CV and Interview Skills10th February 2015

Dr Guy Undrill

Consultant Psychiatrist, 2gether NHS Foundation Trust and College Regional Advisor Severn Deanery

South West Division Training

1 Preparation

1 In the year coming up to CCT

Preparation isn’t about preparing for an interview, it’s about preparing for a rôle: the interview is just one of the more visible steps on the path to becoming a consultant. You can’t start your preparation too early and in many respects, most of what you do during your three years as a registrar/ST4-6 should be focussed on your ultimate goal of becoming a consultant. In the next few years, this is going to be a highly competitive process if trusts freeze posts: it isn’t enough to be a sound clinician, you will need to have a strong CV in at least one of teaching, research or management. If you bear that in mind, the interview falls into context as a relatively small part of the total journey.

Work on your CV. Often, trusts now use NHS jobs and its electronic forms, dispensing with the need for a paper CV, but having a thought through outline ready to go is a good idea. By now there shouldn’t be major gaps, but if there are, fix them as soon as you can.

In the year before you CCT, start getting some job descriptions ( JDs) of the kinds of jobs you might be applying for and reading them critically. The most informative ones will be the ones from local trusts where you know (or can find out) the actuality of the job and so can begin to learn to spot how and where JDs deviate from reality.

Set up email job alerts through the BMJ jobs pages.

Start reading up on:

•the major trends in your area

•clinical governance and risk

•managing change and new service development

•handling complaints

• budgets and finance

•new legislation

See also Appendix 2: Interview Questions.

2 Before applying for the job

A job you might want has been advertised. Can you apply? Generally, you need to have your CCT or be within six months of obtaining it. If the latter criterion applies, the Regional Advisor will advise the appointments committee as to the likelihood of you achieving a CCT in this time-frame. You should be included (or be eligible for inclusion) on the Specialist Register. The JD should not specify the speciality of your CCT in the essential part of the person spec. This is important to know as sometimes candidates may have the right experience but the ‘wrong’ CCT.

3 Find out about the job

Read the advert, the job description and person specification. The initial information pack should also have the interview date. Job descriptions are increasingly reflecting a sellers market: some of the jobs out there are packed with clinical work, split between multiple sites and pulled be-tween different teams. They may offer unattractive remuneration, e.g. be advertised an 8PA job. Sometimes jobs may be part of services that are changing: although a JD has to go through an approval process (see below) when it is advertised, jobs that change do so without any external scrutiny. Sometimes this can be in your favour (a job that is advertised midway through a re-organisation may seem inconsistent and poorly thought through, but there are plans to change it to something more coherent); often it isn’t.

Visit the Trust. The trust should provide you with a list of relevant people to talk to. This is not part of the selection process and you should be careful not to be seen to be canvassing support. Similarly, although the trust should tell you that a pre interview visit is not part of the selection process, people will be checking you out. Use it as an opportunity to impress with your professionalism. The trust may pay your expenses for a pre-interview visit.

On your visit, don’t be afraid to ask the tough questions. Has the post been advertised before? Are there problems filling it? Ask about the office and the secretary. Ask about facilities, wards and interview rooms. Are you inheriting staff (secretary, SAS doctor)? In this situation, there are sometimes issues around capability the trust is leaving for you to sort out. Given the opportunity, appoint your own secretary and SAS doctors. Ask to see data on the workload of the team (poor data usually conceals poor practice somewhere). Check that there is CPD time . What are you expected to do in your CPD time? Check that there is a budget of at least £1500 attached to your study leave. The entitlement to sabbaticals was removed in the new consultant contract; does the trust have its own policy on sabbaticals and career breaks? Ask the medical director if any consultants have been suspended; if so, why, and what was the outcome? What are the absentee rates and staff turnover rates like in your pro-spective department? What about the use of agency staff? Check whether Mental Health Act work is included in the contract. What is the S136

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policy? Is mentoring available? Are there opportunities for a special interest session or day? If a nominally full time job is advertised at 8pa, are there opportunities to bring it up to 10pa by taking on extra work (if a full time job is what you want)?

Read the Trust’s Annual Report. This is usually available from the Trust’s website, or failing that, the Press Officer or the Chief Executive’s office. What is the trust’s management structure? If there is a business plan for the trust or your department, read that. If there are development plans are the time-scales and budgets realistic? What does the Care Quality Commission say about the Trust?

If you are relocating, you may also need to gather data on local housing, schools and amenities.

Make your application. If necessary (it usually is), tweak your CV to reflect the job description and person specification (see below).

4 Find out who is on the interview panel

The Appointments Advisory Committee is a legally constituted committee established by the trust, which may include the following people:

Role Function Hidden agenda

A lay member: usually the chair of the board or a non-executive director.

Chairs the meeting, helps the committee reach a deci-sion, ensures candidate selected on professional merit, ensures process observed (no discrimination); may have a deciding vote.

Little.

The chief executive or a nominated senior manager.

Wants an appointment that will help the trust achieve its strategic objectives.

The corporate objectives are not always aligned with the interests of the consultant body. He/she may want someone to change some dynamic within the consultant body. He/she is more driven by cost: if there is an expensive locum in post, this may be a factor.

The college assessor. This member is an established consultant from outside the trust who ensures the job has been approved as advertised (by contacting the regional advisor). He/she may advise on the likelihood of a pre-CCT trainee completing training. His or her main focus will be on the training and CPD opportunities in the post.

If there is no college assessor, he or she may have withdrawn because the job has not been approved. This should be a red flag.

Little.

Local consultant. This member is an established consultant from within the trust who will be assessing your suitability to work in the local environment. Will you get on with people and be a reliable colleague?

Variable, depending on the local situation: a failing service will take anyone. There may be difficult or unpleasant jobs no-one else on the consultant body will do (either the job itself, or a role such as audit lead). The worst case scenario is that this person will be trying to appoint you to a job made of the unwanted off-cuts of other people’s jobs. Alternatively, he or she may per-ceive the local situation as comfortable and not want someone rocking the boat. There may be a wish to be rescued from the current situation with concomitant unrealistic expectations.

Local manager. This member wants someone to fulfil local service objectives and to fit in with the local set up.

Variable, depending on the local situation: a strong manager may want an ally, or may not want a competitor. There may be a wish to be rescued from the current situation with unrealis-tic expectations.

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Role Function Hidden agenda

The University advisor This person will come from the local University’s men-tal health department and will be leading on assessing your research and teaching activity, and your potential contribution to the academic department (research, teaching, examining).

Little, unless you are a star researcher who can influence RAE/REF ratings.

Medical Director This person will be interested in how you are likely to contribute to the trust, how you will fit into the con-sultant body and your contribution to governance.

May be wanting to fill the post. Will be looking at issues that will cause him/her grief: complaints, sickness, interpersonal difficulties. May be look-ing for future management potential.

There may also be other additional members of the panel considered appropriate by the trust. There may be a service user.

Some people like to avoid surprises by doing a google and/or medline search on the people on the panel.

5 Interview preparation

If there are unusual features (such as unexplained gaps) on your CV, prepare for the question that will come about them. Be clear what you have to bring: what are your strengths and weaknesses? Why should they appoint you and not someone else? What are your career plans? How does your CV reflect your career so far?

6 Other reading

Your own CV: remind yourself what’s on it nearer to the interview!

Re-read your portfolio. Reflective accounts can form the basis of useful anecdotes for the interview, particularly if the learning point(s) matches one of the competencies on the person specification.

Re-read your own published work.

7 The college approval process

Job descriptions are submitted to the college for approval prior to advertising. Scrutiny of job descriptions is essentially a process for ensuring jobs that are safe and ‘doable’.

Consultant job timetables are split into two types of activity, DCC (Direct Clinical Care) and SPA (Supporting Professional Activity). DCC refers to direct care and activities related to it, such as dictating letters from a clinic or making phone calls to patients. SPA refers to activity such as management, audit and CPD.

Job descriptions are compared to college norms. The current guidance is on the college website as CR174 Safe Patients, High Quality Services. It is worth reading as some jobs in some parts of the country get through the process with more scrutiny than others! Check to see if the workload in the job is reasonable. For example, it suggests that a full time inpatient general adult job corresponds to 15 to 20 beds with 5PAs on the ward, 2PAs for Mental Health Act work and 0.5PA clinical admin.

Full time jobs should generally be split 2.5SPA/7.5DCC, a norm supported by the college, the BMA and the Academy of Medical Royal Col-leges. 1.5 SPA is considered essential for CPD and revalidation, and the further SPA is needed for involvement in management. If the job has a trainee, this should attract 0.5 SPA for supervision, doing WPBAs and so on. Part time jobs should not have their SPA reduced pro rata as the time taken to revalidate is similar for full and part time consultants.

A job that has not been approved by the college should be treated with a healthy degree of suspicion. It may be perfectly good; however, most trusts regard college approval as an important quality control and very few bypass the process (even though it is voluntary). Look closely at the activity levels in the JD and explore the trust’s governance before the interview. The local Regional Advisor might be able to provide information about why the job was not approved.

The college is not a Union. JDs are checked to see if they are safe and doable: this does not necessarily mean that they are attractive jobs.

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2 Your CVThe purpose of a CV is for the interview panel to judge four things things, in this order of importance:

1 Is this candidate shortlistable?

To shortlist, a candidate must be technically appointable, which is to say he or she must have meet the criteria listed on the ‘essential’ part of the person specification. In laying out your CV, think about the people shortlisting you. Typically, they will have a pile of CVs and will be doing the shortlisting at the end of a busy day or in the evening at home. Shortlisting is a quick first pass of CVs to see which can be thrown out. Make sure the things that are listed on the person spec as essential aren’t just on your CV, they stand out like a beacon. It isn’t unreasonable to put them all in a panel on the first page. You have already made a friend on the panel: ten seconds to go on the ‘shortlist’ pile.

2 What are this candidates written communication skills like?

People often claim good written communication skills yet produce a CV that tells the opposite story. There isn’t a recipe for a perfect CV be-cause the way it is structured and laid out should be highly personal and reflect the way you think. This takes work, probably 20 to 40 of hours of work to get it really slick. Start working on your CV early and show it to people for feedback. Ask to see other people’s CVs and borrow the best ideas.

Think again of the people on the appointment panel, who will be busy. Structure your CV so that it has a fast track and a slow track: the fast track is for skim reading and enables readers to find information quickly; the slow track has more detail and is more discursive.

3 What is this candidate like as a person?

Many interviewers look for the unusual or turn to the back first to find out about interests and achievements outside of medicine. Give them something to read!

4 What experiences has this person had?

Although a ‘competency based’ CV is good and helpful to the appointment committee, don’t neglect the personal. Who did you work for and where? The interviewer is interested in the personal experiences you have had with particular trainers that he or she may know.

3 On the dayAllow plenty of time to reach the interview, allowing time for yourself to calm down and use the loo if needed. Take the telephone number of Medical Staffing in case of last minute delays.

Take some change for the car park or a taxi.

Dress smartly and conservatively, but clothes you are used to: not something you’re wearing for the first time.

Turn your mobile off.

All of the panel should all introduce themselves. It is obviously easier to remember names if you have found out in advance who is to be on the panel; but don’t worry too much about remembering names. It is more important to try to retain their rôles.

Pour yourself some water at the beginning.

In the interview, smile and make eye contact. Address the whole panel. Answer the questions. Aim to demonstrate some of the behavioural competencies listed in the Appendix during your interview. Don’t get into an argument.

Be yourself.

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4 Understanding the process: person specificationsTo understand how to perform well at interview it is helpful to consider the process ‘from the other side’. What information is the interview panel looking for and how will they try to elicit it?

If the trust’s appointment processes are good, each part of the appointment process (shortlisting/interview/group task/psychometric testing) will focus on testing different aspects of your suitability, so that there is minimal overlap between the information gained from each component. This ideal is rarely met.

Ideally, as part of the recruitment process, the necessary competencies should be defined for a job. These should then be used to construct the job description, and write the advert; to carry out shortlisting; and to develop interview questions.

Competencies can be technical or behavioural. Technical competencies are the particular skills and knowledge for a job: psychiatric assessments, prescribing, knowledge of the Mental Health Act etc. Behavioural competencies are less specific to a particular job and include the ‘softer’ skills of teamwork, communication, decisiveness and leadership (see Appendix 2 for a longer list of behavioural competencies).

The competencies required for different grades of job vary. At higher levels in an organisation, behavioural competencies usually become rela-tively more important than technical competencies. Interviewers for higher grade posts often assume a certain level of technical competence. They will be seeking evidence of behavioural competencies: i.e., although they may be asking questions designed to elicit whether you can do the job, they are probably going to be focussing on your motivation for the job and your ability to work well with existing members of the team/organisation. Group tasks and psychometrics focus on this aspect of appointment as the cost of appointing someone without particular behav-ioural competencies (e.g. the ability to lead a team) are high.

This model implies that it is acceptable not to have certain competencies at certain levels within an organisation. An organisation that promotes a learning environment will often actively protect more junior members from needing to learn ‘higher’ competencies while they are acquiring the competencies appropriate to their rôle.

Interviewers recognise this: you will not be expected to a dynamic, organisationally aware leader-manager as an ST4. By the time you get to your consultant interview, you will be expected to have developed some leadership skills. However, in both cases, you will be expected to have some idea about where your deficits lie and what you plan to do about making these good: i.e., by the end of your ST6 year you should have acquired some competence in self development.

More importantly, you will be expected to demonstrate (rather than simply evidence) behavioural competencies in an interview. There’s no point in telling people how great your communication skills are if you don’t make eye contact in the interview.

One way of thinking about the competencies required in the appointment process is to consider them in terms of authority, presence and im-pact.

Authority

Authority is about credibility: your achievements, titles, qualifications, roles. You’ve passed your membership, you’ve done stacks of audits, there are dozens of workplace based assessments in your portfolio, you’ve published in all the best journals, you know how to wash your hands and when to call the fire brigade. Authority is embedded in your CV and your references.

Authority is about past achievements, and these are what gets you through the door and in to the interview. To get an interview, you have met the requirements on the job description and person specification: you are technically appointable. The problem for you at the interview is that so are all the other candidates. If all you do is tell the panel what they already know from your CV, which the panel should already have already read, why would you bother to have an interview? At the interview have some anecdotes prepared for technical competencies mentioned on the person spec, but don’t trade on authority. At the interview, authority is often (largely) assumed. Similarly, much as you will be expected to know the Department of Health’s directive du jour, it isn’t good enough to just regurgitate it. Have an opinion on it.

Presence

Presence is about creating relationships in the here and now. Can you create a rapport with all the different people on the panel, quickly and under pressure? Can you command respect from the panel? This is an important skill to demonstrate. It involves a kind of meta-awareness of what is happening in the interview in terms of thoughts, feelings, intuitions and actions both for yourself and for the panel, so that you can be gracefully open to whatever the panel ask you to consider.

Impact

Appointment panels are looking for people who can ‘do’ change, who aren’t going to quickly ossify into a role and then be a problem for col-leagues, nurses, juniors and managers for the next twenty years. Good candidates adapt to change; excellent candidates make it. The people who really shine at appointment panels are the ones that don’t simply go along with change, they make it and lead it. The very best candidates will

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show their ability to make changes right there in the interview room. They will pick up a tension in the panel or in a group task and diffuse it They listen to the question and give an answer the interviewer wasn’t expecting, in a way that changes the frame of reference and shifts the dis-cussion.

The appointments panel want to know if this relationship they are entering with you can work long term. Woody Allen once said that a relation-ship is like a shark: it has to move forward or it dies. People on interview panels watch Woody Allen films: they don’t want to be appointing tomorrow’s dead shark. Most trusts already have more of those than they need. They want to know can you stay in this relationship for the long term?

5 Understanding the process: interview structure

Opening Phase

This will vary but usually will start with the panel asking you questions. The college assessor is often the first person to ask a question, often a simple factual questions about work history (not least to give you a chance to settle down).

Some studies suggest that 85% of selection decisions are made within four minutes of the start of the interview: don’t neglect making good first (and last) impressions. Make the primacy and recency effects work for you.

Candidate performance varies with anxiety. A little anxiety is good, you will perform better with it; if you are very anxious your performance will suffer. Learn some simple cognitive strategies for dealing with anxiety if this is likely to be a problem.

Don’t forget how much communication is non-verbal: keep your head and hands still, look the questioner in the eye, speak up.

Stay present and in the moment.

Middle Phase

Panels usually divide the questions between them. Similarly, they may delegate the record keeping rôle: someone may well be taking notes the whole time without talking to you at all (typically someone from HR). Don’t be put off if there are people who don’t ask you anything or even look at you.

The degree of training that members of the interview panel will have had in interviewing will vary, and interviewers may not follow this pattern. As the interview progresses the questions should become more probing: don’t be afraid to ask for a question to be repeated. The interviewer should be trying to get at the higher level behavioural competencies in the person specification: bear this in mind when answering questions.

As in the psychiatric interview, the interviewer should ask one question at a time. But if they give you a run of three or four questions, pause for a moment; think which question it suits you best to answer; go for that one.

Simple factual questions will progress with more difficult follow up questions. A good interviewer will be working up the following hierarchy of questions:

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III Values, attitudes and beliefs Why is that important?How does that concern you?Why do you feel like that?

II Interpretation and meaning What does that mean to you?What interests you about that?What are the implications of that?

I Data collection Who?What?Where?When?

Hierarchy of questions in an employment interview

The interviewer wants to know about values, attitudes and beliefs: but he or she also needs evidence for these. He or she may use focused inter-viewing to try and elicit this. Focused interviewing attempts to obtain examples of behaviour which are relevant to the behaviours relevant to the position.

Focused interviewing reframes hypothetical questions as behavioural questions: e.g. the hypothetical question ‘what changes would you have made in your last job’ becomes ‘give me an example of some difficulties in your last job. How did you address them?’ The interviewer trained in focused interviewing will be alert to some words and will attempt to unpack them.

•‘We’ did this – did you do it, were you involved (or were you just in the same unit as the people that actually did it?)

•Use of the conditional mood (would, could, should). What did you actually do?

๏Make the interviewer’s job easier for him or her by giving behavioural answers to any hypothetical questions he or she asks. Use the acronym STAR: Situation, Task, Action, Result.

๏Try to make your answers longer than their questions. This makes their job easier.

๏Structure your answers.

Supplementary questions surrounding your leisure activities as specified on your CV should not be treated any differently to work focused ques-tions: they can be used to offer behavioural evidence of specific competencies as defined in the person specification.

Some of the questions will be difficult. Don’t expect to have all the answers: what is more important is how you approach the question.

Closing Phase

Usually you are given a chance to ask some questions in the final phase of the interview. Use the psychology of the interview: make this stage count. Have some questions that demonstrate the competencies sought, and also to demonstrate that you are interested in this particular post with this particular trust. This is your chance to find out about the employer: don’t be afraid to ask them the difficult questions.

6 Questions that shouldn’t be askedIt is either unlawful or contrary to various pieces of guidance to discriminate against someone on grounds of race, gender, disability, religion, belief, marital status or class. Selection criteria should relate to personal capability to meet the requirements of the job. Note also that the Dis-ability Discrimination Act compels employers to make ‘reasonable adjustments’ to the working environment if this were to put a disabled poten-tial employee at significant disadvantage.

Questions about personal circumstances and future plans are legitimate in employment interviews (for example if it involves unsocial hours); what is not acceptable is to ask such questions only to a particular subgroup of candidates.

Questions about marriage plans or family ties should not be asked. Candidates who may reasonably be expected to have family ties abroad should not be asked about visits ‘home’.

Candidates should not be asked about social customs, political beliefs or religious practices, nor should the different social interests of people from different ethnic groups be permitted to influence the selection process.

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7 Leading a group task in a selection process.

1 Outline of the task

Selection interviews for consultant posts are increasingly supplemented by a group task. Typically, the candidate will be given a scenario to prepare a couple of weeks before the interview, for example to lead a thirty minute discussion on a particular subject. The topic will usually relate to the job the candidate is applying for, perhaps looking at key challenges ahead or how to improve aspects of the service.

On the day, a panel of (any or all of) managers, patients, colleagues and carers will be assembled and the candidate will lead a discussion with them. They will be asked to evaluate the candidate’s communication, leadership and interpersonal skills as well as their approach to the job and how they think about the service.

They will be rate the candidate’s performance on dimensions such as answering questions, being persuasive, leadership, managing time, inter-personal skills, organisation and conviction. Typically the candidate will be individually rated on a scale which is summed into a score and fed back to the main interview panel by one member of the discussion group. The discussion group may also feed back more general impressions to the interview panel.

2 Learning facilitation

You cannot learn how to facilitate two weeks before your interview. Work on your facilitation skills as a senior trainee.

There is a spectrum of experiences you can draw on: clinical communication skills…presentations…teaching sessions…chairing meetings…fa-cilitating a therapeutic group…running a change project. Take these opportunities when they come, get feedback on them, reflect on them, get some training, practice them some more.

There are some tips on facilitation at http://www.businessballs.com/workshops.htm. Appreciative inquiry is a useful methodology for inter-view tasks involving eliciting a team’s views about organisational change: there are articles at the Appreciative Inquiry Commons http://appreciativeinquiry.case.edu/. The handout ‘Meetings’ at guyundrill.com is also useful.

3 Advice for the task

Read the description of the task that medical staffing give you carefully.

Prepare yourself: know the service and job you are applying for, know the relevant national guidelines and current thinking in the field.

Go into the room with a very clear vision of your ideas and opinions, but be prepared to keep them to yourself initially: let them emerge organi-cally in the discussion.

The amount of time allocated is short: a truly realistic, wide ranging discussion is not going to be possible. In some respects this is like a CASC or OSCE exam: do a miniaturised version of what you would do to facilitate a group discussion ‘in real life’, with a beginning, a middle and an end.

Introduce yourself, do a round of introductions. Establish yourself as friendly but authoritative and in charge. Give lots of eye contact and smile.

Provide some structure: tell people what you are going to do in the time.

In the short time you have, covering one aspect of the brief in more depth is probably going to come across better than a general overview. It allows you to show expertise and will probably be both more memorable and more interesting than a birds eye view of all the issues - which anyone could do.

Elicit people’s opinions with open questions and use reflective listening. Show that you are interested in the answers people give. Use selective reflections to keep the group on task. High level skill is using selective reflection to guide the discussion in the direction of your vision.

Use summaries, again, guiding the discussion by pulling out themes and concerns of the group. If you can gently tilt the summary towards your vision, do so, but also allow solutions to emerge from the discussion.

Show your knowledge, both hard (research, guidelines, the local situation etc) and soft (one or two brief anecdotes about pertinent issues that demonstrate your approach).

Ensure you include everyone.

A high level skill is being able to alternate between joining in the discussion with stepping back and keep an eye on process. It mirrors what the panel are looking for in real life: a team member who is also a leader. If the discussion is either faltering or lively (especially if there is conflict), step back and prioritise process.

Personalise what you are doing. Show yourself and don’t be afraid of showing a bit of passion or fire. Be clear about your own role in the job.

Balance guiding towards clear conclusions with being flexible if people clearly want to talk about issues other than those you intended.

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Towards the end, signpost that things are coming to the end; summarise; move to some conclusions. Thank people for their time.

4 Don’t

Treat it as an interview and get into a question and answer session.

Treat it as a presentation.

Be timid.

Dodge questions or overuse the technique of throwing a question to the other participants.

Get into an argument: accept challenges gracefully.

8 After the event

If you got the job...

Congratulations. Technically you are the ‘preferred candidate’ until CRB checks, references, checks on registration and health checks are com-pleted. Negotiations about specifics, such as start date, relocation allowances, job plan, numbers of PAs, incremental dates, secretarial time, of-fice and so on, will happen at this point. If you are unsure about what is and isn’t negotiable, seek advice from the BMA. Try to get an induction of at least three weeks with minimum clinical work and on-call while you meet everyone in the locality and work out what you need to do. Most people find the first year as a consultant is hard and this might be the last bit of protected thinking time you’ll get for a while.

Don’t submit your notice of termination of your old job until the details of your new contract are acceptable to you.

If you didn’t get the job...

You are entitled to feedback as to why you were not shortlisted/appointed. Try to listen to the feedback in an open minded way: not getting a job can feel like a hurtful rejection and it is easy to respond to feedback defensively, which isn’t the way to learn from it. Feedback may be pro-vided orally on the day by a member of the AAC; if feedback is not to be provided on the day, the trust should write to you to advise you who to contact for feedback.

Think about honing of your ‘appoint-ability’. The BMA does 1-on-1 careers coaching and interview practice.

9 ReferencesDepartment of Health (2010) Joint Guidance on the Employment of Consultant Psychiatrists Downloadable from http://www.rcpsych.ac.uk/pdf/Joint%20Guidance%20on%20the%20Employment%20of%20Consultant%20Psychiatrists.pdf

Royal College of Psychiatrists (2012) Safe Patients and high quality services: a guide to job descriptions and job plans for consultant psychiatrists. Downloadable from http://www.rcpsych.ac.uk/usefulresources/publications/collegereports/cr/cr174.aspx

Undrill, Guy (2008) guyundrill.com.

10 AcknowledgementsThanks to Dr Adrian James for some of the content of this handout and to Dr Amjad Uppal for comments on an earlier version.

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Appendix 1:Behavioural competencies

A) Communication

Effective communication skills (with patients, relatives, colleagues, the public). Oral communication skills including awareness of non-verbal communication, effective presentations to a group. Written communication skills including clarity of expression, correct gram-mar. Appropriate use of IT. Good use of visual aids. Showing an understanding of problems in communicating with individuals from different cultures or with sensory impairment, and developing means of overcoming these difficulties. Checks for understanding by asking questions.

B) Commitment

Belief in one’s own job and its value to the organisation.

C) Self development

Active efforts towards evaluating and improving skills and perform-ance; demonstration of life long learning (of knowledge, skills, atti-tudes). Stays up to date in specialist areas. The ability to receive criticism constructively (and the higher level competency of actively seeking constructive feedback). A willingness to seek help and learn from colleagues in psychiatry and other disciplines when unsure of the correct course in clinical or managerial problems. The ability to find and evaluate information and apply the results to practice.

D) Self organisation

Effective time management. Planning and organising one’s own time, setting goals and priorities, maintaining an awareness of the relationships between activities. The ability to assess the urgency of a situation and respond accordingly. Dealing with competing de-mands on time.

E) Delegation

Using subordinates effectively. Allocating responsibilities appropri-ately to more junior members of staff. Clarity of what is delegated; how it is delegated; the target of the delegation.

F) Attention to detail

Carefully monitors the details and quality of own and others' work. Expresses concern that things be done right, thoroughly, or pre-cisely. Completes all work according to procedures and standards.

G) Initiative

Active attempts to influence events to achieve goals; self starting rather than passive acceptance; originating ideas and actions.

H) Resilience and tolerance for stress

Stability under pressure and/or opposition (time pressure, opposi-tion of ideas, task difficulty, conflicting demands). Demonstration of

a range of techniques for coping with stress. Ability to deal with disappointment and/or rejection.

I) Impact and persuasiveness

Creating a good first impression, gaining attention and respect, demonstrating confidence. Using appropriate communication skills to gain agreement or acceptance of a plan, idea or activity from oth-ers.

J) Rapport building and sociability

Initial and continuing impact. Honesty and courtesy to patients, relatives, unpaid carers, medical colleagues and other staff of what-ever seniority, age or perceived competence. The ability to meet people easily and be liked; to get along well with people and put them at ease; to work well in a team setting. Having a personal style not perceived as abrasive or irritating to either colleagues or pa-tients. Maintaining working relationships in difficult circumstances.

K) Sensitivity

Appreciating difference, including racial and sexual difference. Val-ues and incorporates contributions of people from diverse back-grounds. Accurate appraisal of the different feelings, skills, compe-tencies and needs of others. Compassion, both for patients and for members of staff working under pressure or struggling. Tolerance and acceptance of behaviours with which one might disagree. Will-ingness to examine own reactions to patients and others. Dealing fairly with complaints.

L) Leadership

Use of appropriate interpersonal styles and methods in guiding individuals (including subordinates, peers, superiors) towards the completion of a task. This includes the ability to influence and direct others without reliance on authority or position.

M) Behavioural flexibility

Changing behaviour to reach a goal; using different leadership styles in different situations and in respect of different needs of subordi-nates. This is not changing one’s mind relative to a situation or commitment; it is changing styles or methods to achieve a goal.

N) Negotiation

Communicating information, arguments or ideas in a way that gains agreement or acceptance. Judging when to give way and when to stand firm.

O) Tenacity

Staying with a position or a plan of action.

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P) Adaptability

Maintaining effectiveness in varying environments with differing tasks, responsibilities and people. Maintaining effectiveness during periods of change.

Q) Independence

The ability to work relatively unsupervised; the willingness to stand up for ideas and question others (peers, higher management); not giving in to others out of a desire to please or an unwillingness to avoid confrontation/conflict.

R) Teamwork

Appreciating the roles of individuals from other disciplines and specialities. Willingness to work in a team when not the leader; effective team member even when working on something not of personal interest.

S) Organisational awareness and compliance

Awareness of organisational structure; awareness of internal and external constraints and pressures on the organisation (financial, legal, political, pressure groups, patient advocacy groups). Anticipa-tion of the effects of change on organisational structure. Adherence to operating policies and statutory requirements in service delivery. Seeking approval from the necessary authorities for making changes.

T) Management control and monitoring

Supervision skills, including the establishment of procedures to monitor, review and regulate the activities of more junior members of staff. Assessment of knowledge, skills and attitudes; giving con-structive feedback.

U) Development of more junior members of staff.

Training, mentoring and coaching of more junior members of staff. Teaching skills including interactive and problem based learning. Increasing the effectiveness of more junior members of staff; identi-fying and designing appropriate developmental situations to moti-vate more junior members of staff to self development.

V) Decisiveness and risk taking

The ability to make a decision or render judgement. Balancing risks: knowing how much information is necessary to make a decision; knowing when to make a decision with incomplete data and when to deliberate or seek more information.

W) Planning and organisation

Establishing a plan to achieve a specific goal for self and others. Identifying problems, breaking them down into tasks, prioritising and assigning personnel and resources effectively; budgeting of time and resources.

X) Ethical practice

Maintains high ethical standards in self and others. Confronts po-tentially unethical behaviour, reports indiscretions appropriately.

Y) Discernment and judgement

Considers alternative available actions, resources, and constraints before selecting a method for accomplishing a task or project. Re-frains from "jumping to conclusions" based on no, or minimal, evi-dence; takes time to collect facts before decision-making. Considers cost and efficiency when making decisions establishing or changing work procedures. Considers the long-term as well as immediate short-term outcomes and actions. Considers ‘soft’/relational factors in making decisions. Appropriately balances needs and desires with available resources and constraints. Recognises when to escalate appropriate or specific situations to the next higher level of exper-tise.

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Appendix 2: Interview Questions

A) Background, CV, training and career plans

Tell us about yourselfTalk us through your CV/Application formWhat is exceptional about your CV?What part of your CV are you most proud of? If you had to do your training again, what would you change?What do you enjoy most and least about your speciality?Where do you see yourself in 10 years' time?How do you see your career develop?Why do you want to join this Trust?Why did you choose this speciality? What have you done to prepare yourself for a career in your special-ity?What job have you particularly liked/disliked?Having completed your CCT/CCST, do you feel ready to be a con-sultant?What do you like the most and the least about your speciality?Looking back at your training, what went well and what could be improved? Can you give us a critical review of your training?What weaknesses are there in your training?What are you particularly expert in?What sub-speciality interests do you have?Why did you decide on a career in this speciality?What personality characteristics are desirable in a consultant in your speciality?What do you particularly like about your speciality?What will you be doing in 10 years time?How do you see your career developing over the next 5, 10, 15, 20 years?What professional ambitions do you have once you become a con-sultant?How will you manage to maintain your professional standards as a consultant?What would you most like to contribute to your speciality?How would you like to be remembered when you retire?From where do you see the major advances in your speciality com-ing?What has been the biggest advance in your speciality in the last 10 years?In what ways do you think being a consultant will differ from being a specialist registrar/ST6?Which of the posts you have held has been most influential in your career?What is your view of private practice? How can it be successfully integrated with the requirements of NHS medicine?Do you intend to do private practice?How will you ensure that you fulfil your NHS commitment?What do you think of the concept of junior and senior consultant posts?

Do you think it should be the rule rather than the exception for established consultants to move between posts?What would you say are your good and bad points?What has been your most frightening experience?What aspect of your speciality do you do least well or do badly?What has surprised you most during your training?Do you think that an interview such as this is the best way of choos-ing a consultant?What motivates you in your speciality?Are you happy in your career so far?Have you always wanted to be a hospital consultant in your special-ity?

B) The Royal College

What is or should be the role of the Royal College?What should the College be doing for established consultants?Is the College simply there to organise training and accreditation?What specialist societies are you a member of ?Should all the College activities be based in London?How would you like to see the College becoming involved in educa-tion and training countrywide?What meetings have you attended in the past year? Were they valu-able?

C) The Department and Hospital to which you are applying

Why do you want to come to this hospital/trust/department?What do you particularly like about this post?What particular talents will you bring to this department?What difficulties do you foresee in this job programme?If you had to drop something from this programme to enable you to develop or expand a special interest, what would it be?Why do you think we should appoint you?What shortcomings do you see in this department?What facilities would you like for this department?What do you think you will get out of this job?

D) Experience and personal qualities

What do you have to offer us?Give us three adjectives that describe you best?What would your colleagues say about you? What would you like written in your obituary? What are your main strengths? What is your main weakness? What skills have you gained that will make you a good Consultant?What are the qualities of a good Consultant?What makes you a good candidate for the job?How would your seniors motivate you?Tell us about your worst consultant/colleague.

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What are your hobbies? How do they influence your medical prac-tice?What sort of hospital would you rather work in and why?How would you balance extra-curricular activities with being a Con-sultant? How would you rate your communication skills? Give us an example of a situation where your communication skills made a difference to the care of a patient.What skills have you acquired that make you a good communicator? Do you work better as part of a team or on your own?

E) Leadership and management

What makes you a good leader?What does leading by example mean to you?What makes a good team?What leadership skills have you acquired during your training?How can you improve your communication skills as a leader?Tell us about your experience of managing a team of people.What is the difference between management and leadership?Are you a leader or a follower?How do you motivate others?Describe a situation where you had to give negative feedback to somebody.Tell us about a situation where you had to bring a difficult person on board.Tell us about a situation where you showed leadership.Tell us about a situation where you showed initiative.How would you ensure that your team is up to scratch?What do you think about management issues? Do you think it's something we should he getting involved in as clinicians?What management structures exist in your present Trust?What problems do you see in having doctors as managers?What problems do you see in having a doctor as Chief Executive?What is the role of clinical director?Would you relish being a budget holder?What performance indicators of a hospital department could the purchasing authority reasonably request when negotiating con-tracts?Where would one look for additional funding for clinical work?What have you learnt from the management courses you have at-tended?How would you cope with the management’s demands to increase workload to reduce waiting lists?If a consultant failed to turn up to their fixed session, what would you as department chairman do?How would you justify additional spending on new equipment and drugs?How would you achieve a balance between two differing and con-flicting financial pressures within the Trust e.g. new drugs vs. ac-commodation?

How would you compare the UK to other countries in which you have worked in terms of value for money for health care?If a financial request is turned down, to whom do you appeal?How would you describe you own personal style of manage-ment?What is good leadership? Differences between leadership and management? Describe a management dilemma. How did you resolve it?

F) Stress and conflict

What makes you angry?What irritates you at work?What makes you angry about your job?Do you ever lose your temper? Have you ever been in a situation where you have had a conflict with a colleague? Give an example of a situation where your work was criticised.How would you cope with criticism or a complaint being made against you?What is your approach to resolving conflict? How would you handle a non-performing junior colleague?One of your SHOs says he is getting bored in his job. How do you respond?How would you handle a situation where you had a disagreement with a nurse over the management of a patient?What would you do if a patient disagreed with your treatment ap-proach?How do you handle stress?How do you normally cope with pressure?How do you recognise when you are stressed?What difficult decisions have you made in a clinical setting?

G) Research and audit

Tell me about your research experience. Tell me about your research. Assume that you are talking to a group of charity workers from your funding organisation.How much of your research is your own design and how much was guided by your supervisor?How did you organise your research project? Did you supervisor write your grant application?Why is Research important?How do you go about setting up a Research project?What did you gain from your Research?When doing Research, what is the one most important factor to get right? Do you think all SpRs/ST4-6s should do research?Would you like to participate in research if you were appointed?Should all research be carried in tertiary centres or do DGHs have a role?What is Evidence Based Medicine?What are the pros and cons of Evidence Based Practice?What is your understanding of the term "Research Governance"?

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What are the different levels of Evidence available?What is an audit?Tell me about your Audit experience.What is the difference between Audit & Research?Tell me about the Audit cycleWhat research plans do you have for the future?Is there a specific line of research you would like to follow?Why do you think we have a University representative on this panel? What is his role?What recent article that have you read, has changed your clinical practice?What journals do you take and read regularly? Why?What is your favourite journal?Do you think everyone should do some research during their train-ing? Why? What are the advantages?What is the value of research in your speciality?Do you think you will have enough time for research in this job?What is the purpose of the hospital ethical committee?Who should sit on the hospitals ethical committee?Do you think it is important to have an academic department of your speciality?What is the role of the academic department of your speciality?Should all research be carried out in a major centre or university teaching hospital?

H) Teaching and training

What should we teach the juniors? Tell us about your teaching experience.How would you organise the initial training in your speciality?What are the disadvantages of the reduction in junior doctors’ hours?How much of psychiatry/your subspeciality should be taught to medical undergraduates?How is your speciality taught to medical undergraduates in your area?An F1 tells you that he/she want to pursue a career in psychiatry. How would you advise him/her to proceed?Do you think one year outside the speciality, in something like gen-eral medicine is a good idea?How would you assess the competence of a new ST1?If you like teaching, why have you applied to a DGH as opposed to a teaching hospital?What particular areas of teaching do you wish to develop?What are the advantages and disadvantages of working as a consult-ant in a hospital which takes on brand new SHOs/CT1s?What is your favourite method of teaching?What teaching experience have you had?What qualities make a good teacher?What teaching facilities would you hope to find in the hospital to which you were appointed?For how much time should juniors be accompanied?What do you think are the desirable characteristics of a specialist registrar/ST4-6? Do these differ in early and later years?

What educational meetings or conferences have you attended in the last year? What did you learn from them?If you were to write a review article or a book, on what subject would it be?Do you think that journal clubs are valuable?Do you think you are adequately trained for this job?What faults do you think your SpR training had in the various hospi-tals in which you worked?What efforts did you make to obtain specialist experience in particu-lar areas over and above that available on the normal rotations?What teaching are you best at (small groups, seminar, lectures, one-to-one)?Are you prepared to fulfil your teaching commitment?What gaps are there in your training?Were you exposed to your speciality before you started your train-ing?Why does the Post Graduate Dean hold half of each junior doctors salary?What do you understand by specialist accreditation?What methods of teaching do you know. Which do you prefer and why?You are given a group of six SHOs to teach in a week's time on a subject to be chosen by you. How do you go about preparing for it?What would you teach a group of junior SHOs in 30 minutes?How would you convince a junior colleague of the importance of teaching?Give me an example of a situation where you recognised that a member of your team had a deficiency/difficulty.What is Problem Based Learning? What are its pros and cons? How do you know what you don't know?Tell me about a memorable case where you haveHow do you identify your training needs?What do you get out of teaching others?When did you last call your consultant?What is the biggest mistake that you have made in a clinical setting? How do you keep your skills up to date?Do you feel appraisals are a useful process?Some people think that appraisals are a waste of time and just a paperwork/box-ticking exercise. What do you think?How do you prepare for your own appraisal?How would you prepare yourself to appraise one of your junior colleagues?Do you feel Revalidation & Assessment will resolve the issues they are meant to address?

I) Ethical Issues & Difficult Work Scenarios

How would you handle a problem doctor - for example if you sus-pected that a consultant colleague had a drink problem?One of your SHOs has been arriving late by 20 minutes for the past four days. What do you do?A patient mentions to you that on two occasions they have smelt alcohol on your CT4's breath during clinic in the past few weeks. What do you do?

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How would you react if a patient refused to be treated by one of your junior doctors because he is foreign?You see a patient verbally abuse a nurse. What is your response?One of you peers arrives constantly late for work in the morning. What do you do?One of your junior colleagues is placing patients at risk. How do you react?A colleague does something that goes against an important Trust policy. How you do you tackle it? How would you approach the consultant?Your SHO mentions that another SHO is complaining about the fact that their consultant does not provide adequate teaching. How do you respond?A patient mentions that, during an examination, one of your col-leagues examined her breasts. Although the patient is not aware that such behaviour was inappropriate in that context, you are. How do you respond?You observe a consultant colleague making inappropriate sexual remarks to one of your patients. There are no other witnesses and the consultant is not aware that you were there. How do you react?Your consultant mentions something to a patient, that you believe to be wrong. How do you react?You have heard rumours that one of your colleagues is taking drugs. You also know that some drugs have disappeared from the cabinet. How do you react?One of your colleague seems to be suffering from stress. What do you do?You have suspicions that one of your peers has been stealing an important amount of hospital property (including stationery and needles). What do you do?

J) Service provision

What is the impact of revalidation on psychiatrists?What is your opinion on the Health and Social Care Act 2012?What challenges do you see for psychiatry in the NHS in the next ten years? How will you manage them?What is World Class Commissioning? How will you sell your service to the commissioners? What is PBR? Will it alter the way in which hospital medicine is practised and funded?What are your thoughts on performance related pay for doctors, for nurses and for non-clinical staff?How does the recovery model differ from the medical model?What have we learned from Mid Staffs and the Francis report? You are working as a consultant and you are recommending that one of your patient should be given a particular treatment based on the best evidence available. Hospital managers inform you that this treatment cannot be given as it is too costly. What do you do then? How would you inform the patient? What if the course of action you recommended was actually contained in a NICE guideline?How is the role of the consultant changing?

How can we persuade the public that doctors can be trusted?Is the expanding role of nurses a benefit or a danger to the medical profession?How do you think a blame-free culture can be brought about in the NHS?What risk management arrangements operate in your Trust?Do you take part in a critical incident reporting system?How does critical incident reporting relate to audit and risk man-agement?How would you handle an informal / a formal complaint against yourself from a patient?What would you do if a nurse made you aware of a colleagues poor performance?How does your Trust handle verbal and written complaints about its staff?What do you feel about revalidation of consultants?How could consultant revalidation be implemented and what are the most important criteria and restrictions?

K) Governance and quality

How will you add value to the Trust? How will you improve the service you provide? How will you know this is better? What is Clinical governance? What is it about and what are its ele-ments?Have you been involved in any serious untoward incidents/complaints? What did you learn? What is quality? How will you measure it? What outcome measures are relevant in this service?What do you understand by the term Clinical Governance?How does Clinical Governance affect patient safety?How should it be applied to individuals and to the Trust?What are your responsibilities under clinical governance?How does Clinical Governance impact on your daily work?Do you think Clinical Governance is useful or is it just another layer of bureaucracy?Are there any problems with the way Clinical Governance is imple-mented?Who, in your Hospital, is responsible for Clinical Governance?What is Clinical Risk Management?What happens to Critical Incidents Forms once they have been submitted?What is NICE? What do they do?Tell us about a NICE guideline relating to psychiatry/your sub-speciality.What is the National Patient Safety Agency?What do you know about the European Working Time Directive? What are its effects on the medical profession in the UK?What does the CQC do?

L) Non-Medical

What do you do when you are not working?

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Do you have any interests outside your speciality, either medical or non-medical?Why do you want to come to this town, or city or part of the coun-try?Do you have ambitions outside medicine?Is there anything you would like to ask the committee?What achievement in your life are you most proud of ?Do you consider your relative youth or excessive age a drawback for this post?

What sort of questions do you think I as a lay person should ask you?What is the role of a lay person on a consultant appointment com-mittee?What are you passionate about?How do you feel about yourself?What are the most important characteristics for the person ap-pointed to this post?

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