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All stations/Station 1/Sub-station 1A

Sub-station 1A — Clinical Scenario

An unseen acute medical vignette. You verbalise assessment, differentials, immediate management, escalation and safety-netting at registrar level.

7–8 minutes 2 consultant examiners Station 1
Practise Clinical Scenario questions Run a timed mock

What happens in the room

  • You are given a short clinical stem (often on-screen) at the start of the station.
  • You talk through your approach out loud — examiners follow a structured marking sheet and may interject with probes.
  • Expect at least one deterioration / curve-ball mid-scenario (new vital sign, abnormal result, family member at bedside).
  • Final 60–90 seconds usually cover escalation, communication with the team and safety-netting.

What the examiners are scoring

  • Structured ABCDE assessment and immediate resuscitation priorities.
  • Targeted differential with the most dangerous diagnosis named early.
  • Logical, prioritised investigation plan (bedside → bloods → imaging → special).
  • Definitive management aligned to NICE / specialty society guidance.
  • Recognition of the sick patient, when to escalate to ITU, and clear SBAR communication.
  • Human factors: situational awareness, team leadership, calling for help.

Framework — ABCDE → Differentials → Investigations → Management → Escalate / Safety-net

  1. 1A–E

    Airway, Breathing, Circulation, Disability, Exposure — state what you'd look for and the first intervention at each step.

  2. 2Differentials

    Name the top 3 with the can't-miss diagnosis first; justify with one feature each.

  3. 3Investigations

    Bedside (ECG, ABG, BM, urine dip) → bloods → imaging → specialist. Say why, not just what.

  4. 4Management

    Immediate (O2, fluids, antibiotics, reversal agents) → definitive (NICE pathway, specialty input) → disposition.

  5. 5Escalate & safety-net

    SBAR to ITU/specialty, ceiling of care discussion, family update, clear handover and what would prompt re-review.

High-yield topics

Sepsis / septic shock (Sepsis Six, lactate trends, source control)Type 1 & Type 2 respiratory failure (NIV vs intubation thresholds)Acute coronary syndromes (NSTEMI/STEMI pathways, GRACE)Acute upper GI bleed (Glasgow-Blatchford, terlipressin, endoscopy timing)Acute kidney injury (NICE AKI, when to dialyse)DKA / HHS (fixed-rate insulin, K+ replacement, complications)Acute stroke (thrombolysis / thrombectomy windows, BP targets)Anaphylaxis, status epilepticus, massive PE (thrombolysis criteria)

Example stems

  • "A 68-year-old man is referred by ED with sudden-onset breathlessness, SpO2 84% on air, HR 122, BP 92/56. How do you proceed?"
  • "You are the medical registrar on call. ED have referred a 25-year-old with T1DM, drowsy, ketones 5.6, pH 7.05. Talk me through your management."
  • "A 75-year-old woman on apixaban presents with melaena, HR 118, BP 88/52. What do you do?"

What a Score 5 answer looks like

  • Opens with a structured ABCDE and names the life-threat in the first 30 seconds.
  • Differential is prioritised, justified and includes the can't-miss diagnosis.
  • Investigations are sequenced and explained — not a shopping list.
  • Quotes specific NICE / specialty guidance and gives doses where relevant.
  • Escalates appropriately, hands over with SBAR, and explicitly safety-nets.
  • Demonstrates situational awareness — recognises deterioration, calls for help early.

Common pitfalls

  • Jumping to investigations before completing ABCDE.
  • Long lists of differentials with no prioritisation.
  • Forgetting analgesia, antiemetics, VTE prophylaxis and DNACPR/ceiling discussions.
  • Ignoring the deteriorating observation that the examiner just gave you.
  • Vague escalation: 'I'd call ITU' without SBAR or a clear ask.