ST3 emergency medicine uses the three station format shared with the physician higher specialties: suitability and commitment, a clinical scenario with communication scored inside it, and an ethical scenario, with two assessors in each. The scenarios are resus room level, and the ethical dilemmas are the ones an emergency department throws up every night. This guide covers the questions that come up in nearly every interview.
Suitability and commitment
- Why emergency medicine, and what have you done to show you are committed to it?
- What do you know about the curriculum, the MRCEM and FRCEM exams, and the structure of training?
- What makes you suited to emergency medicine, and what will you find hardest?
- Emergency medicine has well known problems with burnout and retention. How will you sustain a career in it?
- Tell us about an audit, QI project or teaching activity relevant to emergency care.
The burnout question is asked in most EM interviews and it is not rhetorical. Assessors want a real strategy: how you manage shifts and recovery, what you do outside work, what you would do if you noticed the signs, and what the department can do. Candidates who say they thrive on the pace read as naive.
The clinical scenario
The scenario is an undifferentiated patient in resus, usually in parts, with a communication task attached. The ones that recur:
- The hypotensive, tachycardic, drowsy patient with no history, then an ultrasound finding.
- Major trauma: lead the primary survey, then a tension pneumothorax.
- The three year old with fever, a non blanching rash and a prolonged capillary refill.
- ST elevation ninety minutes from a cath lab.
- The tiring asthmatic, silent chested, saturating 88 on high flow oxygen.
- The intoxicated, combative patient with a head injury.
- Heavy bleeding at thirty weeks of pregnancy.
- The sudden severe headache.
Answer as the registrar running resus: the primary survey, the immediate interventions, the team and who does what, the decision, the escalation, and the communication with the patient or family. Communication is scored inside the station, so when the assessor says "the mother is screaming", speak to the mother.
The ethical scenario
- A patient who has taken an overdose wants to leave the department.
- A fifteen year old asks for emergency contraception and does not want her parents told.
- The department is full, ambulances are queuing, and a frail patient in the corridor is deteriorating.
- A colleague discharged a patient you think should have been admitted, and they return much worse.
- A patient discloses domestic abuse in confidence and does not want anything done.
- Police ask for information about a patient in the department.
These test capacity, confidentiality, safeguarding, and prioritisation under pressure. Work through patient safety, information, escalation and support, name the law and guidance that apply, and say what you would do. The overcrowding scenario is a leadership question in disguise: how you prioritise, who you escalate to, and how you protect the patient in the corridor.
How to prepare
List the ten resus presentations and talk each through aloud as the team leader, with a communication task attached. Write a one minute answer to each commitment question with a specific in it, including an honest answer on burnout. Then practise the ethical scenarios with someone who asks "and if they still want to leave?" The interview is thirty minutes and the assessors will probe in every station.