CST Clinical Tips

Catrin Morgan
17/1/24
Preparation is Key

Prepare for this interview like you would prepare for an exam
 Useful revision resources

But the most important revision resource is each

other!
Competition Ratios
Clinical station
• 2 clinical scenarios
• Provided during the interview and allow candidates to think on their
feet
• Generally this is 1 ATLS scenario and 1 CCrlSP/ward scenario (but not
always)
• Have a structure, need to look slick and generally talk at the examiner,
don’t give them the opportunity to ask you a question you may not
know the answer to!
Mark Scheme for Clinical
Clinical scenario station – trauma
ATLS (read the initial management chapter)
Examples
• Open fracture
• Tension pneumothorax
• Traumatic pneumothorax
• Abdominal trauma
• Haemorrhagic Shock
• Burns
• Head injury
• Compartment syndrome
Clinical scenario station – example answer
You are called to ED. A 25 year old female has been brought in by
ambulance with significant burns following a house fire. How would
you approach the situation?
Clinical scenario station – example answer
I would start by ensuring a trauma call has been put out to have
members of the anaesthetic team, general surgical tea, orthopaedic
team and A&E ready to receive the patient. I would ensure the team
were gloved and gowned and ask nursing staff to have any special
equipment we may need available to hand (IV access, difficult airway
and chest drain kit). I would then approach the patient using the
principles of ATLS.
Clinical scenario station – example answer
• A (+ C-spine) – assess airway, if patent then start high
flow O2, triple immobilise C-spine
• B – exposure, chest expansion/percuss/ausculate,
saturations, RR, in a burns patients look for
circumferential chest wall burns (?need for
escharotomy)
• C – central pulse, cap refill, BP, IV lines, bloods, IVF to
maintain haemodynamic stability if needed, look for
signs of major hemorrhage
• D and E – gross neurological assessment, formal GCS,
temperature and blood sugar levels, log roll (PR
exam), assess area of burn
Clinical scenario station – example answer
• Fluid resuscitation
Parkland formula 3-4mls/kg/& TSBA (half given in first 8 hours, rest over the
next 16 hours). Time of injury marks start of fluid resuscitation

How would you monitor adequacy of resuscitation?

Urinary catheter (measure urine output), ECG, pulse, BP, RR, ABG

Secondary survey is especially important in burns – other injuries are

frequently missed if distracted by the obvious burn injury
Check mechanism of injury, think smoke inhalation, toxic substances,
clothing, first aid measures, check distal pulses (rigid eschar can obstruct
venous return resulting in ischaemia)
 Clinical scenario station – example answer
• How would you assess area of burns?
Rule of Nines

Palmar method (use patients palm not your own!) – palmar surface approximates to 1% body
surface area
Clinical scenario station – example answer
• When would you consider referring this patient to a burns centre?
There are nationally agreed referral guidelines
Burns >3& TBSA (>2% in children)
Burns of specified areas (face, hands, gentialia, major joints)
Full thickness burns
Electrical/chemical burns
Associated inhalation injury
Extremes of age
Pregnant women
Non-accidental burn
Burns with associated trauma
Clinical scenario station – example answer
• The patient is being transferred to a specialist burns centre. How
would you dress the burn wounds?
Wounds should be washed with normal saline, covered in cling film or a
clean dry sheet
If transfer is significantly delayed then discuss with burns centre for
advice regarding a more formal dressing
Clinical scenario
• Be systematic in your answer
• Occasionally get unusual scenarios (such as burns/cauda equina) –
they are not looking for in depth knowledge on the subject, just
logical answers
• Do spend time practicing with friends on a range of different subjects
so there are no surprises
Clinical scenario station - clinical ED/Ward
Examples: Wound infection
Ureteric colic Anastomotic leak
Supracondylar fracture NOF
Upper GI bleed Post
Acute urinary retention thyroidectomy
Acute ischaemic limb Sepsis
AAA Pancreatitis
Bile leak Cauda equina
Clinical Scenario station – example question
You are asked to see a 67 year old. He has a past medical history of
COPD secondary to smoking. He is one day post repair of a hernia. He
has a productive cough and a temperature of 38.2 degrees. He has a
heart rate of 105, respiratory rate of 21 with saturations of 95%.

How would you proceed?

What is the most likely cause of this patient’s high respiratory rate,
pyrexia and tachycardia?

Which factors could be responsible for these complications?

Clinical scenario station – example answer
• How would you examine this patient and how would you proceed to
management?
I would start by ensuring that the patient was haemodynamically stable with
assessment of the airway, breathing and circulation following ALS
principles….(this should slip off your tongue!)
Contact senior team member, bloods/cannula/MSU/blood cultures/ABG/CXR
Mention titrating oxygen therapy carefully given COPD
Further investigations (eg CTPA) – mention these last
MDT approach – I would involve the respiratory physiotherapy team early,
pain team review, if I suspected infection I would commence antibiotics
according to local protocol after taking appropriate microbiology guidance
Clinical Scenario station – example question

The most likely cause is a postoperative pulmonary atelectasis. The risk

of this is magnified in patients with pre-existing pulmonary disease
(shows you have listened to the question).
List 3-4 other important differential diagnoses.
Clinical scenario station – example answer
• Which factors could be responsible for these complications?
Always split complications into pre-op, peri-op and post-op factors
Pre-op: smoking COPD (excess mucus production reducing functional
respiratory reserve, more susceptible to infection)
Peri-op: intubation irritating respiratory mucosa, oedema, lying supine,
CO2 insufflation results in splinting of diaphragm and reduced
ventilation to the lung bases)
Post-op: pain, sedation, reduced mobility could inhibit clearance of
secretions
Clinical scenario
• Examiners are looking for candidates who will be safe, logical and
aware of their limitations
• Even in seemingly simple or straightforward questions don’t be afraid
to mention calling for senior support/help of other healthcare
professionals
• They want to see that you can work as a part of a team and have an
MDT approach
Top tips
• Prepare like you would prepare for an exam, don’t leave it down to
chance
• Check that the link works on the device you plan to use for the
interview
• Ensure that your camera and microphone are turned on and working
• Ensure no one disturbs you
• Practice your leadership presentation – no excuse not to score highly
or forget your presentation
• For your clinical station – again prepare and practice with your
friends/colleagues
• Most importantly – put your game face on and back yourself, make
your own luck!