How to approach it
What a strong answer needs to show
First minute: stabilise and organise help
Say where you are, who is unwell and the immediate risk. For an unstable patient, arrange ABCDE assessment, monitoring, resuscitation support and senior escalation together.
- Use nurses and the emergency response team appropriately.
- Explain what you would start now and what needs a senior decision.
- Reassess after intervention rather than ending with a list of tests.
Grade and specialty matter
A junior medicine, ED, paediatric or surgical fellow does not have identical autonomy; a senior fellow's responsibilities can differ even within one Trust.
- State your limits without abandoning action.
- Use the service's referral and escalation arrangements.
- Do not import an IMT or CST national interview rubric into this local role.
Close the loop
Describe documentation, timely handover, ongoing observations and how you would communicate with the patient and team.
- Prioritise outstanding results and safety-netting.
- Use a concise situation–background–assessment–recommendation handover when appropriate.
- Say what would prompt re-escalation.
Fictional adult-ward illustration: a coherent opening
Prompt: as a junior fellow you are called to an adult inpatient who has become confused and hypotensive. This illustrates the order and communication of an opening response, not a complete management plan or a diagnosis. Actual assessment and treatment depend on the patient, local protocols and your competence.
- Opening: 'I would attend urgently, ask the nurse to obtain immediate help through the local deterioration response and alert the registrar to the change. I would assess and address immediate threats using ABCDE, working with the team rather than waiting for all the history or results.'
- Continuation: 'As I work through ABCDE, I would check the patient's level of consciousness and arrange prompt blood glucose measurement to look for a reversible cause of the new confusion. I would review the observations and their trend, establish relevant background as assessment proceeds, and explain my findings and concern to the senior. I would reassess after interventions and seek further help if the patient deteriorates or the response is inadequate.'
- Handover: 'I would document the assessment and response, and explicitly hand over unresolved concerns, outstanding actions and who will review them. I would check that the receiving clinician understands and has accepted the plan.'
Why the opening hangs together
The reasoning follows recognition, immediate assessment and help, review of response, then transfer of responsibility. It avoids committing to a diagnosis from two findings. Once the panel supplies assessment findings, the answer must move on to patient-specific reasoning and treatment rather than repeating the framework.
- Assessment and escalation run together: asking for help is not postponed until a full examination or investigation list is complete.
- Reassessment tests whether actions helped. 'I would do ABCDE' alone does not explain what happens when the patient remains unwell.
- Handover names ownership of the next step. A pending result needs a clinician and a plan, not merely a tick beside 'handed over'.
Change responsibility when the grade changes
A senior title does not remove limits of competence. A senior fellow may have an agreed role in leading the team and supervising juniors; a junior fellow should not invent that authority. Establish the advertised scope and available consultant support.
- Junior: explain the immediate actions you can undertake, early senior attendance and any task requiring direct supervision.
- Senior: where within your role, allocate team tasks, check progress, support the junior and involve the consultant when the situation exceeds your capability or requires their decision.
- If the usual senior cannot respond, use the alternative urgent escalation route. Do not leave an unstable patient waiting for a single unavailable person.
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.
- You are called to a newly confused, hypotensive inpatient while the ward is busy. What happens in your first five minutes?
- A discharge-ready patient develops new chest pain. How do you reprioritise?
- The registrar is in theatre and you need help with a deteriorating patient. What are your escalation options?
- At the end of a shift, two results remain pending for patients you have reviewed. How do you hand over?
Common mistakes
Where otherwise good answers lose clarity
- Listing investigations before immediate safety measures.
- Saying 'I would escalate' without naming who or when.
- Assuming an unfamiliar procedure is safe unsupervised.
- Forgetting reassessment, patient communication or handover.
Preparation plan
How to practise this deliberately
- Choose common emergencies for the advertised specialty.
- Practise a spoken first-minute response.
- Check local senior-cover arrangements if provided.
- Ask a clinician at the relevant grade to challenge your limits and escalation.
Continue into practice
Practise the answer, not just the reading
Spoken Clinical Fellow & Trust Grade 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.
Bring the actual job pack and your CV to your preparation. Clinical scenarios at launch cover Medicine and Surgery; other specialties focus on job-specific non-clinical questions.
Explore Clinical Fellow & Trust Grade 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 Clinical Fellow & Trust Grade guide.