Skip to content
The Interview Bank
Menu
InterviewsSpecialty TrainingNational specialty recruitment interviewsClinical Fellow & Trust GradeLocally employed and fellowship postsConsultantConsultant appointment preparationFree toolsPortfolio & readinessThe MSRA BankResourcesHow it worksSign inExplore interviews

ACCS Emergency Medicine · Clinical / ethical station

Emergency Medicine clinical and ethical interview station

The confirmed 2027 ACCS EM format combines clinical and ethical judgement in a station of up to 10 minutes. Make the immediate risk, safe first actions, use of the team and professional reasoning visible.

Last verified: 6 October 2026Parent guide: ACCS Emergency Medicine

Confirmed 2027 format: one combined clinical/ethical station lasting up to 10 minutes. No official five-plus-five split or detailed scoring anchors are published. All prompts are original and the response structures are Interview Bank advice. Teaching amendments: sources checked on 14 October 2026; the inherited recruitment verification date is retained.

ContentsHow to approach it

How to approach it

What a strong answer needs to show

What the task is actually testing

The 2027 criteria emphasise sound judgement, prioritisation, safety, initial management of acute illness, teamwork and leadership. Ethical reasoning must work inside the clinical and operational reality of the ED.

  • Recognise immediate threats and work within ST1-entry competence.
  • Prioritise when patients, tasks or professional duties compete.
  • Use nursing, senior, specialty and resuscitation support appropriately.
  • Explain uncertainty, reassessment and the threshold for changing the plan.

Structure an unstable clinical answer

Lead with risk and help, then use a clinically appropriate structured assessment. An exhaustive differential before resuscitation usually obscures the decision the station needs.

  • Confirm location and personal safety, call the relevant senior or resus team and allocate roles.
  • Use ABCDE with monitoring, access, focused treatment and repeated assessment.
  • Name the high-risk working diagnoses and investigations that change immediate management.
  • State disposition, senior decision ownership and a clear handover.

Address immediate risk and consent together

Urgency shortens the time for a discussion; it does not automatically remove the need for consent or other valid authority. Identify the actual decision, the time available and what the patient is willing to accept while the team addresses risk.

  • Presume an adult has capacity and offer appropriate support to understand and decide. A refusal of one test is not necessarily refusal of assessment or all care; clarify its scope. Assess decision-specific capacity if there is reason to doubt it, not simply because you disagree.
  • Respect an informed decision by an adult with capacity, subject to the applicable law. Explain relevant risks and alternatives without coercion, agree any acceptable care and seek senior advice for a disputed or legally complex situation.
  • If an adult is unconscious or assessed as lacking capacity and their wishes cannot be established, GMC guidance permits care immediately necessary to save life or prevent serious deterioration. Choose the least restrictive suitable option within competence. Seek senior help without delaying immediately necessary care; check known wishes and any applicable advance decision under the relevant jurisdiction's law, and record the reasoning.
  • For a colleague concern, protect patients now and seek suitable help. Clinical care, factual documentation and necessary reporting have their own purposes; an ethics discussion does not complete those actions.

Escalate when the risk exceeds your control

Escalation should name the person, urgency and help required. It is triggered by physiology, diagnostic or ethical complexity, resource conflict, failed response or work beyond competence.

  • Call the ED senior or resuscitation team early for instability or competing critical patients.
  • Involve specialty, anaesthetic, critical-care, safeguarding, mental-health or security support according to the actual problem.
  • If a referral is disputed, keep treating the patient and escalate through clinical hierarchies rather than debating while risk rises.
  • Close the loop on delegated care and outstanding results.

Avoid sounding scripted

Frameworks are useful only when they change with the information given. Interviewers need to hear your prioritisation, not a memorised tour of every possible action.

  • Respond to new observations or history before finishing your prepared sequence.
  • Say why an action comes now and what can safely wait.
  • Name one or two dangerous alternatives rather than listing every differential.
  • Use plain professional language and make patient communication part of the 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 with possible sepsis wants to leave before treatment is complete. Talk through your immediate and ethical priorities.
  2. Two deteriorating patients arrive together and only one resuscitation space is free. How do you allocate care and maintain oversight?
  3. An older patient with head injury is confused, refuses imaging and tries to leave. What do you do?
  4. A colleague appears impaired during a crowded night shift. How would you protect patients and manage the concern?
  5. A specialty team declines your referral while the patient's observations worsen. Explain your clinical and professional response.
  6. A relative demands information about an adult patient who asked that nothing be shared. How would you approach the conversation?
  7. A patient deteriorates in a corridor escalation area with limited monitoring. What are your priorities and escalation route?
  8. A child with possible safeguarding concerns is about to be removed from the department by an adult. What would you do?

Common mistakes

Where otherwise good answers lose clarity

  • Starting a long differential before recognising and treating physiological instability.
  • Saying 'I would escalate' without naming who, how urgently or what help is needed.
  • Delegating the second patient without monitoring, ownership or closed-loop communication.
  • Treating capacity as a permanent diagnosis rather than decision- and time-specific.
  • Jumping to incident reporting before making the patient and department safe.
  • Applying a memorised framework after new information has changed the priority.

Preparation plan

How to practise this deliberately

  • Practise ABCDE, help, treatment, differential, investigations, reassessment and disposition aloud.
  • Mix clinical deterioration with refusal, confidentiality, colleague and safeguarding problems.
  • Use two-patient scenarios to practise delegation and maintaining oversight.
  • Ask a partner to interrupt with changing observations or resource constraints.
  • Review current Good Medical Practice and local escalation routes alongside the official EM criteria.
  • Use the Emergency Medicine practice route for original timed questions and examples.

Continue into practice

Practise the answer, not just the reading

Spoken ACCS Emergency Medicine 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 ACCS Emergency Medicine 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 ACCS Emergency Medicine guide.

Found this guide useful? Share it with a colleague.