The clinical station at ST3 looks like the clinical station at IMT, and the mistake candidates make is to answer it the same way. At ST3 the assessors are scoring a registrar's judgement: decisions, prioritisation, and the communication that goes with them. Clinical reasoning carries about twice the weight of communication in this station, but both are scored, and an answer that escalates everything to the consultant scores like an SHO.
How the station runs
A scenario from your specialty's acute core, given in parts. The first part is the presentation and the first decision. Then a result, a change or a complication. Then a communication task: the family, the junior who called you, the consultant to phone, the patient who wants to leave. The assessors probe between parts: what else would you want, what would change your plan, what if the result were different.
What registrar level sounds like
Three things distinguish the top band:
- Decisions, stated. "I would start thrombolysis" rather than "thrombolysis should be considered". If you would wait for something before deciding, say what and why.
- Prioritisation across the department. The registrar has other patients and a team. Say who you would delegate to, what you would ask the SHO to do, and how you would keep the take moving while you deal with this patient.
- Escalation with a purpose. You still call the consultant, but you call with a plan and a question, not a request to be told what to do. "I am starting X, the patient is Y, I would like you to come in because Z" is the registrar's phone call.
The communication element
When the assessor introduces a person, speak to them. Describing what you would say scores less than saying it. The common tasks:
- The angry relative: acknowledge, listen, explain what is happening and what you are doing, agree the next contact.
- The junior who made an error: patient first, then the junior, without blame, then the reporting.
- The patient who wants to leave against advice: capacity, understanding, risks explained plainly, a safe plan if they still go.
- Breaking bad news: SPIKES, with a warning shot and a pause.
Adapt to the person. The daughter who is a nurse needs a different conversation from the son who has flown in from abroad.
The scenarios to prepare
Make a list of the ten acute presentations a registrar in your specialty must manage alone overnight, and for each prepare the decision points and the likely communication task. For most physician specialties the list overlaps with the IMT scenarios (sepsis, the bleed, the arrhythmia, the breathless patient, the confused patient) with the specialty's own emergencies added. Talk each one through aloud with a timer, then have someone interrupt with a complication half way through.
The end of life question
A scenario about a frail patient with a poor prognosis, a family who want everything done, and a decision about escalation or resuscitation appears in many ST3 interviews. Answer it as the senior clinician: the clinical reality, the patient's wishes if known, the conversation with the family, the decision and its documentation, and the consultant's involvement. Show that you can hold the conversation yourself and that you know when to involve others.
Prepared this way, the clinical station is the one where a well organised candidate can score highest, because judgement and communication are both learnable with practice against a clock and a probing partner.