Clinical Station: Interview Guide
CST Interview Guide
Background
During the Clinical station of the interview, lasting 10 minutes, candidates typically encounter two scenarios, focusing on surgical situations, such as trauma cases or post-operative complications.
Part A | Candidates read a short scenario beforehand, followed by a series of questions from interviewers based on the scenario.
Part B | A clinical scenario is presented during the station, prompting questions on investigation, differentials, etc.
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Each scenario is marked separately and lasts for 5 minutes, with interviewers assessing:
1. Clinical skills and knowledge demonstrated.
2. Judgment and prioritisation abilities under pressure.
3. Communication skills in conveying decisions and rationale effectively.
When facing an acutely unwell patient scenario, it's crucial to follow a structured approach. Begin by gathering pertinent information, prioritising tasks based on urgency, and seeking relevant background details and observations. Assess the situation's urgency, considering immediate actions like initiating a cardiac arrest call if necessary, and delegating tasks to nursing staff where feasible.
This guide will focus on how to structure your answers for the clinical stations and a general overview of how to revise for this tricky interview station.
Systematic Approach | Initial Statement
Following the initial vignette, the next most common question is “what would your initial management of the patient be?”. The key to answering this question is to be structured and ensure examiners know that you are methodical, safe and competent at evaluating surgical emergencies and post-operative complications.
The systematic approach for management of clinical conditions is outlined below and should follow either an A-E approach or ATLS approach (if Trauma station). Prior to this you should start by stating what your key concerns are given the history.
Key Concerns
Identifying your key concerns early within the station is critical. You want to alert examiners to the fact that this is a potential emergency or that you aware of factors that would make the presentation more concerning at this stage. It is important to also mention the guidelines / standards that are applicable to the management of the scenario.
Guidelines / Standards
Advanced Trauma and Life Support (ATLS) Principles
CCrISP protocol
National Institute for Clinical Excellence (NICE): Guidelines
BOAST (orthopaedic stations)
Example
Patient with an Open Tib-Fib Fracture
“My key concern in this patient is that there is a high energy injury mechanism that will need management in accordance with ATLS principles. I would also like to exclude a compartment syndrome or NV injury. As this patient has an open fracture, I would manage this patient in line with BOAST: Open Fractures guidelines.”
Systematic Approach | ATLS
When faced with a high-energy injury mechanism, it's crucial to demonstrate your understanding of ATLS principles during your interview. Practice utilising ATLS principles for all the stations in the “Trauma” section. Here's a guide to help you prepare and excel in discussing your approach to managing such trauma cases:
Opening Statement
Begin with a succinct and confident statement to set the stage for your clinical scenario:
“This patient has a likely high-energy injury mechanism; I would ensure the patient is managed via ATLS principles. This involves initiating a trauma call, introducing team members, assigning roles, and conducting a primary and secondary survey to identify any life or limb-threatening injuries.”
ATLS Pathway Overview
You may be asked to elaborate on the ATLS assessment. Familiarise yourself with the following steps, ensuring you can discuss each element clearly:
C-spine
Triple protection - collar / blocks / tape
Airway
Assess for stridor or upper airway sounds
Look for vomitus or blood in mouth - remove with yanker suction
If airway compromised proceed to airway management algorithm
Airway manoeuvres - jaw thrust (as patient C-spine immobilised)
Airway adjuncts (oro/nasopharyngeal airway)
Definitive airway - laryngeal mask airway or endotracheal tube
Surgical airway
Once happy with airway - 15L non-rebreathe mask + proceed
Breathing
Check oxygen (O2) saturations + respiratory rate (RR)
Focused respiratory examination
Inspect chest for signs of trauma - Ecchymosis / flail chest / open pneumothorax
Ensure trachea central
Equal chest expansion
Bilateral air entry
Order respiratory investigations (if indicated)
CXR
Arterial blood gas (ABG)
Circulation
Check heart rate (HR) and blood pressure (BP)
Focused cardiovascular examination
Check CRT - warm + well perfused? Cold clammy?
Heart Sounds
Assess for signs of haemorrhage
Chest
Abdomen
Pelvis
Long Bones
Surrounding patient
Ensure pelvic binder is applied
FAST scan for sources of bleeding
Gain intravenous (IV) access and resuscitation fluids (20mls/Kg)
Order cardiovascular investigations
Trauma bloods: full blood count (FBC), urea and electrolytes (U+Es), liver function tests (LFTS), clotting, group and save (G&S)
ECG
VBG - lactate
Disability
Temperature - avoid hypothermia
Glasgow Coma Scale (GCS)
Glucose
Pupils
Exposure
Examine for other injury
Log roll patient - examine for spinal tenderness
Reassessment and Escalation
At the end of your assessment, emphasise the importance of reassessing A-E and escalating appropriately to senior staff.
Top Tips for Success
Preparation: Thoroughly review the ATLS manual and attend an ATLS course if possible.
Practice: Rehearse your opening statement and detailed ATLS steps to ensure you can articulate them confidently and concisely.
Clarity: Be clear and structured in your responses. Use bullet points or mnemonic devices to remember key steps.
Calmness: Stay calm and composed, demonstrating your ability to handle high-pressure scenarios effectively.
Reassessment: Always mention reassessment and escalation to show you understand the dynamic nature of trauma management.
By following this guide and practicing diligently, you will be well-prepared to demonstrate your competency in ATLS principles during your interview.
Systematic Approach | A-E Assessment
When encountering a surgically unwell patient, you should prioritise a systematic assessment following the A-E approach. This involves promptly addressing any life-threatening issues while simultaneously gathering essential information to guide further management. This can be applied for the majority of the other “non-trauma” stations on the website and you should be able to do this quickly and succinctly.
A-E Approach Overview You may be asked to elaborate on each component of the A-E approach. Familiarise yourself with the following steps, ensuring you can discuss each element clearly:
Airway
Ensure patent airway by applying a 15L non-rebreather mask.
Consider the need for airway adjuncts if the patient is not maintaining adequate oxygenation.
Assess for signs of airway obstruction or compromise, such as stridor or decreased breath sounds.
Breathing
Evaluate for central trachea, equal chest expansion, and percussion to assess lung sounds and presence of pneumothorax.
Perform a focused respiratory examination to identify any signs of respiratory distress or compromise.
Monitor oxygen saturation and respiratory rate continuously.
Consider performing ABG analysis and chest X-ray if there are concerns about ventilation or oxygenation status.
Circulation
Check heart rate, blood pressure, and auscultate heart sounds for signs of cardiac dysfunction or fluid overload.
Assess JVP to evaluate fluid status and cardiac function.
Obtain an ECG if the patient is tachycardic or there are concerns about cardiac rhythm abnormalities.
Order relevant blood tests including full blood count (FBC), urea and electrolytes (U&Es), liver function tests (LFTs), clotting profile, and cross-match.
Consider VBG analysis for lactate levels if ABG is not immediately available.
Initiate intravenous access with two large bore cannulas and begin fluid resuscitation according to the patient's hemodynamic status.
Monitor urine output and maintain a fluid balance chart to assess response to resuscitation.
Disability
Assess the Glasgow Coma Scale (GCS) to evaluate the patient's level of consciousness.
Measure glucose levels to rule out hypoglycemia or hyperglycemia.
Evaluate pupillary response and use the AVPU (Alert, Voice, Pain, Unresponsive) scale to assess neurological status.
Exposure
Inspect wounds for signs of infection, hemorrhage, or foreign bodies.
Assess for signs of deep vein thrombosis (DVT) or cellulitis around any indwelling lines or catheters.
Escalate to senior clinicians as appropriate following the initial A-E assessment, providing concise and relevant information about the patient's condition.
By adhering to the A-E approach, you can effectively prioritise and address the needs of patients presenting with acute illness or injury. Practice articulating your approach confidently and succinctly to demonstrate your competency during interviews or clinical scenarios.
Systematic Approach | CCrISP Principles
During the interview, it can be useful to mention CCrISP principles after the initial A-E assessment. Completing the CCrISP Triple Assessment allows for a comprehensive evaluation of the patient's clinical status, aiding in the formulation of an appropriate management plan tailored to the underlying condition or pathology. This structured approach ensures that no pertinent information is overlooked and facilitates effective communication and decision-making among multidisciplinary team members.
incorporating the principles of the CCrISP Triple Assessment, which includes three key elements:
Review Clinical History & Focused Examination
Gather detailed information about the patient's medical history, surgical interventions, and any relevant comorbidities.
Examine the history of the present illness, including symptom onset, progression, and associated factors.
Perform a thorough physical examination, focusing on relevant systems and areas of concern.
Review Investigations and Results
Evaluate the results of relevant investigations, including laboratory tests, imaging studies, and procedural reports.
Analyse laboratory parameters such as complete blood count, electrolytes, renal function, and inflammatory markers to aid in diagnosis.
Interpret imaging findings from modalities such as X-rays, ultrasound, CT scans, or MRI scans to identify any abnormalities or complications.
Formulate Management plan
Formulate ongoing management plan with appropriate escalation to seniors
Reassess patient with A-E to observe if deteriorating or if any interventions have been successful
Mentioning the CCrISP triple assessment within the interview will demonstrate your ability to integrate clinical data, interpret findings, and prioritise interventions to optimise patient outcomes. Additionally, it highlights the significance of ongoing reassessment and adjustment of management strategies based on patient response and clinical evolution.
Revising for the Clinical Station
To perform well during the CST interview, you should demonstrate safe practice by producing thorough assessments, ordering specific investigations, and escalating to seniors within a 5-minute timeframe. Advanced candidates will have a deeper understanding of management plans and surgical aspects for each scenario.
The CST Revision website scenarios are designed to cover everything you need for the interview and enhance your understanding of common surgical conditions. They are designed to take longer than 5 minutes to complete in order to cover all potential topics you may be asked alongside giving you an advanced understanding of the surgical conditions. A solid grasp of these scenarios, combined with strong interview techniques, will put you in an excellent position.
Below are some tips for revising for the clinical station in individual versus group settings. Remember, practice is key!
Individual Practice
Reading & Answer Preparation: Focus on both clinical knowledge and management station questions.
Practice Scenarios: Record yourself responding to questions, review the footage, and refine your technique. Although initially uncomfortable, this method is highly effective.
Utilise Website Scenarios: Test yourself on commonly asked scenarios to reinforce your knowledge.
Group Pracitce
Virtual Practice Sessions: Form a small group for virtual mock interviews to simulate the actual interview environment. Maintain formality to mirror real conditions.
Constructive Feedback: Ensure group members are at a similar level and provide honest, constructive feedback.
CST Interview Courses: Attend as many group interview courses as possible. Put yourself under pressure, observe how other candidates answer, and incorporate useful tips into your own technique.
Supplementary Resources
In addition to the provided question bank, these resources can further enhance your preparation:
ATLS Manual
CCrISP Handbook
Oxford Handbook of Surgery
BMJ Best Practice
NICE Guidance
MRCS Revision Resources
CST Surgical Interview Courses