To crack the CST interview - you need to have a solid framework for the clinical station. I have tried to outline the sections below with key sentence structures that you should attempt to make your own. The clinical example that I will chose to show this structure is that of a patient on the ward post-appendicectomy having abdominal pain and fever.

1. Set the scene - When given any clinical question the first thing you need to do is set the scene for the interviewers. This would involve:

• Recognise that the patient is unwell and needs to be seen

• You should kindly ask the nurse to get ready the patient's drug chart, ward round and any operative notes and arrange for a fresh set of observations. 

• On the way to the patient you should mention the differential diagnoses that you are thinking of, hihglighting the one that you are most concerned about given the brief. 

• I'd begin my assessment following A to E principles as per the Ccrisp protocols.

For example: This is a patient with new onset of abdominal pain and fever post operatively, they may be unwell and I'd like to assess this patient as soon as possible. I'd kindly ask the nurse to help me in my assessment by getting a fresh set of observations and bringing the patient's drug chart, ward round and operative notes to the bedside. On the way to the patient I would be thinking of the most likely differentials , which given the brief can be: post operative ileus, ischaemic bowel, abscess/collection, pancreatitis. Given that the patient is febrile my top differential would also be sepsis. 

2.  A to E Assessment - An efficient run through the A to E is key to coming across as a competitive candidate. I would recommend practising this thoroughly to come across smooth and slick in your delivery.

Airway

I would ensure airway patency and use suction or adjuncts if necessary. If the patient is speaking, the airway is patent and I would move on to assess breathing. 

Breathing

• I'd inspect their breathing for symmetrical airway expansion, feeling for a central trachea, palpating, percussing and auscultating the chest for signs of dullness, hyper-resonance and abnormal breath sounds. 

• I'd measure their RR, attach a sats probe monitor and start them on 15L high flow oxygen from a non-re-breath mask and titrate to sats.

• I'd perform an ABG to get real time data on the partial pressures, Hb and lactate levels.

• I'd reassess the patient and if responsive and stable move onto assess their circulation 

Circulation

• I’d feel their peripheries, pulse, get a BP and CRT reading, inspect their JVP, mucous membranes for hydration status. 

• I’d palpate and auscultate the heart and request an ECG reading.

• At this point I’d gain large bore vascular access in each ACF and ask for a panel of bloods - FBC, U&E, CRP, LFTs, amylase (since they’ve had abdominal surgery), clotting, CXM and G&S. 

• If hypotensive I would start a 500ml bag of crystalloid solution STAT (250ml if known cardiac failure), take blood cultures and start broad spectrum abx as per local hospital guidelines if febrile, insert a urinary catheter to monitor input and output and ensure the Sepsis 6 is complete.

• I'd also consider doing a urine dip & sending it for microscopy and culture and consider a bladder scan. 

Disability

• I'd reassess A-C and if responsive then move on to assess their neurology. 

• I'd check their GCS, the size and reaction of their pupils to light 

• and measure their blood glucose and temperature

Exposure

• I’d then expose the patient maintaining dignity and normothermia and do a top to toe examination followed by a focused examination (abdominal in this case)

• E.g., I would palpate all 4 quadrants of the abdomen checking for tenderness, guarding and peritonism

• I would remove the surgical dressing and inspect the wound for signs of infection and bleeding. 

3. Investigations - after finishing your A to E you need to list the investigations that you would want for this patient. Although you have already mentioned some in your A to E spiel, it is important to present the remaining options in a structured manner. 

For example:

• Following the completion of my examination I would consider additional tests to aid the narrowing of my diagnosis, these include

• An Erect CXR to check for air under the diaphragm

• Abdominal XR to check for dilated loops of bowel

• If the patient is haemodynamically stable I would also consider a CTAP with contrast to look for intra-abdominal collections or leaks. If they have poor renal function I would consider hydrating her with IV fluids before the scan.