Top 10 Tips for the O&G ST1 Clinical Prioritisation Station

What Is the Clinical Prioritisation Station?

The clinical prioritisation station is one of the three main interview stations in the O&G ST1 national recruitment process and carries up to 40 marks (20 per panel member). You are given a scenario in which you are the SHO on call and have received multiple bleeps or referrals simultaneously. You will typically be presented with four clinical scenarios, each with a brief clinical history and a set of observations. Your job is to decide the order in which you would see these patients and then talk the examiners through your assessment and management of each one.

You get five minutes of reading time followed by approximately six minutes to deliver your answer. The examiners will generally not interrupt or ask questions - you speak for the full six minutes. This format rewards candidates who are structured, systematic, and confident in talking through their clinical reasoning out loud.

Critically, this station is not purely O&G. The scenarios are designed to test FY2-level knowledge and may include general medical, surgical, and orthopaedic presentations alongside obstetric or gynaecological cases. You are also told which team members are available to help you: typically a nurse, an FY1, and one or more specialty registrars. The examiners are assessing your problem-solving, clinical decision-making, ability to manage others, organisational skills, and above all, patient safety.

Here are our top ten tips for maximising your score.

1. Use Every Second of Reading Time

You have five minutes of reading time before you start speaking, and this is where the station is won or lost. Have a pen and paper ready before the interview begins - you are allowed to use them.

For each scenario, jot down:

• How you would prioritise this

• Your working diagnosis and one or two differentials

• Key investigations you would request

• Key management steps, usually in an ABCDE format

• Who you would escalate to or delegate to

Do not spend all five minutes reading and re-reading. Read once carefully, decide your priority order, then spend the remaining time building your notes for each case. These notes are your script for the next six minutes.

2. State Your Priority Order Upfront

When the speaking time begins, start with a clear, confident statement of your priority order: "My order of priority is patient D first, then patient C, then patient A, then patient B." This immediately orientates the examiners and tells them you have a plan. It also gives you a moment to settle into the station before diving into the clinical detail.

Do not waste time justifying your order at this point - the justification will become apparent as you talk through each case. Just state it clearly and move straight into your first priority.

3. Prioritise by Haemodynamic Instability, Not by Diagnosis

The golden rule of prioritisation is that the sickest patient comes first, regardless of what their underlying diagnosis is. An upper GI bleed with a blood pressure of 90/70 is a higher priority than a suspected ectopic pregnancy with stable observations, even though the ectopic is the O&G case and you are interviewing for an O&G post.

Look at the observations first. Tachycardia, hypotension, tachypnoea, desaturation, and pyrexia are your red flags. Any patient who is haemodynamically unstable or showing signs of clinical deterioration (a high NEWS score) should be at or near the top of your list. If two patients are both unstable, the one with the greater immediate threat to life takes priority. If all four patients are relatively stable, prioritise by the potential for rapid deterioration if untreated.

4. Use an A--E Approach for Every Patient

When talking through your management of each case, use the A--E (Airway, Breathing, Circulation, Disability, Exposure) framework as the backbone of your answer. This is what the examiners expect and it demonstrates safe, systematic clinical reasoning.

You do not need to laboriously go through every letter for every patient, but for your highest-priority patient -- particularly if they are acutely unwell -- walking through A--E shows the examiners you would approach the situation safely. For each step, mention what you would assess and what you would do: "For circulation, I note the patient is hypotensive and tachycardic. I would obtain two large-bore IV cannulae, take bloods including a group and save and crossmatch, and commence fluid resuscitation." This level of detail is what distinguishes a top-scoring answer from an average one.

5. Give Differentials, Not Just a Single Diagnosis

The examiners are not just assessing whether you can identify the most likely diagnosis - they are assessing your breadth of clinical thinking. For each scenario, offer two or three differential diagnoses. A woman presenting at 11 weeks pregnant with heavy vaginal bleeding could have a threatened miscarriage, an inevitable miscarriage, or an ectopic pregnancy. An elderly patient who is confused postoperatively could have sepsis, delirium, medication-related causes, or an acute neurological event.

Giving differentials shows you are thinking like a safe clinician who keeps an open mind rather than anchoring on a single diagnosis. It also picks up additional marks in the assessment criteria, which reward breadth of clinical reasoning alongside correct prioritisation.

6. Use the Whole Team

The scenario will tell you which team members are available - typically a nurse, an FY1, and one or more specialty registrars. You are expected to use them. This is not just a clinical knowledge test; it is a test of your ability to manage a ward and delegate safely.

Think about what each team member can appropriately do:

• Nurse: take observations, relay basic updates to relatives, commence monitoring, assist with cannulation, stay with an unstable patient while you attend to another.

• FY1: review a stable patient, prescribe routine medications, complete a discharge summary, take bloods, clerk an admission.

• Specialty registrar: come and assess an acutely unwell patient in their specialty, provide senior decision-making, arrange urgent theatre if needed.

Candidates who try to do everything themselves score lower than those who demonstrate they can coordinate a team. If a patient has a suspected appendicitis, escalate to the surgical registrar. If a relative wants a routine update, ask the nurse to explain that you are currently managing unwell patients and will be available shortly. If a discharge summary needs completing, ask the FY1. This is how real clinical practice works, and the examiners want to see it.

7. Spend More Talking Time on Higher-Priority Patients

The marks are weighted: the first-priority patient carries the most marks, the second and third carry intermediate marks, and the fourth carries the fewest. This means you should spend the most time and give the most detail on your first-priority case. Walk through the A--E assessment, list your differentials, describe your immediate management, state your investigations, and explain your escalation plan.

For your fourth-priority patient, a brief but safe summary is sufficient. Do not spend three minutes on the stable patient with no analgesia prescribed. A common mistake is giving equal time to all four cases - resist this. The examiners are expecting to hear the most clinical depth on the sickest patient.

8. Always Escalate to a Senior

If a patient is acutely unwell, one of your first actions should be to escalate to the appropriate senior. This is not a sign of weakness - it is a patient safety requirement and the examiners actively mark for it. Say explicitly: "I would call the medical registrar using SBAR to request they come and review this patient urgently."

Mentioning SBAR (Situation, Background, Assessment, Recommendation) when you describe your escalation is a quick way to demonstrate that you communicate in a structured and professional manner. You do not need to role-play the handover in full, but naming the tool shows the examiners you use it in practice.

Remember that you can escalate to different registrars for different patients. If you have a gynaecological emergency and a medical emergency simultaneously, inform both the gynaecology registrar and the medical registrar. You are not expected to manage everything yourself - you are expected to recognise who needs to be involved and get them involved early.

9. Watch for the Hidden Ethical or Non-Clinical Scenario

Almost every clinical prioritisation set includes one scenario that is not primarily a clinical emergency. A common example is a relative calling the ward requesting information about a patient. This is a test of whether you recognise the confidentiality issue: you cannot disclose clinical information to a third party without the patient's consent, even to a family member.

Other non-clinical scenarios might include a patient requesting a discharge summary, a complaint from a relative, or a request to prescribe routine medication. These are almost always the lowest priority clinically, but they still carry marks. Acknowledge the scenario, explain how you would handle it (usually by delegating to the nurse or FY1), and briefly reference the relevant principle - for confidentiality, cite GMC guidance. Do not skip these entirely; a brief, safe answer picks up marks that many candidates leave on the table.

10. Talk Through Every Step Out Loud

A common pitfall is assuming that the examiners will infer your reasoning. They will not. If you would put out a crash call, say so. If you would request a group and save, say it. If you would keep the patient nil by mouth in case they need theatre, verbalise it.

This station rewards candidates who think out loud in a clear, structured way. Practise delivering your answers aloud - not just planning them mentally. The six minutes pass very quickly, and candidates who have practised speaking continuously for that length of time handle the pressure far better than those who have only ever prepared silently. Record yourself, listen back, and refine. You will be surprised how much sharper your delivery becomes after just a few practice runs.

Key Topics to Revise

Because the clinical prioritisation station tests FY2-level knowledge across multiple specialties, you need to be comfortable with more than just O&G. Based on previous interviews, we recommend revising the following topics:

• O&G emergencies: ectopic pregnancy, miscarriage (threatened, inevitable, incomplete), postpartum haemorrhage, pre-eclampsia/eclampsia, sepsis in pregnancy, hyperemesis

• General medicine: upper GI bleed, sepsis, acute kidney injury, diabetic emergencies, chest pain, PE, anaphylaxis

• General surgery: appendicitis, bowel obstruction, acute abdomen, postoperative complications

• Orthopaedics: postoperative confusion, VTE

• Pain management: postoperative pain, prescribing analgesia and antiemetics

• Confidentiality: GMC guidance on sharing information with relatives, Caldicott principles

• Infection: urinary tract infections, wound infections, postoperative pyrexia, sepsis six