The clinical scenario aims to evaluate your aptitude at the level of an ST3 registrar by judging your knowledge and response to a challenging clinical situation that you are likely to encounter on a busy on-call take in the NHS. The cases are typically complex and will include some form of management challenges that you will have to navigate and make a decision. This article has some general tips and advice to help you score the highest in this area.
1. Understand the Evaluation
First, you need to understand the examiners’ score sheet. You will be evaluated by 2-3 independent panellists on:
- Ability to recognise the clinical issue (25%) – making a correct assessment of the patient’s diagnosis and other relevant issues surrounding their clinical context/ presentation
- Judgement and prioritisation (25%) – your responses on treatment/ management plans and sequencing of your responses
- Planning and use of resources (e.g. Investigations, staff) (25%) – your decision-making as you progress making management plans, escalating/ involving other staff
- Communication (25%) – clarity of your communication, use of assertive language, and appropriate terminology (especially in UK/ NHS surgical practice)
A standard evaluation scoresheet will look as follows:
| Station: Clinical Scenario | |||||
| Recognition of clinical issues | 5 | 5 | 10 | ||
| Judgment & prioritization | 5 | 5 | 10 | ||
| Planning & use of resources | 5 | 5 | 10 | ||
| Communication strategy | 5 | 5 | 10 | ||
| Comments: Panellist 1: No concerns, safe approach Panellist 2: Very little prompting | |||||
| Overall Performance: | 3 | 3 | 6 | ||
| Overall station performance: | |||||
| Probity concerns | No concerns | No concerns | |||
| Probity concerns | |||||
| Comments: Panellist 1:excellent stepwise and clear approach and management plan , Panellist 2: covered all aspects of management , examination and plan | |||||
| Aggregate Score | 46/46 | 100% | ||||
2. Response structure/ framework:
You should have a simple structure/ framework to help you respond comprehensively to the questions you will be asked. The panellist may interrupt you as you speak, so you need to be able to maintain your train of thought. Despite having a template structure, you should be fluid and flow in the direction the panellist/ examiner is leading you. You will score low points if you are rigid and only strictly follow your structure.
I personally like the SPIES structured approach:
- Situation – Take note of the Situation/ context:
- Where are you? In the wards, in clinic, theatre, A&E?
- What are the possible differentials for your patient
- What other issues are happening?
- Priority – Prioritise your issues from above.
- What would you like to sort out/ discuss 1st
- Usually, emergency interventions should take priority in accordance to CCRISP approach.
- Intervention – Structure your intervention in a step-wise approach
- This usually starts with a quick A to E assessment according to CCRISP protocol to determine if your patient is stable or not
- For unstable patients, manage/ intervene as appropriate in each stage, e.g. Breathing- give high flow O2, Circulation- take blood for investigations, start fluids, give blood or antibiotics, fix a urine catheter, etc.
- Don’t spend too much time on the CCRISP unless the panellists are prompting you towards that
- Gather more information:
- This follows your CCRISP assessment
- Depending on your context/ location- check the patient’s previous records, operation notes, investigations, review charts
- Ask for additional history or information
- Make a treatment plan:
- Includes additional investigations, patient consent
- Assigning tasks to juniors
- This usually starts with a quick A to E assessment according to CCRISP protocol to determine if your patient is stable or not
- Escalation – Contacting/ informing your seniors, referral to other specialities, booking theatre, etc.
- Support – Support your juniors, consultants or other team members in delivering the patient’s management plan.
- Remember to mention that you will discuss/ inform the patient’s next of kin.
- Documentation of the encounter and any appropriate forms
3. High-yield topics
The clinical scenario station test common general surgery or vascular emergency cases that you encounter while working on-call in the NHS. Below is a summary of some of the high-yield topics:
| General Surgery | Vascular Surgery |
| Diverticulitis | AAA + post-op complications |
| Acute & Chronic Pancreatitis | Diabetic Septic Foot |
| Cholecystitis, Cholangitis, Choledocholithiasis | Amputation |
| Necrotizing Fasciitis | Acute & Chronic Limb Ischaemia – Acute limb ischaemia vs critical ischaemia |
| ATLS | Compartment syndrome |
| Small and Large bowel obstruction | Reperfusion syndrome |
| IBD | Intra-Abdominal Hypertension (IAH) & Abdominal Compartment Syndrome (ACS) + management |
| Appendicitis | Shock |
| Perforated DU | Anticoagulant types |
| Major/ Massive Haemorrhage Protocol | |
| DVT | |
| ATLS | |
| Chronic venous insufficiency | |
| Aortic Dissection | |
| Carotid endarterectomy | |
| AV shunt | |
| Thoracic outlet syndrome | |
| Vasculitides |
4. Talk the talk: Semantics
Responding using particular words will create a good impression with your panellist. These words showcase your familiarity with surgery within the NHS. Here is my ‘dictionary’ of common keywords.
| Item | Item |
| Sliding scale insulin, variable rate insulin or fixed rate | As per the Trust policy |
| Orthotics team | Safeguarding – Adult or child |
| Closed loop obstruction | Early communication and escalation |
| Debrief | Consultant – on call, responsible |
| Reflect | Respect form/ DNACPR |
| Feedback | Protocols – CCRISP, ATLS, SEPSIS 6 BUNDLE |
| MDT approach | Ceiling of care/ advanced care planning |
| Language line | Priorities of care |
| Level 2/3 care | End of life care planning |
| Consent Form 1, 2 & 4 | Care nurse specialist (CNS)– stoma, cancer |
| Laparotomy +/- Bowel resection +/- Wash out +/- Stoma | Grading/ Classification criteria – Glasgow, Strasberg, liver/ spleen trauma |
| Audit | Frailty – Rockwood frailty scale, WHO performance status |
| Clinical concerns | Co-morbid |
| Organization/ management concerns | Best interest |
| Training issues | Patient safety |
| Duty of candor | Transfer to resus |
| Organize team | CEPOD/ Theatre coordinator |
| Patient Baseline (Elderly – HB, Cr, eGFR) | Return to theatre (RTT) >> MnM (Morbidity & Mortality) discussion |
| Mental Capacity | Major Hemorrhage Protocol |
| Lasting Power of Attorney (LPA) | Massive Transfusion Protocol |
| Next of Kin (NOK) | Code Red |
| Provide support | Trauma call |
| National Emergency Laparotomy Audit (NELA) | Assign team member roles |
| Physiological & Operative Severity Score (P POSSUM) | Safety net advice/ safety netting |
| Palliative care | Seek/ gather more information |
| Comfort care | Incident form/ Datix |
| Cardiac risk index | Root Cause Analysis (RCA) |
| Cardiac Exercise Tolerance testing (CET) | Clinical prioritization |
| Empathetic, non-confrontational, non-judgmental | Cardiac arrest call |
| Clinical governance meeting | Quality Improvement (QI) |
| Theatre brief | Documentation |
| Ad-hoc | Rota manager |
| anaerobic threshold (AT) (normal is 50-60% of VO2 max) if < 11 ml O2/kg/Min (<40% predicted) = high risk >20ml O2/kg/Min (>75% predicted) is low risk | compos mentis |
| That was a challenge I was anticipating | Hot clinic, Ambulatory/ same day emergency care unit, clinical decision making unit |
| Would you like anyone to join you? | We want to maintain dignity, comfort, and have him/ her pass away surrounded by friends and family |
| Does he have any spiritual needs that we can support | Would he like to be kept in hospital or at home/ community |
In summary, preparing for the General & Vascular Surgery ST3 interview’s Clinical Scenario Station requires a thorough understanding of the evaluation criteria and a structured approach to responding to clinical challenges. Focus on recognising clinical issues and fluid/ responsive communication based on your panellists’ prompts/ direction. Utilise frameworks like SPIES to maintain organised responses and be familiar with high-yield topics relevant to general and vascular surgery. Review realistic example scenarios from vascular and general surgery on this website. Lastly, incorporating NHS-specific terminology will demonstrate your familiarity with the system, helping you to make a strong impression on the interview panel.