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ST4 Medical Specialty

Acute Internal Medicine ST4 Interview Masterclass

Own the acute take. Prioritise the unselected. Escalate decisively.

March 2026 · 40 minutes · Qpercom (virtual) · 2 per station

Competition
4.43:1
Scenarios
6
RIS
10–50
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Specialty focus areas

High-yield prep targets unique to Acute Internal Medicine.

Station 1 — Acute Take Command Hub

  • Triage the unselected medical take: NEWS2, sepsis-6, AKI bundle.
  • Run the post-take board round — prioritise sick, septic, soon-to-deteriorate.
  • Rapid escalation: ITU referral, NIV thresholds, RRT activation.
  • Boarding, flow & site pressures — work with bed managers without compromising care.

Station 2 — Med Reg Leadership & Governance Hub

  • Overnight take governance: SBAR handover at 21:00 and 08:30.
  • Junior support: when to come to the floor, when to coach by phone.
  • Clinical incident framework: Datix, candour, SI investigation, SPIES.
  • Capacity, DoLS and DNACPR conversations under time pressure.

Interview format

2 stations · scored 1–5 per domain · appointability: RIS ≥30, no 1s, max two 2s.

Station 1

  • Clinical Scenario7–8 min
  • Suitability & Commitment7–8 min

Station 2

  • Medical Registrar Suitability7–8 min · 1 minute talk
  • Ethics, Professionalism & Governance7–8 min

Acute Internal Medicine preparation material

Scenarios, frameworks and model answers mapped to this specialty.

Clinical Scenario
3 scenarios

A 68-year-old presents with sudden-onset breathlessness, SpO2 88% on air, HR 122, BP 90/60. Walk me through your assessment and initial management.

Open scenario
Community Acquired Pneumonia with High NEWS2

Community Acquired Pneumonia with High NEWS2 — manage the first hour.

Open scenario
Anaphylaxis in the medical assessment unit

A 40-year-old develops urticaria, lip swelling and wheeze 10 minutes after starting IV co-amoxiclav. BP 78/40. How do you manage?

Open scenario
Portfolio & Commitment
1 scenario

Give a 1-minute presentation on your role as a medical registrar.

Open scenario
Management & Leadership
1 scenario

How do you prioritise when there are three sick patients simultaneously?

Open scenario
Ethics & Professionalism
1 scenario

A consultant from another specialty refers a patient you don't think needs admission. How do you handle it?

Open scenario
How to prep for Acute Internal Medicine
  1. 1. Master 5-6 acute clinical stems using A-E + SBAR.
  2. 2. Rehearse a 1-minute "why this specialty" pitch tied to your portfolio.
  3. 3. Prepare an interesting case presentation (4 min + Q&A).
  4. 4. Drill ethics scenarios with the SPIES / Four Quadrants framework.
  5. 5. Run a timed mock under exam conditions weekly.
  6. 6. Calibrate against the portfolio self-assessment.
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