Introductory and specialty related questions
- Could you give me a brief overview of your professional background and what led you to apply for this position?
- How would you define yourself in terms of your skills, accomplishments, and career aspirations?
- Tell me about your most significant achievements to date and how they relate to the role you are applying for.
My name is Samuel Rodriguez, I am currently working as an SHO in Acute Medicine in Cambridge [mention your trust if you like].
I graduated from the University of Sao Paulo in 2011.
I have completed my medical school in Brazil and have completed my internship there as well. I also did an elective rotation in neurology during my internship. In my current trust, I am working in the trust where we cover the acute medical ward as well as the ambulatory care unit.
Since the beginning of my career, I have thoroughly enjoyed my experience in medicine because of the analytical and communication challenges they provide, and this is the reason I am applying for training in medicine.
I have also worked as a clinical tutor, teaching basic clinical skills such as history taking, examinations, and communication skills to undergraduate students. That job helped me in brushing up my teaching skills which I am eager to carry forward. It enhanced my confidence, and I discovered a new aspect of my personality interacting with students and I am looking forward to train myself further by attending the “train the trainers” course this year.
I am involved in 3 QIP projects. I have led my own project that brought a significant change [mention the outcome briefly here] and played a significant role in the other 2 which are still going on.
I am currently participating in three QIP projects. I spearheaded one of the projects, which resulted in a significant positive impact [briefly mention the outcome], and I have also played an important role in the other two ongoing projects.
Speaking from a personal standpoint, I consider myself to be an honest, dependable, and highly cooperative individual, which is reflected in my MSFs. As for my hobbies, I enjoy a variety of activities, but my favorite pastime is [insert your favorite hobby here].
[Please take note that the candidate’s response is both clear and succinct. Observe the structure of the answer, where the candidate first introduced himself and provided a brief overview of his current position in one sentence. Then, he proceeded to explain his background and expeditiously transitioned into why he has a passion for medicine. The candidate also outlined his skills in an organized manner, starting with the most important one. He briefly addressed all areas mentioned in his actual application and provided evidence to substantiate his claims where possible. Furthermore, note that the candidate concluded his answer on a personal note. If you follow this structure, you can avoid giving interviewers any prompts, which is not ideal and can lead to a poor outcome.]
To see more similar questions and understand the do’s and dont’s of this section:
Common Clinical Questions
36-year-old man admitted with productive cough and fever for 3 days. His blood results show high white cell count and raised creatinine. His NEWS is zero with BP of 127/67 mmHg, HR 70/min, Oxygen saturation of 94% on Room air, RR 16/min, Temp 37.1 degrees. How will you manage this case?
This is a 36 years old male who presents with a history of fever and productive cough that has lasted for three days. I plan to take a detailed history of his presenting complaints, including the onset, duration, progression, and relief of fever and cough, as well as any associated symptoms. Additionally, I will gather more information through the patient’s past medical history, including any comorbidities (especially if the patient is young), current medications, family history of chest infections, smoking habits, travel history, occupational history (e.g. exposure to fumes from working as a painter), and social history (e.g. living arrangements in a hostel or shared living space with multiple other people).
Next, I will perform a general physical examination of the patient, starting with his hands to look for any signs of tar staining, CO2 narcosis, perfusion status, or clubbing. I will also assess his pulse rate, rhythm, and character, and examine his face for signs of anemia, dehydration, or central cyanosis. Additionally, I will look for palpable lymph nodes and assess if his JVP is raised or not. Then, I will perform a focused respiratory exam, inspecting for any scars, chest wall asymmetry, or changes in respiratory rate. On palpation, I will check for tracheal deviation, chest expansion, and vocal fremitus, and percussion to identify any areas of hyper-resonance or dullness. Lastly, I will auscultate his breath sounds for the presence or absence of wheezing or crepitations.
Given the patient’s symptoms, I would like to order basic blood work, including FBC, CRP, U&E, LFTS, CXR, and ECG. I would also like to test for HIV and TB (Acid Fast Bacilli) to investigate the cause of the patient’s pneumonia. However, before proceeding with the HIV test, I will obtain the patient’s consent. At this stage, my differential diagnoses include typical and atypical pneumonia, lower respiratory tract infection, and infective exacerbation of asthma (if the patient has a history of asthma).
[If the examiners provide you with further information, you will update your differential diagnosis and list of investigations accordingly].
Finally, I plan to start the patient on antibiotics according to hospital guidelines, calculate the CURB-65 score (with attention to diastolic blood pressure), and admit the patient if the score indicates the need for hospitalization.
While you answer the question, the examiner or judge may complicate the above scenario by adding additional details:
A. If a nurse were to inform you that a patient’s blood pressure has dropped to 84/45 mmHg and their heart rate is 120 beats per minute, what steps would you take in this situation?
As the patient’s condition has become unstable, I will now switch to the ABCDE approach and tailor my management to each step. Since the patient is both hypotensive and tachycardic, I suspect they are in shock, most likely septic shock given their infection. To address this, I will immediately administer bolus intravenous fluids and consider following the SEPSIS 6 protocol, which includes early recognition, antibiotics, fluid resuscitation, blood cultures, measure lactate, and urine output. Additionally, I will perform a blood gas analysis to gather more information about the patient’s condition. I will also inform my senior and discuss my plan for managing the patient’s unstable condition.
B. If the same patient were to then desaturate and begin breathing at a rate of 40 breaths per minute, with an oxygen saturation of 82% on room air, what steps would you take to address this situation?
Given the patient’s continued instability, I will initiate the ABCDE approach and address each finding accordingly. As the patient is experiencing tachypnea and desaturation, I will administer 15 L/min of oxygen via a non-rebreather mask to maintain oxygen saturation above 94%. Additionally, I will consider potential causes of acute decompensation, such as tension pneumothorax, and perform a thorough physical examination to rule out this possibility (rule out by auscultation and arrange for portable CXR but this should not delay treatment). I will also obtain a blood gas analysis to further evaluate the patient’s respiratory status. It is important to promptly address any potential causes of respiratory distress while simultaneously informing my supervising physician of the patient’s status and discussing my plan of action with them.
[Notice on deterioration the candidate has started ABCDE approach straightaway].
C. If, after the above situations, a blood gas was performed and showed type 1 respiratory failure with a pO2 of 7.0 kPa, what steps would you take next to manage the patient’s condition?
I will initiate oxygen therapy to achieve adequate oxygen saturation above 94%. Additionally, I will perform a comprehensive ABCDE assessment to further evaluate the patient’s clinical status.
For more questions and to understand how to approach clinical station with various presentations:
Rare Clinical Questions
A 31-year-old gentleman admitted with loose stools. He looks very tired and you noticed him having dry lips.
A. He is recently returned from cruise trip in Mexico. He is vitally stable, and his blood are normal. Kindly give your D/D with reasoning and treat the patient.
As the patient’s condition is currently stable, I will proceed with taking a detailed history of his loose stools [using the ODIPARA method]. I will inquire about any associated symptoms such as abdominal pain, vomiting, fever, rashes, joint pains, or blood in the stools. Additionally, I will obtain information about the patient’s past medical history, current medications, occupation, and whether any other family members are experiencing similar symptoms.
To determine if the patient’s recent travel to Mexico is correlated with his symptoms, I will ask specific questions about the duration of his stay, the activities he engaged in, and the food he consumed. Furthermore, I will conduct a thorough physical examination of the patient. Although his blood tests seem normal, the information provided suggests that he may be dehydrated.
Therefore, I recommend admitting the patient to the hospital for intravenous (IV) fluids, stool charting, and stool culture workup. Based on the information gathered so far, the patient most likely has traveler’s diarrhea.
B. He is having shortness of breath for last one month and complains of ongoing lethargy for last six months. How will you approach this scenario, give your differential diagnosis please?
In this case, the patient’s medical history suggests that their symptoms are chronic. To gain a better understanding of their condition, I will conduct a thorough inquiry into their symptoms, beginning with their loose stools. I will ask about the frequency, consistency, presence of blood, weight loss, abdominal pain, and whether or not the stools alternate with constipation. Additionally, I will inquire about any associations between their loose stools and food intake, as well as any other symptoms such as rashes or joint pains.
To investigate the patient’s lethargy, I will ask about the onset and progression of this symptom, as well as any factors that exacerbate or alleviate it. Similarly, I will ask about the patient’s shortness of breath and conduct a detailed examination of their family medical history, specifically looking for any indications of bowel disease or autoimmune conditions.
Furthermore, I will review the patient’s medical history to determine if they have any other medical conditions or are taking any medications that may contribute to their symptoms. I will also examine
For more questions and to understand how to approach clinical station with various presentations:
James is admitted with pneumonia in care of the elderly. He is 87 years old man who is known to have lung ca and is currently on palliative chemotherapy. His son is very unhappy and want him back in his home. How will you proceed?
I will visit the ward and engage with the nursing staff to gather information on the current situation and determine why the patient’s son is dissatisfied. Once I have gained an understanding of the situation, I will approach the patient to inquire about his well-being. During this conversation, I will seek his consent to discuss his medical condition with his son. If he grants permission, I will assess his comprehension and decision-making abilities before proceeding to discuss his condition with his son.
Given the scenario, I understand that the patient is an elderly individual receiving palliative chemotherapy for lung cancer and is currently hospitalized with pneumonia but has the capacity to make decisions. If the patient consents, I will arrange to speak with his son in a private setting and temporarily hand over my bleep to a colleague if I carry one. Additionally, I will request the presence of nursing staff during this conversation. I will address any questions the son may have and provide appropriate answers.
A. At this point interviewer tells you; Son is terribly upset that my dad is left to die and would prefer him to be taken home, how are you going to proceed?
B. Interviewer tells you that son is still insistent to take him, then what are you going to do about it?
C. Interviewer says that father want to leave as well, how are you going to proceed then?
Although I believe it may not be the best decision, I will adhere to the principles of the Mental Capacity Act and respect the patient’s wishes if he chooses to be discharged against medical advice. I will discuss this decision with my senior colleagues and ensure that the patient signs a discharge against medical advice form. Additionally, I will ensure that the patient completes the full course of antibiotics and other medications and request his GP to continue monitoring his blood investigations in the community.
[Key points: Consent taken, Capacity (quick assessment), MCA principles (unwise decision)]
To view more similar ethical scenarios and understand the key points involved:
Consider a scenario where you have prescribed 10mg of Amlodipine to a hypertensive patient who has already taken their regular daily dose of Amlodipine 10mg four hours ago, but their blood pressure remains elevated. What would be your course of action in this situation?
Based on the statement provided, it appears to be a prescribing error. My primary concern would be to ensure that the medication has not been administered and that it has been removed from the patient’s medication chart. If the medication has already been administered, I will assess the patient’s well-being and consult with the pharmacy to determine any necessary measures.
Additionally, I will inform my senior colleague of the situation. I will then communicate with the patient and provide an apology for the error. I will explain what actions are being taken to rectify the situation and offer appropriate remedies as part of my duty of candour. If the patient wishes to file a complaint, I will provide them with the necessary guidance. I will ensure that the incident is appropriately documented and that my nursing colleagues are informed. Finally, I will complete a Datix form for the incident.
[Key points: Patient safety, Duty of candour, Datix]
A. What is duty of candour?
As part of the duty of candour, healthcare professionals are expected to be transparent with patients in case something goes wrong during their treatment. This includes:
- Communicating any mistakes to the patient or their advocate, carer, or family, as appropriate.
- Offering an apology to the patient.
- Providing a reasonable solution to rectify the situation, if possible.
- Fully explaining to the patient, the immediate and potential long-term effects of the mistake.
To learn more about difference between ethics and professionalism as well as to practice various presentations:
How would you describe clinical governance? In what ways do you think clinical governance has impacted patient safety?
Clinical governance is an essential process that focuses on improving patient safety and the quality of healthcare. It is a framework that includes a range of activities that clinicians should be involved in to maintain and improve the quality of care and ensure the full accountability of the healthcare system to patients. In other words, clinical governance is a quality assurance process designed to ensure that standards of care are maintained and improved.
The clinical governance framework consists of seven pillars, each with its own set of objectives and activities. The first pillar is patient and public involvement, which involves engaging patients and the public in the design and delivery of healthcare services. The second pillar is IT, which aims to use technology to improve patient care and support clinical decision-making. The third pillar is risk management, which involves identifying and managing risks to patient safety. The fourth pillar is audit, which aims to monitor and evaluate the quality of care being delivered. The fifth pillar is training, which aims to ensure that clinicians are adequately trained and competent to deliver high-quality care. The sixth pillar is effectiveness, which involves measuring and improving the outcomes of healthcare interventions. Finally, the seventh pillar is staff management, which aims to ensure that staff are appropriately skilled, supported, and motivated to deliver high-quality care.
Overall, clinical governance has improved patient safety and the quality of care provided by the NHS. By focusing on the seven pillars, clinical governance ensures that healthcare providers are accountable for their actions, that patient safety is prioritized, and that high standards of care are maintained and continuously improved.
[At minimum, a candidate answering this type of question should have a basic understanding of the definition of clinical governance and be able to list some of its pillars.]
To learn what other type of questions can be asked under governance and practice such questions: