ST3 Interview: Communication, Clinical, & Structured Interview

Clinical Scenarios

The published guidance describes two clinical scenarios within the ten-minute clinical section, which may include photographs.

A useful way to practise each scenario is:

1. Identify the main problem and immediate concern

• What is the likely problem?
• What are you most worried about?
• What could cause harm if it is missed or delayed?

2. Describe the focused assessment

• What information do you need now?
• This may include a focused:
  • History
  • Examination
  • Review of observations
  • Review of photographs or investigations
• Keep it relevant to the question.

3. Explain your initial actions and investigations

• What needs to happen immediately?
• What investigations would change your management?

4. Give a definitive plan

• State what you would do and explain why.
• If there are several reasonable options, explain which factors would influence your choice.

5. Address escalation, complications and follow-up

• Who needs to be involved?
• What complications are you watching for?
• What happens next?

Answer the Question Being Asked

The structure above is a guide, not something you need to repeat from the beginning for every question.

• If the panel asks: "How would you manage this operatively?", move towards the operative decision.
• Do not spend half your answer retaking a history they have already given you.

This is a common problem: candidates can give several management options without actually selecting or explaining an approach.

A stronger answer is:

"My preferred approach would be X because of Y. If Z were present, that would change my management because..."

That shows both a decision and the reasoning behind it.

What Clinical Topics Should You Cover?

You cannot revise every possible plastic surgery topic in the same depth.

Focus on common presentations, important emergencies and the clinical decisions expected of an incoming ST3.

Hand Trauma

• Tendon injuries
• Nerve injuries
• Hand fractures
• Fingertip injuries
• Hand infections
• Vascular compromise

For each one, be able to discuss assessment, immediate concerns, and a sensible management plan.

Burns

• Assessment
• Initial management
• Referral
• Operative principles
• Complications

Practise presenting burns referrals concisely and identifying which features change urgency or management.

Skin Cancer

• Assessment
• Biopsy
• Excision principles
• Reconstruction
• MDT working

Reconstruction

• Wound assessment
• Skin grafts
• Local flaps
• Choosing an appropriate reconstructive option

You should be able to explain why your reconstructive choice is suitable rather than simply naming an option.

Emergencies

Important topics to cover include:

• Necrotising fasciitis
• Compartment syndrome
• Replantation and revascularisation
• Failing flaps
• Flexor tenosynovitis
• Open fractures

For emergency scenarios, focus on recognising the problem, identifying what cannot wait, initiating appropriate management, and escalating early when needed.

Aesthetic Surgery

Important topics to cover include:

• Breast reduction and mastopexy
• Breast augmentation
• Abdominoplasty
• Rhinoplasty

For these procedures, revise the relevant anatomy, indications, patient assessment, operative principles, and potential complications.

Postoperative Problems

Revise bleeding, infection, deteriorating patients, and threatened reconstruction.

These are useful topics for practising both clinical decision-making and prioritisation.

Five Questions to Ask Yourself for Every Topic

Rather than trying to memorise one perfect answer for every possible scenario, practise answering:

1. What is the problem?

2. What cannot wait?

3. What would I do next?

4. Why am I doing it?

5. When do I need help?

If you can answer those five questions clearly, you already have the basis of a safe clinical response.

Common Clinical Scenario Mistakes

1. Giving Every Possible Differential

• Show that you have considered alternatives, but don't lose the main problem in a long differential.

2. Giving Every Possible Treatment

• A long list is not the same as a management plan.
• Choose an approach and tell the panel what would change your choice.

3. Ignoring Urgency

• The first thing you discuss should not always be definitive reconstruction.
• If there is a time-critical problem, deal with that first.

4. Ignoring Your Limits

• Some complex cases may be deliberately designed to test whether you recognise when senior support is needed.
• You do not need to pretend that you would manage everything alone.

Communication & OSCE

The communication station has varied between recruitment cycles.

Historically, candidates have prepared for areas including consent and presenting an urgent clinical problem to a senior.

More recent candidate experience described in the updated guide included prioritisation instead of a dedicated consent station.

The best preparation is therefore to practise the skills that carry across all of them.

Calling a Senior

When contacting a senior, your aim is not to demonstrate how much information you have collected.

Your aim is to make sure they understand the problem and what you need from them.

Make clear:

• Who the patient is
• What has happened
• Why you are concerned
• What you have found
• What you have already done
• What you need from your senior
• How urgently you need their input

If the situation is urgent, communicate that early.

Do not hide the important problem at the end of a long presentation.

Prioritisation

A prioritisation exercise is not simply:

"Patient A first, patient B second and patient C third."

You need to explain why.

For each case, think about:

Which patient needs attention first?

• Identify the immediate threat.

What can safely wait?

• Explain why delay is reasonable.

What can happen at the same time?

• You do not need to perform every action yourself or one after another.
• Consider what could be delegated or started while you assess another patient.

Who else should be involved?

This may include:

• Senior surgical colleagues
• Nursing staff
• Anaesthetics
• Other relevant teams

What would make you change your order?

• Priorities should change if the patient's condition changes.
• Explicitly explain what can happen in parallel, who you would involve, and how you would reassess your priorities if the situation changed.

Consent

Even if your recruitment cycle does not contain a dedicated consent station, consent remains useful practice for communication.

A clear consent discussion should cover:

• What the procedure is for
• Relevant alternatives
• What the operation involves
• Important risks
• Recovery and aftercare
• The patient's questions or concerns
• Whether they have understood

Speak to the patient as a patient.

Do not turn the explanation into an exam answer filled with technical terminology.

There are two common pitfalls: failing to address patient concerns and giving explanations that are either too technical or too vague.

Practise the Same Information for Different Audiences

A useful exercise is to take one case and explain it three times.

To a Consultant

• Be concise and clinically focused.

To a Colleague Taking Over the Patient

• Be practical and clear about what has happened and what still needs to happen.

To the Patient

• Use plain language and focus on what matters to them.
• The clinical information may be similar.
• The way you communicate it should change.

The Structured Interview

The structured interview is different from the clinical and communication stations.

This is your opportunity to talk about yourself, your achievements, and the experiences that have shaped you as a doctor.

The published guidance describes a ten-minute structured interview with two or three questions.

Potential areas include:

• Audit
• Research
• Teaching
• Leadership
• Management
• Risk and patient safety
• Consent
• Ethics

You may be asked about your own experiences, but you should also understand the principles behind them.

Make the Most of This Section

Unlike the clinical stations, where candidates may give similar answers to the same problem, the structured interview gives you an opportunity to show what makes your experience different.

This is where you can let your personality come through.

Use examples from your own work, explain what you contributed and show what you learnt.

Always bring the answer back to yourself.

If asked about research, do not spend the entire answer describing the study. Explain your involvement and what you learnt from it.

If asked about leadership, do not simply describe what the team achieved. Make your own role clear.

If asked about a difficult experience, explain how you responded and how it has influenced your practice.

The panel should come away understanding not only what you have done, but also how those experiences have prepared you for ST3.

Prepare Examples, Not Speeches

Build a small bank of experiences covering:

• Research
• Audit
• Teaching
• Leadership
• Teamwork
• A challenge or mistake

For each important experience, prepare five elements:

• Context: What problem or need existed?
• Contribution: What did you personally do?
• Outcome: What changed, and how do you know?
• Reflection: What worked, what was limited, and what would you change?
• Relevance: How will this influence your practice as a registrar?

Know your examples well enough to adapt them to different questions.

Do not memorise a speech word for word.

Audit

If discussing an audit, be prepared to explain:

• The standard you assessed
• What the initial results showed
• What intervention was introduced
• What the re-audit showed
• Your personal contribution
• What you learnt

You should also understand the principles of the audit cycle rather than simply describing your project.

Research

For your main research projects, understand:

• The research question
• Study design
• Your contribution
• Main findings
• Limitations
• Clinical relevance

Be prepared to discuss the work behind a publication on your CV.

Explain what you personally contributed and what you took away from the experience.

Teaching

Rather than simply saying you delivered a teaching session, explain:

• How you identified the learning need
• How you planned the teaching
• How you adapted it to the learners
• How you assessed its effect
• What you learnt

Leadership & Teamwork

Choose examples where your contribution is clear.

Be able to explain:

• What was happening
• Your responsibility
• What you did
• How you worked with others
• The outcome
• What you would do differently

Reflection is important. The panel is interested in what your experiences say about you as a future registrar.

Common Pitfalls

• Being too general: Give specific examples rather than broad statements about your skills.
• Describing the team rather than yourself: Acknowledge the team's work, but explain your own contribution.
• Not reflecting: Explain what you learnt and how it will influence your future practice.
• Giving rehearsed answers: Know your examples, but respond to the actual question.
• Forgetting the relevance: Bring your answer back to how the experience has prepared you for ST3.

How to Practise Clinical Scenarios Properly

Reading an answer is not enough. Take a scenario and give yourself the same conditions you will face in the interview.

Then:

1. Read the question.
2. Answer aloud.
3. Time yourself.
4. Get feedback.
5. Identify one thing to improve.
6. Answer the same scenario again.

Do not immediately move on to another question. The second attempt is often more useful than the first because it forces you to apply the feedback.

Feedback Checklist

After a clinical or communication answer, ask:

• Did I actually answer the question?
• Was my main decision obvious?
• Did I explain why?
• Did I identify the important risk?
• Did I know when to escalate?
• Was there unnecessary detail?
• What important point did I miss?

These are the same questions recommended for making mock interviews useful.