Technically speaking, the NHS wants to appear to recruit candidates in a fair way in order to ensure that they make a decision based on the full knowledge of what the candidates have to offer (you neer know – an external candidate may be far better than the current internal candidate). As such the system will always be made to appear fair, even if in practice, it is not always the case.

The decision making system can operate in two ways:

1. A voting system, whereby all panel members have a vote, with the candidate collecting the most votes being given the job;
2. A points system whereby all candidates are marked separately, the points added up, with the candidate collecting the most points being given the job.

Whilst it is true without a doubt that some trusts apply the system in the fairest possible way (we have seen examples of preferred candidates losing out by as little as 0.5 points), both decision-making systems are opened to abuse. For example:

• The regulations state that the panel must contain a majority of clinicians. As such, it can be easy for those clinicians to agree to vote for a particular candidate. This however makes the assumption that the preferred candidate performs roughly as well as the others, otherwise the panel will struggle to justify voting for someone who is clearly a poor performer at interview. That is also why “preferred” candidates should not be too complacent and should ensure that they can put on a good performance on the day.
   
• The points system, on the surface, seems a lot fairer, but can also be easily manipulated. For a start, when do you mark? After each candidate? Or at the end once you have seen all the candidates. Marking after each candidate could be seen as unfair towards those who were interviewed first as experience suggests that those first in line tend to be marked more harshly due to the absence of a benchmark. Marking at the end (a widespread practice) can lead to manipulation of the results as interviewers simply have to make sure their favoured candidate is given a greater score. Such manipulation of the marks is made easier by the fact that the criteria used to select candidates are very loose. For example “Has demonstrated appropriate communication skills” is a very subjective criterion whicch could easily lead to a 0/10 or a 10/10 depending on whether your face fits or not.

There is a debate to be had about whether interviews should actually be fair or not. If you place yourself in the interviewers’ shoes you will rapidly see that in many cases it can be safer to opt for the guy you know, even if he has weaknesses, than for someone new whose weaknesses are an unknown quantity.  It is often argued that internal candidates are at an advantage, and they certainly are since (i) they have a better idea of the department’s needs and are therefore better able to push the right buttons at the interview and (ii) they are a known quantity. But, external candidates also have a major advantage: they can bullshit their way to the job a lot better than an internal candidate ever could, precisely because they are unknown to the panel and because most of what they say is unverifiable.

Added to all this is the fact that, even if a panel is intent on being totally fair, subonsciously interviewers have a tendency to mark internal cnadidates slightly higher anyway. In addition, still subconsciously, most people’s unwritten agenda is that the local candidate will get the job unless someone else can demonstrate that they are substantially  better or add much more value.

All that being said, there are clear examples of situations where some recruitment processes or interviews are being fixed or heavily influenced. These would include:

• Publishing job adverts in the wrong section of a paper (so that only the chosen candidate knows where to find it).
• Writing job descriptions which contain criteria that very few people would meet (such as publications on specific topics).
• Telling people at pre-shortlisting or pre-interview visits that there is a favourite candidate and that therefore they should not bother applying.
• Asking questions/presentation topics which require so much local knowledge that only an internal candidate would be in a position to answer them.
• Deliberately shortlisting weak candidates to stand against the preferred candidate.
• Refusing to see candidates for pre-interview visits, meaning that only the local candidate would be able to gather crucial information.

Although common practice, those behaviours do not affect the majority of cases and it is fair to say that most interviews are actually fully opened to competition, as the frequent failure of local candidates indicates. Indeed, local candidates run the risk of being complacent only to be beaten by a well prepared external candidate. In fact, many local candidates fail to carry out pre-interview visits and are often less informed than external candidates on the Trust’s internal matters.

But at the end of the day, does all this matter? If you go to an interview, you cannot turn up thinking that the job is someone else’s. Not only will this affect your confidence, it will also ensure that you perform badly and appear demotivated on the day. There are plenty of stories of outsiders beating the local candidate, even when the process was rigged. There are plenty of storied about preferred candidates falling apart through lack of preparation. And there are plenty of storied about second jobs being opened to accomodate an external candidate who performed well at an interview.

For more information about consultant interviews, visit our free information pages on consultant interviews.  If you want assistance with your consultant interview preparation, why not attend our famous consultant interview course!

Following several requests, here is a summary of the key rules of body language:

1. Maintain eye contact with the person who is talking to you. At your interview you will face between 2  interviewers (for ST interviews and some locum consultant interviews) and 8 interviewers (for some locum consultant interviews and for substantive consultant interviews). In some regions/trusts, you may have up to 14 people on a panel (not uncommon in Northern Ireland and Scotland). It is impossible to look at everyone all the time, and if you did you would soon get dizzy! Conversely, it is important to try to involve everyone whenever possible to avoid having a situation where the panel member at the end of the table has to wait for 45 minutes before you look at them. So, look principally at whomever is asking you the question and, occasionally, look around to ensure you connect with the others.
    
2. Put your hands on the table. Most of the panel members will have their hand on the table, taking notes, playing with their pen , or simply being attentive. It is crucial that you place yourself at the same level as the panel by also having your hands on the table. If you don’t, the table will act as a barrier between you and them and you are more likely to end up looking like a schoolboy/girl waiting to be interrogated. If you are worried about fidgeting, slightly interlock your fingers to stop yourself from moving your hands too much.
    
3. Do not place your elbows on the table. Elbows on the table not only are rude/familiar, they also make you invade the buffer zone between you and the panel, with the risk that you might come across as threatening. Leave your elbows slightly outside of the table. This is typically achieved by sitting approximately 20 cm from the table.
    
4. Move your hands if you want, but only in front of you. No need for Shirley Bassey impressions. Arm movement outside of the area in front of you will take the attention away from your face. To ensure that the attention remains on you and not on your hands, do not go left or right of your body; and do not move your hands above chest level in order to avoid obscuring your chin or face.
    
5. Dress conservatively. The interview is a business meeting. You must wear a suit, preferably of a dark colour (navy/black for men, any dark colour for women). Wear a lighter shirt/blouse/top so that it frames your face. Don’t forget: they want to look at you, not your clothes! Most colours are fine, though men should avoid wearing pink (tie or shirt) because this is a colour better fitted to mediation and team playing which does not convey a strong sense of leadership. As such, though it would be suitable if you were going to a meeting to resolve a conflict, it is less suitable for an interview setting.
    
6. Avoid anything that can take the eye away from your face. This would include any big items of jewelery (small is okay), as well as items such as poppies, red/pink ribbons, daffodils.
7. If there is no table, you may cross your legs, but with the crossed leg always facing in the direction of the person who is talking to you. This will enable you to turn your body towards them whilst at the same time being able to rotate to engage wit the other panel members.

If you want to discuss any of this or anything relating to a forthcoming interview, why not join us in one of our consultant interview courses. They run 3 to 6 times per week in London so that you have plenty of choice for dates.

1. How can we maintain quality of care whilst cutting costs at the same time?
2. If I told you that we needed to cut costs in your department by 15%, where would you find the cost savings?

In giving answers to such questions, the majority of candidates are having trouble distinguishing between cost savings and cost efficiency. Some then picked on by interviewers or get feedback that they had a poor graps of basic business concepts. I thought it would be useful to deal with this topic in an article in an attempt to remove any ambiguities.

Cost efficiency means that for a given cost, you are making the best use of the resources available. So for example, if a nurse costs the department £35,000 p.a. then she is cost efficient by being made to see as many patients as possible. In other words, you are getting the most out of the cost.

Cost cutting however refers to the fact that the cost of employing the nurse in the first place would be lowered. In other words, this would involve demoting her to a lower salary (tricky!) or making her redundant (tricky too, but far more feasible). 

Note that when you are making the nurse see more patients, you are actually cutting the cost of dealing with one patient (since her salary is spread over more patients than before but you are not cutting the cost of her employment.

When you get questions on cost-cuttings, they refer to cutting the overall cost and not the cost per patient. Overall, there are many ways in which costs can be cut in an NHS environment, which would include:

1. Making staff redundant (salaries are the biggest expense).
2. Using cheaper drugs (drugs are the second largest expense).
3. Moving to day-case surgery, thus enabling a cut in the number of ITU beds, lowering the number of infections and readmissions (thus enabling redundancy of staff)
4. Using cheaper staff to carry out tasks (e.g. replacing doctors by nurses, consultants by senior staff grades.
5. Using permanent staff instead of locums
6. Replacing one consultant by increased PAs for the other consultants in the team (the total cost to a Trust of paying 8 consultants £10,000 more is lower than paying one consultants £80,000)
7. Encouraging follow-ups to be done by GPs (thus enabling redundancy of staff)

So for example, in anaesthesia, implementing pre-operative assessment clinics would lower the number of cancellations because patients would be better assessed and any risks identified. This would result in a fuller utilisation of the resources available and therefore greater efficiency, but not in cost savings because the trust would have to pay the salaries, theatre time, etc just the same.

Hope this helps! Good luck to everyone!

The UKCAT is marked by first allocating a score based on the number of questions attempted and the accuracy of the answer. However, each candidate’s score is then compared to a sample/test population, which is essentially the first 3000 candidates who first took the test in 2006. This then leads to a score of between 300 and 900 for each category. That means that, it is possible to get a high score even if you cannot complete a full section or, if you did, even if you don’t get everything right. For example, let’s assume that the best candidate at the time only managed to answer 80% of the QR questions and got them all right then you could get a very high score even if you only answered 70% of the questions.

How medical schools use the UKCAT results

Each medical school uses the results in its own way.

1. Some medical schools have a cut-off mark below which they will not interview candidates. That cut off mark can be fixed (i.e. say 675 marks every year) or set in accordance to a percentage(e.g. they will look at candidates who are in the top 20% for UKCAT results, in which case the actual number of marks required may vary from year to year).
2. Some medical schools translate the UKCAT results in a number of points (e.g. 5 points if score is above 700, 4 if above 600, etc) which are then added to the UCAS score, and used in the overall assessment of candidates.
3. Some medical schools ignore UKCAT generally and use it only to decide on borderline cases.

For full details on how each school uses the results, please refer the UKCAT description page on the ISC Medical website

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The questions mirror the level of difficulty that you can expect at the exam, from relatively easy to stretching. Each chapter contains comprehensive techniques to help you handle each of the four sections of the UKCAT. The breadth and depth of the explanations, tips and techniques provided will ensure that you are fully prepared to answer all questions confidently, correctly and within the short period of time allocated.

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The authorities (trusts, GMC) have been very careful to remain very vague on the topic, preferring to leave it to both candidates or trusts to judge the matter on individual merits.

This is where one must differentiate the legal position from the moral position i.e. what you are entitled to do versus what would annoy people the most.

Legally, there is nothing that stops you from accepting a job from Trust A and then a week later, on receiving an offer from Trust B, resign from Trust A before you have even started your new job.

However there are other factors coming into play:

1. The GMC has issued further guidance saying that as far as they were concerned this was a matter of patient safety. In other words, if you are announcing the day before you are supposed to start a job that you are no longer willing to accept the post, this will mean that patient care will suffer through lack of coverage, it may take time to get locums, etc, and you could potentially get into serious trouble. You could argue of course that the job is not meant to be starting until much later (3 to 6 months) but if you are in a specialty where recruiting people is difficult then you may still get into trouble.
    
2. You will annoy greatly a number of people in your specialty and if they are influential this may well work against you, particularly if your name starts circulating with a trouble-maker tag attached to it.
    
3. If you pull out of a job after the recruiting trust has rejected all other candidates, then they may well have to readvertise and this may also affect your reputation since, essentially, they will have wasted their time and money because of you.

So there is no strict yes/no answer but one which very much depends on the people involved, the type of jobs you are applying for, your own attitude towards your career, and most importantly, the likelihood that you could actually be successful at the second interview.

In such situation, most people I know have pulled out of Trust A to have a good go at Trust B and not risk the wrath of the establishment. Other candidates have been honest with Trust A, hoping they would be understanding and that way there would be no issue. Having said that, if I were Trust A, I would not give the job to the candidate unless this was a locum job.

 The only easy option is when you have two interviews within one or two days of each other. You would simply switch your phone off and not accept the first job until you had the results of the second one, but anything longer than one day is too long to wait.

Want to discuss any individual circumstances? Why not join one of our consultant interview courses? Courses are run several times per week in London.

Candidates applying for consultant posts are very good at scaring themselves about NHS issues during their preparation for the big day. Across the range of thousands of candidates that we coach every year for their consultant interview, it is common to hear comments of the type: “I heard they can ask you anything about NHS issues” or “I don’t understand anything to all this management stuff”.

In reality, although it is of course important to understand what is going on in the NHS, the emphasis is not so much on knowing a lot of facts, but on understanding at a more global level how this will affect your speciality in the forthcoming years and therefore your role as a consultant in the unit which you are aiming to join. Doctors have always been trained to learn information which is then tested at exams. At the interview, it is your awareness and analytical power which is being tested rather than your ability to regurgitate information.

As such, it is unlikely that you will be asked very factual consultant interview questions such as “What are the 8 ways in which the clock can stop for the 18-week target calculation?”; and you will only be asked questions of the type “Tell me what you know about Darzi.” in the 4 to 6 weeks or so following the publication of a report.  Instead, you are far more likely to be tested on the broader implications of those reports, which, by itself, does not require any detailed knowledge of those issues. For example, currently, consultant interview questions associated with the Darzi report are more likely to be of the type:

• “How can we improve quality of care in a cost-cutting  environment?”, a question which refers both to the emphasis on quality in the Darzi report and to the forthcoming cuts in NHS budgets, but requires no specific knowlegde of the Darzi report. Instead, it requires a good knowledge of the areas of inefficiencies in your speciality in general and in the department that you are aiming to join.
   
• “How would you measure quality of care in your specialty?”, a question which relates directly to the Darzi report, Patient-Reported Outcomes Measures (PROMs) and patient experience, thus linking to the auditing of key performance indicators and patient feedback, neither of which are fully developed in the Darzi report.
   
• “How can we improve the quality of training in the current environment?”, a question which relates not only to the diminishing hours of training imposed by the EWTD, but also to the fact that spending time on training juniors is not always compatible with a drive towards efficiency and cost-cutting. No report will give you the answer to this question.

Consequently, although it is of course important to read and understand the key reports published by various organisations, you should not fall into the trap of trying to learn their content with a view to regurgitate it. Instead, you should make note of the key issues and try to understand their practical implications.

One of the greatest difficulties in reading about NHS issues is that it seems like there is an endless supply of documents. So don’t make the mistake that many candidates at consultant interviews make, which is to start right back to 1948. No one really cares about the old issues, and even the Tooke report which dates back to 2008 is no longer talked about. Look at the key documents published in the last 18 months or so, both at a global governmental level (e.g. Darzi) and at speciality level (e.g. recent NICE guidelines, Royal College strategy documents, etc). You may start with one and find that it refers to 2 or 3 others, which in turn refer to 2 or 3 others. It is important that you follow the trail so that you can appreciate how they all interlink. This should take about 4 or 5 hours of your time. If you feel that you are spending excessively longer then you are probably spending too much time on the detail.

Then, once you have a rough idea of what it going on, think of the implications. Try to do this by yourself to start with because at the interview there will be no one to help you, so it is important that you forge your own opinions and ideas about the implications of what you read.

Some of those implications may be common sense (for example, if you are place an emphasis on productivity and cost saving then training may be affected) but others may be less obvious to you simply because you are not involved in the day-to-day management of their unit. For that reason, as a second step. it is useful to discuss issues with your educational supervisors as well as  clinicians in their team how this influences their speciality and their department in practice. If you are applying for a job as an external candidate, it is also extremely useful to raise those issues at pre-interview visits so that you can get the local point of view on all important matters (knowing you may well be quizzed on those at your consultant interview).

All those impostant NHS topics are also obviously discussed on our consultant interview courses.

The old system had long been perceived as unfair by applicants because it placed a heavy weight on candidates’ writing style and not so much on academic performance. In addition, some candidates had their application reviewed by experienced colleagues/consultants, meaning that competition was unfair.  Under the new system, more weight will be allocated to academic performance.

One of the problems associated problem with the SJT is that it makes the system too standardised and does not differentiate enough between students. It is possible to “learn” to answer SJT questions and the system may not actually be an improvement. Still it seems that those involvement in GP recruitment are happy with that mode of recruitment and it is therefore logical that other parts of the system should follow suit.

For full details of the proposals, you can visit the Medical Schools Council website.