Hardest SFP Questions & Answers
SFP Application Specialists
SFP interview preparation requires a great deal of preparation, focused on clinical, academic and personal domains. This article focuses on some of the most difficult questions.
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Discuss an instance where you had to use problem-solving skills in a research setting. How did you approach the situation?
During a research placement, I was tasked with identifying potential markers for early Alzheimer’s disease using a data-driven approach. After weeks of data collection, I realised that the initial analysis method we chose was not yielding the nuanced insights we expected. Instead of panicking or forcing the data to fit the method, I revisited the literature.
I decided to apply a more sophisticated machine learning algorithm. After discussing with my supervisors and getting their input, I restructured the analysis pipeline. The new method successfully identified several promising biomarkers. This experience honed my problem-solving skills, emphasising the importance of adaptability and thorough understanding of the subject matter in research settings.
How have you exhibited your aptitude for critical thinking in a complex academic situation?
In a challenging bioethics seminar during medical school, we were tasked with dissecting complex ethical scenarios that had no straightforward answers. One such scenario involved medical futility and end-of-life care, a subject that evoked passionate debates within the class.
Rather than simply accepting the loudest viewpoints, I applied critical thinking to dissect the nuances and ethical principles involved, such as autonomy, beneficence, and justice. I cross-referenced the scenario with relevant medical laws, consulted ethical guidelines, and incorporated diverse perspectives from philosophy, sociology, and healthcare economics.
This approach allowed me to present a nuanced argument that impressed the seminar leader and contributed to a more comprehensive class discussion. The ability to apply critical thinking to complex academic situations will undoubtedly be vital in the Specialised Foundation Program, where quick yet thoughtful decision-making is essential.
How have you incorporated constructive criticism or feedback to improve your performance in a non-clinical setting?
In a non-clinical setting, specifically during my time as a project manager for a student-run environmental advocacy group, constructive criticism played a crucial role in my professional development. After leading a campaign aimed at reducing plastic waste on campus, I requested feedback from my team members and supervisors. The feedback highlighted that my communication style could be perceived as overly directive, which had occasionally stifled team creativity.
Taking this constructive criticism seriously, I sought out resources to improve my leadership communication. I enrolled in leadership workshops that focused on fostering open dialogue and encouraging team member input. I also started regular one-on-one meetings with team members to discuss their ideas in a more relaxed setting, away from the group dynamics that might inhibit open sharing.
These adjustments proved fruitful. Subsequent campaigns benefitted from more diverse input and a broader range of ideas, making our group’s initiatives more comprehensive and effective. This experience taught me the value of constructive criticism and continuous improvement, particularly in roles that require collaboration and leadership.
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Clinical: Emergencies & Management
You are the on-call junior doctor in the medical ward. A 75-year-old patient with a history of chronic obstructive pulmonary disease (COPD) develops fever, hypotension, and altered mental status. The nurse suspects septic shock. How would you approach and manage this patient?
Upon receiving the SBAR handover, I would quickly proceed to the patient’s bedside. I would check DNACPR and escalation status. Vital observations would be checked, including SO2, HR, BP, RR, and Temperature. The nurse would be instructed to carry out 15-minute observations and notify me or my senior for any sudden deterioration.
The patient is vocalising, thus the airway is assumed to be patent.
Since the patient has COPD and fever, I’d administer oxygen judiciously to aim for a saturation of 88-92%. An ABG and CXR would be considered.
I would administer IV fluids, after gaining wide-bore IV access, considering the patient’s age and possible frailty. Blood cultures and lactate would be measured.
GCS would be monitored. Any significant drop would be urgently addressed.
I would examine the skin for any signs of infection.
Senior input would be sought immediately, and sepsis guidelines reviewed. The events would be carefully documented.
You are the on-call junior doctor in the cardiology ward. A 65-year-old patient suddenly collapses and is unresponsive. The nursing staff initiate a "Code Blue" for cardiac arrest. What immediate actions would you take to manage this in-hospital cardiac arrest scenario?
I would first check DNACPR and escalation status. I would then ensure that a 2222 call has been made to summon the resuscitation team. Upon arrival at the bedside, I would confirm cardiac arrest by checking for responsiveness, pulse, and breathing. I would then immediately begin chest compressions at a rate of 100-120 per minute and a depth of 5-6 cm.
As CPR continues, I’d ensure the defibrillator is ready for use. After attaching the defibrillator pads, I’d assess the cardiac rhythm and administer shocks as indicated.
Intravenous access would be secured for administering adrenaline and other medications per ALS guidelines. Airway management would include basic manoeuvres and possibly inserting an oropharyngeal airway, followed by endotracheal intubation if an anaesthetist arrives. Blood samples would be drawn for testing and I would continuously monitor vital signs and ECG. After ROSC (return of spontaneous circulation), I would immediately inform my senior and review the NICE guidelines for post-resuscitation care. All actions would be carefully documented.
A 23-year-old male is rushed to the ED with sudden sharp pain on the right side of the chest and difficulty breathing. He was lifting heavy boxes when the symptoms started. Decreased breath sounds on the right side noted during examination. You are an FY1. How would you approach this case?
In the case of a 23-year-old male presenting with acute sharp chest pain and decreased breath sounds on the right side after lifting heavy boxes, the likelihood of pneumothorax is high. My immediate priority would be to alert the senior respiratory team and prepare for emergency interventions. I would supply the patient with high-flow oxygen to keep oxygen saturations above 94%, as per NICE guidelines. Concurrently, I’d arrange for an urgent chest X-ray to confirm the diagnosis, although I would be prepared to proceed with immediate needle decompression before imaging if a tension pneumothorax is suspected, in line with emergency protocol.
Following senior guidance, I would proceed with inserting a chest tube under sterile conditions. Close monitoring of vitals and clinical response post-intervention would be critical. I would also arrange for a repeat chest X-ray to confirm correct tube placement and lung re-expansion. This scenario calls for immediate, decisive action, while keeping the patient informed and as calm as possible under the circumstances.
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Clinical Questions: Prioritisation & Ethics
You are an FY, and part of a committee deciding the allocation of a limited number of ICU beds during a pandemic. How would you approach this ethically complex situation?
First, I would advocate for an approach guided by well-established ethical principles, such as justice, beneficence, and non-maleficence. Decisions should be based on medical need and likelihood of recovery, rather than factors like age, social status, or other non-medical criteria.
Transparency and fairness are critical, thus any decision-making process would be collective, involving a multidisciplinary team including medical professionals, ethicists, and possibly community representatives. Guidelines and protocols for such situations should be referred to, if available. The aim would be to maximise overall survival and the quality of life post-treatment.
Patients who are not allocated a bed should still receive the best alternative care available and ongoing reassessment in case a bed becomes available. Additionally, both the decision-making process and individual decisions should be clearly documented for future scrutiny and learning. While these are emotionally draining scenarios that carry a high moral burden, they require a judicious and ethical approach.
A medical student who is part of your team expresses interest in performing a minor procedure but has not had much practical exposure. The patient is somewhat anxious. How do you navigate the ethical implications?
In this situation, the primary ethical principles at play are patient well-being, informed consent, and the educational needs of future healthcare providers. I would first assess the medical student’s theoretical competence and gauge their readiness for performing the minor procedure.
Next, I would have a candid discussion with the patient, explaining the student’s need for practical experience while acknowledging the patient’s anxiety. The patient’s informed consent is paramount; thus, the decision to allow the student to perform the procedure would ultimately lie with the patient.
If consent is given, I would closely supervise the medical student to ensure the procedure is carried out safely and correctly. In this way, I could balance the ethical need for medical education with the patient’s well-being and autonomy.
A 15-year-old patient wishes to undergo a surgery that their parents disagree with. The procedure is not life-saving but would significantly improve the patient’s quality of life. What are the ethical considerations here?
This scenario principally involves the ethical principles of autonomy and beneficence. The 15-year-old, though a minor, has a certain level of decision-making capability. However, being under 16 in the UK, their parents are generally considered the final authority in medical decisions.
My role would be to fully inform both the patient and the parents of the risks and benefits associated with the surgery, including how it could improve the quality of life. A multidisciplinary meeting with the patient, parents, and medical professionals could provide a platform to negotiate a shared decision.
If disagreement persists, an ethics consultation might be necessary. Ultimately, while the parents’ wishes are legally prioritised for minors under 16, ethical medical practice demands that the minor’s perspective is given significant weight, particularly when the procedure could substantially affect their quality of life.
As an FY1 in a busy A&E, you encounter two critically ill patients simultaneously: one with a suspected stroke and another with severe sepsis. Which patient would you prioritise and why?
Given the time-sensitive nature of stroke management where “time is brain,” I would prioritise the stroke patient. Both conditions are life-threatening and necessitate immediate treatment, but thrombolysis for stroke usually has a narrow window of 4.5 hours, making every minute count.
Meanwhile, sepsis, although also requiring prompt attention, allows for a little more time for administration of broad-spectrum antibiotics and fluids, following the Sepsis 6 care bundle. By prioritising the stroke patient, I could potentially limit the extent of irreversible brain damage, optimising the chances for better long-term outcomes. That said, I would also immediately call for backup and initiate treatment protocols for the sepsis patient, ensuring they are not neglected.
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