoid your thought process from being lost in the midst of being ‘grilled’ by interviewers. Here is an example structure of how you could answer this question which is accompanied with a list of associated follow-up questions that your interviewers may interject: 1. Introduction a. b. c. d.

Title of the study or trial name Who are the authors? Are they leaders in the field? Where was the research conducted? Where and when was the study published?

2. Rationale and hypothesis a. b. c. d.

What was the rationale for the study? What was(were) the question(s) the study is trying to answer? Why is this(these) question(s) important for clinical practice? What was(were) the hypothesis(es)?

3. Method a. What was the design of the study? For example, was it a single-centre or multicentre study? Was it a randomised trial, cohort study, case-control study, or cross-sectional study? b. What were the inclusion and exclusion criteria? Do the inclusion criteria allow you to generalise the results to the wider patient population? c. How long was the follow-up? Is this duration appropriate for the disease being studied? d. If it was a randomised trial, what was the intervention and what was the control group? e. What was the timeline for the trial? f. What were the primary and secondary endpoints? Are the endpoints appropriate for the study? g. How was the outcome measured? Was it measured in a central lab? Or was the endpoint determined locally by each centre? h. Was it an open-label trial or a blinded study? Was it single-blinded (patients are blinded)? Was it double-blinded (patients and outcome assessors)? i. What statistical analysis was performed? j. Was the study appropriately powered? k. Was an intention-to-treat or per-protocol analysis performed? Was this appropriate for this study? 4. Results a. b. c. d.

What did the results show? Were the results expected? What proportion of patients achieved the endpoints? Were the results interpreted correctly?

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e. For systematic review or meta-analysis i. Were there publication biases? ii. Were the articles included appropriate? Did the paper only include randomised trials? Or did the paper include a mixture of different study types? iii. What were the I2 or Q statistics? Was there heterogeneity? Was it appropriate to do a meta-analysis? Were included papers weighted according to quality? 5. Conclusions a. What was the authors’ conclusion of the study? b. Was the conclusion appropriate? c. Did the study answer the question it intended to ask? 6. Limitations a. What were the limitations of the study? b. Are there any more limitations that the authors did not recognise? c. Do these limitations affect the generalisability of the results? 7. Clinical Implications a. What are the clinical implications of the study? The results were statistically significant, but what is the clinical significance of the results? b. What is the difference between clinical significance and statistical significance? c. How will it affect our practice? d. What would be the future or the next phase of the study? Remember to practice talking out loud about the findings from the paper using the same structure listed above. It does not look good if you are not able to speak fluently about or remember the important findings of the paper. For this answer, we have selected a recently published article in the New England Journal of Medicine entitled ‘Partial oral versus intravenous antibiotic treatment of endocarditis’.5

Example of an Effective Answer I recently read an article about the POET trial which was published in the New England Journal of Medicine in January 2019 regarding the use of partial oral antibiotics versus intravenous treatment for left-sided endocarditis. The study was led by investigators from the University of Copenhagen. Endocarditis of the left side of the heart is often treated with intravenous antibiotics for up to six weeks according to both European and American guidelines.1 However, a prolonged six-week course of intravenous antibiotics itself has its own risks, such as the need for a long-term central or peripheral line and the risk of line infection, prolonged hospital stay and risk of hospital-acquired infection, general deconditioning from hospital stay, and expense. Oral antibiotics, if effective, may provide a good alternative. 5

Iversen K, Ihlemann N, Gill SU, et al. Partial oral versus intravenous antibiotic treatment of endocarditis. N Engl J Med 2019;380(5):415–24.

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This was a multicentre, randomised, non-inferiority trial comparing partial oral antibiotics versus intravenous therapy for left-sided endocarditis caused by Enterococcus, Staphylococcus aureus, or coagulase-negative Staphylococcus.2 Patients from both groups received intravenous antibiotics for at least ten days. Those randomised to the oral antibiotic group were then switched to oral antibiotics while those in the intravenous group continued intravenous antibiotics for six weeks. The primary outcome was a composite of allcause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteraemia up to six months after antibiotic therapy was completed.3 The primary composite outcome occurred in 12.1% of patients in the intravenous group and 9% of patients in the orally treated group, which met the non-inferiority criteria of the trial.4 The Kaplan–Meier also showed a clear separation of both curves, in favour of the oral antibiotic group.4 When looking at the individual distribution of the four components of the primary composite outcome, there were almost double the events of all-cause mortality in the intravenous group (13 in the intravenous group versus 7 in the oral group), but no difference in the number of unplanned cardiac surgery, embolic events, or relapse of bacteraemia and the overall composite outcome between the groups met the non-inferiority criteria of the trial. The authors concluded that in patients with endocarditis on the left side of the heart, changing to oral antibiotics was non-inferior compared to continuing intravenous antibiotic therapy for six weeks.5 Dissecting the Answer 1. Background to give the interviews the context and rationale for the study. 2. Provides a definition of the intervention and active control arms of the study. 3. Summarises the trial methodology and also lists what the important outcomes of the trial were. 4. Summarises the results in one or two sentences. 5. A final statement that summarises the conclusions from the study

An answer like this will probably take you one to two minutes to speak at a regular pace. In most cases, however, you will probably be interrupted half-way through your answers to clarify certain things you have said or be quizzed by your interviewers. A few follow-up questions to this example could be: Example follow up question (1) Q: Do you think the results are generalisable? Or, what are the limitations of the study? A: The trial only included patients with endocarditis on the left side of the heart. Therefore, for patients with right-sided endocarditis (which is more common in intravenous drug users) the findings of this trial will not be applicable. Also, the trial recruited only patients with endocarditis caused by Streptococcus, Enterococcus faecalis, Staphylococcus aureus, and coagulase-negative Staphylococci. Although these are the most common causes of infective endocarditis, there are many other pathogens which can cause endocarditis, the management for which these trial findings cannot be applied.

Example follow up question (2) Q: How will this trial inform your practice? A: For patients with endocarditis caused by these microorganisms, I would certainly consider a switch to oral antibiotics after a course of intravenous antibiotics. This finding will be particularly applicable to patients who are

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compliant with their medications. For patients who are known to be poorly compliant with their medications, my preference would still be to keep them in the hospital to complete the course of intravenous antibiotics for six weeks.

Bear in mind that there are no right or wrong answers to these follow-up questions. The interviewers are not looking for the ‘correct answer’ but are more interested to see how you can synthesise and critically appraise the literature.

4.5.11 Critical Analysis of an Abstract or Paper Unlike in the previous question (Section 4.5.10), where you will have had all the time in the world to read and prepare an answer for a paper of your interest, in some interviews, you will be asked to read an abstract or full paper that is given to you by your interview panel. You will often be given 10–30 minutes to read the article before your interview starts. If you are given an abstract, you will have more than enough time to read all of it, but if, however, you are given a full-length article to read, the time constraint will demand a methodological and streamlined approach. Here is one approach to reading a paper: Step 1 – Abstract: Read the abstract to get an idea of the overall message the paper is trying to convey. A simple summary of a study could adopt a PICO structure (Patients, Intervention, Comparison, Outcomes). (3 minutes) Step 2 – Rationale and Objectives: Read through the introduction section quickly to gain some background understanding and to understand the rationale. For the introduction, focus on the last paragraph to determine the aims of the study. (3 minutes) Step 3 – Methods: Then focus on the methods and be able to describe the study design (e.g. RCT), patient cohort (inclusion criteria), study arms, and outcome measures. (5 minutes) Step 4 – Results: When attempting to understand the results, focus on the key figures and figure legends. You should be able to decipher the important information from the diagrams without having to read all of the text. For trials, you may be asked ‘what type of diagram is this?’ (e.g. a consort diagram). If there is a Kaplan–Meier plot, can you see separation of the lines? Are the results statistically significant? (5 minutes) Step 5 – Conclusions and Limitations: How can you explain the findings of this paper in one or two sentences to a layperson? Do not bother reading all of the discussion section, although looking for the paragraph describing the limitation of the study can be helpful. How are you going to use this information to inform your clinical practice? (4–5 minutes) Total duration: approximately 20 minutes

4.5.12 Should All Trainees Be Involved in Research? There is no correct answer to this question and, again, it would not be uncommon that this topic sparks some healthy debate in the interview. Candidates answering this question should focus on debating the pros and cons of all trainees being involved in research. Bear in mind that research activity can come in many forms, ranging from clinical studies, basic science, to attending academic conferences. Answers should, therefore, not be constrained to one area of academia and should be broad.

4.5 Research Questions

• • • •

• • • •

Reasons for all trainees being involved in research include: The Good Medical Practice guidance issued by the General Medical Council states that as doctors ‘you must be competent in all aspects of your work, including management, research and teaching’.6 Research aims to discover new treatment options and improve patient care, so the involvement of doctors helps to guide this process. Research encourages trainees to keep up to date with advances in their specialty. Research helps to develop generic yet important skills. Examples of these include excellence in organisation, time management, leadership skills, and critical thinking. Reasons against all trainees being involved in research: Research can be a hard career and often yields disappointing results. If doctors are not dedicated to research due to disinterest, they will not be successful or effective. Forcing doctors who have no interest in doing research may discourage candidates from pursuing a medical career in the first place. Research is time consuming and takes time away from clinical practice – ‘de-skilling’ is a problem, especially for procedural specialties like interventional cardiology or surgical specialties. Research is expensive, and it would be difficult to secure funding to support research activity for all doctors. Example of an Effective Answer Promoting clinical research is important in order to advance the care we provide to patients, but whether all doctors should have to do it, is debatable. Most doctors will get involved in research in some form or another, for example through attending conferences, presenting at journal clubs and attending courses. All clinicians should have some knowledge of general research principles and be up-to-date with the medical literature within their field.1 Learning how to interpret and critically appraise the literature is important, as clinicians need to be able to assess the validity of medical studies and whether or not it should change their clinical practice.1 Above and beyond this level of involvement, however, it is not necessary for all doctors to be as heavily involved in research.2 While some doctors may be passionate about research, mandating all doctors (passionate or not) to take significant time away from their clinical interests may deter prospective candidates from the profession. Research is difficult, timeconsuming, and often yields negative and disappointing results. Academic medicine, therefore, demands doctors who are passionate about research and will persevere through these difficult times as well as those who will enjoy the rewards of their research career. Dissecting the Answer 1. Understand the importance of research to clinicians. 2. Explores the cons about mandating research for all clinicians.

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Good Medical Practice. General Medical Council. www.gmc-uk.org/ethical-guidance/ethicalguidance-for-doctors/good-medical-practice/domain-1–knowledge-skills-and-performance

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The Interview

4.5.13 What is Evidence-based Medicine? Evidence-based medicine (EBM), as defined by David Sacket in his seminal article in the BMJ in 1996, is ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’.7 For interview purposes, regurgitating this answer may sound robotic and impersonal. Paraphrasing this definition into something along the lines of ‘EBM is the process of combining the best available research evidence with your own clinical judgement and applying this into clinical practice’ makes this more unique and sounds less regurgitated. To make your answer even better, however, requires an example of how you have observed or partaken in the process of EBM. The Process of Applying EBM into Clinical Practice • • • • •

EBM begins with a question with regards to the clinical care of patients. The PICO framework (Patient, Intervention, Comparison, and Outcome) can often be applied to EBM to succinctly summarise this clinical question. The clinician performs a literature search to identify the evidence relevant to the clinical question. The available evidence is then critically appraised to determine if the evidence is applicable to the patient(s) concerned. The clinician applies the evidence in the management of the case after discussing with the patient. The outcome of the intervention is then evaluated. Example of an Effective Answer Evidence based medicine (‘EBM’ for short) is the process of utilising the best available evidence, combined with our clinical judgement in treating our patients.1 This process often starts with an important clinical question. When dealing with treatments, the PICO framework (which represents patient, intervention, comparison and outcome) can often be applied to streamline the clinical question. Once the question is conceived, a detailed search of the medical literature is performed. The best available evidence is critically appraised to determine if the evidence applies to the clinical problem you have encountered. In conjunction with the patient’s wishes, the newly learned evidence is then applied into clinical practice and the outcomes are evaluated. A case which I have recently encountered and in which we applied the principles of EBM was a patient whom I admitted with alcoholic hepatitis.2 This was the second patient admitted during that week with alcoholic hepatitis, and the first patient died shortly after admission. This patient was admitted with jaundice and bilirubin of >400 μmol/L. He had a Maddrey Discriminant Function (MDF) score of 50 where score of >32 on the MDF indicates severe disease with a 28-day mortality of 30–40%. We treated him with a course of prednisolone, in line with the European Guidelines of Hepatology. As he had no clinical improvement after three days, however, I decided to look into the literature to evaluate whether there were any other treatment options available. My search brought me to a randomised trial published in the New England Journal of Medicine that showed that N-acetyl cysteine in addition to prednisolone given for five days was associated with a 16%

7

Sackett DL, Straus SE, Richardson WS, et al. Evidence based medicine: What it is and what it isn’t. BMJ 1996; 312(7023): 71–2.

4.5 Research Questions

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reduction in 28-day mortality for patients with severe alcoholic hepatitis. I discussed with my consultant about commencing this treatment, which we eventually did. The patient’s bilirubin subsequently improved to