Clinical Mock 7 – updated for 2024
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 SHO in the Emergency Department. You are asked to see a 28 year old man who has presented with dizziness. He is otherwise fit and well. The triage nurse asks you to review him in the triage bay urgently because his observations are abnormal.
His observations are:
HR 180bpm
BP 90/62
SpO2 99% on room air
RR 31bpm
Temp 36.8C
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
- 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.
Decision Making
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Click the tab above to reveal questions.
- How would you approach this situation?
- [If not already mentioned by candidate] What is the most appropriate area for this patient to be treated in?
- What signs or symptoms would prompt you to escalate this patient’s care?
- What would you do if this patient suddenly became unresponsive while you were in the midst of your initial assessment?
Answer Frameworks
Click each tab to reveal the answer frameworks.
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How would you approach this situation?
- Review patient’s notes for any history of decompensation such as syncope.
- Examination: ABCDE. Follow the ‘Look-Feel-Listen-Measure-Treat’ structure to each element of the A to E.
- Call for help! This patient is tachycardic and experiencing dizziness. Although he does not have any signs of decompensation requiring immediate electrical cardioversion, he is likely to need prompt treatment for his tachycardia. Your ED registrar should be alerted about this patient as soon as possible.
- This patient should be moved to resus for continuous cardiac monitoring with defibrillator pads placed on his chest while the rest of his assessment and treatment is carried out.
- Throughout your ABCDE assessment, you should mention members of the MDT who you may ask for help from or delegate tasks to. For example, the healthcare assistants may be asked to bring you necessary equipment and carry out a 12-lead ECG while nursing staff may be trained in cannulation and may help to take blood from the patient.
What is the most appropriate area for this patient to be treated in?
- Recall that at the start of this scenario, you are in the triage room.
- This patient should be moved to resus for continuous cardiac monitoring with defibrillator pads placed on his chest while the rest of his assessment and treatment is carried out.
What signs or symptoms would prompt you to escalate this patient’s care?
- This is straight out of the ALS tachycardia algorithm. The four life-threatening features that would prompt you to electrically cardiovert this patient are shock, syncope, myocardial ischaemia, and severe heart failure.
- Any other signs of decompensation or deterioration should prompt you to call for help and escalate this case to a senior in your team.
What would you do if this patient suddenly became unresponsive while you were in the midst of your initial assessment?
- Call for help immediately.
- Check for a pulse and commence CPR if there is no central pulse felt. Begin a timer.
- If patient remains tachycardic with a palpable pulse, attach defibrillator and deliver a synchronised DC shock if the patient is in a shockable rhythm (which is highly likely the case if they have a palpable central pulse). Begin a timer. Declare the emergency and that the patient must be moved to a place of safety (resus) as soon as practicable.
- For more detail on the ALS Tachycardia Algorithm: https://www.resus.org.uk/sites/default/files/2021-04/Tachycardia%20Algorithm%202021.pdf
Airway | Look | No obvious obstruction |
Feel | Breath is felt from patient’s mouth | |
Listen | No added noises | |
Measure | N/A | |
Treat | Patent airway, nothing to treat | |
Breathing | Look | No cyanosis |
Feel | Equal bilateral chest movement | |
Listen | Normal breath sounds throughout | |
Measure | – SpO2 99% on room air. RR 31bpm. | |
Treat | No current indication to treat breathing | |
Circulation | Look | Flushed skin |
Feel | Warm peripheries, regular pulse. No peripheral oedema | |
Listen | Difficult auscultation | |
Measure | – Capillary refill 2 seconds. HR 180bpm, BP 90/61mmHg | |
Treat | – Large bore IV access, blood samples (Troponin, FBC, U&E, CRP, LFTs), VBG | |
Disability | AVPU | Alert. GCS 15/15 |
Blood glucose | 7 mmol/L | |
Abdomen | No abnormalities | |
Pupils | Equal and reactive to light | |
Exposure | Look | No abnormalities |
Feel | No abnormalities | |
Treat | N/A |
Team Working
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Click the tab above to reveal questions.
Don’t need to explicitly ask if already demonstrated in other part of interview.
- What team members would you like to involve in the management of this case and what roles could they play?
- Who do you think should lead a cardiac arrest and why?
- Have you ever had to lead a high-pressure situation and how did you deal with it?
Answer Frameworks
Click each tab to reveal the answer frameworks.
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What team members would you like to involve in the management of this case and what roles could they play?
- Senior ED colleagues (ED Registrar or consultant): to advise about management of the patient.
- Junior ED colleagues: to help with scribing and carrying out practical tasks related to patient care.
- ED nurses and healthcare assistants: help with attaching patient monitoring, cannulation, blood-taking, or processing a VBG sample.
- Outreach nurse specialists: often valuable facilitators in the management of acutely unwell patients who can offer practical and some clinical help.
- Porters: to help physically transfer the patient to a monitored bay (most likely resus).
- Cardiology registrar: their presence is not immediately indicated. However, in a young patient with what appears to be a tachy-arrhythmia without any other underlying cause, it is likely they will require cardiology follow-up.
Who do you think should lead a cardiac arrest and why?
- There is no one right answer to this question. In some situations, the responsibility to lead a cardiac arrest falls to the most senior person attending (e.g., Medical or ED registrar). However, this is not always true. For example, medical consultants may be present in cardiac arrests but do not lead the arrest itself.
- A cardiac arrest may also be appropriately led by the doctor who was first to the scene (often a foundation doctor or SHO) as they may have a better understanding of the situation and thus be best placed to lead the whole team. This minimises the risk of misinformation or information loss through multiple handovers in an acute situation.
- Whoever leads the situation must be ALS certified, be clear that they are leading the arrest, stand back from the patient, communicate to all team members clearly, and delegate tasks appropriately.
- Leading a cardiac arrest does not necessarily mean that they would have to be the most knowledgeable person in the room. Rather, they should be able to draw on everyone’s knowledge and skills in the room to deliver the best care for their patient. The best leaders often ask their team members for their ideas!
Have you ever had to lead a high-pressure situation and how did you deal with it?
Do not get tunnel vision due to the scenario you have been presented. High-pressure situations are not confined to acutely unwell patients or cardiac arrests. You may also have had to take the lead on a high-pressure family discussion, project, teaching programme, or interaction and conflict with colleagues.
You should aim to spend no more than 30 seconds on describing the pressure of your situation and the rest of your answer on how you overcame the pressure. Reflect on how the pressure made you feel or react.
Your interviewers will be keen to hear about what tools you use to deal with stepping up to leading under pressure. Some tools to deal with leading high-pressure situations include asking for appropriate help, going back to basics (e.g., ABCDE with an acutely unwell patient; information-seeking instead of blame in a conflict), communicating clearly, drawing on the rest of your team’s talent and skill to overcome a problem, and being open to suggestions from other team members.
Working Under Pressure
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Click the tab above to reveal questions.
- What aspects around the management of an acutely unwell patient make you feel stressed?
- How do you unwind after a long or stressful day at work?
Answer Frameworks
Click each tab to reveal the answer frameworks.
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What aspects around the management of an acutely unwell patient make you feel stressed?
- This question presses you for insight into things that make you feel stressed in a clinical setting.
- There is no right answer as the interviewers will be looking out for honesty and clarity.
- Some things that trainees at the SHO level find stressful include: Stepping up to lead the management of a patient while feeling ‘unqualified’ for the role, juggling leading other team members and decision-making, being unsure about their own clinical judgement, being worried about misdiagnosing an acutely unwell patient, stepping into unknown or new clinical territory, or carrying out practical procedures in an acutely unwell patient (e.g., venepuncture or cannulation).
- You should talk about how you identify that you are becoming stressed and how you manage this stress so as not to impair your clinical performance.
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.’
Examiner Feedback
| Decision making | Team working | 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.