Acute internal medicine: Specialty Training Interview Questions

The acute internal medicine questions that sit on top of the specialty training core: clinical scenarios, the system and governance questions specific to the specialty, and presentation titles.

Updated 28 October 2026

The structures these questions are marked on

  • SAFER See the patient, Assess systematically with ABCDE, Fix what you can and decide, Escalate with a clear request in SBAR or ISBAR, Review: the patient told, the handover, the documentation and what you would do if the first plan failed. Full guide →
  • The What it is in a sentence, Why it matters with a fact, What it means for this organisation and specialty, What I would do at my level and how I would measure it. Full guide →
  • STAR Situation in a sentence, Task: what you had to do, Action: what you did in the first person, Result: the outcome with a number where there is one. Add Reflection for STARR. Full guide →

Motivation

Point to things you have done rather than feelings you have: tasters, audits, courses, exams, conferences. Name what you will find hard, honestly. Know the curriculum, the stages and the exams, and have an answer for what you would do if unsuccessful this year.

  1. Asked in most interviewsUsually asked by the consultant colleague in the specialty

    Why acute internal medicine, and what have you done to show you are committed to it?

    Evidence: the acute medical unit experience and what it confirmed, the same day emergency care involvement, the audit, the course, the leadership on the take. Say what each taught you about the job.

  2. Asked in most interviewsUsually asked by the clinical director or clinical lead

    What do you know about the acute medicine curriculum, dual accreditation with internal medicine, and the skills it requires?

    Group 1 with the acute take at its heart, the length, the procedural and ultrasound skills, the same day emergency care and ambulatory components, and the exams. Two accurate sentences, then what will be hardest.

  3. Often askedUsually asked by the consultant colleague in the specialty

    Acute medicine has a high turnover and a high burnout rate. How will you sustain a career in it?

    A real strategy: the shift pattern and recovery, the balance of acute and ambulatory and specialty interest work, life outside, and what you would do if you noticed the signs.

  4. Often askedUsually asked by the clinical director or clinical lead

    What is same day emergency care, and why does it matter to the specialty?

    Assessment and treatment of patients who would otherwise be admitted, on the same day, with the patient going home. Why it matters: flow, patient experience, and the specialty's identity. Say what you have seen work and what has not.

Clinical scenario

Go to see the patient, assess with ABCDE, treat what can be treated, escalate early and clearly, and say what you would do afterwards. Assessors are scoring judgement, prioritisation and escalation rather than knowledge; a safe answer that asks for help early beats a clever one that does not.

  1. Asked in most interviewsUsually asked by the clinical director or clinical leadSAFER

    You are leading the acute take. Twelve patients are waiting to be seen, two are unwell, and the emergency department is asking for decisions. How do you run it?

    Triage by acuity with the observations, see the sick two first or allocate them, delegate the rest to the team with clear instructions, keep the board moving with decisions on admission and discharge, communicate with the emergency department and the bed manager, and escalate early when the take is unsafe. Say what you would do about the queue.

  2. Asked in most interviewsUsually asked by the consultant colleague in the specialtySAFER

    A 68 year old is referred from the emergency department with a temperature, a heart rate of 120 and a blood pressure of 85. Talk us through your management.

    The sepsis bundle within the hour, the source sought, fluids with reassessment, the lactate, the senior and critical care outreach if the pressure does not respond. Then the handover to the ward or intensive care in SBAR.

  3. Asked in most interviewsUsually asked by the clinical director or clinical leadSAFER

    A patient presents with sudden severe headache. What do you do?

    Subarachnoid haemorrhage until proven otherwise: the CT within the pathway's time, analgesia, the observations and the GCS, the lumbar puncture if the CT is negative and the timing allows, and the neurosurgical discussion if positive. Say what else is in the differential.

  4. Often askedUsually asked by the consultant colleague in the specialtySAFER

    A patient presents with a first seizure and is now alert. What do you do?

    The history from the witness, the examination, the glucose and the bloods, the ECG, the CT, the decision about admission, the first seizure clinic referral, and the driving advice which is a legal obligation. Say what would make you admit.

  5. Often askedUsually asked by the clinical director or clinical leadSAFER

    A patient in same day emergency care has a suspected deep vein thrombosis. Talk us through the pathway.

    The risk score, the D dimer by the score, the ultrasound, the anticoagulation started while waiting if the probability is high, the ambulatory follow up, and the safety net. Say what would take the patient out of the ambulatory pathway.

  6. Often askedUsually asked by the consultant colleague in the specialtySAFER

    A patient with a paracetamol overdose presents eight hours after ingestion. What do you do?

    The timing and the dose, the level against the nomogram, the acetylcysteine by the guideline, the bloods and the liver watched, the psychiatric assessment once medically fit, and the criteria that would prompt the transplant centre call. Say what you would do if the patient wanted to leave.

  7. Often askedUsually asked by the clinical director or clinical leadSAFER

    A patient with hyponatraemia of 118 is drowsy. What do you do?

    Severe symptomatic hyponatraemia: hypertonic saline by the guideline with close monitoring and the rise limited to avoid osmotic demyelination, the cause sought with the osmolalities and the urine, the fluid status assessed, and the senior and intensive care involved.

  8. Often askedUsually asked by the consultant colleague in the specialtySAFER

    A patient presents with an anaphylactic reaction on the acute medical unit. What do you do?

    Intramuscular adrenaline now at the right dose, oxygen, fluids, the trigger removed, repeat adrenaline if needed, the observation period, the tryptase, and the allergy referral and the adrenaline autoinjector before discharge.

System knowledge

Name three current pressures and link each to your specialty and your own experience. Know how your training is governed: the ARCP, the curriculum, the college and the GMC.

  1. Often askedUsually asked by the clinical director or clinical leadSYSTEM

    What are the biggest challenges facing acute medicine in the NHS, and how do they affect training?

    Flow and corridor care, same day emergency care capacity, workforce and the registrar on the take, the four hour standard's effect on the unit, and the effect on training. Link each to what you have seen.

Governance, safety and quality

The problem, the measure, what you changed, the result and whether it lasted. Be clear about your own contribution. Know the definitions and be able to say which your project was.

  1. Often askedUsually asked by the clinical director or clinical leadSTARR

    Tell us about an audit or QI project in acute medicine and what changed.

    The problem, the standard, the measure, the change, the result, your part. If it was on sepsis, early warning scores, time to senior review or ambulatory pathways, say why it mattered.

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