The physician higher specialties share one interview format at ST3 and ST4. Three stations of about ten minutes, two assessors in each, and four scored domains: suitability and commitment, clinical reasoning, communication, and ethical reasoning. Communication is scored inside the clinical station rather than separately, and clinical reasoning carries roughly twice its weight there. Because the format is shared, so are most of the questions. This guide covers the ones that come up in nearly every interview, whichever specialty you have chosen.
Station one: suitability and commitment
The assessors here are testing whether you have chosen this specialty for reasons that will survive a decade of training, and whether you understand what the job is.
- Why this specialty, and what have you done to show you are committed to it?
- Talk us through your training and what has prepared you for this post.
- What do you know about the curriculum, the exams and the structure of higher training, including dual accreditation with internal medicine?
- Tell us about an audit, a QI project or teaching you have done that relates to this specialty.
- What will you find hardest about this specialty, and how will you sustain a career in it?
- What would you do if you were not appointed this year?
The scoring rewards evidence over enthusiasm. A taster, a project, a course, a conference, a paper, each with what it taught you, scores. A list of reasons you like the specialty does not. Know the group 1 and group 2 structure and what dual accreditation means for your rota, because the question about it is almost universal.
Station two: the clinical scenario
The scenario is pitched at a registrar leading the acute take or running a clinic in the specialty, and it is usually in parts: the presentation, then a result or a change, then a decision. Expect a scenario from your specialty's acute core (for cardiology an ST elevation infarct a long way from a cath lab; for respiratory the tiring asthmatic; for gastroenterology the variceal bleed; for geriatrics the delirious patient who wants to go home) with communication built in: the family at the bedside, the junior who called you, the consultant to be phoned.
Structure the answer as the registrar would: assess, stabilise, decide, escalate, communicate, and say what you would do afterwards. The communication part is scored on whether you adapt to the person in front of you, so when the assessor says "the daughter is angry", speak to the daughter rather than describing what you would say.
Station three: the ethical scenario
The ethical scenarios at ST3 are registrar level: you are the senior person in the room overnight.
- A patient with capacity refuses treatment for a life threatening condition.
- A consultant's management plan is one you believe is unsafe.
- A junior made an error that reached the patient and has not told anyone.
- A relative asks you not to tell the patient their diagnosis.
- A colleague appears unwell or intoxicated at work.
Work through patient safety, information, escalation and support in that order, name the obligations that apply (capacity law, candour, the GMC's guidance on colleagues), and say what you would actually do. The follow up is always "and if that did not work?", so have the next step ready.
Preparing by specialty
The shared format means you can prepare the suitability and ethics stations in the same way whatever your specialty. The clinical station is where the specialty matters: list the ten acute presentations a registrar in your specialty must be able to manage alone, and talk each through aloud with the communication scenarios attached. Then practise with someone who interrupts, because the assessors will.