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CST · Two clinical scenarios

CST clinical station: priorities, decisions and escalation

In the confirmed 2027 format each five-minute clinical answer is assessed for clinical knowledge, judgement under pressure and communication. Start with physiology and the immediate threat, then explain your decisions.

Last verified: 6 October 2026Parent guide: CST

Two five-minute clinical scenarios and the 0–6 assessed elements are confirmed for 2027. These original prompts are practice, not recalled questions. Teaching additions: sources checked on 13 October 2026; the inherited article retains its existing verification date.

ContentsHow to approach it

How to approach it

What a strong answer needs to show

Find the unwell patient

If physiology is abnormal, lead with immediate assessment and resuscitation.

  • Use ABCDE, observations and repeat assessment in an unstable postoperative patient.
  • Call for help early, including surgical registrar and anaesthetics/critical care where appropriate.
  • Initiate access, bloods, blood products or antibiotics according to clinical findings and local protocol.

Say what changes management

The interviewer needs your working diagnosis and the decision point, not an exhaustive list.

  • Link investigations to questions: bleeding, sepsis, obstruction, ischaemia or complication.
  • Reassess response to treatment before discussing theatre, scan or ward-level observation.
  • Explain who makes the definitive operative decision and what you will communicate.

Use the final minute well

A five-minute answer must have a clear order and named escalation.

  • Summarise risk, initial actions and the next time-sensitive decision.
  • If two patients are unwell, allocate another clinician and hand over the second risk.
  • Avoid sounding scripted: respond to new vitals or results rather than finishing a memorised differential.

Fictional case: make your concern and your first action explicit

A patient six hours after laparotomy becomes pale and tachycardic, with falling blood pressure and fresh blood in the drain. You are the early core trainee called to the ward. These invented findings suggest bleeding and deterioration, without establishing the source or definitive treatment.

  • Link your concern to those findings. Arrange immediate assessment and urgent surgical senior help, using the hospital emergency response where indicated. Begin assessment and initial care within competence while help is coming.
  • Explain what you need to clarify from the examination, observation trends, operation and treatment already given. Select information that changes the next decision rather than listing every postoperative complication.
  • Make the request to the senior specific: the patient’s present state, the concern, care underway and the decision or bedside help needed. An early core trainee should not promise independent definitive surgery.

Reassessment needs a question to answer

An improvement in one observation does not establish that the underlying problem has resolved. A useful explanation connects the response to care with the next clinical assessment and senior decision.

  • Ask what has improved, what concern remains and what would change the plan. Imaging or definitive treatment depends on the whole picture and senior assessment; neither is an automatic next step for every postoperative deterioration.
  • Clinical principles checked on 13 October 2026 against Resuscitation Council UK’s ABCDE approach; supervision checked against the ISCP core curriculum. This lesson concerns recognition, reassessment and escalation, without doses or a universal operative plan.

Original practice questions

Questions worth practising aloud

These are original preparation prompts written around published domains and entry-level expectations. They are not recalled interview questions.

  1. A patient six hours after laparotomy is pale, tachycardic and has new blood in the drain. What happens in your first few minutes?
  2. A patient with abdominal pain and vomiting becomes hypotensive while waiting for imaging. Explain the reassessment and who you call.
  3. The ward reports fever and confusion in a patient two days after bowel surgery. How do you prioritise resuscitation, source control and escalation?
  4. A trauma referral arrives while you are reviewing a deteriorating inpatient. How do you delegate and communicate both risks?

Common mistakes

Where otherwise good answers lose clarity

  • Ordering a scan before stabilising an unstable patient.
  • Naming a complication without explaining what would confirm or refute it.
  • Promising unsupervised CT1 surgery.
  • Saying 'escalate' without naming the senior or urgency.

Preparation plan

How to practise this deliberately

  • Practise an ABCDE opening in under 45 seconds.
  • Use a five-minute clock with new information introduced halfway through.
  • Summarise the patient and the ask to a simulated registrar.
  • Review local escalation pathways and current surgical acute-care teaching.

Continue into practice

Practise the answer, not just the reading

Spoken CST practice is launching soon. At launch, choose a Question bank prompt, work on your answer and use structured feedback to improve it. Explore the practice experience while you prepare with these free questions.

Explore CST practice

Official source

Check the live recruitment guidance

Interview formats can change between cycles. This focused guide should be used alongside the official source below and the full CST guide.

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