Getting Interviewed : Junior Clinical Fellow , Trauma and Orthopedics

 

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My interview team consisted of the orthopedic lead consultant, the service delivery manager and a lady from medical recruitment.

The interview was divided into 4 parts:

Clinical and Skill Based Assessment

I was asked the following questions by the orthopedic consultant:

What is compartment syndrome and how is it caused?

Compartment syndrome of a limb is due to raised pressure within a closed fascial compartment causing local tissue ischaemia and hypoxia.

When is compartment syndrome most commonly seen?

In clinical practice, it is most often seen after tibial and forearm fractures, high-energy wrist fractures and crush injuries. Other important causes include restrictive dressings or casts, prolonged immobilization and reperfusion of ischaemic limbs.

What are the compartment pressure findings to diagnose the condition?

1. A difference between the diastolic blood pressure and the compartment pressure of less than 30 mmHg suggests an increased risk of compartment syndrome.

2. Absolute compartment pressure greater than 40 mmHg, with clinical symptoms suggests compartment syndrome.

Why is early detection important?

Early diagnosis and treatment is vital to avoid severe disability.

How do you detect compartment syndrome?

The key clinical findings are pain out of proportion to the associated injury and pain on passive movement of the muscles of the involved compartments. Limb neurology and perfusion, including capillary refill and distal pulses, should be clearly documented but do not contribute to early diagnosis of the condition.

When do you need to escalate to your senior when dealing with a suspected compartment syndrome case?

Patients documented to be at risk of compartment syndrome should have routine nursing limb observations for these early signs and these should be recorded. These observations should be performed hourly whilst the patient is deemed still to be at risk. If pain scores are not reducing, then senior clinical review is mandated.

What is the management?

Patients with symptoms or clinical signs of compartment syndrome should have all circumferential dressings released to skin and the limb elevated to heart level. Measures should be taken to maintain a normal blood pressure. Patients should be re-evaluated within 30 minutes. If symptoms persist then urgent surgical decompression should be performed.
Compartment syndrome is a surgical emergency and surgery should occur within an hour of the decision to operate.

What does the surgical management involve?

Surgery should involve immediate open fascial decompression of all involved compartments, taking into account possible reconstructive options. Necrotic muscle should be excised. The compartments decompressed must be documented in the operation record. All patients should undergo re-exploration at approximately 48 hours, or earlier if clinically indicated. Early involvement by a plastic surgeon may be required to achieve appropriate soft tissue coverage.

What is the management of lower leg compartment syndrome?

For lower leg fasciotomies it is recommended to perform a two-incision four-compartment decompression.

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What is Acute kidney injury?

AKI is defined as : Increase in serum creatinine by 0.3mg/dL or more within 48 hours or Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or
Urine output less than 0.5 mL/kg/h for 6 hours

How to do you manage AKI?

I talked about the classification into Pre-renal , Renal and Post-renal causes . Then I discussed about the investigations and treatment accordingly.

He gave me a scenario : a patient who had a hip hemiarthroplasty 5 days ago, is desaturating on room air and is tachypneic, what are the main differentials?

1. Pulmonary embolism
2. Hospital acquired pneumonia

What do you see yourself doing in the next 10 years?

I see myself as a consultant in the field of medicine I like, improving on my skills, trying to gain expertise.

An ideal answer would be to divide your goals as : Clinical , Academic, Managerial and Personal ( CAMP )

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Audits and Quality Improvement Projects

How many audits have you participated in, in the past year ?

 

Tell me about the most interesting audit which you took part in?

Professional Dilemma Questions

The service delivery manager gave me a scenario and asked me for my response:

You see two of your colleague doctors fighting in the ward. How would you respond to this?

I answered the question according to the SPIES structure :

1. Seek information — Ask your colleagues to move to a private space with yourself
2. Patient safety — Ensure no patient harm has been done
3. Initiative- Learn more about what the incident is about and explain why such behavior is unacceptable in a sensitive hospital environment
4. Escalate- to the educational / clinical supervisors on the doctors involved and further if the matter is serious
5. Support — the doctors involved

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Questions from my side

The lady from medical recruitment asked whether I would take the post if an offer was made and whether I had any questions.

I asked the team whether I will get more research and surgical hands-on opportunities in the department .

Iwas successful in the interview for the above-mentioned post and received a job offer in the following days.