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RADIOLOGY ST1 INTERVIEW

Specialty Recruitment Assessment (SRA; situational judgement test - SJT) and interview advice for those applying for an ST1 radiology registrar job in the UK. 

RADIOLOGY ST1 INTERVIEW

In order to get a radiology registrar position in the UK, you have to get through the Specialty Recruitment Assessment (SRA) and the ST1 interview. Applications are managed through the Oriel system. The application is open to doctors who have completed, or are due to complete, FY2 by the time the ST1 job in radiology starts. You should refer to The Royal College of Radiologists' (RCR) eligibility criteria for the complete list of requirements. The RCR also provides information on the competition ratios from past years. The latest information on the interview cycle can be found on the RCR website

This process can be daunting. However, as someone who managed to get the highest interview score in the country, I can say that it is possible to do well with careful preparation. On this page, we provide some advice on the interview process. If you have further questions, feel free to contact us. Best of luck!


SPECIALTY RECRUITMENT ASSESSMENT

The Specialty Recruitment Assessment (SRA) has recently been incorporated into the radiology selection process (first used for the cohort starting in 2016). This exam consists of a section on Professional Dilemmas (i.e. workplace ethics questions) and a section on Clinical Problem Solving. The exam was originally created for those applying to GP training, and is now used by a number of specialities. As this exam was designed for GP trainees it is quite broad in its scope, and focuses on the immediate investigation/management of disease (as opposed to complex tertiary level care). Now that this exam is being used by multiple training programmes, you will sometimes hear it being referred to as the "Multi-Specialty Recruitment Assessment" or "MSRA".

You have 110 minutes to complete the Professional Dilemmas section. In previous years, approximately half of the questions have been "multiple best answer" and the other half "ranking" questions. "Multiple best answer" questions will require you to select more than one correct answer from a list. "Ranking" questions will need you to order a list of answers from best to worst. The examiners will also include a few pilot questions, which do not count towards your score, but are being trialled for future SRA takers. You will not know which questions are being piloted, so you will have to take all questions seriously!

The Clinical Problem Solving section takes 75 minutes. As with the Professional Dilemmas, this section includes some pilot questions. As you will not be told which questions are going to count towards your score, you will need to treat them all as "real" questions. In previous years, approximately half the questions in this section have been extended matching questions (EMQs) and the other half have been single best answers (SBAs), with a few multiple best answers (MBAs) thrown in.

There is no negative marking in either the Professional Dilemmas or the Clinical Problem Solving sections, so you might as well answer all questions. To really understand the format of the exam it is best to see some example questions. Click here for an explanation of the exam structure and click here for some example questions. To see where we got these files from, click here. Although these documents were written for GPs, they are still relevant to you as radiology applicants, as you are taking the same test.

The SRA is taken on a computer in a carefully controlled exam environment. If you want to get a feel for the exam software, you can download a free trial from the Pearson VUE website (this is the organisation that delivers the exams): Click here to visit their website.

The college is using the SRA to screen out low scoring candidates. The test score also contributes to the final ranking of the candidate. There are many resources available in book form and online to help you revise for this exam. Although some say that the ethics questions are not the sort of thing that you can prepare for, we would disagree! Here is a question book written for GPs taking the same exam, you may find it useful: Succeeding in the GP ST: Professional Dilemmas Specialty Recruitment Assessment (SRA).

PORTFOLIO

There are a number of ways to score points at interview and with a bit of time and effort you can secure many of these points before the day!

The following are key things to have done by the time of your interview. It is essential that you have evidence for these achievements included in your portfolio; without evidence, you may not be awarded the points you derserve! Providing good quality evidence will show the interview panel that you're organised and committed to a career in radiology.

Taster Week: Arrange one or two taster weeks within a radiology department as early as possible. A taster week won't necessarily differentiate you from the crowd but it is an essential feature of your application. You probably won't gain any extra marks doing a taster week at a specialist teaching hospital compared to a local district hospital so organise one that's convenient and enjoyable for you. Try contacting the medical education department of the hospital you're hoping to visit, they should be able to put you in touch with the correct people. Your taster week is also a great opportunity to work on an audit/research project, so we recommend organising the taster week as early as possible, so that you have time to complete the audit/research project by the time of the interview.

Degrees/Post-graduate Qualifications: If you have completed an undergraduate degree or post-graduate qualification that's great, you'll gain a slight advantage at interview. If you haven't, it's not the end of the world. If you have, bring your degree certificate.

Audit: The gold standard is a radiology based, closed-loop audit with national/international presentation and/or publication. Getting as close to this as possible will help you score big marks. Try looking through the AuditLive section of the RCR website to find an interesting and acheivable audit to complete in your local radiology department. The British Institute of Radiology run an annual meeting for trainees and this is a great opportunity to present your audit. The BMJ Quality Improvement Reports Journal is a good way to get your work published.

Publications: If you have any kind of publication that's great. If you want to try and get something published before the interview then start early and submit one, or multiple pieces of work, to a variety of websites or journals. If you don't have the time then try writing a response letter to an article that interested you. Before you start writing, identify a journal that you think will be interested in publishing your work, and tailor your work accordingly. Some journals have a fee for publication, so make sure you do you research thoroughly. Getting published is not easy, feel free to email radiologynation@gmail.com if you have an idea for a research publication or letter to the editor and want to talk it through with us.

Teaching: Your career within the medical profession won't progress without participation in teaching. Ideally for the radiology interview you want to arrange your own radiology teaching programme, obtain feedback, and show that you have reflected upon your teaching.

Organising a teaching programme is difficult, but it is possible if you're motivated and want to shine at interview. If you struggle to arrange this then try to deliver as much one-off teaching as possible, ensuring at least one presentation is radiology based. Collecting eedback forms is essential as you need to show evidence for your teaching (you only need to bring a sample the forms to the interview though!).

Examples of topics you could teach to medical students/foundations doctors include chest/abdomen radiograph interpretation (perhaps in collaboration with a radiology registrar), CT head interpretation, and i-Refer guidelines for various clinical presentations. The list is endless and you should try to find something interesting, interactive, and useful for the target audience, doing this will give you more to talk about during your interview.

Courses and Conferences: Attendance at a radiology conference or course is a great way to show that your interest in this speciality is genuine. To maximise the points you score, present your radiology based audit/research project at a conference.

Check out our Conference page for upcoming conferences.

INTERVIEW

A few years ago the interview process had a set structure with fairly repetitive questions, scenarios and images. This structure was known all too well by those arriving for interview which meant the college was unable to reliably differentiate canditates. The Royal College of Radiologists now regularly change the setup of the interview, which keeps things more of a level playing field! That doesn't mean that you cannot prepare for the interview. Quite the contrary! Although the exact set up of the interview may be different year on year, the same principles apply.

We'll try to highlight the key areas you should prepare, taking note of the interview structure over the previous years. We cannot see into the future but we expect that future incarnations of the interview will cover these basic areas.

Practice is essential when preparing for the interview. In this section we'll discuss the various hot topics that you should read around thoroughly in preparation for the interview. For general advice about medical interview technique, there is a widely read book available: Medical Interviews: A comprehensive guide to CT, ST & Registrar Interview Skills. We read this before the interview (it doesn't take long to read) and found it very helpful.

Things that can come up at interview:

Portfolio: Make sure you bring evidence of all your achievements to the interview. The panel may not give you credit for something you have done, unless you can prove it somehow! You should have a well organised portfolio that will allow you to quickly access the relevant documents. Having an organised portfolio is a way of showing that you are a responsible person who will be just as organised when it comes to working as a radiology registrar. Things that you need evidence for include the following:

  • Additional degrees or qualifications
  • Radiology expereince
  • Taster week
  • Research
  • Publications / Presentations
  • Audit / Re-audit
  • Teaching with feedback forms

If you feel you haven't shown off a particularly unique achievement then try to incorporate it into an answer. Show the interviewer what they've asked to see and move on by saying "I've also...", "I'd like to show you..." or "I'm really proud of...". You have to be very careful when doing this, as you do not want to sound contrived!

Commitment To Specialty: Demonstrating your commitment can be challenging but with thorough preparation you should be able to answer any question they throw at you. You can be asked to talk about your experience in radiology, your knowledge of the specialty, what challenges you might face, and how things will be different to your previous job. You may also be asked about the 'hot topics' which we will discuss later. You need to appear enthusiastic and interested in radiology (which should be easy to do!) and give quick, to the point answers so that you get through all the questions the interviewers have to ask you. As there are only so many points you can score per question, there is no benefit in giving a very long answer to the first question, if it means that the interviewers never get a chance to ask you the later questions!

Ethics and Clinical Scenarios: Assessment of ethics in the interview has largely been replaced by the SRA, however it's worth being aware and preparing in full for every eventuality, as you can never tell what will come up this year!

Hot Topics:

Exam structure: This is something you'll just have to sit down and learn. Interviewers have been known to ask about this and it should be easy marks. We direct you to the RCR website for the most up to date information regarding exams.

March ST1
First FRCR examination: "knowledge of the physics that underpins medical imaging and of the anatomy needed to perform and interpret radiological studies"RCR

  • Anatomy - 100 images with free text answers, administered over 90 minutes
  • Physics - 40 true or false questions (each with 5 parts), administered over 2 hours

December ST3
Final FRCR part A examination: MCQs covering "all aspects of clinical radiology and the basic sciences of physics, anatomy and techniques"RCR

  • Cardiothoracic and Vascular
  • Musculoskeletal and Trauma
  • Gastro-intestinal
  • Genito-urinary, Adrenal, Breast, and Obstetrics & Gynaecology
  • Paediatrics
  • Central Nervous System and Head & Neck


These modules were previously examinated separately with an expectation that they're completed before progressing to ST4. From December 2017 the modules have been merged into one single examination consisting of two papers taken on the same day.

April ST4
Final FRCR part B examination: a reporting session, a rapid reporting session and an oral examination assessing "all aspects of clinical radiology against the Specialty Training Curriculum for Clinical Radiology"RCR

Teleradiology and outsourcing: As the demand for imaging outstrips the supply of radiologists, there is often a surplus of unreported studies. Outsourcing of this excess is common practice in the UK, and it is achieved through teleradiology. Teleradiology is the transfer of images to an external person for reporting. There are a few issues with teleradiology, some of these are logistically (security of data transfer), some financial (more expensive to outsource in the long term), and some are related to quality of reports (external reporters do not always have access to prior imaging so cannot make accurate comparisons).

Skills mix: Skills mix is the training of non-radiologist members of staff in radiology procedures and reporting. This is one of the big talking points regarding the future of radiology. The idea that other MDT members are taking work from radiologists is clearly a threat to the specialty and will impact radiology training, however given the ever increasing workload, skills mix is crucial in ensuring a functioning department with a quick turnaround. Examples of skills mix include reporting radiographers (MSK plain film, CXR, CT head), cardiologists reporting cardiac CTs & MRIs, vascular surgeons performing interventional procedures.

Radiation protection: Important documents to browse and understand are the Ionising Radiation (Medical Exposure) Regulations and the Ionising Radiations Regulations. These documents are the basis to UK radiation protection and a general understanding of the principles will help you to answer many ethical questions.

Feel free to download our PDF for a quick overview of these guidelines.

Discrepancy and duty of candour: Radiologists have a well defined position on discrepancies ("mistakes") and their duty of candour towards patients. We recommend that you attend your local discrepancy meeting to see examples of interesting cases and gain an understanding of how the radiologists deal with discrepancies. The RCR says "the purpose of discrepancy meetings is to facilitate collective learning from radiology discrepancies and errors and thereby improve patient safety". "Duty of candour" is an important topic in the NHS. Have a read through the RCR's statement on duty of candour in radiology and formulate your own thoughts on what you would do if you came across a discrepancy.

Artificial intelligence: The use of computers to make radiological diagnosis is a topic of considerable interest and concern for some radiologists! Before these computer generated algorithms can be used in clinical practice there needs to be more clinical validation. It is quite likely that artificial intelligence systems of some kind will become integrated into clinical practice at some point in the future. This does not mean that radiologists will be out of a job! However, the specific nature of the job may change, and if you look through the history of radiology you will see that it has changed many times already. One of the ways in which we can ensure our future is to provide actionable reports, and not merely descriptive ones. Descriptive reporting, such as saying "indeterminate low density in the liver, correlate clinically" is not helpful to clinicians, and leaves radiologists more open to being replaced by computers. Using your clinical knowledge, integrating the imaging findings with the clinical history, and providing useful advice on how findings should be managed, are all ways in which radiologists can ensure their longevity.

Interview Preparation Courses: There are a number of radiology interview courses out there, which may help you gain extra marks. Remember, they do fill up very fast, especially those ones with mock interviews included.

RANKING

While many people have an idea of where they want to work, and perhaps where they don't want to work (!), many will not have a clue about large parts of the country! The best way to find out about life in different regions is to talk to radiologists who work, or have worked, in that deanery. This is going to be difficult, as you are not likely to meet people from all parts of the country, but it is worth trying to broaden your horizons in case you hear about somewhere new that you like. Click here for an estimate of the numbers of training posts for different parts of the country.

One of the key differences in training programmes, is whether you want to train in an "academy" or in a traditional training scheme. If you work in an academy, some of your time will be spent out of the hospital and in a structured learning environment, where you will have lectures or interactive sessions on radiology. There are three academies, Peninsula (Plymouth), Norwich, and Leeds. The North East (Newcastle and Middlesbrough) and South Wales deaneries are moving towards an academy style system and they may change during the course of your training.

The current estimate for the number of radiology training positions is 222. However, this often rises later in the application cycle as more funding becomes available, therefore it is probable that the total number of positions will be similar (perhaps higher) than last year, which was 262. Click here for a statistical summary of previous interview cycles with competition ratios.


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