What to Do When Reference Requests Get Awkward

Hello and welcome to the ACER 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. All right, welcome back to our ACER Consultant Interview Podcast. Hi Becky, how are you?

I'm great, thank you. Great to be here.

Great, let's get going. We're going to start with our question of the week. So this is a question that one of our academy students has posed to us. What's— what is the question this week?

Okay, so, I haven't told my current colleagues I'm applying for a new job because if I don't get it, I'll stay in my current job and it might be awkward. Can you give me any advice about the references? Um, like, who, who should be the referees and when to ask them? Yeah, agreed, that is potentially super awkward.

Okay, so how would you approach it? Well, everyone does go from one job to another, so it is awkward, but it's not crime of the century. You probably need to have one reference from your current post. They might actually request that it has to be, but also, I think it would look a bit weird if you didn't have one from your current post.

Yeah. I mean, I think if you're in a consultant post and you haven't got one of your current colleagues, it would raise an eyebrow about why that was. I suppose the other thing to say is, just kind of flipping it around slightly, it actually really annoys me when people expect me to provide them with a reference and they haven't spoken to me first. Oh, me too. Which is a bit rude. So, I think actually just being mindful of that. So, just, you know, I do think that best practice would be to be open and honest about it and say that you're going for a new post, can I ask you to be a reference? That would be best practice. I appreciate that there may be some situations where that might not be appropriate.

Yeah, it's good advice, not just for consultant interviews, but for any time you put someone down as a reference. Just send them an email to say, look, this is what I'm applying for, and Anyway, it helps them know what's coming, what the role is. If you've got information about yourself that is useful for them to do the reference, depending on how well they know you, just give them that. So, that's useful. This is a question where they don't want to do that because they don't want to tell them that they're applying, which is a bit trickier.

It is trickier. So, I suppose, So the first thing to say is sometimes there's a box that you can tick on the interview form with the referees, and it says, can we contact this referee prior to interview, yes or no? And you can just tick that. So I think, you know, if it's a no, tick the box, that's absolutely fine. And then if you get offered the job, then you quickly scoot over to that referee and check with them that they'll happily provide you one. So that bit's okay. I think if that box doesn't exist, then ideally you'd find somebody else from your organisation that you could— that could provide you a reference, because they— I do think it's important to have one from your current place of employment so that it doesn't look like you've kind of gone rogue and you're not telling anyone that you're leaving and nobody would give you a good reference. I suppose that the, the real difficulty is what are you going to do if that tick box doesn't exist, um, and you just don't want to tell anyone?

Do you not, do you not think also that it's good, like, it's a small world, medicine's a small world, so I mean, how likely is it they're not going to hear from someone they know? I suppose it depends what your specialty is, but if you thought about like PEM, our, our specialty, And I was applying for a job elsewhere, I just think someone would call. Wouldn't they just call the clinical leads and just say, oh, I saw Tessa's applying. So, I just think they might find out, and then it'll be worse because you've not told them. So, I don't know how likely it is you'll be able to keep it quiet. So, you might just be better just to have an honest conversation with the lead.

I also think there's potentially some good to come out of this? Because actually, if you've got a good clinical lead, their response to that should be, okay, can we actually have a chat about why you want to leave?

Yeah.

Because if you're going to the job of your dreams, and it hasn't come up prior to now, and you've been in a job that was good but not perfect for a while, then you can say, look, this is the one I've always wanted, or it's 50 miles closer to home, or whatever it might be, that's absolutely fine. But the other part of that is maybe it's an opportunity to say, do you know what, there are actually some aspects of this job that are just not quite working for me at the moment. And maybe the clinical lead can say, okay, well, let's have a chat about that.

Yeah.

So that then if you don't get the new job, they're gonna, um, make some changes to this current job that make it a bit more palatable for you. I think what we're saying is, really try to find a way to ask them for a reference before you go.

You've probably got to do it. It doesn't mean you need to tell all of your colleagues and make a big announcement, but I think it's probably courteous to tell the lead, who will be the person probably that's best to write the reference anyway.

Yeah. We probably didn't quite answer that question the way that you wanted us to, but—

There you go.

Sorry to say, that is what we think. Yeah.

Okay, so should we go on to look at the golden example for the week? So this week we've got, um, a duty of candour example. So tell me about a time you did duty of candour. Um, what's the example that we've got?

Okay. Oh, so a patient needing oxygen for chest infection came to harm because a nursing assistant changed them from the Wall oxygen over to a cylinder of oxygen. The cylinder was dialed correctly, but the safety cap hadn't been removed, and so no oxygen was delivered to the patient.

Okay, that's bad. That's a bad story, but a great example for Jitup Kanda, right?

Absolutely.

Yeah, it's a great example. We talk about a mistake example, and if it was your mistake that you were the person who. Connected the cylinder and didn't connect the oxygen and didn't check they were getting oxygen, this would not be a good mistake example to use because it's bad. You just think, this is one for the how the hell did that happen bin. This is, come on, how the hell did Becky not check the safety cap being removed? So, it wouldn't be good for a mistake, but for duty of candor, it's different because it's not your mistake, and you shouldn't be choosing one that's your mistake. And this is the reason why, because actually with duty of candor, The more significant the error was, the better it is as a duty of candor example, because you're showcasing your skills in telling a patient, something really bad happened, and I'm really sorry about it, and this is how we're going to rectify it. So, it's much better to have a bigger mistake. And because it's much better to have a bigger mistake, you need to make sure it's not your mistake. And this seems like it wasn't them. It's nothing to do with them. They're just the person doing the duty of candor.

Yeah, it's perfect. Yeah, as you say, the mistake can be as big as you like for duty of candour because it wasn't your mistake, and that's the important part. And then this would allow the candidate to just focus on what it's like to deliver duty of candour. So what it's like to have that conversation with the patient or their family, to make the apology, to be honest. And then to follow the subsequent steps of duty of candour in terms of reporting, investigation, learning, and feeding back to the patient and family about that learning. So actually, I think this is a really nice duty of candour example. And the other thing that I like about it is that it's actually really easy to understand. It can be explained in a couple of sentences. We all know What went wrong and that it's bad. Even if there were people on the panel who were non-clinical, they can still get this. Somebody wasn't plugged into oxygen. Okay, that sounds bad. So actually, it's great on every level. I really like it.

Yeah. And although this is slightly sidetracking from whether it's a good example or not, it's just reminded me of something that I think people commonly miss when they're doing their duty of candour answers. is to say, people get very focused on this is the story. So, I went and told them this, I'm sorry, we've done this, here's your PALS leaflet, here's your governance, blah, blah, blah. But they don't do the bit where they actually hear what did the patient say? What were they, you know, how did they respond? And so, just to have a bit of pause, like you've told them this has happened. What did they say? They were furious. They were upset. They were happy that I'd explained it so well. And just adding that, it just makes it more real. And it also shows a bit about you and how you think about your interactions with patients, rather than just rattling on to the next steps. So, I think it's a good tip to stop and just say what happened.

Yeah, I think that's really important.

Okay, so we're going to go on to the interview question of the week that we'll discuss. What question have we got this week?

Oh, this question is, tell me about your worst Oh, man. What do you think?

Absolutely hate this question. It doesn't get asked often, but it has been asked a few times. I just think it's so unfair. I think it's so unfair because your mind, whatever happens in whatever way you prep for your interview, tell me about your worst day, your mind automatically goes to something hideous that's happened, something that you probably didn't need or want to share in your interview, but they're kind of forcing you to do it. And I think that's harsh.

Mm-hmm. It's a low blow. And also, yeah, as you say, you're just gonna think of all the hideous things that have happened to you. Maybe, you know, all the times that you've cried on the way home. You know, all of the— you just don't really wanna go there. But I think the key point about, This question, and any question that they ask you really, the way you think, what the heck? You've just got to sit there and think for a second, why are they actually asking me this? What could be the possible reasons for them to ask me this? And, you know, what can I do to get something good out of it? What would you read into this?

I suppose I'm just thinking what What I would do to answer this. So I would probably avoid— would definitely avoid error.

Yeah.

Because any error that you choose here is going to be a really bad mistake. And all the things that we tell our students is to try— you don't need to overshare. This is your interview. You're choosing what you get to share. So your worst day, if it's a mistake, is too much oversharing, I think, for a consultant interview. for your dream job. So, I would avoid that. So then, worst day could be systems things going wrong, patient care not going in the way, you not being able to deliver the care you could to your patients in the way you wanted, not due to your error, but due to systems thing. Or it could be teams, I guess, teams not functioning in the way that you wanted.

Yeah.

So, I suppose these are the things that I would Think about.

I suppose I'm just also thinking, if you've been involved in a major incident, say, yeah, um, and, you know, you'd seen some hideous stuff, uh, then maybe that would be the one to reflect on, because that would be an absolutely devastating day for you as a professional.

Yeah.

Um, but it would also give you some great options in terms of reflecting on things that allow you to show, first of all, a bit of who you are, Um, and a bit of senior-level thinking around this, because, because I think maybe there's a kind of dual purpose to this, uh, question. It's that they want to see who, who are you, what, what kind of things affect you, what do you take home, what do you reflect on, what stresses you out, that, you know, that kind of thing. Um, but then you, you, you want to show them, okay, you know, I am affected by the hard stuff, but Actually, but I'm a consultant, and so what I can also see around this is not only my part and the immediate team, but also the bigger picture. So, so maybe just taking that kind of, um, major incident example, you can, you know, say now how it affected you. I saw some of the worst things I'd ever seen in my whole life, or whatever. Um, but actually what it's taught me is what, what I need in terms of looking after myself, how we respond as a team, and then how we reflect as a wider system. And then you could, you know, talk a bit about those 3 different things.

I like that.

I think that would kind of sell me.

I suppose I don't know how many people would be— would have been involved in a major incident. I suppose that's—

Or something awful.

You might have had a bad— yeah, a bad case or collection of cases that is not bad because you messed up. Yeah, it's probably that.

Or even just, you know, like sometimes the department's had a real run of awfulness. Um, and, you know, you could talk about one day that happened, you know, towards the end of that run of badness and, and what it meant to you and how you responded as a team. You know, some— I think something like that would be fine as well. Um, I think you need to show a bit of who you are and then kind of zoom out a bit and show what, what it means for the system.

Yeah, I think that's good. And that's a way to— because you have to meet the question asked for vulnerability, because they're pushing you to be really, really vulnerable. And so it's reining it back so you're not fully like, just, you know, here I am in my therapy session, going to tell you everything. But also not saying something that's too minimizing or too minor. So yeah, I think that's great. Great compromise, a great example.

Yeah. Try to avoid crying in that answer if you can.

No. Yeah, you definitely want to avoid tears as a general rule through your whole interview, but definitely in this question. Our final thing we're going to look at is our tip and trick of the week. So I thought we would discuss how to choose a good example for a conflict with a colleague, because I think this is— most people find finding their mistake example hard, but actually I think finding a good conflict with a colleague example is a real challenge for people. So, we have some simple rules that help people find a good conflict example. And I thought it'd be good to think about the places where people most go wrong with this. And the first one where people most go wrong is about who they're having the conflict with. So, what's your advice about how to choose who you have the conflict with?

I think that the general advice around this is, it should be a conflict with somebody who's on the same level as you. So if you, you know, if you're talking about something that happened during your time as a registrar, you will maybe talk about a conflict that you've had with a registrar in a different specialty. So you were making or receiving a referral and there was some conflict around that. And so that, that's it, that would be the, the goal— somebody who's the same level as you.

Yeah, because you don't want— it's just not a good look to be like kind of punching down essentially and being like, oh yeah, the SHO was doing whatever the F2 was. It's just not a good look. And similarly, we've had some people try and use examples where they're second-guessing their consultant. There's a new consultant on and they did this, but I know that we don't normally do that. And so I— and it's just, it doesn't make you come across in the way that you would want to come across in your interview. So, yeah, definitely just sticking to the same grade as you is the safest thing. And also, it being another doctor is the safest thing.

Yeah.

Because I think, you know, getting into arguments with nurses, not cool.

It's an absolute red line, no.

Yeah.

It just makes you look like somebody who can't work in a team.

Yeah. The only exception we've found to that is with people like in neonates, for example, where they're working with midwives or NICU nurses closely. Maybe there would be an exception, but generally, I think it doesn't work.

Yeah. I think if somebody is operating on essentially the same level as you clinically and in terms of leadership and management or whatever, that's probably okay. But those would be the exceptions rather than the rule.

Yes. So, the easiest thing is another doctor, same grade. And then the last thing that you said there was that they should be in a different specialty. And it's just, you don't want to be getting into an argument with someone else on your team, like your immediate team, because it just raises more questions about you and how you'll be in their team.

Yeah, exactly. And then I think the next thing is that you need to have been able to resolve this conflict yourself in the moment. So, you need to be able to demonstrate skills of de-escalation. And, you know, then finding some sort of compromise and maintaining your professional working relationship with that colleague. There cannot be a situation where, you know, so I just— so they just wouldn't listen to me. So in the end, I phoned my consultant, they phoned their consultant, and their consultant agreed with me, and they told them actually they would have to take the patient, and that showed them. Just no.

Just talk about it. Or my least favorite thing in the world, which is submitting a datix about them, which I absolutely hate. In real life, I absolutely hate when people use incident forms to complain about the something reg. The so-and-so reg was really rude, and they said X, Y, and Z. So yeah, it does need to be something that you resolve yourself, and then not something that then becomes a long-term saga that needs escalation, and ideally not something that you're involved in. Because the whole point is to show senior-level skills in resolving conflict. So, if you have to go to your boss, and they, I went to my boss, they went to their boss, then it just flags your juniorness, I suppose, and you're trying to show senior-level skills. So, yeah, I think if you choose your example that way, it'll help get you on the right track.

Yeah. I was just thinking, there's one other thing that I think about that as well. When you're talking about this conflict, So let's say, you know, you were trying to refer a patient for, you know, you thought they had an acute surgical abdomen, the surgeon wouldn't accept them, and then you, you know, eventually managed to get the patient accepted. And then you said, and at the end of it, they actually did have an appendicitis.

Yeah, I was right.

Stop it. It's not about you being right. Yeah, it's about you de-escalating the conflict. So it doesn't matter whether the patient had appendicitis or not. What matters is that you de-escalated that conflict yourself, maintained a working relationship, and kept the patient at the centre of it, and kept them safe.

Yeah.

So I think there are a few simple rules, but they are actually rules.

They are, yes. Follow them and you'll get a— you just have a safer example to share that you can then focus on your skills of de-escalation, and not focus on the, why was Tessa doing that with that patient? person and how did they get into that situation?

Absolutely.

Great. Okay. Well, I think we will wrap up there. We have lots to come in future weeks, and next week we are going to be talking about lots of things, including why we think that camp as a structure is dead and why we actually put the P at the start. And we'll talk about that next week. So I shall see you then.

Can't wait.