Personal view or opinion piece
Open Access

Obtaining a National Training Number in Trauma and Orthopaedics

Louis Hainsworth[1], Oliver Beaumont[1]

Institution: 1. Somerset NHS Foundation Trust, Musgrove Park Hospital
Corresponding Author: Mr Louis Hainsworth ([email protected])
Categories: Students/Trainees, Postgraduate (including Speciality Training)
Published Date: 28/01/2021

Abstract

The disruption caused by COVID-19 significantly affected national recruitment for national training numbers across all specialties. Within Trauma and Orthopaedics this led to a drop in the number of jobs offered and will likely lead to an increase in competition for the 2021 recruitment cycle. This article considers the key steps of the application process and five interview stations. Preparation for the interview is key and starts taking place months before the interview itself. Preparation can take place in a variety of formats whether on your own or in a group. Multiple courses and websites are available to aid preparation to ensure you can perform to the highest standard and obtain a national training number.

 

Keywords: Training; Career Progression

Introduction

COVID-19 had a significant impact on the 2020 recruitment cycle, with widespread changes to the normal processes. The ST3 Trauma and Orthopaedics (T&O) national recruitment took place without interviews and involved a considerable reduction in the number of jobs offered down to 132 from 167 in 2019 (Health Education England, 2019). The impact of this is likely to drive the standard of competition up for the 2021 recruitment cycle. For those hoping to obtain a National Training Number (NTN) in T&O it is essential they prepare appropriately to maximise this opportunity. This article provides an overview of the selection process and outlines structured methods of preparation to maximise chances of scoring well for this vital interview.

The Application Process and Interview

The ST3 Trauma & Orthopaedic surgery national recruitment is run by Health Education Yorkshire and Humber (2020). Their website contains all the key information and dates for the application process, including applicant handbook and person specification (Health Education Yorkshire and Humber, 2020). Applications are via the Oriel recruitment portal. The application system opens at the end of January to early February and closes by mid-February each year with interviews taking place in March or early April. It is first vital to ensure that you have met all the essential criteria prior to applying.

 

As part of the application process you must complete a self-assessment section. This poses 10 questions identifying your experience of key areas including audits, teaching, presentations and published work. This section forms part of your portfolio score at the interview and so it is important you complete it correctly. On the Health Education Yorkshire and Humber website there is a helpful self-assessment scoring guide which if viewed early enough may allow you to complete necessary projects in time to maximise your marks. It is important to note that the self-score given must reflect work completed at the time of online Oriel application. Projects completed or presented after this point will not count towards your score in this section even if completed prior to interview.

 

The interview consists of 5 stations, each of 15 minutes. These are: portfolio, clinical, technical, communication and presentation scenario.

  • Portfolio station -  The assessors will have taken time to review your portfolio and validate your self-assessment questions. You will then be asked questions about your attributes and prior experiences. Ensure evidence for your self-assessment answers is clear and easily accessible. If the assessors have to ask you about your evidence, then you are losing time to answer questions which may score you marks.
  • Clinical station - This consists of two common orthopaedic clinical scenarios where you will be asked a range of anatomical and clinical questions.
  • Technical skills station - You will complete one or two technical tasks while being observed, an example is inserting a lag screw. An examiner frequently acts as a scrub nurse for the skills. Therefore, polite and clear communication skills are essential to score top marks.
  • Communication station - You will be observed taking part in a clinical scenario with an actor. This is frequently divided into two parts; obtaining information and giving information.
  • Presentation station - Firstly you will deliver a pre-prepared 3-minute presentation, on a topic of your choice. Make sure this is well rehearsed with a clear and appealing A4 handout. Easy marks will be docked if you do not keep to time. You will then undertake a case prioritisation or handover discussion where you will have to show prioritisation and decision-making skills and justify your decisions.

Preparation

Your approach to the interview should be similar to that of an exam. The interview is more closely aligned to postgraduate exams than a traditional interview and your preparation should therefore reflect this. We have divided the preparations to consider into 4 main sections; self-directed learning, groupwork, websites and courses.

Self-directed Learning

The self-directed portion of your preparation should be started approximately 4-6 months prior to the interview as this will form the foundation knowledge. Topics to review include anatomy of both upper and lower limbs, notably the course of the upper limb nerves are a challenging and frequently tested area. Many clinical scenarios are centred around NICE or BOAST guidelines, so these are easy points if you are well prepared.

 

This is also the time to ensure you are scoring as many points as you can in the portfolio section. Review your audits to ensure you have closed the loop and gain all feedback on teaching sessions you have delivered. It is important to note that this is not the time to be starting any new projects. They are unlikely to be completed in time and your time will be better spent elsewhere. Finally ensure you have certificates and evidence for all presentations, publications etc that will be required. These can frequently take a while to obtain if you do not have them already, so start early to avoid disappointment.

Group work

Group work is vital to a successful performance at the interview. This takes many different formats across the preparation stage. Whether this be via video calls or in person, all is beneficial. Around 2-4 months before the interview is the time to work with other applicants, senior trainees or consultants to practice verbalising your answers to common questions and themes. It is important that this does not just focus on the clinical scenarios but covers the breadth of the interview. Previous years interview scores clearly show that the average score in the communication station is significantly lower than all others. This is reflection of poor preparation for this element of the interview. The solution to this, is through repeated practice with peers.

 

In the final 8 weeks leading to the interview we advise that groupwork should add realism. It is important to reflect the interview environment as accurately as possible. This means holding your own mock interview and wearing interview attire. Ideally you should be able to speak to company reps who may be able to provide dry bones and kit for the technical skills stations. The benefits of a mock interview cannot be underestimated. In addition to practicing the scenarios, applicants must learn to move on to the next station and clear the mind of previous performances to function at a high level.

Websites

There are a range of websites available offering practice questions themed towards the Orthopaedic registrar interview including but not limited to; orthopaedicprep.com, st3interview.com and orthointerview.com. Each website has a bank of interview questions and scenarios which follow the same format as the actual interview. There is no single website that is going to give you an advantage over another and so it is important to review the sample questions on each and decide what will benefit your learning style. Each also includes videos of technical skills stations allowing you to familiarise yourself with the kit and techniques you will be undertaking at the interview.

 

These websites can be used throughout your preparation in both your self-directed learning and group work. For self-directed learning they can be used to give you an understanding of the breadth and depth of knowledge that is required. In groupwork they can be used as practice interview scenarios with gold standard answers to reflect upon.

Courses

The courses that are available in preparation for the interview can be divided into three main categories: 1) knowledge courses 2) mock interview courses 3) combination of both. Knowledge courses consists of a series of presentations across the breadth of baseline orthopaedic knowledge that would be expected at interview. These courses reflect the self-directed learning you will be undertaking. We therefore feel that if you choose to undertake a knowledge course it would be best to do this at the start of your preparations. If you are to take such a course within weeks of the interview it is unlikely you will add significant information that you can confidently use at interview.

 

Mock interview courses are widely available and useful to gain realistic practice of the actual day. Given the wealth of choice it is important to consider some key elements prior to picking your course. The first is the format of the mock interview. Is the mock interview going to be one applicant per station, or will you be going round in a group The second aspect to consider is the faculty. Are the faculty consultants who have been on the interview panel themselves or are they trainees who have recently successfully completed the interview themselves. Ultimately undertaking a course is not a requirement to be successful at interview. However, they do provide further practice and feedback on your performance.

On the Day

The interviews take place at Elland Road football stadium in Leeds. On the day you will have received an allotted time to arrive. There is no need to arrive before then, this time allows you to sign in and then you will have all your essential paperwork such as your passport and GMC registration reviewed. You will then have a significant wait while all other candidates sign in. During this time, it is important to try and relax so you can perform at your best in the interview.

 

You will then be divided into small groups and distributed to a rotation of the interview. Each interview station takes place in a separate room and you will rotate through the five stations. Depending on the numbers within your rotation there is usually one rest station. Within each station there will be at least two consultants. There may be a third person that will not be grading you but ensuring the interview process is fair. Once the interview is over it is time to relax and treat yourself for all your hard work. The outcome of your interview is released via email through the Oriel portal several weeks later.  

What If You Don’t Get Your Job

Despite all your preparations, there is no guarantee that you get a job in your first choice deanery. If this is the case you have to consider your next steps. If you have been offered a job, but in another deanery, it is worth considering this versus applying again the following year. There may be the option of an inter-deanery transfer down the line if you meet the requirements. If you decline a job or did not get offered a job, it is important that your next steps set you up to improve for the following years application. Obtain your interview feedback and see where you can improve. Reflect honestly on where you lost marks and how you prepared in each area. When looking for employment for the upcoming year you should consider how the role will help you develop as a well-rounded candidate not just as an orthopaedic surgeon. Clinical teaching fellow posts are increasingly sought-after as they allow applicants to develop their teaching abilities, and potentially begin a post-graduate certificate in education, alongside their clinical practice.

Conclusion

To have the best chance of obtaining the highly desired NTN in Trauma and Orthopaedics, clear planning and preparation is required. Ultimately hard work invested in the process will put you in the best position to be successful on the day.

Take Home Messages

  • Rigorous preparation is required to obtain a national training number in Trauma & Orthopaedics
  • A combination of self-directed learning, groupwork  and courses will put you in the best position to be successful.

Notes On Contributors

Louis Hainsworth is an ST4 trauma and orthopaedic registrar in the Severn deanery, currently working at Weston General Hospital. He undertook his undergraduate training at Peninsula College of Medicine and Dentistry before completing his postgraduate training within the Severn deanery. He has a keen interest in teaching and has completed a PGCE in Medical Education.

Oliver Beaumont is an ST4 trauma and orthopaedic registrar in the Severn deanery, currently working at Bristol Royal Infirmary. Oliver undertook his undergraduate training at Bristol Medical School and Core Surgical Training as part of the Severn Deanery at Musgrove Park Hospital. He has an interest in teaching and trainee development.

Acknowledgements

None.

Bibliography/References

Health Education England. (2019) Specialty Training Competition Ratios. Available at: https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202019_1.pdf (Accessed: 05/06/2020).

Health Education Yorkshire and Humber. (2020) Trauma & Orthopaedic Surgery ST3 National Recruitment. Available at: 

https://www.yorksandhumberdeanery.nhs.uk/recruitment/national_recruitment/national_trauma__orthopaedic_surgery_st3_recruitment (Accessed: 05/06/2020).

Appendices

None.

Declarations

There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

Personal opinion piece with no ethical approval required.

External Funding

This article has not had any External Funding

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