Clinical Mock 4 – updated for 2026
Candidate Instructions
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.
Clinical Vignette
You are the orthopaedic FY2 on ward cover. You have been called to review an 84y/o woman on the ward. She was admitted yesterday having fallen and suffered a fractured neck of femur, which was repaired earlier today. She returned to the ward from theatre about three hours ago. The nurses say she has recently become confused and is shouting out for ‘Jonathan’.
Her observations are:
HR 110bpm
BP 85/59mmHg
SpO2 93% on room air
RR 22bpm
Temp 37.4C
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
- Reflective practice
- Working under pressure
- Global rating
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 5 minutes on each of the three 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.
Clinical Judgement and Decision Making
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Click the tab above to reveal questions.
- Describe how you would review this patient.
- How can you minimise the patient’s risk of harm to herself?
- Who else might you speak to for help with managing this patient?
Answer Frameworks
Click each tab to reveal the answer frameworks.
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Describe how you would review this patient.
– Post-operative confusion is a common presentation, especially in frail and elderly patients. You may not know all the differentials to this, but being able to verbalise a methodical and safe approach will score you highly. Remember, this is not primarily a test of your clinical knowledge; this is an interview to assess a much wider range of skills.
– History: A good answer will start with a review of the patient’s past medical and social history to understand what this patient’s baseline cognition is. In contrast, a weak answer would rush straight into the examination of the patient. An outstanding answer would list specific concerns about the patient’s history that would inform your assessment of the acutely: history of dementia, any missed medication for dementia, use of hearing aids or glasses that have not been fitted back on to patient, omission of regular analgesia, addition of new classes of analgesia, diabetic patient with prolonged fasting, patient normally independent vs. fully dependent in nursing home etc. You do not need to memorise or come up with such an extensive list in your interview, but do need to demonstrate some breadth of thinking!
– You should also ask the patient who ‘Jonathan’ is, as you may be able to allay her anxieties or identify her concern from the outset.
– Examination: ABCDE approach with focus on any injuries the patient may have sustained in their confused state, any sign of infection, and patient’s cognition (AMTS, GCS). Follow the ‘Look-Feel-Listen-Measure-Treat’ structure to each element of the A to E.
– For a gold-medal answer, you could mention looking at the patient’s anaesthetic chart to see if anything was given intraoperatively that could contribute to post-operative confusion, such as Ketamine. The patient may have had a spinal anaesthetic with a fascia-iliaca block without any regular analgesia – this may have since worn off and left the patient in excruciating pain.
– Treatment: The patient’s findings and observations suggest she may have a LRTI. Review CXR and commence antibiotics as per trust guidelines if there is consolidation. Patient may also be suffering from hypoventilation and basal atelectasis, which is common post-operatively. They should be seen by physiotherapists to improve deep breathing and prevent development of LRTI.
How can you minimise the patient’s risk of harm to herself?
– De-escalation techniques: talk to patient, re-orientate patient, and find out if ‘Jonathan’ can feasibly sit with patient or talk to her virtually.
– Reverse any reversible causes: hearing aids, glasses, pain or unintended over-sedation
– If patient requires constant reassurance, they may need a one-to-one or ‘special’, where a healthcare assistant sits with the patient all the time.
– Consider lowering the patient’s bed to nearly floor-level to minimise their risk of falls. Use of padded bed rail covers minimises their risk of sliding out between the rails or hitting the rails and injuring themselves.
Who else might you speak to for help with managing this patient?
– Matron or nurse in charge: patient would be best monitored in a bed space easily observed from the nursing station and should not be isolated.
– Ward nurse: may be able to tell you timeline of patient’s deterioration and if it correlates with any specific events. They may also have had contact with the patient’s family or carers and be able to provide a comprehensive social history.
– Physiotherapist or occupational therapist: may offer useful advice on how to keep the patient as safe as possible during their acute confused state.
– Pain team: if you suspect that underlying cause of patient’s delirium/ confusion is pain.
– FY1 colleague: delegate task of fact-finding (patient’s medical, drug and social history) or to speak to the patient’s next of kin.
– Orthopaedic and medical registrars: for any escalation of care if you have concerns about the aetiology of this patient’s confusion or management
Airway | Look | Patient as patient is obviously vocalising |
| Feel | N/A |
| Listen | N/A |
| Measure | N/A |
| Treat | N/A |
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Breathing | Look | No cyanosis, bilateral chest rise |
| Feel | Equal but shallow chest rise |
| Listen | Bibasal crepitations |
| Measure | – SpO2 93% on room air. RR 22 |
| Treat | Start oxygen via nasal canulae |
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Circulation | Look | Nil abnormalities |
| Feel | Warm to touch, regular pulse |
| Listen | No added heart sounds |
| Measure | – Capillary refill 3 seconds. Tachycardic and hypotension |
| Treat | – Large bore IV access, blood samples (blood cultures, FBC, U&E, LFT), VBG |
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Disability | AVPU | Alert. GCS E4 V4 M6 |
| Blood glucose | 5.1 mmol/L |
| Pupils | Equal and responsive to light |
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Exposure |
| Clean wounds |
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Reflective Practice
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Click the tab above to reveal questions.
- Do you think there is stigma around mental health in the workplace?
- What do you think about checklists in anaesthesia?
- Do you think there is stigma around mental health in the workplace?
Prompt: Do you think patient mental health issues are stigmatised? What can you do to reduce stigma around mental health in your workplace? - What do you think about checklists in anaesthesia?
Prompt: Are there any weaknesses or issues with using checklists?
Answer Frameworks
Click each tab to reveal the answer frameworks.
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Do you think there is stigma around mental health in the workplace?
– However you answer this question, you should bring it back to yourself. You may choose to talk about how you have campaigned for improved mental health support in your department or how you maintain good professional relationships so that you can support colleagues.
– Give a succinct example of how you bring a positive attitude to mental wellbeing at work and what you do to maintain your own mental wellbeing while balancing the stressors of work.
– Do not forget that there can be stigma around mental health issues for both patients and staff! In this case, if the patient’s post-operative confusion is not correctly identified and is instead stigmatised, the patient could have come to real harm.
What do you think about checklists in anaesthesia?
– Checklists are a big part of ensuring safe practice in anaesthesia and in the wider context of theatres. It provides essential prompts in an acute situation (eg. emergency intubation checklist) and ensures all steps are followed in routine procedures (eg. WHO theatre checklist).
– Talk about checklists that you know of and why they are important.
– Useful as they are, they should not remove independent clinical thinking and decision-making. They are therefore dangerous if used as rigid instructions rather than mental prompts.
Working Under Pressure
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Click the tab above to reveal questions.
- The nurses call you a few hours after you review the patient. She is becoming increasingly uncooperative, pulling off her oxygen mask, and not allowing nurses to carry out their clinical observations on her. How would you proceed?
- How do you unwind after a long or stressful day at work?
- How can we make hospitals more friendly to patients who have poor cognition or special needs?
- What do you think would make a good team with regards to the management of this patient?
Answer Frameworks
Click each tab to reveal the answer frameworks.
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The nurses call you a few hours after you review the patient. She is becoming increasingly uncooperative, pulling off her oxygen mask, and not allowing nurses to carry out their clinical observations on her. How would you proceed?
– This situation demonstrates an escalation in the patient’s agitation with some signs that she may be becoming a greater danger to herself.
– Call for help: escalate this to your registrar as this patient may no longer be in an appropriate location for their clinical needs and it sounds like this patient may require more than one pair of hands to enable a meaningful evaluation of their current clinical status.
– You should aim to carry out an ABCDE assessment as pragmatically as possible so that the patient is not further agitated but that at least allows you to assess their oxygen requirements. Do not forget that hypoxia
– Consider speaking to the medical registrar, ITU registrar and outreach nurses for help. If this patient’s agitation is severe, they may require a transfer to HDU or ITU for higher levels of care including sedation and invasive ventilation.
– These situations are tricky in real life and so the interviewers would not expect a straightforward answer from you! Demonstrate that you are weighing up the benefits of keeping the patient in their current ward, which is less busy than a HDU or ITU setting versus the patients potential need for escalated care that is not sufficiently managed on a surgical ward.
How do you unwind after a long or stressful day at work?
– This question is deliberately open-ended to give you an opportunity to tell them something about yourself that you haven’t yet been able to highlight. Any extracurricular activities can be highlighted in your answer here.
– You should also reflect on why these activities are helpful in helping you unwind, and of the importance of having interests outside of your primary job.
– Consider the importance of maintaining a good work-life balance to prevent burnout, and how non-medical interests can help you develop skills that make you a better doctor.
– A poor answer simply states, ‘I go for runs to keep fit after long days at work’. Compare this to an outstanding answer such as, ‘After a stressful day at work, I often feel the need to expend some energy or let steam off. I enjoy running to help me clear my mind and the act of exercise itself makes me feel so much better afterwards. I find that I sleep and rest better, and concentrate well at work when I run regularly. I’m currently preparing for the Brighton half-marathon – I’ve never done anything like this before, but I thought I’d challenge myself this year! I think it’s really important for doctors to pursue other interests as otherwise work can really grind you down and lead to burnout. We’re all human and finding the things that help us refuel and rest is just as important as all the other work we do when we see our patients.’
How can we make hospitals more friendly to patients who have poor cognition or special needs?
– As with other similar questions, the actual ‘list’ of attributes you give is not where the bulk of your score lies. It is how you reflect on the importance of the points you listed and any examples you can give of your own experience that made you highlight those particular points in your interview.
– You should consider ‘forget-me-not’ signs above the beds of patients with dementia to remind staff that the patient may not fully communicate their needs.
– Similar signs indicating a patient’s use of hearing aids, glasses, specific preferences are also used in some trusts
– In patients who require frequent admission, they may come with ‘hospital passports’. Similarly, patients from care homes are usually admitted with a booklet detailing their preferences and needs. These resources should be referred to in order to inform a patient’s medical care plan.
– Other strategies include clocks with dates and time of day, positioning of bedspaces close to windows, daily communication with patient to orientate them. There is a fairly extensive list – whichever few examples you pick, you should reflect on them and provide real life examples from your own practice.
What do you think would make a good team with regards to the management of this patient?
– Most candidates are likely to come up with a list of things that make a good team in general – this is a good starting point: communication, good working relationships, clear definition of roles, clear lines of escalation, having the same goal, good leadership, are just some of the aspects of a good team.
– As with other similar questions, the actual ‘list’ of attributes you give is not where the bulk of your score lies. It is how you reflect on the importance of the points you listed and any examples you can give of your own experience that made you highlight those particular points in your interview.
– With regards to this case, communication between team members is critical as this patient is unlikely to communicate her needs to the team clearly. The team should also be consistent in their approach to and care of this patient to minimise disruptions. Any known care needs should be handed over clearly
– A poor answer would merely list attributes of a good team. An outstanding answer would reflect and evidence the attributes on their list, for example, ‘Communication is especially important in making a good team for this patient. In my practice, I have found that when patients are confused or unable to communicate their needs well, the information handed over between colleagues becomes even more vital to our ability to care for the patient’.
– Remember that this is an interview, not a test – you should use every opportunity to bring your answers back to yourself!
Examiner Feedback
| Decision making | Reflective practice | Working under pressure | Global rating |
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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’ . Both of you will benefit from constructive criticism. Think of any way your partner may be able to improve. Reciprocal constructive feedback is the key.