Core Surgical Training
How to Prepare for the CST Management Question
The management scenario in the CST interview: what is scored, the SPIIES DR structure with a worked example, the scenario families and the follow-up probes.
By the TheatrePass editorial team · updated 2 September 2026 · 9 min read
The management scenario is one of the three questions in the 15 minute Management and Clinical station, answered in five minutes before a panel of two. Candidates fear it for the wrong reason: there is no algorithm to hide behind, so it feels unanswerable, and the temptation is to memorise ethics vocabulary. The station is testing whether you can hear a messy human situation, keep patients safe inside it, and act like a sensible colleague. That is learnable as structure, and the structure is SPIIES DR.
What is scored
The management question is scored 0 to 6 on three published criteria: probity and professional integrity and awareness of safety and ethics; judgement under pressure and prioritisation; and communication. Panels score what you would actually do and the order you would do it in. Naming a principle helps only when it is attached to an action.
SPIIES DR
Work through the eight steps in order, but weave them into prose rather than reciting a checklist. Each step is a sentence or two; the whole answer is about four minutes, leaving room for the follow-up.
| Step | What you say | Example phrase |
|---|---|---|
| Spiel | Name the issues at stake and acknowledge the difficulty | The main issues are patient safety and professionalism, and because the consultant may be going through something personal this needs handling sensitively |
| Patient safety | The immediate action that protects this patient and others | As always my main priority is patient safety: I would ensure the clinician is removed from the clinical environment as non-confrontationally as possible, and any patients already seen are reviewed |
| Information | Establish the facts in person before acting | I would speak to them directly to confirm my concern, find out what duties they carried out, and whether this is isolated or a pattern |
| Initiative | Practical steps within your competence | I would arrange safe transport home and ensure cover is arranged, volunteering to absorb their workload |
| Escalate | Proportionately, to as few people as necessary, naming the chain | Because a senior colleague is implicated I would involve the clinical lead or medical director |
| Support | The patient, the colleague, the team, through named services | Occupational health, their GP, a confidential helpline or dependency services; a formal apology to any patient who witnessed it |
| Document | A contemporaneous record and a Datix | I would document the events and complete an incident report, with senior help |
| Reflect | Learning and prevention | I would reflect on whether this could have been managed differently or prevented |
A worked example
You are asked to consent a patient for a procedure you do not know. Spiel: this is difficult because I have clear instructions but not the knowledge to take informed consent, which would invalidate it. Patient safety: weighing it up, consenting would shorten the patient's fasting time, but GMC guidance is that only a competent clinician, preferably the operator, should consent, and the patient could come to harm if I did. Information: I would feed back to my senior that I cannot consent for this procedure and ask whether someone else can. Initiative: I would apologise, offer to find another registrar or the on-call team, and ask to observe the consent process and read up so I can consent next time. Escalate: I would already have escalated early. Support: an information leaflet for the patient and an apology for any delay, and holding the bleep for whoever consents. Document: a contemporaneous record, and a Datix if the patient came to harm from a delay. Reflect: on the learning need this exposed.
The scenario families
| Family | Typical scenario | What is really scored |
|---|---|---|
| Impaired or struggling colleague | A consultant or registrar smelling of alcohol, or a friend who is withdrawn and repeatedly late | Patient safety first, then compassion and the right support channels |
| Error and disclosure | Wrong-site surgery, a retained swab, your own prescribing error | Candour in action, the never event process, learning rather than blame |
| Consent and competence pressure | Asked to consent for a procedure you do not know, or to perform one you have never done | Knowing your limits, declining safely, finding the right person fast |
| Team conflict and escalation | Told to discharge a patient you think is unwell; a registrar undermining you; an unfair rota | Professional language, patient focus, proportionate escalation |
| Ethics and law | A Jehovah's Witness with a ruptured aneurysm; a DNACPR discussion; the Mental Health Act; a patient who refuses a foreign doctor | Naming and weighing autonomy, beneficence, non-maleficence and justice; the Mental Capacity Act |
| Prioritisation | Two patients, one operating theatre | NCEPOD classification, who decides, and communication with both patients |
How panels probe
The first answer is rarely the whole question. Panels change one variable and watch whether your judgement holds:
- What if the consultant asks you to keep it between the two of you?
- What if no harm came to the patient: do you still tell them?
- How would you escalate this, and what would you expect at senior level?
- What if it happens again next week?
- What if the patient asks you directly what went wrong?
Keep the structure, adjust the action, and never abandon the safety statement you opened with. Answer the probe directly from the relevant SPIIES DR step rather than restarting the whole framework.
Common pitfalls
- Jumping straight to escalation before securing patient safety.
- Reciting SPIIES DR as a flat checklist instead of applying it to this scenario.
- Over-escalating: telling more people than necessary and breaching confidentiality.
- Forgetting the human dimension: a colleague who may be struggling, a patient or relative who is distressed.
- Omitting Document and Reflect, which are easy marks.
- In ethics scenarios, failing to name the competing duties and how you weigh them.
Interview Library › Management and clinical › Postoperative Sepsis After Emergency Laparotomy
Management and clinical
Postoperative Sepsis After Emergency Laparotomy
You are the surgical SHO covering the wards overnight. A nurse asks you to review a woman in her sixties who is three days after an emergency Hartmann's procedure for perforated diverticulitis. Her NEWS2 score is 7: temperature 38.6, heart rate 118, blood pressure 96 over 58, respiratory rate 24, oxygen saturations 94 per cent on air,…
How would you assess and manage this patient?
“"I have been called about a post-operative patient with a NEWS2 of 7, three days after an emergency Hartmann's procedureSigmoid resection with end colostomy and closure of the rectal stump, described by the French surgeon Henri Hartmann in 1921.Hartmann H, 1921. This patient sounds critically unwell and I would go and assess her immediately. I would ask the nurse to prepare the drug chart, fluid chart and operative notes for my arrival, would kindly request a fresh set of observations, and would alert my registrar on the way that there is a septic…”
“At the bedside, I would first ensure that the patient is stable and would put out an emergency call if there was any concern of haemodynamic compromise. Otherwise, I would begin my assessment following the CCrISP protocol and would first examine the airway. If the patient is talking, then the airway is patent and I would move on to assess breathing.”
Why this scores
“would alert my registrar on the way that there is a septic post-operative patient on the ward”
the CCrISP opening statement: prioritisation is signposted before the bedside is reached, and the senior is warned early rather…
“I would take blood cultures before starting broad-spectrum intravenous antibiotics according to the trust…”
the circulation stage delivers the sepsis six in the correct order, cultures before antibiotics, so treatment does not destroy…
References
Suspected sepsis in people aged 16 or over: recognition, assessment and early management… National Institute for Health and Care Excellence
Management and clinical · 62 scenarios
8 more…
How TheatrePass helps
Management answers only become reliable when they are spoken, interrupted and probed. TheatrePass mock interviews run management scenarios aloud with follow-up questions in the style panels use, and every management scenario in the CST bank carries a model answer built on SPIIES DR with the phrases that score highlighted, so the structure is automatic before the day.
Interview formats and selection criteria change between recruitment cycles. Content is reviewed each cycle and dated; always confirm details against the current national recruitment guidance.
