Core training was previously 2 years however it has since been changed to 3, so trainees enter at ST4 level instead of ST3, as was the case previously.
The cardiology ST4 interviews are a highly competitive process which understandably cause considerable anxiety for candidates. However, there are several things that you can do to help you perform at your best. The aim of this article is to outline the interview process and to give some advice based on our personal experience and opinion. We’ve also produced our Cardiology ST4 Interview Question Bank to help you prepare.
For Cardiology 2022, the window for uploading evidence is Monday 17th January – Friday 28th January 2022.
The interview dates are as follows: 2nd, 3rd, 4th, 7th, 8th, 9th, 10th, 16th and 17th March 2022, and this applies to all regions.
The interview will comprise four sections. Each section will last about 5-10 minutes and the total interview will last around 40 minutes. There are five score areas in total as you will also be marked on your communication skills.
Section 1 – Suitability and Commitment
Section 2 – Medical Registrar Suitability
Section 3 – Professionalism and Governance
Section 4&5 – Clinical Scenarios
Section 1: Suitability and Commitment
This section gives you the opportunity to answer the question: “Why are you the ideal candidate for cardiology training?” and allows you to build on the information you provided in your application form. The section varies slightly each year and will last around 7 minutes. Despite the changes in wording, every year its essence is the same and it is an opportunity for you to sell yourself and outline why you are suitable for cardiology training.
Most candidates will have very similar curriculum vitae: publications, presentations, audits/QIPS, research, clinical cardiology rotations during foundation or core medical training, cardiology specific courses (e.g. echocardiography courses), MRCP (or pending). Whilst it’s important to mention these, the point of this question is not to simply list your achievements or experiences as you did in your written application. You must qualify your achievements and relate them to cardiology, explaining how they will make you a better cardiology registrar.
- What did you do on your cardiology rotation that makes you suitable for cardiology? Did you manage outpatient clinics?
- What clinical skills did you practice or are competent in that are cardiology-specific?
- If you attended an echocardiography course, have you practiced this on the ward, and are you able to acquire basic images?
- Did you spend time in the catheter lab, understanding coronary physiology, the practical aspects of angiography, and managing the complications associated with interventional cardiology?
- What did you learn from your research projects, or when writing or publishing your research? What skills did you acquire through these processes, and importantly, how will that be helpful to you in cardiology training?
- What audits or QIPs have you completed, and what will you be able to bring to the teams that you will join as a cardiology registrar?
You will appreciate from the questions above that the seven-minute slot should not be spent simply listing your experiences or achievements. It is imperative that you relate it to cardiology training, clearly demonstrating what you have learned and most importantly how you will be able to apply it to your specialist training.
Seven minutes is a very short time in which to do this. You must be economical with your words and make each one count for something. Try not to waffle. Similarly, it is important not to appear too rehearsed. For this reason, we recommend that you don’t write down your “speech” and read it out to the interviewers.
Ensure that you make eye contact, smile (even though you will be nervous) and come across as positive and enthusiastic, but not overly confident or arrogant. Remember, the interview is an opportunity for your future consultants to judge whether or not they would want you to work alongside them, so it’s important to come across well.
You should ensure you know your written application inside out and can qualify and explain everything in it.
Section 2: Medical Registrar Suitability
In this section, there will be a short theme/question provided to you by interviewers, and you will have approximately 5 minutes dedicated to discuss it. You will need to think about the non-clinical aspects of being a medical registrar.
This question focuses on two of the Capabilities in Practice (CiPs) from the Internal Medicine Stage 1 Curriculum:
- Managing an acute unselected take
- Managing a multi-disciplinary team including effective discharge planning
Think about examples from your experience in managing a team and caring for acute medical admissions, including scenarios you were faced with, how you managed them and anything you had learned.
Section 3: Professionalism and Governance
The third section is based on professionalism and governance. These questions can be difficult to pre-empt and are given to you during the interview , so you do not have time to prepare beforehand. Our advice here would be to ensure that you understand clinical governance and the various activities that comprise this umbrella term (eg. teaching and training, audit, information technology etc.). Have examples of activities that you have been engaged in that demonstrate your understanding and participation in clinical governance. Again, it is important to not just list what you have done, but to explain your learning and how you would apply it to cardiology training.
We would also recommend reading GMC guidelines for doctors, including best practice, consent, confidentiality and mental capacity. Having some knowledge about the role of indemnity organisations like the MPS may also be helpful. It is possible that there will be scenarios similar to the situational judgement test (SJT) taken by final year undergraduates and GP trainees during their application process. Irrespective of the scenario, your goal should be to demonstrate that you are sensible and safe, aware of guidance and can quote some references (for example GMC guidelines).
Section 4&5: Clinical Scenarios
Here you will be given a clinical scenario to review for a few minutes. You will then be asked questions on this scenario for around 10 minutes. Once this is complete, you will be provided with a second scenario and this time, questions will begin straightaway, so you won’t have time to prepare like in the first scenario. Questioning on the second scenario will take approximately 6 minutes. Remember, this is not an opportunity to tell the interviewers everything that you think you know about cardiology. Make sure you listen carefully to the questions and answer them concisely, ensuring you don’t deviate too far away from what has been asked.
The most important point for you to remember is to start with the basics and be safe. They want to know that you are competent and will work within the confines of your knowledge, without trying to do something that you are not yet trained to do. There is nothing wrong with suggesting investigations that you cannot perform, but we’d advise you to start with the basics. Try to put yourself in the scenario and say what you would do in real life. This question is designed to test your clinical acumen and judgement, so saying that you would do a coronary angiogram or insert a pericardial drain as your first response is unlikely to score you many points.
Think about the steps you would take. For example, start by saying you would take a history and examine the patient, managing them in a systematic and organised fashion. Your first priority would be to stabilise the patient and ensure basic tests are done (blood tests, ECG, urine dip, chest x ray, ensuring there is vascular access and a cardiac monitor). You would then inform other members of the team to organise specialist tests and management, so think about how you would communicate this. The point here is to emphasise that you are able to manage acutely and chronically unwell patients presenting with cardiovascular illnesses. You will be expected to have some knowledge of managing cardiology specific scenarios, for example post-angiography or post coronary syndrome complications, however, you should aim to demonstrate this knowledge once you have first covered the basics.
You should be aware of the NICE and ESC guidelines for common presentations such as stable angina, coronary syndromes, heart failure, hypertension, tachy- and brady-arrhythmia, syncope. You should also be aware of the cardiology specific investigations eg. echocardiograms, stress tests, CT coronary angiography, angiography and angioplasty, cardiac MRI etc. However, due to time limitations there are unlikely to ask you detailed questions about these so a general overview should suffice. Your goal should be to demonstrate you have knowledge of guidelines and are able to apply them to an unwell patient.
Remember, in order to score highly you need to answer the questions concisely, start with a basic management plan and then move to more complex tests and investigations. You must then demonstrate that you know when to escalate for help and can think laterally about the patient’s problems, ideas, concerns, and expectations.
We hope that the above has been useful in outlining the interview process and has given you an insight into what you may expect. Of course, interview formats and their content can change, and your own experiences may differ to those noted above. But you can be confident that the same principles will apply to your interview and hopefully you will find our advice informative and useful.