The CST Clinical Scenarios
How the Core Surgical Training clinical scenarios work: two acutely-unwell-patient cases, the A–E and escalation approach examiners want, common topics, and how to prepare.
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A patient is going off on the ward and you are the surgical SHO holding the bleep. That is the setup for both clinical scenarios in the Core Surgical Training interview: five minutes each, given on the day, testing whether you can keep an acutely unwell patient safe at core-trainee level. Not whether you can operate. Whether you are safe.
What actually happens
The examiner reads a short case stem. A patient a few hours after surgery, tachycardic and hypotensive, say. Then they ask how you would approach it, one question at a time, and stay deliberately neutral throughout. No confirmation you are right, no teaching. If your plan is unsafe they will not correct you, though you may get a flat “Are you sure about that?” Treat that question as a fire alarm.
What examiners are looking for
- Safe immediate care. An A–E assessment and resuscitation before anything else.
- Clear reasoning and prioritisation. Sensible investigations and management, in the right order.
- Escalation. Recognising your limits and escalating early to the registrar or consultant with a structured SBAR handover.
Where candidates lose marks
The two big ones pull in opposite directions. Some candidates play the registrar, reeling off definitive management for a patient they haven’t assessed. Others assess forever and never commit to a plan or a phone call. The station is pitched at a core trainee: assess systematically, start sensible management, and escalate early. Saying “this is beyond my level, I’m calling my registrar” earns marks. It does not lose them.
Common topics
Cases span the surgical specialties. Common ones to rehearse:
- General surgery: post-operative bleeding, anastomotic leak, upper GI bleed, small bowel obstruction, perforated peptic ulcer.
- Urology: testicular torsion, acute urinary retention, renal colic with urosepsis.
- Orthopaedics/trauma: compartment syndrome, cauda equina, septic arthritis, the limping child.
- Vascular / other: ruptured AAA, acute limb ischaemia, tension pneumothorax.
How to prepare
Rehearse whole cases out loud on a five-minute timer, always starting with A–E and always finishing with a clear escalation. Frameworks like CCrISP and ATLS give you a scaffold that holds up under pressure. You can rehearse the CST clinical scenarios with an AI examiner on Reviva, which stays as neutral as the real panel does.
Frequently asked questions
- What are the CST clinical scenarios?
- Two five-minute cases within the Management & Clinical station, given to you on the day. You are presented with an acutely unwell surgical patient, usually a post-operative complication or a surgical emergency, and asked to think on your feet.
- What level are the CST clinical cases pitched at?
- At a core surgical trainee, not a registrar. Recognising when something is beyond your level and escalating appropriately, with a structured SBAR handover, is a marked strength, not a weakness.
- How do I prepare for the CST clinical station?
- Drill a safe, systematic approach: an A–E assessment, sensible initial investigations and management, clear prioritisation, and early escalation. Practise the common surgical emergencies across the specialties out loud, on the clock.
Sources. Based on the Core Surgical Training selection format modelled by Reviva and the official HEE national recruitment guidance. Educational only. Confirm the current format against the official national recruitment portal.