Internal medicine: Specialty Training Interview Questions

Why internal medicine, and why now?

Why medicine with evidence: the acute take, the breadth, the diagnostic work, the long relationship with patients. Why now in terms of readiness: the experience you have, the exam you have started, the registrar role you want. Avoid why not something else.

What have you done to show your commitment to a career in medicine, and what is your strongest achievement?

Three things done on purpose with what each taught you: the audit on the acute take, the MRCP Part 1 sat early, the taster, the course, the conference. Then the achievement that best shows you are ready to be a medical registrar, with its result.

What makes you suited to being a medical registrar, and what will you find hardest?

Qualities with evidence: the sick patient you managed, the team you led, the handover you did well. Then the honest difficulty: running the take alone, the breadth of knowledge, the exams alongside work, the DNACPR conversations. A candidate who finds nothing hard reads as unprepared.

Which medical specialty are you aiming for, and why?

A specialty with reasons from what you have seen, and openness about how training may change it. Know whether it is group 1 or group 2 and what that means for your rota. The assessors want direction, not certainty.

What do you know about the IMT curriculum, the MRCP exams and what the ARCP will require?

The stages of IMT, the MRCP Parts 1, 2 and PACES and when they fall, the capabilities in practice, and the ARCP evidence: workplace based assessments, supervisor reports, teaching, audit, procedures. Two accurate sentences, then how you would fit the exams around work.

Tell us about an audit, QI project or teaching activity in your portfolio and what it changed.

The problem, the standard, the measure, what you changed, the result, and your own part. For teaching, what you taught, to whom, and how you know it worked. Numbers make this answer.

A patient with capacity refuses treatment for a life threatening condition. How do you approach this?

Confirm capacity, make sure the refusal is informed, explore the reasons, offer alternatives, involve the senior and the family if the patient wishes, document, and respect the decision while leaving the door open. Say what changes if capacity is in doubt.

You discover a colleague prescribed the wrong dose of insulin and the patient became hypoglycaemic. What do you do?

The patient first: assess and treat the hypoglycaemia. Then tell your senior, report the incident, and make sure the patient is told under the duty of candour. Then support the colleague. Say what you would do if a senior told you not to report it.

A relative asks you not to tell the patient their cancer diagnosis. What do you do?

The information is the patient's and the duty is to them. Explore the relative's reasons, explain that you cannot withhold a diagnosis the patient wants to know, find out what the patient wants to know, and involve the senior. Say what changes if the patient has said they do not want to know.

A patient lacks capacity and needs urgent treatment. How do you proceed, and who do you involve?

Assess capacity properly, act in the patient's best interests for treatment that cannot wait, involve the senior and the family and any advance decision or attorney, document the capacity assessment and the reasoning, and plan to reassess. Know the Mental Capacity Act's principles.

Your registrar asks you to discharge a patient you do not think is ready. What do you do?

Say your concern with the specifics, ask for the reasoning, and if you still think the patient is unsafe to go, say so and escalate to the consultant. Patient safety before hierarchy. Say how you would keep the relationship with the registrar.

A patient asks you for information about another patient on the bay. How do you handle it?

Decline warmly: you cannot discuss anyone else's care. Say what you can do: let the other patient know someone was asking, or help if the concern is about noise or behaviour on the bay.

What is the duty of candour, and when have you applied it?

The duty to be open with patients when something has gone wrong: tell them, apologise, explain what happened and what will be done. Give a real example of a time you applied it, or of a time you saw it done well, and say what it required of the junior doctor.

A 68 year old man on the ward has a temperature of 39, a heart rate of 120 and a blood pressure of 85 over 50. Talk us through your assessment and management.

• Follow-up: Now hand this patient over to the medical registrar. | SBAR

Sepsis: the sepsis six within the hour, cultures before antibiotics, fluids with reassessment, the lactate, the source sought, and the senior called. When the pressure does not respond, intensive care outreach. Then the SBAR handover to the registrar in forty seconds with what you want them to do.

A 22 year old with type 1 diabetes presents with vomiting, a glucose of 28 and ketones of 5. Walk us through your management.

• Follow-up: What are the key complications of treatment, and how do you avoid them?

Diabetic ketoacidosis: fluids first, a fixed rate insulin infusion, potassium replacement guided by the level, monitoring of the glucose, ketones and gas, the cause sought, and the senior told. The complications of treatment: hypokalaemia, hypoglycaemia, cerebral oedema in the young, and fluid overload in the old. Say how you would avoid each.

A patient on the ward has a potassium of 6.9. What do you do?

• Follow-up: Hand over to the registrar. | SBAR

Treat the heart first: an ECG, calcium gluconate for the membrane, insulin and dextrose to shift the potassium, a nebulised beta agonist, then the cause and the removal. Cardiac monitoring throughout and the senior told. Then the handover: the level, what you have given, and what you want the registrar to do.

A 75 year old woman presents with sudden onset left sided weakness that began 90 minutes ago. What do you do?

The stroke pathway: time of onset confirmed, the stroke team called, the CT now, the glucose checked, the thrombolysis decision within the window with the stroke registrar, and thrombectomy considered. Say what you would do while the CT is arranged and what would exclude thrombolysis.

A man with COPD is breathless, drowsy and has a saturation of 94 on 15 litres of oxygen. What are your concerns, and what do you do?

Hypercapnia from oxygen until proven otherwise: a gas now, controlled oxygen to the target saturations, nebulisers and steroids, antibiotics if infected, and the senior called because this patient may need non invasive ventilation. Say what would make you call intensive care.

A patient on the ward is acutely confused overnight. How do you assess and manage them?

Assess for the cause: infection, drugs, pain, retention, constipation, hypoxia, metabolic. Observations, examination, the drug chart, bloods, a glucose. Treat the cause, keep the patient safe without sedation if possible, and involve the senior. Say what you would tell the nurses to watch for.

A 55 year old presents with central chest pain and ST elevation on the ECG. Talk us through your management.

ST elevation infarct: the primary PCI call now, aspirin and the second antiplatelet, analgesia, oxygen if hypoxic, and the cardiology registrar. Say what you would do if the cath lab were ninety minutes away and whether thrombolysis would be considered.

A patient with pneumonia has a creatinine that has doubled since admission. How do you approach this?

Acute kidney injury: the cause sought (sepsis, hypovolaemia, the drugs, obstruction), the drug chart reviewed and the nephrotoxins stopped, fluids guided by assessment, a bladder scan, bloods and the urine checked, and the senior told. Say what would make you call the renal team.

A patient becomes breathless and hypotensive after a blood transfusion starts. What do you do?

Stop the transfusion, keep the line, ABCDE, treat the anaphylaxis or the haemolysis as you find it, bloods and the unit back to the laboratory, and the senior called. Then the transfusion reaction investigation and the report. Say what you would tell the patient.

What are the biggest challenges facing acute medicine in the NHS at the moment?

Three pressures linked to what you have seen: the acute take, corridor care and flow, same day emergency care, the shift of chronic disease to the community, workforce and rotas. Say what a trainee can do about one of them.

What is the role of the medical registrar in a hospital at night?

The senior decision maker for the medical patients at night: leads the take, reviews the sick, supports the juniors, decides on escalation and ceilings of care, and knows when to call the consultant. Say which parts you are ready for and which you will grow into.