Nearly every NHS trust interview for a junior or middle grade post includes a clinical scenario about a deteriorating patient, and it usually comes in two parts: the nurse's call, then what you find when you arrive. Panels use it because it tests the things that matter most in a new doctor: whether you go and see the patient, whether you assess systematically, and whether you escalate early and well. This guide covers the structure that scores and the scenarios that recur.
The scenarios
- You are called to see a patient who is deteriorating on the ward.
- A nurse calls you about a patient with chest pain and a low blood pressure.
- A patient two days after surgery is breathless with a fast pulse.
- A patient on the ward collapses and you are the first doctor there.
- A patient with sepsis is not responding to fluids.
- A nurse asks you to prescribe a medication you do not know for a patient you have not met.
- You have three unwell patients and you are the only doctor.
The structure
- Go and see the patient. Say it first. The commonest way to fail this question is to describe tests you would order from the phone.
- Ask for the observations and the chart on the way, and ask the nurse what has changed.
- ABCDE. Airway, breathing, circulation, disability, exposure, treating as you go: oxygen, access, bloods and a gas, fluids if appropriate, monitoring.
- The focused assessment: the history, the examination, the trend in the observations, the drug chart, the recent results.
- The likely problem and what you must exclude.
- The immediate management with specifics.
- Escalate early with SBAR: the registrar, the critical care outreach team, or an arrest call if the patient is peri arrest. Say what you want the senior to do.
- The patient and the family: what is happening and what happens next.
- Document and hand over.
The follow up
The panel will worsen the scenario: the blood pressure is 80, the patient is drowsy, the registrar is not answering. Go back to ABCDE, treat what you can, and escalate past the person who is not answering: the consultant on call, the outreach team, the arrest team. Say that you would rather escalate once too often. If the panel asks what you would say on the phone, give the SBAR in four lines.
SBAR in 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 senior to do, stated plainly, including whether you need them now.
Practise it until it is automatic. Panels score the handover as evidence of communication, and a good clinical answer with a vague handover loses marks.
Knowing the limits of the role
Panels want to hear that an SHO or a registrar knows what they do alone and what they do not. Say when you would call for help even before the patient is very unwell: when you are unsure, when the plan is beyond your competence, when the patient is not improving. For the medication you do not know, do not prescribe it until you have looked it up and seen the patient, and say how you would explain the delay to the nurse.
The three unwell patients
Triage by acuity using the observations, see the sickest first, delegate what nurses can do, and escalate early for help with the rest. Say what you would ask each person to do and when you would review the others. The panel is scoring prioritisation and the willingness to ask for help.
What the panel scores
Going to see the patient, a systematic approach, treating as you go, early and clear escalation, honesty about limits, and communication with the nurse, the patient and the senior. A safe answer that asks for help early scores better than a clever one that does not.
Preparing
Talk each scenario through aloud in three minutes, then hand over in SBAR, then have someone worsen it and ask who you would call. Do it until the structure survives interruption. It is the one question in the interview you can be almost certain of, and a fluent answer sets the tone for the rest.