ST3 surgical interviews are run by each specialty's recruitment office, so the exact format differs between general surgery, trauma and orthopaedics, urology, vascular, plastics and the rest. The shape, though, is shared: clinical scenarios at surgical registrar level, a management or leadership scenario, and questions on your portfolio and commitment, with two or three assessors per station. The assessors are deciding whether you can be the registrar on call, and the questions that follow come up in nearly every specialty.
Commitment and the portfolio
- Why this surgical specialty, and what have you done to prepare for it?
- Talk us through your training and what has prepared you for ST3.
- Tell us about your operative experience and the procedures in your logbook.
- Which achievement in your portfolio best shows you are ready for higher training?
- Tell us about an audit or QI project and what changed.
- What research have you done, and what did you learn from the process?
- What teaching have you delivered, and how would you teach as a registrar?
- What are the biggest challenges facing surgical services, and how do they affect training?
The assessors have your portfolio and will probe the logbook: how many as first operator, under what supervision, which you could do alone. Answer with a specific and a reflection. For research, honesty about your role matters more than the number of papers.
The clinical scenarios
At ST3 the scenarios test judgement as the registrar on call: the decision to operate, the decision not to, and the complication you own.
- The deteriorating patient three days after a colectomy with tachycardia, fever and pain, then a leak on the CT.
- The eighty year old with dementia from a nursing home with a perforated viscus.
- The massive upper gastrointestinal bleed the endoscopist cannot control.
- The patient on warfarin who needs an emergency laparotomy.
- The trauma patient with a pelvic fracture and hypotension.
- The anastomotic leak after your own operation.
- The painful, cold leg at 3 am.
- The patient who refuses to go back to theatre.
Answer as the registrar: assess, resuscitate, decide, involve the consultant with a plan rather than a question, speak to the family, and say what you would do afterwards. The assessors will worsen the scenario and ask what you would do if the consultant were two hours away. Make the decision.
The management scenario
- You are the registrar. The theatre list is overbooked, the consultant is in clinic, and the anaesthetist is refusing to start a case they think is unsafe.
- A junior on your team is not coping and patients are affected.
- You witness a consultant belittling a trainee in theatre.
- You believe a technical error was made in an operation you assisted on.
- A colleague appears to be operating while impaired.
Patient safety first, then information, escalation and support. For the anaesthetist, the panel wants to hear that you treat their refusal as a safety veto, find out the concern, and reorganise the list. For the belittling consultant, that you would act in the moment if the trainee or the patient were at risk, speak to the trainee afterwards, and know the reporting route.
Specialty specific additions
Each specialty adds its own clinical stems and knowledge questions: the open fracture and the compartment syndrome in trauma and orthopaedics, the obstructed infected kidney in urology, the ruptured aneurysm in vascular, the burn and the flap in plastics. Prepare the ten emergencies your specialty's registrar must manage alone and the national audits and guidelines the assessors expect you to know.
What the assessors score
Decisions made and explained, safe resuscitation before any decision, honest handling of complications including your own, leadership in theatre and on the ward, communication with patients and the team, and evidence of commitment at this level. The common failure is the candidate who answers every scenario by asking the consultant what to do.
Preparing
The clinical scenarios talked through aloud as the registrar with the worsening prepared. The management scenarios with their next steps. One minute answers to the portfolio questions with the logbook numbers ready. The specialty's current issues with your own view. Then timed practice with assessors who probe, because they will.