AST Clinical station template_test_220721
Instructions for the Clinical Station
This is your Clinical Interview. You have 2 minutes to read the following clinical vignette. After this, you will be allocated 15 minutes for your clinical interview.
Examiner Instructions
Examiner instructions:
This mock contains more questions than you will be able to go through in a 15-minute interview. This is reflective of the real interview where interviewers are given an option of a few questions they can ask the candidates in the 15-minute time frame. Questions in red are mandatory.
You should choose a range of questions over the course of the 15 minutes that will enable you to assess the candidate on the following four domains: decision-making, team-working, working under pressure, and reflective practice.
It is your duty to keep track of time so that you are able to ask a reasonable spread of questions that allow the candidate the opportunity to score points in all four domains. Aim to spend about 3.5 minutes on each of the four assessed domains.
You can only ask the questions verbatim, as they are written. You may repeat the question if the candidate seeks clarification. For the ABCDE assessments, you may confirm findings with the candidate (for example: yes, the airway is patent. Or ‘there are no added breath sounds to auscultation).
Mandatory question at start of interview:
“Have you read and do you understand the clinical vignette?”
Proceed to interview once candidate has confirmed this.
Decision Making
☝️
Click the tab above to reveal questions.
- What challenges do you anticipate you will encounter in this case?
- How would you assess this patient?
- [If candidate mentions measuring amylase] The patient’s amylase comes back as raised. What would you do next?
- The patient continues to scream in excruciating pain. How would you address this?
- When would you call for help from your registrar?
Answer Frameworks
Click each tab to reveal the answer frameworks.
👈
What challenges do you anticipate you will encounter in this case?
– Patient safety: true surgical abdomen vs drug-seeking behaviour
– Who: ED Registrar is pushing his own agenda for quick discharge of the patient. May be difficult interaction if you do not agree with his assessment of the patient
– Where: ED can be busy, so communication with nurses and the wider teams involved may be impacted. Be mindful of communicating plans to all relevant people and patient, and document clearly in the patient’s notes.
How would you assess this patient?
History and examination/ investigations, Escalation + Case-specific
Case specific: Do not come with assumptions! May need escort or witness if there are concerns about patient’s behaviour towards staff.
History: read notes before seeing patient. Find out what, if any, investigations have been carried out so far. Speak to patient to take full history about his abdominal pain. This is his third presentation in three days and you must be able to rule out causes of an acute abdomen before putting this down to drug-seeking behaviour. Some differentials you are concerned about include: pancreatitis, gastric or duodenal ulcer perforation, acute liver failure.
Examination: ABCDE. Follow the ‘Look-Feel-Listen-Measure-Treat’ structure to each element of the A to E.
Click the ABCDE framework below for a full answer.
Investigations: ABG (for lactate, PaO2, PaCO2, blood glucose), CXR, ECG, Bloods + IV Access, CT scan. For this patient, serum Amylase and CT-abdomen should be mentioned.
Escalation: Discuss case with surgical registrar to ensure you have not missed any important investigations. Agree to call them back if patient deteriorates or requires further reviews from a senior.
[If candidate mentions measuring amylase] The patient’s amylase comes back as raised. What would you do next?
This is in keeping with likely acute pancreatitis. Always verbalise clearly what your differentials are or what you are treating.
- IV fluid resuscitation
- Maintain saturations >94%
- Analgesia – usually requires IV opioids
- CT-abdomen (if not already mentioned)
The patient continues to scream in excruciating pain. How would you address this?
Seek information: ask patient about nature and severity of allergic reaction. Look through patient’s notes or GP letters for confirmation of this
Decision: in absence of any evidence refuting the patient’s claims, should treat patient as though they do have an allergy.
[If candidate has recognised likely acute pancreatitis] Consider IV morphine as there is an identified organic cause for patient’s pain. It would be negligent not to treat the patient’s pain.
When would you call for help from your registrar?
Clinical: any abnormal results OR no abnormal results but patient continues to be in severe pain. As an SHO you should not be making decisions to discharge patient’s from ED without senior review.
Non-clinical: if communication with ED registrar becomes difficult, or if patient’s behaviour escalates to aggression towards staff
Airway |
patent, as patient is vocalising clearly |
Breathing | observations do not suggest any immediate breathing issue. Auscultate as basal pneumonia may present with similar pain. |
Circulation | hypertensive and tachycardic. May be due to pain or underlying cardiac pathology. Examine for capillary refill time. Auscultate heart sounds.
|
Disability | Patient is Alert on AVPU scale. Formally assess GCS. Examine pupils and blood glucose.
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Exposure | Patient has needle track marks, distended abdomen and tender epigastrium. |
Team Working
☝️
Click the tab above to reveal questions.
Don’t need to explicitly ask if already demonstrated in other part of interview.
- You have ordered a few investigations but the results are taking a long time to come back. The ED registrar wants you to discharge the patient and call the patient back if any results are abnormal. What would you do?
- Who else might you ask for help in managing this case?
Answer Frameworks
Click each tab to reveal the answer frameworks.
👈
You have ordered a few investigations but the results are taking a long time to come back. The ED registrar wants you to discharge the patient and call the patient back if any results are abnormal. What would you do?
Seek information: Try to understand why the ED registrar thinks this patient should be discharged
Demonstrate consideration for ED registrar’s opinions: Acknowledge pressures and ED registrar’s concerns
Communicate clearly: Explain why you do not think it would be safe to discharge the patient before results are back due to excruciating nature of pain, and that patient’s social history means that he may be difficult to contact once he is discharged.
Escalate: If ED registrar is not receptive, speak to your surgical registrar and ask them for help to review the patient and re-discuss their plan with the ED registrar
Who else might you ask for help in managing this case?
– Nursing staff: help with regular observations, IV cannulation and bloods
– Security: if patient becomes aggressive toward staff
– Surgical FY1: help order tests and chase results
– Surgical SpR: decision to admit or discharge, if patient deteriorates after immediate management
– Drugs and alcohol liaison team: if patient has no abnormalities on investigation, continues to use drugs or alcohol in excess, and would like help stopping
Working Under Pressure
☝️
Click the tab above to reveal questions.
What challenges do you anticipate you will encounter in this case?
Follow-up questions
2. How would you assess this patient?
3. [If candidate mentions measuring amylase] The patient’s amylase comes back as raised. What would you do next?
4. The patient continues to scream in excruciating pain. How would you address this?
5. When would you call for help from your registrar?
Answer Frameworks
Click each tab to reveal the answer frameworks.
👈
What challenges do you anticipate you will encounter in this case?
Follow-up questions
2. How would you assess this patient?
3. [If candidate mentions measuring amylase] The patient’s amylase comes back as raised. What would you do next?
4. The patient continues to scream in excruciating pain. How would you address this?
5. When would you call for help from your registrar?
How would you assess this patient?
History and examination/ investigations, Escalation + Case-specific
Case specific: Do not come with assumptions! May need escort or witness if there are concerns about patient’s behaviour towards staff.
History: read notes before seeing patient. Find out what, if any, investigations have been carried out so far. Speak to patient to take full history about his abdominal pain. This is his third presentation in three days and you must be able to rule out causes of an acute abdomen before putting this down to drug-seeking behaviour. Some differentials you are concerned about include: pancreatitis, gastric or duodenal ulcer perforation, acute liver failure.
Examination: ABCDE. Follow the ‘Look-Feel-Listen-Measure-Treat’ structure to each element of the A to E.
Click the ABCDE framework below for a full answer.
Investigations: ABG (for lactate, PaO2, PaCO2, blood glucose), CXR, ECG, Bloods + IV Access, CT scan. For this patient, serum Amylase and CT-abdomen should be mentioned.
Escalation: Discuss case with surgical registrar to ensure you have not missed any important investigations. Agree to call them back if patient deteriorates or requires further reviews from a senior.
[If candidate mentions measuring amylase] The patient’s amylase comes back as raised. What would you do next?
This is in keeping with likely acute pancreatitis. Always verbalise clearly what your differentials are or what you are treating.
- IV fluid resuscitation
- Maintain saturations >94%
- Analgesia – usually requires IV opioids
- CT-abdomen (if not already mentioned)
The patient continues to scream in excruciating pain. How would you address this?
Seek information: ask patient about nature and severity of allergic reaction. Look through patient’s notes or GP letters for confirmation of this
Decision: in absence of any evidence refuting the patient’s claims, should treat patient as though they do have an allergy.
[If candidate has recognised likely acute pancreatitis] Consider IV morphine as there is an identified organic cause for patient’s pain. It would be negligent not to treat the patient’s pain.
When would you call for help from your registrar?
Clinical: any abnormal results OR no abnormal results but patient continues to be in severe pain. As an SHO you should not be making decisions to discharge patient’s from ED without senior review.
Non-clinical: if communication with ED registrar becomes difficult, or if patient’s behaviour escalates to aggression towards staff
Reflective Practice
☝️
Click the tab above to reveal questions.
What challenges do you anticipate you will encounter in this case?
Follow-up questions
2. How would you assess this patient?
3. [If candidate mentions measuring amylase] The patient’s amylase comes back as raised. What would you do next?
4. The patient continues to scream in excruciating pain. How would you address this?
5. When would you call for help from your registrar?
Answer Frameworks
Click each tab to reveal the answer frameworks.
👈
What challenges do you anticipate you will encounter in this case?
Follow-up questions
2. How would you assess this patient?
3. [If candidate mentions measuring amylase] The patient’s amylase comes back as raised. What would you do next?
4. The patient continues to scream in excruciating pain. How would you address this?
5. When would you call for help from your registrar?
How would you assess this patient?
History and examination/ investigations, Escalation + Case-specific
Case specific: Do not come with assumptions! May need escort or witness if there are concerns about patient’s behaviour towards staff.
History: read notes before seeing patient. Find out what, if any, investigations have been carried out so far. Speak to patient to take full history about his abdominal pain. This is his third presentation in three days and you must be able to rule out causes of an acute abdomen before putting this down to drug-seeking behaviour. Some differentials you are concerned about include: pancreatitis, gastric or duodenal ulcer perforation, acute liver failure.
Examination: ABCDE. Follow the ‘Look-Feel-Listen-Measure-Treat’ structure to each element of the A to E.
Click the ABCDE framework below for a full answer.
Investigations: ABG (for lactate, PaO2, PaCO2, blood glucose), CXR, ECG, Bloods + IV Access, CT scan. For this patient, serum Amylase and CT-abdomen should be mentioned.
Escalation: Discuss case with surgical registrar to ensure you have not missed any important investigations. Agree to call them back if patient deteriorates or requires further reviews from a senior.
[If candidate mentions measuring amylase] The patient’s amylase comes back as raised. What would you do next?
This is in keeping with likely acute pancreatitis. Always verbalise clearly what your differentials are or what you are treating.
- IV fluid resuscitation
- Maintain saturations >94%
- Analgesia – usually requires IV opioids
- CT-abdomen (if not already mentioned)
The patient continues to scream in excruciating pain. How would you address this?
Seek information: ask patient about nature and severity of allergic reaction. Look through patient’s notes or GP letters for confirmation of this
Decision: in absence of any evidence refuting the patient’s claims, should treat patient as though they do have an allergy.
[If candidate has recognised likely acute pancreatitis] Consider IV morphine as there is an identified organic cause for patient’s pain. It would be negligent not to treat the patient’s pain.
When would you call for help from your registrar?
Clinical: any abnormal results OR no abnormal results but patient continues to be in severe pain. As an SHO you should not be making decisions to discharge patient’s from ED without senior review.
Non-clinical: if communication with ED registrar becomes difficult, or if patient’s behaviour escalates to aggression towards staff
Examiner Feedback
| Decision making | Team working | Working under pressure | Reflective practice |
|---|---|---|---|
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Scoring system:
1 = unsatisfactory
2 = weak
3 = typical
4 = very good
5 = outstanding
See a guide to the scoring matrix section of this question bank.
Feedback Prompts
1. What domains did the candidate give very good or outstanding answers for?
2. What domains do you think the candidate could work on?
3. Please provide feedback on the candidate’s style of interview. Consider their eye contact, body language, pace and clarity of speech. Do they have any tics, habits, or quirks that do not come across well in their interview?
Don’t be afraid to give honest feedback!
It can be tempting to give generic positive feedback to your partner, e.g. ‘that was really good, I wouldn’t change anything’
However it is vital to try your very best to be constructively critical. Think of any way your partner may be able to improve. Reciprocal constructive feedback is the key.