Emergency medicine: Specialty Training Interview Questions

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

Evidence over enthusiasm: the emergency rotation and what it confirmed, a taster, a course, an audit in the department, a conference, a trainee association. Say what each taught you about the job rather than the excitement.

What do you know about the EM curriculum, the MRCEM and FRCEM exams, and the structure of training?

The stages, the MRCEM and FRCEM and when they fall, the structure of training including the ACCS entry and the ST3 level, the subspecialty options. Two accurate sentences, then how you would fit the exams around shifts.

What makes you suited to a career in emergency medicine, and what will you find hardest about it?

Qualities with evidence: the undifferentiated patient managed, the department run, the team led. Then the honest difficulty: the shift work, the crowding, the emotional load, the decisions with incomplete information. Say how you would manage it.

Emergency medicine has well known problems with burnout and retention. How will you sustain a career in it?

A real strategy, not a slogan: shift patterns and recovery, life outside the department, what you would do when you noticed the signs, and what the department can do. Candidates who say they thrive on the pace read as naive.

Tell us about an audit, QI project or teaching activity relevant to emergency care.

The problem, the measure, what changed, the result, and your part. If it was on flow, triage, sepsis or a pathway, say why that mattered for the department.

A patient who has taken an overdose wants to leave the department. What do you do?

Assess capacity with the overdose in mind, find out why they want to leave, address what you can, explain the risks plainly, and if they lack capacity the law allows you to keep them for treatment. Involve the senior and the mental health team. Say what you would do if they had capacity and still left.

A 15 year old attends with a friend, asks for emergency contraception and does not want her parents told. What do you do?

She is your patient. Assess Gillick competence against the Fraser guidelines, explore the relationship and the circumstances, explain confidentiality and its limits, encourage a trusted adult, and involve safeguarding if there is any concern about exploitation or the age of the partner. Do not promise absolute secrecy.

The department is full and the ambulance queue is growing. A frail patient in the corridor is deteriorating. How do you prioritise and escalate?

The corridor patient first: assess, treat, and get them into a monitored space. Then triage the department, delegate explicitly, and escalate: the consultant, the nurse in charge, the site manager, the executive on call. Say what you would tell the waiting room and what you would do about the queue.

A colleague discharges a patient you think should have been admitted, and they return the next day much worse. What do you do?

The patient first. Then tell the consultant what happened, report the incident, and speak to the colleague without blame. Open disclosure if there was harm. Say how you would make sure the learning reached the department.

A patient tells you in confidence they are being hurt by their partner but does not want anything done. What do you do?

Believe them, assess their safety and the children's, know the pathway and the independent domestic violence adviser, document carefully and in a way that protects them, and do not act beyond what they want unless a child is at risk. Say what you would offer and that the door stays open.

A 45 year old arrives by ambulance hypotensive, tachycardic and drowsy with no clear history. Talk us through your approach.

• Follow-up: A bedside ultrasound shows free fluid in the abdomen. What now?

Shock with no history: the primary survey, two large bore cannulas, bloods and crossmatch, a fluid bolus with reassessment, the ECG and the glucose, and the bedside ultrasound. When there is free fluid, this is a bleeding abdomen: the major haemorrhage protocol, blood, the surgeons now, and theatre or interventional radiology. Say who you would call and what you would tell the family.

A motorcyclist is brought in after a high speed collision. Lead the primary survey.

• Follow-up: Breath sounds are absent on the left and the trachea is deviated. What do you do?

The primary survey in order with a trauma team allocated: airway with cervical spine control, breathing, circulation with haemorrhage control, disability, exposure. When breath sounds are absent on the left and the trachea deviated, it is a tension pneumothorax: decompress now, then the chest drain. Say what you would do if the patient arrested.

A three year old arrives with a fever of 40, a non blanching rash and a prolonged capillary refill. What do you do?

Meningococcal sepsis until proven otherwise: antibiotics now at the weight based dose, fluid boluses by weight with reassessment, oxygen, access, bloods and cultures, the paediatric team and intensive care called, and the parents told what is happening. Say the dose per kilogram and that you would not wait for results.

A 70 year old with chest pain and ST elevation is in the department 90 minutes from the nearest cath lab. What do you do?

Primary PCI if the cath lab can be reached within the window, thrombolysis if it cannot, with the cardiology registrar on the phone. Aspirin and the second antiplatelet, analgesia, oxygen if hypoxic, monitoring, and the transfer arranged. Say what would exclude thrombolysis.

A patient with asthma is tiring, silent chested, with a saturation of 88 on high flow oxygen. What do you do, and who do you call?

The silent chest and the saturations on high flow are the warning: nebulisers and steroids, magnesium, a gas, and the anaesthetist and intensive care called now because this patient may need intubation. Say that you would not leave the bedside.

A patient is brought in by police, intoxicated and combative, with a head injury. What are your concerns, and how do you manage them?

Safety for everyone first; the police can help. Then the head injury is the priority: the GCS, the pupils, the mechanism, the anticoagulants, and the CT within the hour by the guideline. Sedation only if needed for safety and imaging, with the airway considered. Say what would make you call the neurosurgeons.

A woman at 30 weeks pregnant arrives with heavy bleeding and abdominal pain. What do you do?

Antepartum haemorrhage at 30 weeks: resuscitate, no vaginal examination, the obstetric team now, bloods and crossmatch, anti D considered, the fetal monitoring, and steroids for the baby. Placenta praevia and abruption are the diagnoses that matter. Say what you would tell the woman.

A patient presents with a severe headache that started suddenly an hour ago. What do you do?

Subarachnoid haemorrhage until proven otherwise: the CT now, analgesia, the observations and the GCS, and if the CT is negative the lumbar puncture at the right time. Say what else would be in the differential and when you would call the neurosurgeons.

What are the four hour standard and the twelve hour target, and what do they mean for how a department runs?

The four hour standard measures the share of patients seen and admitted, discharged or transferred within four hours; the twelve hour target measures the long waits that cause harm. For the department they drive flow, staffing and the escalation when the department is full. Say what they do and do not measure.

What do you understand by exit block, and what can an ED do about it?

Patients who need admission cannot leave the department because there are no beds, so the department fills and the waiting room backs up. It is a hospital problem of bed capacity and flow. What the department can do: early senior review, ambulatory pathways, same day emergency care, escalation with data, and protecting the sickest.