The management and clinical station carries the largest share of the core surgical training interview score, and it is scored on judgement at FY2 to CT1 level rather than on operative knowledge. Candidates lose marks by answering as a registrar would, describing the operation, and skipping the resuscitation and the escalation that the assessors are actually scoring. This guide covers the structure that scores and the scenarios that recur.
How the station runs
Fifteen minutes. Two clinical scenarios of about five minutes each, given to you in the interview with no reading time, and a management question. The assessors probe between stages: what else would you want, what if the pressure fell, who would you call and what would you say.
The structure for a clinical scenario
- Go and see the patient. Say it first.
- ABCDE with resuscitation as you go: oxygen, access, bloods including a group and save or crossmatch, fluids, analgesia, monitoring.
- The focused assessment: the history that matters, the examination of the abdomen, the chest, the wound, the limbs, the drains and the chart.
- The investigations and why: the bloods, the gas, the imaging, and what each would change.
- The likely diagnosis and what you must exclude.
- The immediate management: nil by mouth, the nasogastric tube, the catheter, the antibiotics, the reversal of anticoagulation, the analgesia.
- Escalation with SBAR: the registrar, and the consultant if the registrar is scrubbed, with a clear request. Intensive care outreach if the patient is deteriorating.
- The patient and the family: what is happening and what happens next.
- Afterwards: the documentation, the handover, and what you would reflect on.
The scenarios that recur
Bowel obstruction: the distended, vomiting patient with no bowel motion. Resuscitate, nasogastric tube, catheter, bloods and a gas for the lactate, the CT, and the call to the registrar with the question of whether this is a closed loop that needs theatre tonight.
The deteriorating post operative patient: tachycardia, fever and pain three days after a colectomy. Sepsis until proven otherwise, the sepsis six, the thought of the anastomotic leak, the CT, and the early call because this patient may need theatre or intensive care.
The stabbing with a pressure of 80: the trauma call, the primary survey, two large bore cannulas and blood, the chest drain if there is a haemothorax, the massive haemorrhage protocol, and the registrar and consultant now.
Biliary sepsis: right upper quadrant pain, fever and jaundice. Resuscitate, antibiotics, bloods including the liver function and the clotting, the ultrasound, and the question of whether this is cholangitis needing urgent decompression.
The upper gastrointestinal bleed: melaena with a haemoglobin of 70. Resuscitate, crossmatch, stop the anticoagulant, the gastroenterology and anaesthetic teams, the major haemorrhage call if unstable.
The ischaemic limb: the painful, pale, cold leg. Time matters; analgesia, anticoagulation after discussion, the vascular registrar now, and the imaging the vascular team want.
The head injury on anticoagulants: the GCS, the neurological examination, the CT within the hour, the reversal of anticoagulation, and the neurosurgical discussion.
The pregnant woman with right iliac fossa pain: appendicitis until proven otherwise, with the obstetric team involved, the ultrasound first, and the discussion about imaging and theatre with the senior.
Prepare each to the point where the structure is automatic, then practise the worsening: the pressure falls, the patient stops responding, the registrar does not answer.
The management question
The management scenario tests judgement and professionalism: the deteriorating patient with the registrar scrubbed and the consultant in clinic, the consultant shouting at a trainee in theatre, the wound dehiscence you believe was a technical error, consenting for a procedure you have never seen, the patient who refuses an operation, the impaired colleague. The structure is patient safety first, then information, then escalation through the right route, then support for everyone involved. Say what you would do and the next step if it fails.
What the assessors score
Safety and system in the assessment, the escalation with a clear request, honesty about the limits of the role, communication with the patient and the team, and judgement in the management scenario. The veto applies to unsafe answers, and the commonest unsafe answer is the SHO who plans to manage alone.
Practising
Talk each scenario through aloud in four minutes, then have someone worsen it and ask who you would call. Do the same for the management scenarios with the follow ups. The assessors will probe for the whole fifteen minutes, and the candidates who do well are the ones whose structure survives it.