Clinical Oncology Interview

Dear Friend,

It seems like another weekend where I am again on-call, this time in the acute medical unit. In fact, this is the start of 7 consecutive shifts in a row, from Saturday to Friday. Now that I have my offer for clinical oncology, I must admit that I have started counting down the days of IMT and waiting for my new job to start. 

As I said in last week’s newsletter which was about my portfolio to apply to oncology, this week is the next part, which is about my interview for clinical oncology. Rather than me just explain what my answers were, I think a very good exercise would be for me to give you the questions that came up and give you the week to think about how you would go about answering them. Feel free to read up, draft your answers. 

Next week, I’ll then reveal what my answers were to the various questions. I must have done something right as I received my interview feedback this week, which stated I scored 100% in my interview – a full 80/80. 

The interview for clinical oncology was comprised of 3 sections. Clinical station, ethics and motivation. 

Clinical station (10 minutes)

This station had 2 panellists. The station was divided into 2 clinical scenarios, each of 5 minutes. They gave me 2 minutes reading time before the first scenario, but there was no break or reading time before the second. 

Scenario 1: You are the oncology registrar who is asked to review an elderly man in the ward who is confused. The gentleman has a background of metastatic non-small cell lung cancer for which he is on palliative radiotherapy.  

• What would you do next?
• What are you main differentials?
• What investigations would you request?
• What would be your management?

Scenario 2: A 40 year old female patient who is 3 days post chemotherapy for locally advanced colorectal cancer calls in saying she is not feeling well. She reports some left sided chest pain and feeling a bit sweaty. 

• What would you do next?
• What are you main differentials

This lady explains that she does not want to come to hospital as she has 2 small children at home and there is no one to look after them. 

• How do you proceed?
• If she refuses to come in, what else could you offer?

Ethics station (10 minutes)

This station had 2 panellists. The station was divided into 2 ethical scenarios, each of 5 minutes. There was no reading time before either of the scenarios. 

Scenario 1: You are in clinic and are recruiting a patient for a phase 2 clinical trial.  

• Please explain how you would go about doing this to the patient. 
• Is there any training that you would need to undertake for this trial?
• Who else would you involve?

Scenario 2: You are the oncology registrar and one of your patients on the ward is very unwell with neutropenic sepsis. Her BP is low and you feel she needs ITU support for inotropes. The lady’s partner says that she had an advanced directive that she would not want intensive care treatment and by taking her to ITU you are going against the patient’s wishes.  

• How do you proceed?

Motivation and portfolio station (10 minutes)

This station had 2 panellists. The station was divided into 2 parts, each of 5 minutes. There was no reading time before this station.

First half: 

• Tell me why you want to clinical oncology?
• Tell me from your experiences where you have demonstrated initiative.

Second half:

• Where do you feel the field of clinical oncology is advancing?
• Tell me about a typical week of a clinical oncologist?
• Tell me about any challenges you might face during training.  

Summary

That sums up my clinical oncology interview. I prepared for about 2 weeks intensely for this, making sure I knew the various oncology emergencies, knowing my portfolio inside out and learning how to structure ethical scenario based questions. Despite getting 100% in my interview, my overall rank from the total number of aplpicants (around 200-300) was 4th. This is probably because the other 3 had done PhD or teaching qualifications. However, given that there were so few jobs in London, I did have to perform this well to guarantee myself a London job. 

Have a go at these scenarios this week. and I’ll give you my answers next week.  

Drug of the week

Duloxetine

This drug inhibits both serotonin and noradrenaline (NA) reuptake to potentiate 5-HT and NA transmission at the synaptic cleft.

It acts as SSRIs at low doses, whereas a higher dose is needed to achieve the noradrenergic effects.

The main uses of duloxetine are in major depressive disorder, generalized anxiety disorder, neuropathic pain, chronic musculoskeletal pain, and fibromyalgia

A Brain Teaser

A 80-year-old woman presents with a 5 month history of urinary incontinence when she coughs or sneezes. She has tried pelvic floor exercises for the last 3 months but has not found them helpful. She is extremely worried about having surgery and would rather have medical treatment for her incontinence.

What is the first-line drug therapy to treat her presentation?

A: Desmopressin 

B: Duloxetine

C: Mirabegron

D: Oxybutynin

E: Tolterodine