Station 2 of the IMT interview is where most of the clinical marks sit, and it has two parts that are scored separately: the clinical assessment and management, and the handover. Candidates who prepare only the clinical part leave marks on the table.
How the station runs
You are given a clinical scenario, usually a patient on the ward or in the emergency department with a short history, observations and some investigation results. The assessors ask you to talk through your assessment and management, probing as you go: what else would you want to know, what is your differential, what would change your plan. Then they ask you to hand the patient over to the medical registrar, and score that as a separate item.
Communication is scored in this station as well, which means the way you explain your thinking matters, not only its content.
The scenarios that recur
The same acute presentations come up year after year, because they are the ones a medical registrar must be able to manage:
- Sepsis with hypotension
- Diabetic ketoacidosis
- Hyperkalaemia
- Acute stroke within the thrombolysis window
- Acute coronary syndrome with ST elevation
- COPD exacerbation with hypercapnia
- Acute kidney injury on a background of pneumonia
- Upper gastrointestinal bleeding
- The acutely confused patient overnight
- Anaphylaxis or a transfusion reaction on the ward
Alongside these, a DNACPR or end of life question is often attached: a frail patient with a poor prognosis and a family who want everything done. That is where the ethics station and the clinical station meet.
A structure that scores
Start with ABCDE and the immediate treatment, because the assessors want to hear that you would stabilise before you diagnose. Then the investigations you want and why, the diagnosis and the differentials you are keeping open, the management plan with the specifics (the fluid, the insulin regimen, the calcium gluconate, the antibiotic choice), and the escalation: who you would call and when.
Say what you would do, in the first person. "The patient should be given" is weaker than "I would give". Mention the things a registrar thinks about that an FY2 may not: the ceiling of care, the bed the patient needs, the family, and the review in two hours.
The handover
Use SBAR and keep it to about forty seconds:
- Situation: who the patient is and the one line problem.
- Background: the relevant history and what has happened so far.
- Assessment: what you think is going on and how unwell they are.
- Recommendation: what you want the registrar to do, stated plainly.
The common failure is a handover that repeats the whole clinical answer. The registrar does not need the differential diagnosis recited; they need to know how sick the patient is, what you have done, and what you want from them. Say "I need you to review this patient within the next fifteen minutes" rather than "it would be good if someone could have a look".
Practising it
Write the ten scenarios on cards and talk each one through aloud with a timer, then hand over each one in SBAR. Record yourself once; most candidates discover they are slower and vaguer than they thought. Then practise with someone who probes, because the assessors will interrupt with "what if the potassium is 7.2" or "the family want to speak to you now", and the ability to adjust without losing structure is what the top band looks like.