Applying to respiratory medicine

BTS has produced a leaflet which outlines what to expect when pursuing a career in respiratory medicine, which can be downloaded here.

Applying to Respiratory Medicine

Respiratory medicine is a diverse and rewarding specialty. In order to become a consultant in respiratory medicine you need to complete specialist training as a registrar in respiratory medicine. This is normally done after core medical/internal medicine training.

Below is a guide on what the application process entails. If you are thinking about respiratory medicine as a career do talk to the respiratory team at your trust. The registrars and consultants will be very happy to tell you about the job as well as get you involved in projects to help boost your application.

More up-to-date information is available on the Physician Higher Speciality Training Recruitment website.

PHST/HST Recruitment (phstrecruitment.org.uk)

Oriel System

The application form for specialist training, is via the Oriel Website. It is worth visiting the Oriel website in advance of the application window, as you can complete the ‘applicant registration’ section in advance. All the non-specialty specific information, which you need to update here, will be pulled across to your respiratory and/or other specialty application page, which will save you time later down the line. The most time-consuming part of this is completing your full employment history. Presuming you applied for core training, the Oriel system should remember your employment history from previously. It is advisable to use your NHS portfolio for easy access to exact dates of different rotations.

Please remember the Oriel system does save work as you go, but it is not uncommon for the website to be ‘down’ and inaccessible during the application time. It is advisable to start and submit the application form early to avoid unnecessary stress, but there are no extra marks for an early application.

Application Form

Specific sections in the respiratory applications include:

References

• You need three referees who have supervised your clinical training during the last two years of your employment. One referee must be your current or most recent consultant or educational supervisor familiar with your clinical development.
• The other two referees do not need to be consultants, but more senior clinicians are likely to have a better awareness of what is involved.
• You should contact your clinical referees in advance to confirm that they are willing to provide a reference and are available and able to do so in the time period required for selection and appointment.

Competences

• The training programme you have completed or are currently on (normally IMT/CMT).
• The date you have completed or whether you expect to complete MRCP prior to starting specialist training (currently ST3). You will need evidence of MRCP and up-to-date ALS certification.
• The date of medical undergraduate degree and a recommended academic/ educational contact at your medical school.

Supporting Information

• Commitment to specialty. You will have 400-word limit to provide supporting information on why you are applying to respiratory. You should avoid repeating the information which is ‘scored’ in other sections (see ‘Self-Assessment Evidence’). Your answer in this section will not contribute to your application score, but commitment to specialty is marked in Station 1 of the interview so this is likely to form the basis for specific questions.
• Training courses attended. A good place to put courses or conferences that do not meet the criteria for ‘points’ in other sections; try and limit these to those most relevant to a respiratory application.
• Achievements outside of medicine. It is not mandatory to enter any information here, but it is good practice to try and put something. This section should include achievements which helps demonstrate desirable characteristics as per the person specification e.g. flexibility, team-working and leadership.

Self-Assessment Evidence

This is the section that takes the longest and involves trying to put your achievements into a ‘box’ for which you then grant yourself a certain number of points. This is universally tricky, but the main thing to consider is whether you can justify why you have allocated your achievement to a certain score if asked about it in the interview. If the interviewers feel you have incorrectly scored yourself, they can mark you up or down at that point. See the ST3 recruitment website for more details.

The domains and maximum word count allowed in this section are:

Ideas for areas that are easily achievable to gain points while in core training include:

• Completing as much of MRCP as possible before the interview.
• Presenting a poster at a national conference: this does not need to be respiratory (though this helps with evidence for commitment to specialty).
• Organising and providing teaching over a period of three months or longer: this can be on a small or large scale and can be to medical students, other doctors or allied health professionals. Make sure you collect evidence of feedback.
• Completing online training courses to support the training in teaching section of the application.
• Presenting the results of a QIP with more than one PDSA cycle: this takes time and commitment, but again, does not need to be in respiratory field.
• Volunteer to be trainee representative or junior doctor forum (JDF) representative.

Application Scoring

You can achieve a maximum of 75 points on your application form. This is used to shortlist applicants for interview. If you are shortlisted for interview, then your application score makes up 20% of your final interview score. It also contributes to your mark for Station 1 (the portfolio station) in the interview.

The Interview

The interview lasts 40-45 minutes in total with three 10-minute stations, with time for rotating in between. There are usually two or three interviewers in each station and they each score you out of five for two different aspects e.g. clinical knowledge and communication in station 2. An independent assessor might also be present, but they would be there to review the interview process, not you as a candidate.

Station 1: Portfolio and commitment to specialty station. Ideas for demonstrating commitment to the specialty include:

• Joining the British Thoracic Society as a junior member.
• Attending a BTS conference or educational course e.g. introduction to respiratory medicine course.
• Attending a Thoracic Ultrasound course.
• Completing a QIP in respiratory medicine.
• Publishing a respiratory case report/ research.
• Keeping a logbook of respiratory procedures you performed.
• Performing a teaching series to medical students on ABGs/ CXRs.

Station 2: This is a short clinical scenario, which you will be questioned on including assessment, management and how you would communicate with the patient and their relatives. This is normally a respiratory case, so being aware of current BTS guidance for common and acute respiratory conditions is worthwhile.

Station 3: This station is split into two 5-minute sections. Firstly, you need to present for three minutes on “an interesting recent development/research finding in respiratory medicine. There are no aids or resources available and the focus is presenting with clarity. You will be questioned for a further two minutes on the case, so it is best to choose something you are interested in.

The second assessment is an ethical scenario, where you will be asked questions about how you approach this. You need to be familiar with GMC Good Medical Practice principles. There are lots of resources with previous interview questions, including a popular book called “Medical Interviews. A comprehensive guide to CT, ST and Registrar Interview Skills by Olivier Picard”.

See the ‘Interview and Scoring’ section on the ST3 respiratory recruitment website for more details.

After the Interview

Once the interviews are complete, you will be sent an email requesting you to rank your training deanery preferences. All candidates who have been assessed as ‘appointable’ will be ranked in order of the total score awarded to them at the interview (including portfolio). Respiratory recruitment teams will then begin making offers to candidates based on this score (highest-scorer first) and the post preferences allocated.

If not successful first time, then it is advisable to continue showing commitment to the specialty e.g. undertaking a clinical fellow position in respiratory to gain more exposure, building up your logbook of procedures and working on further developing the suggestions listed in "Station 1" above. As of August 2021, trainees will need to apply to IMT3 and then re-apply for respiratory ST4 after this. There is minimal information currently on how undertaking a stand-alone IMT3 year will work, except for a statement released by Health Education England in January 2020.

It is worth submitting an expression of interest about a stand-alone IMT3 in order to maximise your chances of staying up-to-date with the latest advice.

Finally, there will be some changes as the Internal Medicine Training curriculum is introduced and applications change to ST4. We will update this page as more information becomes available.

Author: Dr Anna Haley