The Pause: A Game-Changer for Sharper Interview Responses

Hello and welcome to the ACR Consultant Interview Podcast. I'm Tessa Davis.

And I'm Becky Platt.

And if you're a final year trainee or a locum consultant and you want to prep, not panic, then you're in the right place. Welcome back to this next exciting episode of our podcast. Hi, Becky, how are you?

I'm very well, thank you.

Good. Okay, let's get going. So we're going to kick off with the student question of the week. This is a question from one of our Academy students. What have we got up This week.

Okay, so the question is, if my best project was in another specialty and at the early stages of my career, can I discuss that or should I use something more recent?

So what do you think about this?

I think it's actually fine to use a project that was from a while ago. You've still got the skills, right? It's not like you forgot, you know, forgot what you learned because you did it a few years ago. I think if you've done a strong project that's got some great impact where you had a key role and where you've been able to demonstrate some really useful outcomes, maybe you've got some data around it, it can showcase a great skill set for you. It's brilliant. You don't need to say when it was. Most of these projects around audits, QIPs, whatever they might be, um, uh, you know, things that are still relevant a few years later. Um, so absolutely use it. What do you think?

I would actively discourage people from using— saying the year when they did their, their project because it, it's totally irrelevant. Like, and like you say, we know people have been training for years, so you don't need to say, you know, in 2019 I did this, in 2018. You just say the project. And I guess there's 2 elements to this student question. There's the specialty question, and there's the year question, like how long ago. So how long ago, I think, is irrelevant. You don't need to tell them, they're not going to care. And like you say, the skills you're bringing are the skills. The specialty question is different. So people are very worried, like, I did this when I wasn't in this particular specialty, so how is it relevant? But like you say, the skills aren't related to the specialty necessarily, right?

Absolutely. You know, for example, if you, you know, you were on your surgical rotation and now you're, you know, going to be an ED consultant, whatever, that's fine. You know, you're— it's, it's a, it's a skill set that you've still got. It's probably showing an appreciation for stuff that goes on in another specialty. You know, if you've done some service development, you're still focusing on the needs of patients, you know, or the needs of staff, or, you know, some system change. And all of those things are relevant whatever your specialty is. And probably if you're talking about an impactful project that you've done, you're probably talking about a time when you worked in a team, when you had to manage some change, when you had to work to deadlines. All of those skills are highly transferable and relevant you know, in any specialty at any point in your career. So, I think don't be afraid to talk about something that was earlier in your career, or in a different specialty, because the skill set is relevant now.

Exactly. And with the exception of your actual clinical skills, you know, I've done this many of this procedure, this many of this surgery, clearly that is good. You want that to be relevant to your specialty, but the rest is not specialty dependent anyway. So, yeah, totally agree. And I think often people rule out stuff, and it's a loss to what they can contribute to their interview answers because they rule out stuff that really would be very relevant just because they feel it was too long ago or they feel it wasn't in that particular specialty. So definitely, I would definitely include it.

Yeah, keep it in.

Okay, so next up we were looking at the example of the week. So this is a student example that someone submitted. What example have we got this week?

So this is an example of a conflict with a colleague, and the situation is that the surgical SHO refused to cannulate and take bloods from a 10-year-old who was admitted under their care and then refused to do their discharge paperwork. What do you think of this as an example?

Well, I think it's probably quite relatable, so it's not an example where you're like, That's crazy. How did that happen? And that's what you want, is something that someone could hear and think, yeah, that's happened to me, or I've seen that happen. So I think that's the first thing. I think it's clear that the conflict is not the fault of the student, because that's what you want, a conflict that's not you being annoyed with someone else, they're annoyed with you. So that's good. I suppose the only thing that would flag to me is the power imbalance, in that the person going for the interview is likely to be a— is going to be a reg or a consultant, and this is the SHO. So, they're getting into a conflict with someone who's junior to them. And generally, we'd say, don't do that. Find someone who's the same grade as you. I don't know what your thoughts are on that.

Yeah, I think where there's any kind of hint of a power imbalance, you've just got to be a bit careful around it. And I think the other thing is that what we don't want is consultants or senior registrars talking about conflicts that they've had with nurses or other allied professionals.

That's a big no-no.

That's an absolute no. That's a complete red line. So I think this one potentially could work. I would frame it as my surgical colleague or a colleague in a different specialty. Um, because it, it doesn't matter as long as, you know, you're not actively kind of, you know, abusing power in any way or, or there's any hint of that. Right. I suppose the, the other thing to be just a little bit mindful of is setting up this kind of adversarial type of story around different specialties.

Mm-hmm.

So I think, you know, just, just be a little bit careful around that and just be sensitive. And when you talk us through the example, just, you know, focus on de-escalation of the conflict, keeping the patient at the centre, and maintaining a professional working relationship with your colleague.

And I think also is it understanding where they're coming from, because probably this surgical SHO is slammed with work and, you know, is not being obstructive or rude or lazy, but it's actually just like got a million things to do.

Yeah, exactly.

And so I think just acknowledging that actually you could have a chat with them about that and explore where they're coming from and understand is better than saying, oh, you know, this reg— this surgical SHO has always been like that. you can actually say, you know, I know this isn't like them, I sat down and had a chat with them, and that's part of your explanation.

Yeah, I like that. And I think, you know, just understanding, you know, actually how does conflict arise? You know, conflict usually arises because everyone's got so much stuff going on. You know, there's distress in the background, people are tired, people are hungry, people are worried. You know, maybe this person isn't used to cannulating children and actually just, Just can't think of anything worse than going near a 10-year-old and trying to get a cannula in. And so actually unpicking a bit of that as part of your de-escalation, and then finding a way to move forward in a way that maintains that relationship, is what we want from that conflict example.

Yeah, and remembering that the goal of the outcome of this conflict is not to show that you're right, 'cause I think that's often something we see as well, that they go, this is the whole story, this was the conflict, and in the end, I was right because they did need a CT, or they did have a whatever. And that's not really the point. The point is to show all of the stuff we've mentioned about getting on with people, good patient care. And I think if you get preoccupied by showing that you're right, you can come across as being a bit— like, you might be obstructive, or you might be tricky to work with.

Yeah, I think just be mindful of it. What you want to be able to show is that you can de-escalate conflict, Find a way forward that's satisfactory for everyone, maintain patient safety and good professional relationships. Be a normal human.

Be a normal human. So, we think this is a good example, but we'd probably not say it was the surgical SHO.

Yeah, I would just phrase it slightly differently, but otherwise, go for it. Okay, shall we have a look at the interview question of the week then? The question is, what is your experience of governance and QIP? What are your thoughts about this question?

I think this is quite a nice question. It's very common to get a question about governance or about QIPs, and this is quite a broad way to ask the question because it's just saying, what's your experience? It's not saying, tell me about a specific aspect of it. I think that's quite nice, is the first thing. It's also quite broad, which means it can be difficult to pin down specifics because they're just generally asking governance. So I think there's probably 2 sides to the broadness of it. And I would say you're trying to— this is a good time to think about your USPs. So one of your USPs is probably— your unique selling points— one of them is probably going to be a governance thing, or ideally should be.

Mm-hmm.

And so, you're trying to bring that in, to bring in specifics when you're talking about your experience. The other thing that springs to mind is this, the 7 pillars of governance. I don't know how— we talked about this a bit in last week's episode, how likely you are to remember 7 pillars in the heat of your interview.

Don't go near it. I think it's, in any situation where we're under pressure, It's really difficult to remember all of the things we need to remember. That's why we have all these aide-mémoires and all the rest of it. If somebody asked you under pressure to name all 7 pillars of clinical governance, I would challenge you to remember more than 5. So just don't put yourself under that pressure. I think you can reference the fact that there are 7. You know, obviously there are 7 pillars of clinical governance. I'd like to focus on 3, and then you might talk about quality improvement and audit, you might talk about risk, you might talk about clinical effectiveness, say.

I thought you were going to list all 7 there. You're going to like, no, that's it, that's all I've got.

I'm not even under pressure and I can't remember them.

I know.

So no, but use your USPs then to talk about the things. So if you've done an audit, talk about that for one of the things. If you've streamlined your department's complaint and learning process, talk about that. If you've learned how to, you know, manage the risk register, talk about that. You know, that's it. You know, you can get in loads of different things, and I think the broadness is actually your friend, because if there's stuff that you really want to talk about, you can probably ease it into this question.

You're, you're absolutely right that, that it gives you the flexibility. So, it's a very broad question, and you can channel your USPs in there. It's a great opportunity to get something out that you, you know, haven't had a chance to talk about yet as much as you want. So, yeah, I think this is a good version of the question. Sometimes they can be more specific questions about quips, um, or about, you know, a learning point from a quip, or the challenges of making change, that kind of thing. But this is quite a broad one, so I think it's a good idea.

Yeah, I think there's lots of flexibility in there. Um, I think sometimes this question comes up more around, um, audit and, uh, QIP and so on. It might be something like, um, tell us about a time you did a QIP and what you would do differently next time, or what were the challenges or something. So it— that— this is why it's actually really worth working out what your USPs, your unique selling points, are as part of your preparation and really having a list of, you know, what all the steps were in each of those USPs. So if one of those is, I did a quality improvement project on streamlining the triage process for our GP referrals, then you will have a list of bullet points. What are all the things that you did as part of that? You know, got the stakeholders together, Got IT involved, you know, list all of the challenges, all of the various steps, so that if you get asked a question, uh, in this way, you already know what all of the various different angles are that you can take on it. And all you need to do is just pull those out of your mental USP catalog and just tell the panel about it. Um, but this is all in the prep.

It's all in the prep. Yeah, you're absolutely right, because you know it's coming up, a version of it is coming up, so have it ready and you're going to a lot better. You might even be happy when they ask you it. You never know. Okay, and then we've got our tip and trick of the week. So this week we have got using the pause. So we love a good pause in the Academy, don't we?

We do. I think the pause is one, one of your best friends in the interview, um, and you should actually plan that you're going to use this, um, because what it does is allows you to actually engage your brain before you start speaking. So when, when you get a question, you know, the panel asks you, um, can you tell us about a time when you were engaged, when you were involved in making a change in your department? So, so then you take a few seconds and think, okay, right, which one of my USPs can I use to demonstrate this? And what are the 3 points that I'm going to make around it? Like, I'm going to talk about this, this, and this. Take a deep breath, and then you go for it. And that whole process probably takes 10 or 15 seconds, but it's so much better than starting to talk before you've got any idea what you're going to say.

Yep. Or the worst filler— I think you're gonna know, you know what I'm gonna say here.

Thank you for the question.

Yes, that's a great question. Thank you so much. So happy to be asked it. Yeah, that thank you for the question, that's a great question, is just like, it's totally meaningless and it's just a filler to kill time while your brain's like, oh, what am I going to say to answer this? And it's much better just to be silent for that time and just use it to think. Exactly that. How am I going to answer this and have a plan?

Yeah, I think if you feel really awkward doing this for the first, you know, the first time that you do it— and by the way, don't do it for your first question where it's basically tell me about yourself, because you know that question's coming, you don't really need to take the pause. Um, but you know, the first time you do it, you say, I'm just going to take a sec to get my thoughts straight. Then start. Then after that, you don't need to do it. They know what you're doing. Don't do any nonsense cringey fillers. Just take the pause and then smash out the best answer they've ever heard.

And what people will find when you practice doing the pause, you get more effective at using that pause. Because the first time, I think, when people start doing it, they just spend the pause freaking out. Like, oh my God, I'm pausing and now I've got to come up with something and I don't know what I'm going to say. So then the pause becomes Quite stressful period. But as you practice that more, even in your practice, if you have to take a really long pause, but work out how to use your pause to make sure you're answering the question, you plan what you're going to say, you know where you're headed, and then start when you're ready, that window of how long you need to use the pause for will gradually come down. And it will be your best friend.

What I always tell people to do, our students in the Academy, once they've got used to using the structure, using their USPs, and they've done a few questions, I tell them to, um, you know, open up a, you know, a question. So maybe they get somebody else to ask them a question, or they've written out, you know, question cards with 30 different questions on, and they pull out a random one, uh, and then they think about it, pause, and answer. Um, it's so much better than sitting there for 5 minutes thinking Right, how am I going to answer this audit question? Planning it for 5 minutes and then answering it for 3, that, you know, anyone can do that. But the real skill is being able to pull it out under pressure with just, you know, 10 or 15 seconds thinking time, because you've already done all of that prep in the background, and now all you have to do is just put it into action, put it into practice.

Yeah, and even if the panel notice that you're pausing, I don't think that matters. It's even if they think, oh, that's weird, you know, Becky's paused for a long time before she's answered. I don't, I don't think it matters because if you have the benefit, if you feel that the pause benefits your answer, then it's going to improve your score. So even if the pause seems weird, if the answer you come out with scores you higher than it would have done if you'd have just launched into it and just been, you know, having sort of verbal diarrhea, then it's worth it. That's just the The trade-off that you make. And I think almost everyone, probably everyone that I've seen use the pause, finds that it improves their answers, and therefore it's worth doing. And most panel members will be happy that you're giving them a better answer and using the pause to good effect, rather than just launching into it. So they will be pleased that you're using the pause, and they will understand that you're nervous, you care. All of these things is absolutely fine. I think we will wrap up there. So, thank you very much for another excellent episode. We've got lots more great stuff planned next week, including using I rather than we when you're talking about your USPs, and why ownership of your USPs is important. And I know it can be something that people find tricky to do. So, we'll be chatting about that next week, and I'll see you there.

Can't wait.