Clinical scenario questions test whether you can manage an acutely unwell patient safely and systematically. The panel is not looking for a rare diagnosis or an encyclopaedic recitation of every possible investigation — they want to see that you are a safe doctor who follows a logical approach, recognises red flags, and knows when to call for help.
The A–E Structure for Interview Answers
Opening statement: Before diving into A–E, set the scene. “This sounds like an acutely unwell patient. I would ensure I have appropriate help available, put out a call for senior support if needed, and approach the patient using an A–E assessment.” This immediately tells the panel you are thinking about safety.
A — Airway: Is the airway patent? Are there signs of obstruction (stridor, gurgling, inability to speak)? Is the patient talking in full sentences? If the airway is compromised, describe immediate interventions: head tilt/chin lift, suction, airway adjuncts, and calling the anaesthetist. If the airway is clear, state it and move on — the panel does not want you to dwell on a patent airway for 30 seconds.
B — Breathing: Respiratory rate, oxygen saturations, chest examination (auscultation, percussion), work of breathing, tracheal position. Apply high-flow oxygen if appropriate (15L non-rebreathe). Consider: pneumothorax, PE, pneumonia, exacerbation of COPD/asthma, pulmonary oedema. Order relevant investigations: ABG, chest X-ray.
C — Circulation: Heart rate, blood pressure, capillary refill time, IV access (two wide-bore cannulae), fluid resuscitation if shocked, bloods (FBC, U&E, LFTs, coagulation, troponin, lactate, group and save/crossmatch). ECG. Consider: sepsis, haemorrhage, cardiac event, anaphylaxis.
D — Disability: GCS or AVPU, pupils, blood glucose, temperature. Consider neurological causes, hypoglycaemia, drug effects.
E — Exposure: Full examination as appropriate — look for rashes (meningococcal), abdominal signs, limb injuries, back examination. Maintain dignity and temperature.
Beyond A–E: What the Panel Expects Next
After your A–E assessment, the panel will expect you to discuss: your working differential diagnosis (give 2–3 possibilities in order of likelihood), your initial management plan (fluids, antibiotics, analgesia as appropriate), your escalation plan (“I would contact the registrar/consultant to discuss further management”), documentation, and communication with the patient and family where appropriate. Always mention senior review — at JCF level, the panel wants to know that you escalate appropriately, not that you manage everything alone.
Common clinical scenarios in JCF interviews: Chest pain (ACS, PE, aortic dissection, pneumothorax), sepsis (any source), acute breathlessness, upper GI bleed, falls in elderly patients, anaphylaxis, DKA, acute abdomen, post-operative deterioration, stroke, neutropenic sepsis, sickle cell crisis.
- Exercise: Practise 3 clinical scenarios aloud using the A–E template, timing yourself to 3–4 minutes each.
- Resource: Clinical Scenario Flashcard Set (40 acute presentations with structured management outlines).