(IMT Interview তে কী ধরণের প্রশ্ন করে, কিভাবে প্রশ্নের উত্তর দিতে হবে কিংবা কোথা থেকে কী পড়তে হবে- এই লেখায় এই বিষয়গুলো নিয়ে আলোচনা করা হবেনা। বরং কী কী extra কাজ আপনি করতে পারেন ভাল মার্ক পাওয়ার জন্যে, সে বিষয়ে কিছু পরামর্শ দেওয়ার চেষ্টা করবো।)
Internal Medicine Training (IMT) interview is a pivotal moment in your medical career, allowing you to demonstrate not only your clinical knowledge but also your approach to safe, patient-centered care. To make a strong impression, it’s essential to cover specific areas that showcase your competence, empathy, and teamwork skills. Here are some key elements to focus on that can help you stand out in the IMT interview.
1. Is the Patient Very Unwell? Are You Worried About Them?- Say it!
A critical first step in any clinical assessment is identifying whether the patient is acutely unwell and if immediate step is required. In the interview, emphasize your ability to recognize signs of clinical deterioration and to act swiftly. Demonstrating that you have a clear sense of when to be concerned and how to act reflects strong clinical judgment and prioritization skills. Therefore if your patient is unwell, if you are worried aboout him- say it out loud.
2. Pattern Recognition
If you find a pattern in the question, you should make the examiner feel that you have been able to recognize that, however you will do a full assessment to get the full picture and exclude the potential life threatening differentials.
Lets say, someone has come with painful swollen leg and the history indicates that that it is clear-cut story of a DVT. You should definitely recognize the pattern and say that this sounds like a DVT (and on top of that you should mention that you will do a full assessment to rule out other potential differentials including acute limb ischemia, cellulitis etc.)
3. Consider potential Life Threatening Differentials
Let’s say, someone has come with painful swollen leg and the history indicates that that it is clear-cut story of a DVT. You should definitely recognize the pattern and say that this sounds like a DVT and on top of that you should mention that you will do a full assessment to rule out other potential differentials including acute limb ischemia, cellulitis etc.
4. Safe Practice
Patient safety is the foundation of good medical care. During your interview, make it clear that you prioritize safety in every decision and you have the broader picture in mind.
Eg: A lady of childbearing age comes with chest-pain, is tachycardic, has oxygen requirement. You suspect PE and want to do a CTPA. Mention that you’ll make sure she isn’t pregnant by doing a urine dip before requesting the CTPA.
5. Aim to answer without prompts
Confidence and fluency in your responses can make a strong impression during the IMT interview. Aim to answer questions without needing prompts, showcasing both your preparedness and your poise. Practicing responses to common scenarios beforehand can help you articulate your thoughts clearly and confidently. You should not miss points in ABCDE in an acute scenario. Please memorise this. Watch the Resus Council UK video. Write it down to practise if needed. If the examiner has to prompt you to ask for any findings, you my friend haven’t prepared well.
6. Early Escalation
Recognizing when to escalate care is essential. In your responses, explain how you identify warning signs early and involve senior colleagues when necessary. Describe situations where early escalation benefited the patient’s outcome, showing that you’re proactive and prioritize patient well-being over working independently.
Eg: Someone with a Sepsis due to CAP on 15L oxygen via NRB – let’s say they are haemodynamically stable but it might be worth giving a heads up to the ITU SpR and CCOT.
7. Involving the Multi-Disciplinary Team (MDT)
Teamwork is critical to providing high-quality care in medicine. Emphasize your willingness to involve the MDT. Show your skills of involving the MDT. Think if your patient needs any need input from any other speciality/team?
Therapists?
DSN?
Dietician?
Podiatry?
Salt and Language therapy?
Eg: A transplant patient has been admitted to the AMU with a problem that is unrelated to the transplant. It might be worth letting the on-call Renal SpR know and maybe ask their input as well if needed!
8. Patient-Centered Care
Patient-centered care is a hallmark of good medical practice. During the interview, share examples of how you consider each patient’s unique values, needs, and preferences. This might include adjusting treatment plans for a patient’s lifestyle or ensuring they understand their options.
Eg: There is someone with a new diagnosis of AF with high CHADVASc Score- who requires to be on Anticoagulation. It might be worth mentioning that you’ll discuss about the different anticoagulation options with the patient.
9. Mention Resus Status
A vital aspect of patient-centered care is discussing and understanding resuscitation status, particularly for unwell patients. Showing that you understand the importance of this could impress your examiner. You don’t have to decide the resus status for the patient but let the examiners know that you are aware of this and this needs to be sorted.
10. Level of Care
Understanding the appropriate level of care for each patient is important. Is the patient safe to be in a downstream ward or do you need him to be in the AMU or in Resus? Mention if you are happy with level 1 care or does the patient need level 2 or does he need to be in the ITU? Does he need frequent monitoring? Do you want the patient to be close to the nursing station? Do you want the nurses to keep an eye on the patient? If you do, mention it. It will show your ability to make careful judgments tailored to each patient’s needs.
Suggested Reading:
https://www.bmj.com/content/330/7499/s184.3#:~:text=Level%201%E2%80%94Ward%20based%20care,ionotropes%20and%20invasive%20BP%20monitoring.
Level 1—Ward based care where the patient does not require organ support (for example, they may need an IV, or oxygen by face mask)
Level 2—High dependency unit (HDU). Patients needing single organ support (excluding mechanical ventilation) such as renal haemofiltration or ionotropes and invasive BP monitoring. They are staffed with one nurse to two patients
Level 3—Intensive care. Patients requiring two or more organ support (or needing mechanical ventilation alone). Staffed with one nurse per patient and usually with a doctor present in the unit 24 hours per day.
11. Collateral History
Your patient may not be able to provide enough information or may not just be a good historian and therefore you might need to get a bit more information from family/someone who knows the patient- maybe a friend/carer/GP , particularly with elderly patients with dementia, patients from nursing home/care home. If you do, mention it.
12. Longer Term Management
While acute care is important, being mindful of the patient’s long-term needs is also essential. In the interview, demonstrate an awareness of the chronic implications of acute events. For instance, mention if you think the patient is going to need follow-up plans, rehabilitation, or lifestyle modifications. This shows you’re committed to the patient’s journey beyond immediate care.
Does the patient need follow up? Does it need it relatively sooner ie within a week?
Who is going to follow him up and how?
Does he need rehab?
Does he need lifetstyle modification?
Does he need package of care?
13. Acting in the Best Interest of the Patient
Acting in a patient’s best interest means prioritizing their welfare above all else. If situation arises try to mention these words- ‘for the best interest of the patient’/ ‘according to the GMC Good Medical Practice’ / ‘according to the pillar of medical ethics’
14. Medication Reconciliation
Medication reconciliation is a critical step to ensure safe transitions in care. In the interview, discuss your diligence in reconciling medications during admissions, discharges, or when new prescriptions are added. This demonstrates your attention to detail and commitment to preventing adverse drug interactions. In relevant clinical scenarios, you should mention about suspending the nephrotoxic/hepatotoxic drugs/drugs causing interaction.
For example- someone with a BG of Ischemic heart disease coming in with CAP and you are giving him Clarithromycin. He should already be on Statins for his IHD and it might be worth mentioning that he is probably on statins and you’ll suspend these.
15. VTE Prophylaxis
Mention about VTE Risk assessment and prophylaxis. You don’t need to do the assessment in the interview but you should mention it in all scenarios, particularly if there is anything that puts the patient at a risk of developing VTE.
16. Scoring systems
As you already know, scoring systems are quite familiar in medicine and it is very commonly used in hospitals. If your patient needs any scoring, you should mention that you’ll calculate the score and follow the steps accordingly.
Eg: Wells score for PE, Glasgow-Blatchford for Upper GI Bleed etc.
You don’t need to calculate the score, mentioning should be fine.
17. Updating the Next of Kin
Clinical Scenario উত্তরের শেষের দিকে আপনার চিন্তা করা উচিত NOK কে জানানো উচিত কিনা- Is it necessary to discuss anything with the NOK/update the Next of Kin?Particularly if the patient is coming from nursing home/care home, or they are very unwell. Keeping the next of kin (NOK) informed, especially during critical situations, shows your respect for the patient’s support system. Think about it it and mention that you’ll do if needed.
Use the following cheatsheet to prepare for the interview:
FA
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