How to approach it
What a strong answer needs to show
Start with the immediate risk
Before discussing policy, establish whether there is a patient-safety, professionalism or staffing problem that needs action now.
- Protect the patient or team first.
- Gather enough information to avoid acting on assumption.
- Escalate early when the risk exceeds your role or authority.
Use proportionate escalation
Escalation is strongest when it is specific and matched to the problem.
- Name the person or role you would involve.
- Explain what you need from them and how urgently.
- Keep documentation, incident reporting and later reflection separate from immediate management.
Show professional communication
Many scenarios involve a colleague who is struggling, behaving poorly or creating risk. Balance support with clear standards.
- Speak privately where appropriate.
- Use factual observations rather than labels or assumptions.
- Do not let concern for a colleague override patient safety.
Fictional scenario: a tired colleague and a prescribing error
A nurse has stopped an incorrect prescription before administration. The doctor who wrote it reports exhaustion and asks you to keep it between yourselves. These invented facts illustrate the difference between caring for a colleague and addressing patient risk.
- Check whether any medicine reached the patient and whether immediate care is required. Arrange appropriate review of the prescription and acknowledge the nurse’s concern. Reporting alone does not provide care.
- Give the duty senior the factual concern and ask for a safe plan for the colleague’s patients and remaining tasks. A promise of secrecy would obstruct that plan. Do not diagnose impairment or decide fitness to work from one conversation.
- Once care is covered, speak privately with the colleague and ask what support they need. Concern for their wellbeing and action on patient safety can proceed together.
Explain why escalation is proportionate
GMC Good medical practice requires compassion towards colleagues while putting patient safety first. Its continuity, delegation and safety-risk duties were checked on 13 October 2026.
- The senior needs to know the observed error, whether the patient was exposed and the doctor’s reported exhaustion. Unsupported labels about motive or health do not improve that information.
- After immediate care and cover are addressed, record relevant facts and follow local incident and concern processes. Establish with the senior team what explanation the patient needs; avoid a blanket claim about a legal candour threshold.
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.
- A colleague appears exhausted and makes a prescribing error that is caught before reaching the patient. What would you do?
- A senior asks you to perform a procedure you do not feel competent to do unsupervised. How would you respond?
- A nurse raises repeated concerns about another doctor's communication with patients. How would you approach this?
- You notice that an important investigation has not been followed up after handover. What would you do now and afterwards?
Common mistakes
Where otherwise good answers lose clarity
- Jumping straight to Datix or formal reporting before managing immediate risk.
- Over-escalating a low-risk interpersonal issue without first clarifying what happened.
- Trying to solve a serious concern alone rather than using senior support.
- Reciting SPIES or another framework without adapting it to the facts.
Preparation plan
How to practise this deliberately
- Practise separating immediate action, communication, escalation and follow-up.
- Use scenarios involving colleagues, consent, capacity, errors, workload and professionalism.
- Say your escalation route out loud rather than leaving it implied.
- Finish with documentation, learning or system improvement only after the acute problem is safe.
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 practiceOfficial 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.