Clinical audit is one of the most commonly tested topics in NHS interviews. The panel may ask you to define audit, describe the audit cycle, discuss an audit you have completed, or explain the difference between audit and research. You need to be able to do all four.
What Is Clinical Audit?
The NICE definition (from Principles for Best Practice in Clinical Audit, 2002) states that clinical audit is “a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.” In simpler terms for your interview answer: clinical audit measures current clinical practice against an agreed standard to identify whether we are meeting that standard, and if not, to implement changes to improve. The key distinction is that audit measures existing practice against known standards — it does not generate new knowledge (that is research) or evaluate a service (that is service evaluation).
The Audit Cycle — Five Stages
The audit cycle is a continuous loop with five stages. Being able to describe these clearly and map your own experience onto them is essential:
Stage 1 — Select a Topic and Set the Standard: Choose a topic relevant to patient care and identify the standard against which you will measure. Standards typically come from NICE guidelines, national clinical audit programmes, professional body recommendations (e.g., British Thoracic Society guidelines for asthma), or local trust protocols. The standard should be explicit and measurable — for example, “100% of patients admitted with a COPD exacerbation should have an arterial blood gas performed within 60 minutes of arrival” (based on BTS/NICE guidance). State why you chose this topic: was it prompted by a clinical incident, a patient safety concern, a gap you observed in practice, or a departmental priority?
Stage 2 — Define Criteria and Collect Data: Design a data collection tool (proforma or spreadsheet), define your sample (which patients, what time period, how many cases), and gather the data. Data can be collected retrospectively (reviewing past case notes) or prospectively (recording data in real time as patients are seen). Common data sources include electronic patient records, discharge summaries, prescription charts, and observation charts. For your interview, be prepared to state: how many patients you included, over what period, and how you collected the data.
Stage 3 — Analyse and Compare Against the Standard: Analyse your data to determine the percentage compliance with the standard. For example: “Of 50 patients admitted with COPD exacerbation, 32 (64%) had an ABG within 60 minutes, against a standard of 100%.” Present your findings clearly — in an interview, the panel wants to hear the numbers, not vague statements like “compliance was low.”
Stage 4 — Implement Changes: Based on your findings, propose and implement specific changes to improve practice. This is the most important stage for scoring well in an interview, because it demonstrates that your audit had a real impact on patient care. Examples of changes include: creating a new checklist or proforma, delivering targeted teaching to the team, redesigning a clinical pathway, introducing visual reminders (posters, stickers on drug charts), or changing a local protocol. State clearly what you changed, how you implemented it, and who was involved.
Stage 5 — Re-Audit (Closing the Loop): Repeat the data collection after a defined period (typically 3–6 months) to assess whether the changes have led to improvement. A “closed-loop” or “full-cycle” audit — one that includes a re-audit demonstrating improvement — is significantly more impressive in an interview than a single-cycle audit. Even if the re-audit shows only modest improvement, the fact that you completed the cycle demonstrates rigour and commitment to quality improvement. If you have not yet re-audited, explain that a re-audit is planned and describe the timeline.
How to Present Your Audit in an Interview
Use this structure for a concise, high-scoring answer: (1) State the topic and why you chose it. (2) State the standard you measured against (and its source, e.g., NICE guideline number). (3) State your sample size, data collection method, and key findings (with numbers). (4) State what changes you implemented. (5) State the re-audit results if available, or your plan for re-audit. (6) Reflect on what you learned and how it improved patient care. Total time: 2–3 minutes.
Audit vs Research vs Service Evaluation
This is a commonly asked standalone interview question. The key distinction, often quoted from the NHS Health Research Authority, is: Research asks “What is the right thing to do?” and generates new knowledge. Audit asks “Are we doing the right thing in the right way?” and measures practice against existing standards. Service evaluation asks “What standard does this service achieve?” and assesses the effectiveness of a service without comparing against a specific standard. Clinical audit does not require ethical approval from a Research Ethics Committee (REC), but it must comply with data protection regulations and should be registered with the trust’s clinical audit department. Research requires REC approval and must go through the Health Research Authority process.
If You Have Not Completed an Audit
If you have not yet completed an audit, do not panic. The panel will still accept a planned audit that you can describe in detail. Choose a topic relevant to the department you are applying to, identify the standard (cite the specific NICE guideline or protocol), describe how you would collect the data, and explain what changes you would anticipate implementing based on likely findings. Showing that you understand the methodology and can apply it practically is nearly as valuable as having completed one.