Why Overseas Clinical Experience Is Your USP in NHS Consultant Interviews

Hello and welcome to the Ace Your 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 our Ace Your Interview podcast. Becky, it is great to have you with me as always.

Always great to be here.

Okay, let's get into it. So We will start with our question of the week. This is a question that one of our Academy students has posed us. What question have we got from our students this week?

The question is, I have only been working in the NHS for a couple of years and was working overseas for many years before that. I feel like I don't know the NHS and this will count against me. Will it?

Let's say the short answer is no, it will not count against you. That's the short answer. I think that lots of people who have been in the NHS for years also feel when they come to their consultant interviews that they don't know how the NHS works, because it's like this big abstract thing that you don't really need to think about in training, and then suddenly you're being asked like to know about governance and flow and funding and metrics. So actually, the overwhelm is what everyone experiences. Of course, when you've been in the NHS less— for less time, then it's definitely a factor where you think, oh, maybe it's time that's not given me enough knowledge. But the reality is it's probably not time that's not given you enough knowledge, and you need to approach learning about the things that you need to know about governance, funding, metrics in the same way, which is to be streamlined, focused, and that helps you avoid overwhelm. But the second thing is having all this experience from another country is amazing, right?

Absolutely. It's gold. And actually, if you think about it, yeah, you're right, you can learn the NHS stuff, and people should be doing that in their senior years. And we maybe we'll discuss that for a second in a minute. But actually, think about what the transferable skills are from your overseas experience. So you've probably got loads of experience that is highly, highly relevant, and much of it will be the same in terms of managing patients, managing flow, managing families, risk, all of the things that you do. You'll also be somebody who's had to integrate into a new system, and so you'll have some insight around that, and therefore you're probably somebody who's, you know, more sympathetic and better able to help other people integrate into new systems. You're somebody who's had to learn a whole new kind of healthcare system culture, and that comes with other insights as well. So I think it's not at all a disadvantage, but what you must do in the preparation for your interview is really think about what you're bringing as a result of your overseas experience and what your transferable skills are. And as well as doing as much as you can to understand what the NHS system means for somebody in a consultant-level position.

Yeah, I think the 2 big things that I see from people who've worked and trained overseas is firstly, clinical experience is often a lot higher because you're working in different levels, intensity levels, seeing different numbers of patients and different kinds of presentations. So actually, if you think about that, as maybe it's a clinical USP, unique selling point, that you have more clinical experience in a particular thing than the average NHS trainee applying. And so that's really strong. And the second thing I think that often people have is a service development thing that they discount because they think, well, I didn't set it up in the NHS. But actually setting up a clinic, getting funding for something, developing a new service, is massively strong, and most trainees will not have done that. So if you've got things that you did, even though it's in a different environment, it's still relevant. So I'd think about these 2 areas in particular. And once you realize that it's not a disadvantage, it's actually a strength, for all of the reasons you mentioned, then you feel differently about sharing it. So you don't feel embarrassed or like they're thinking, oh, you're not good enough. But actually, It's all of these things mean that you're a stronger candidate, a better candidate, and they will be an advantage for you.

I think you're right, and I think particularly people who've worked in resource-limited settings have often worked at a more senior level than their counterparts in the UK, and so they will have done, you know, much more senior stuff earlier in their career. And we've had examples of students who've, you know, set up PICU, you know.

Yeah.

And been, you know, been the first person who set up a paediatric intensive care unit in, you know, a part of Africa. That's phenomenal work. You know, also, you know, if you've set up, you know, some outreach clinics in remote areas, for example, you've had to work across organisational boundaries and work with a variety of people in a way that's going to stand you in good stead for your NHS consultant career. So just really think about what those transferable skills mean, and don't, don't assume that the people on the panel will understand what you did in that setting without you telling them, because many of them will never have worked in those kind of environments, um, or never worked outside the UK. So if there's particular skills that you're bringing to the table as a result of your experience Tell them, because they don't know without you actually elaborating on that a little bit.

Yeah, because it's like saying, well, I did 12 months working in an emergency department in a hospital in Nigeria. And, you know, assuming most of the panel have never been to Nigeria or been to a hospital there, they wouldn't have a clue what it means, and they'll just be imagining whatever they think it looks like. Whereas if you say, I did 12 months in a tertiary hospital in Nigeria, We in the emergency department, we had 400 patients come into the emergency department each day with, I don't know, 5 code reds a day and 4 intubations, whatever it is. Then you're getting an idea of, okay, this is a really busy unit, and you can compare it to what they know about their experience. So being more descriptive than the length of time and the name of the place will really help people understand what it is that you were doing. One of the things Becky, that you mentioned before was how about what part, what you can do to help understand the NHS structure or show that you understand the NHS structure. What was it you had in mind? What were you thinking about?

And I think that this would apply to you if you've come from overseas or if you've been working in the NHS for the whole of your career. So in the latter parts of your training and certainly in the run-up to your consultant interview, it's really worth trying to understand how systems work. So if you've got the opportunity to go to departmental meetings, you know, go to your clinical governance meeting and understand how those systems work. How do we, you know, follow the course of a DATIX? What happens next? You know, go to the hospital's SI or PSARF meetings and see how those incidents are graded, see how we respond to those things. Spend some time in the, you know, senior team departmental overview meetings if you, if you can go to those and see how we, you know, grade risk, see how we integrate with other services, see how we manage complaints. You know, hang around with the senior nurses as they are, you know, fielding those complaints and interfacing with pals and all of those kind of things so that you've got an insight into the system. beyond what you would've had as a trainee, because actually that is the kind of senior-level knowledge that you need about how the NHS system works on a wider level, and stuff that I think you actually don't get provided in your training unless you're in a particularly good unit or you go out of your way to find it.

Shall we move on to our golden example of the week? This is an example that one of our students have given us for a tell me about a time. Scenario, and in this example we've got a time which is tell me about a time that you made a mistake. So I'm going to tell you the example, Becky, and we can see whether you think it's good or not. So this example is they were asked to investigate a complaint because they were doing it as part of their gaining management experience, and they contacted the junior colleague involved in the complaint via email and said to them, "You need to write and respond to this complaint," and they got sent a copy of the complaint letter. But what happened was the junior had massive stress and anxiety from receiving this letter, and they realised they'd made a mistake by contacting them via email and just sending them a copy of the complaint rather than speaking to them about the case face-to-face. So, what do you think? Do you think this is a good mistake or not, and why?

Well, I actually really like this example, and there are a number of reasons why I like it. So I think the first one is, it is a mistake, and this student is able to take ownership of it, and it's a mistake that they personally made, and they recognise that. You know, and that is in contrast to the mistake that we discussed last week, where the student was essentially trying to take responsibility for somebody else's shortcomings.

Shortcomings.

So I like this. I also like that it's not a clinical example, because we often hear clinical examples, and this, this adds a bit of variety to that, which I quite like. And I like the fact that it's nice and clear to understand. We can all see, you know, we can all understand exactly what happened. We kind of all kind of cringe a little bit when we hear about, oh God, they sent it by email, and then that person was really upset. But equally, they took steps immediately to repair the damage. They've reflected on it, and they can now, you know, provide some nice reflection in that, you know, in the next stages, once they've finished describing the incident about, I've reflected on this, this is what I've learned, this is how I handle this kind of situation now. Maybe they could talk about, you know, they've advised other people about how they would manage this kind of bit of the process. So, all in all, I think it works really well.

It's quite relatable as well, because, well, I don't know about you, but I've definitely been in this scenario on the receiving end as a junior, where you get emailed something, you open your email, and your heart starts racing, and you're like, oh my God, this is bad, what's happened? Inevitably, when you're on holiday and shouldn't have been checking your emails is the sort of time when it happens. So, it's very relatable. And equally, on the other side, I think it's relatable too. It is a mistake that can happen due to inexperience. Because when you're on the other side, you're focused on, right, the admin, I need to get this done, I'm answering this complaint, I just need statements from people. And so the emotional weight that it carries for you as the person doing, you know, coordinating the response isn't the same as the emotional weight it carries for the people involved. And so it's not an uncommon or, well, it's not an unrelatable error. You can see why it happens.

Of course.

And you would definitely feel bad. But also, it's not like a disaster. I'm sure it was able to be smoothed over with the SHO, and a phone call, a meeting, I'm sure will make everything okay. And like you say, definite learning. So, yeah, it's on the grounds of not being too bad, but being bad enough that it shows vulnerability and honesty. I think it's— yeah, I agree. It's a really nice example. Really nice.

Yeah. Absolutely love it. It's exactly the sort of thing we're going for.

Yep. So we're going to go on to think about an interview question for this week. So a question that gets asked, how you would approach it in your interview. So we've got the question today, which is, how would you improve the quality of our service without spending more money? So I think this is coming up quite commonly, I would say. We used to get asked a lot more, like, let's say I give you £1 million to spend, how are you going to spend it? And so we do get our students to think about prepping how they would spend spend various ballpark figures of money. So they have something prepared, because it's quite a hard thing to come up with in the moment, because you get in— what happens is you get caught up with numbers, like how much would it cost to, I don't know, knock down a wall, and how much? And so we try— it's much better to prep that before. But it's far less common because of the state of the NHS right now. It's not that people are flush with cash and throwing it on you to spend.

Mm-hmm.

So it's much more likely that you're going to be asked to make a better service without spending more money. So yeah, it's a pretty common question. We did have someone last week or in the last few weeks get asked a question about spending money. If we gave you money to spend, how would you spend it? And how would you show that it was valuable? As in, how would you show that you used the money well? So it could still come up, but much more commonly is improving efficiency without spending money. So how would you approach this question, Becky?

I think there's a few different things that you could do with this answer. So I think you could think about efficiency. So that would be a common way to approach this, and we might think about efficiency in several different ways. So let's say we wanted to break this answer down into 3 parts. We might think about input, throughput, and output in our service and how we would improve efficiency within each of those areas. I think the other thing that I particularly like when I hear the word quality, I think what I want to hear something about is patient experience. And so I think if I wanted to think about quality, I would think about some patient feedback, you know, so what have you heard maybe on your friends and family test or whatever patient feedback mechanisms you have, even if that's verbal feedback. What have you heard from your patients about what would make a difference to them that you could deliver without spending more money? So it might be something about— it's probably something about timeliness, let's face it. Most people just want stuff to happen quickly.

Yeah.

Might be something about communication. But if you can think about feedback and use that as one aspect of your answer, then I think that that would be really powerful. And I think it's a nice opportunity to remind the panel that you keep the patient at the centre of everything that you do, and that's what you're about. What else would you do with this question?

No, I think that's on track, is just thinking about bringing in your USPs as well and thinking, like, what's your experience? What have you seen? What have you led? What have you seen work elsewhere that you could apply to them? And also using your intel from the pre-interview meetings, I think, is useful here as well. So, what are their priorities? They will have told— they will have some idea about where they're trying to improve quality of care. So, if you can get that from the pre-interview stuff and then reflect it back to them, I think that will impress them as well. So yeah, it's integrating all of these things in the best way you can to make a clear, concise answer.

Yeah, I mean, think about things that you do either as an individual or as a service to improve efficiency. So, you know, if you're an anaesthetist, maybe you could talk about, you know, we have golden patient, or we have, you know, one a specific way of preparing our patients. I do all my pre-op checks in this certain way so that on the morning of theatre, there are no delays, no cancellations, all the rest of it.

Yeah.

Or, you know, you might talk about, you know, post-operative pain management or management of post-op nausea and vomiting. What you have done as a specific project, that's one of your unique selling points that you can talk about. Actually, this massively improves patient experience, Because they're pain-free, they're not being sick, they go home earlier. That's efficient. Patients love it because they're back in their own house by the evening. We love it because we haven't used a hospital bed, and everyone's a winner, and it hasn't cost anyone a penny. So those kind of things are really nice examples for this kind of question.

Yep. And the key thing to remember is that this is a common question, so don't be stumped or surprised if it comes up. make sure you prepare before it. And actually, when you prepare for this, because you'll be thinking about quality of service and thinking about input, throughput, and output, you will be able to apply this for other questions you get asked anyway, even if this exact question doesn't come up. So yeah, definitely worth thinking about that one. Last up today, we've got our tip and trick of the week. What are we looking at for our tips and tricks this week?

So this week we're going to talk about how do you add value as the internal candidate?

Yeah.

This is often— people feel a bit tricky, a bit weird, a bit awkward, a bit nervous about this. It's pretty common. What do you advise people?

Well, I think it's thinking about why they're feeling awkward. So, I think when you're the internal candidate, it can be— you can feel a lot of pressure because everyone in the team knows that you're applying for it. And sometimes they might be like, yeah, for sure, it's yours, Becky. You're definitely going to get this. And you start to feel more and more stressed. Like, well, if I don't get this, everyone's gonna know. And it's my own fault, it's gonna be really embarrassing. And particularly, you might be— you will be doing it in front of not— they won't know all the people on the panel, but you'll know the clinical people on the panel. And you have a fear of making a fool of yourself in front of people that you know and respect. And the fact that they want you to do well, and then you let them down is even worse. So all of that, even though it seems on face value, like, The internal candidate has an advantage. All of that can really psych people out because they just think, imagine what if, and you go into the what if spiral. What if I mess up and it's in front of my bosses and then everyone hears and then everyone knows and then I can't even get a job in a place that likes me? I'm never going to get a job. And so all of these things I think can really weigh on people. So that, I think that's one of the things that really makes you feel at a disadvantage. How would you advise people thinking like that, that, Becky, or feeling that way?

But I think you've got to remember that, that there's a reason why people think that the internal candidates got the advantage, right? And some of that is around the fact that, well, presumably you've been there, people know you and they like you. Let's hope so. Um, and also you've got insider knowledge of this organisation that the external candidate doesn't have. So you've got to use that. So you've got to really make sure that you've got this internal knowledge of the organisation. So make sure that you do understand all of the things that you could know. So, you know, really think about your, you know, knowledge specific to this job and this department. So what, you know, what is on the risk register for this department? What is the current vision for the department? How are you working towards that? What are the challenges in this department and how would you overcome those? What are the priorities for the leadership in the department and how can you support that? And have, have as many conversations with people as you can in your capacity as the interview candidate, not just in your capacity as whoever you are working the shifts. And, you know, make time to have those conversations so that you're getting the knowledge that you need.

Yeah, and just on that, I would definitely do the pre-interview visits, even though you feel like you know them, even with your clinical lead. Because often people are like, well, I know that, you know, I see them every day. So, and they know I'm applying and we've kind of chatted about it. But you should definitely go through that formal process of, I've been shortlisted for the interview, I'm really excited. Would it be possible to meet up with you as clinical lead or whatever in the run-up to the interview? And if they say, don't bother, like we've spoken It's fine, then that's fine. But usually they will still meet up with you. And remember that the reason that you're meeting up with someone pre-interview is to get the intel on what's on top of their mind, because that's likely what they're going to ask you at the interview. And by then they'll have met, they'll probably have met with the panel and they'll have started to think about the questions. So they'll be giving you essentially some tips. And if you miss that step because you're the internal candidate, you don't think you need to. Then you're missing out getting these tips. And potentially they will want to give you them even more because they like you. If they want you to— clinical lead wants to get you the job, then they might give you ideas about what's going to be asked. If you don't have that meeting, you're not going to have the opportunity to get that. And potentially your competitors are going to get that information and you're not. So definitely don't take it for granted. And you should definitely do the pre-interview meetings as well.

Sure, absolutely. And I think in addition to making sure that you do those pre-interview meetings as an external candidate would, in the interview you almost have to behave as an external candidate because you've got to remember that they can only score you on what you say in that interview. They can't score you on the fact that they've known you for the last 5 years and they think you're amazing. That's not a scoring point, that's not a, you know, that's not on the marking grid. And also, they can't take into account stuff that they know about you outside of the interview. So if they know that you've done a massive leadership project on X, and this question about leadership comes up and you forget to say that, they can't score you for that because you didn't say it. And also, there will be people in the interview who don't know you. So, I think once you get in there, you've got to play it straight. Tell them everything that you would tell them if you didn't know them.

Yeah. And what's important to remember is that I think being the internal candidate potentially can be an advantage, but being the internal candidate doesn't necessarily give you an automatic advantage. And equally, being the external won't give you a disadvantage because you could be the internal candidate and do a terrible interview. And you will not get the job. And equally, you could be the external candidate and come in and smash your interview and you will get the job. So it's not on face value. You think, oh, the external, the internal's the favorite, the external's not. But the reality is you have to perform on the day. Now, if you are the internal candidate and you can perform well on the day and use your inside knowledge to your advantage, well, that's gold. Because if you perform well and you show them you know them, you love them, you tailor your answers to show and drop in throughout. I know that you're doing this. I know this is something we've tried. I worked with so-and-so on this and we let— that is gold. So that's— you're going to really struggle to do that as the external candidate. You can do it to some extent, but not to that extent. So the fact of being the internal candidate isn't an advantage in itself, but you can use it to be a massive advantage in those ways. So it's really worth trying to make sure that you can integrate all of the stuff that you know into your answers on the day. Cool. So we will wrap up there, and we will be back next week with lots of more excellent tips. One of the things we're going to be looking at next week is how to talk about your biggest weakness, which I know is a thing that many people feel very stressed about. So we'll talk about that next week. And thanks very much, Becky, and I will see you there.

See you then.