Haematology ST3 Interview Format: How to Prepare and What to Expect

The Haematology ST3 interview can be a daunting prospect. It is a speciality with evolving therapies, clinical trials and a wide field of both malignant and non-malignant pathologies. The aim of this blog post is to give you a general outline of how the interview is formatted and some hints and tips to help along the way.

First thing to say is preparation is everything. Many people sitting the interview will never have done a haematology rotation, will never have looked down a microscope at a bone marrow aspirate or be able to list a bone marrow failure syndrome. That is okay! You are not expected to be answering questions as a haematologist but instead as a safe, logical, confident and enthusiastic doctor who has shown some evidence of interest in this speciality. Knowing what to expect during the interview and having a set of general answers to the more common questions asked will put you in good stead for achieving high scores at each station. Try our Haematology ST3 Interview Question Bank for a large selection of questions and model answers.

The ST3 recruitment page is a good resource for the interview format (http://www.st3recruitment.org.uk/specialties/haematology). There are three stations, all lasting 10 minutes with a 3-5 minute transfer time between stations, so approximately 40-45 minutes in total. The interview stations include:

  1. Assessment of your portfolio
  2. A clinical scenario and ethical scenario/discussion of professionalism and governance
  3. A prepared presentation

Interview station 1:

Knowing your portfolio well is crucial to scoring maximum points in this station. Stick closely to the interview preparation page on the ST3 recruitment website (http://www.st3recruitment.org.uk/recruitment-process/interview/preparing-for-interview) with regards to organising your eligibility and evidence folders. I cannot stress how important the evidence summary form is and ensuring this is the contents page by which all your following evidence is laid out in that particular order is vital. Remember the interviewers only have a matter of 10-15 minutes to assess/examine all your achievements to date and commitments to the specialty, so make it easy for them to follow. There are 16 marks for evidence and 12 marks for suitability to specialty available here from a total score of 80 (including the other two stations). You have already scored points for via your application form for achievements to date but the interviewers will be focusing on responses to questions asked, the breadth and quality of your achievements and your career progression.

Be prepared for the obvious questions of “why haematology?” or “how have you shown commitment to the specialty?” but also “what do you think of the Eportfolio system?”, “What challenges do you think Haematology will face in the next 10 years” or “what have you learned about yourself through your previous MSF’s?”

Expect questions about your achievements, be it audits, research or teachings you have carried out. Know what you gained from doing these and how it may have improved clinical practice. Be able to talk about yourself as a doctor, both positives and negatives, and how you can transfer your skills to a career in haematology. The more you have practiced answering questions like this, the more natural you will come across which will undeniably score you more points. Remember though, if you do talk about something make sure it can be clearly backed up in the portfolio – even if it is a taster week you have previously undertaken in your local hospital or a last minute course you attended, evidence is essential!

Most Haematology consultants will be used to helping trainees prepare for interviews so if you do not know who your local haematologist is; find out! Approach them or the haematology registrar to see if they can ask you questions or provide you with interview tips, this can be invaluable experience for you.

Interview station 2:

Just prior to entering station two you will be given a clinical scenario which you will have a few minutes to read through. This is normally an example of a common haematological case which will point you in a certain direction. There will probably be an abnormal full blood count to assess. Take this time to speculate what the interviewer is likely to ask you. For example, if there is an isolated thrombocytopenia, think what his may be caused by (ITP etc.). If there is an anaemia that is microcytic think of the potential causes (iron deficiency, thalassaemia, chronic disease, lead poisoning). If there is a pancytopenia consider malignancy, sepsis, drugs, vitamin deficiencies etc. Become comfortable with interpreting abnormal full blood counts and listing potential causes. Know the next steps in investigation and the clinical signs and symptoms you may have with each cause. Some common scenarios have included:

  • Elderly patient with anaemia, high ESR and back pain. What would be your differential diagnoses? How would you investigate this patient further? What would you expect to see on a bone marrow aspirate? What is the management of malignant cord compression?
  • Patient has a fever and is found to be neutropenic. Can this patient be managed as an outpatient? What investigations would you carry out? What would be the management plan?
  • WCC 100 and splenomegaly. What would be your differential diagnoses? How would you investigate further?

Haematology is obviously a very broad speciality and you cannot be expected to know how to investigate and manage every clinical scenario thrown at you, but this is where being safe and logical pays off. Have a basic understanding of common haematological investigations including repeating a full blood count, checking an ESR, a vitamin B12 and folate level, protein electrophoresis and serum free light chains and reviewing a blood film. Think imaging; if lymphoma related, an ultrasound +/- core biopsy/excisional node biopsy (never a FNA) or PET CT (for staging); or with myeloma PET CT vs whole body MRI (skeletal surveys are not common practice now). Bone marrow biopsy is likely to be needed if the patient has an underlying haematological malignancy (not required in Hodgkin’s Lymphoma unless abnormal full blood count). Know what tests you would request from the bone marrow biopsy e.g. Immunophenotyping, cytogenetics, molecular tests etc.

A good place to start is the ‘management of haematological emergencies’ section in the oxford handbook of clinical haematology. Again finding a friendly Haematologist to put you on the spot and ask you clinical questions is another good way to prepare.

The second part of this station includes questions around an ethical scenario or clinical governance and professionalism issue. This may include a patient being given the wrong dose of a medication, a transfusion error or a patient complaint. Also be prepared for questions related to improving practice, be it the advantages and disadvantages of research or ethics in clinical trials. I would advise you to know the principles of the GMC good medical practice as well as knowing the basics of medical ethics and legal framework.

Interview station 3:

Station three gives you the choice of preparing either an interesting case you have been involved in or an interesting recent development or research finding in haematology. This is something you prepare prior to the interview which must last 5 minutes and then there will be a further 5 minutes for discussion and questions. No aids or resources are required/available during the presentation but you can use prompts on small cards. You will be scored on your communication skills, the presentation and its accompanying discussion, and during the discussion how you would communicate with colleagues or patients and how you communicate with the interviewers.

This station is a great opportunity to accumulate points as long as you have a good, relevant and interesting presentation and you are able to deliver it clearly and confidently. If you have previously had haematology experience you will hopefully have a few clinical cases that have been either challenging, not had a typical presentation or have required novel treatments which you can talk about. At the same time it is important not to pick a topic too complex as the last thing you want is to be asked questions which you have no idea how to answer. Safe topics may include managing a patient with hyperleucostasis or hyperviscosity as a new presentation for acute leukaemia/myeloma and how you managed this. Also, management of APML, TTP etc. These are topics that a haematologist should know how to manage but are relatively infrequent, making them more interesting, especially as they would be considered haematological emergencies.

With regards to an interesting recent development or research, discussing updated guidelines is often a safe bet as it is something that will or has been implemented into current practice and so would be very relevant to your training. It may even be something the interviewer is unaware of which can get you some bonus points. Another option is to research highlights or updates from the latest EHA (European Haematology Association) or ASH (American Society of Haematology) meetings and present an interesting topic that may have a significant change on current established practice.

Just ensure you have practiced the presentation many times, it is five minutes long and you are confident, having done some background reading on the topic in preparation for relevant questions. Remember the interviewers are not trying to catch you out but instead ensure you have a basic understanding of the area you have researched.

As a final point, the interview goes very fast so being clear and concise with your answers but at the same time getting across all the information you wanted to share is a challenging skill which requires practice. Be organised and be prepared. Communicate well and show enthusiasm. With these attributes you will have the ability to score highly in all three stations.

Best of Luck!

Dr Sam Asher, Haematology ST5, Guys and St Thomas’ NHS Trust

Further Reading

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