Genomics & Genetic Science Interview Questions & Answers

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About this NHS interview question bank

To prepare for a genomics or genetic science NHS interview, expect questions on variant interpretation and classification using ACGS guidance, how you report uncertain results, sample identity and quality, urgent prenatal and rapid testing, consent and familial implications, and how you work with clinical geneticists and genetic counsellors. Build short spoken answers around real cases from your lab work, and know the NHS Genomic Medicine Service, the National Genomic Test Directory, UKAS ISO 15189 and your HCPC or AHCS standards before you walk in.

This bank contains 40 original practice questions with first-person model answers written for genetic technologists and clinical scientists applying for Band 6 posts in NHS Genomic Laboratory Hubs and regional genetics services, with a selection pitched at Band 7 registered clinical scientist level. It covers variant classification, VUS reporting, incidental findings, prenatal and rapid testing, somatic cancer testing, sample tracking, quality and accreditation, ethics of predictive testing and testing children, and the communication skills that sit alongside genetic counselling. Each question explains what the panel is really assessing, the points you must hit, the mistakes to avoid and the frameworks worth reading, so you can practise answers that sound like you rather than a textbook.

 

What this question bank covers

• Motivation for genomic science
• NHS Genomic Medicine Service and the National Genomic Test Directory
• Variant interpretation and ACGS classification
• Reporting variants of uncertain significance
• Incidental and additional findings
• Consent and familial implications
• Confidentiality of genetic data
• Sample tracking and identity errors
• Urgent prenatal and rapid testing
• Somatic cancer genomics
• Working with clinical geneticists and genetic counsellors
• Ethics of predictive testing and testing children
• Safeguarding in genomics
• Equity and ancestry in genomic data
• UKAS ISO 15189 and EQA
• Incidents, PSIRF and duty of candour
• Leadership at Band 6 and Band 7
• HCPC, AHCS and CPD

 

40 NHS interview questions with full model answers. The first 8 are free to read below. Unlock the remaining 32 for £2.99 (12 months' access).

These are original practice questions written to reflect how NHS interviews are run. They are not leaked or official questions, and Healthcare Interview Prep is independent of the NHS.

 

 

Free NHS interview questions and model answers

 

 

Question 1: Why do you want to work in genomic science in an NHS Genomic Laboratory Hub?

Motivation question  ·  Motivation

 

What the interview panel is assessing

The panel wants a genuine reason for choosing diagnostic genomics rather than research or another lab discipline. They are listening for an understanding that every sample is a patient and often a family, and for some realism about the pressure of turnaround times and uncertain results.

 

Model answer

Honestly, it was one report that did it. During my training rotation I was shadowing the scientist who signed out a result for a toddler who'd been through two years of appointments, scans and a muscle biopsy without a diagnosis. The exome found a de novo pathogenic variant in a gene that explained everything. I remember looking at the report and thinking that this single page was going to change how that family understood their child, what they could expect, and whether they could stop searching.

What drew me in after that was the mix of things the work asks of you. On one level it's precise technical science: library prep, coverage, quality metrics, filtering, and getting the bench work right. On another level it's careful reasoning. Variant interpretation is evidence weighing, and you have to be disciplined enough to say when the evidence isn't there. And then it's communication, because a result is only useful if the clinician and the family understand exactly what it does and doesn't mean.

I also like that the results don't stop with one person. A pathogenic finding can open up testing for parents, siblings and cousins, and a careful report can prevent a lot of unnecessary worry in a family as well.

I'm realistic about it. There are backlogs, urgent prenatal samples that land at four o'clock on a Friday, and many cases where we don't find an answer, or we find a VUS that frustrates everyone. But I'd rather work somewhere where the science is that close to a patient's care, and where getting the detail right really matters, than anywhere else.

 

Why this answer works

The answer opens with a specific memory rather than a generic love of science, which makes it believable. It shows understanding of the whole pathway from bench to report to family, and it acknowledges the less glamorous realities of diagnostic work without sounding put off.

 

Key points to include

• A specific moment that shaped your choice
• Understanding that each sample represents a patient and often a family
• Appreciation of both the technical and interpretive sides of the work
• Awareness of familial implications
• Realism about uncertain results, workload and urgent cases

 

Common mistakes to avoid

• Saying you just love DNA or found genetics interesting at university
• Talking only about technology and never about patients
• Making it sound like a research job
• Ignoring the reality of negative and uncertain results

 

NHS values and standards

Improving lives; Commitment to quality of care; Everyone counts; HCPC Standards of proficiency for clinical scientists

 

Further reading

• NHS Constitution for England
• HCPC Standards of proficiency: clinical scientists
• Academy for Healthcare Science Good Scientific Practice
• NHS England: NHS Genomic Medicine Service overview

 

 

Question 2: What do you understand about the NHS Genomic Medicine Service and the National Genomic Test Directory?

NHS Values question  ·  Understanding the NHS

 

What the interview panel is assessing

The panel wants to know you understand how genomic testing is organised and funded in England, not just the science. They are checking that you know why the test directory exists, how it shapes what you test and why, and whether you are aware that arrangements differ in the devolved nations.

 

Model answer

The Genomic Medicine Service was set up in England to make genomic testing more consistent and fair across the country. Before it, what you could get tested for depended quite a lot on which regional lab you were referred to. Now there's a network of seven Genomic Laboratory Hubs, each covering a geography, working alongside clinical genetics services and regional networks that help bring genomics into mainstream specialties like oncology, cardiology and paediatrics.

The National Genomic Test Directory is the backbone of that. It sets out which genomic tests are commissioned, for which clinical indications, using which technology, who is eligible and who can request them. So for a rare disease indication it might specify a gene panel or whole genome sequencing, and the eligibility criteria describe which patients should be tested. For cancer there are separate indications covering tumour and germline tests. It's reviewed regularly, so tests get added, updated or retired as evidence and technology change.

In practice, at the bench and at the reporting desk, it means we check that a request matches a directory indication and the eligibility criteria, we apply the right panel, and we know what's in scope for analysis. That's partly about fairness, because everyone meeting the criteria gets the same test wherever they live, and partly about being good stewards of limited resource.

I'm also aware that it's an England service. Scotland, Wales and Northern Ireland run their own genetics services with their own arrangements, so if I were working with a cross-border referral I'd check the local route. And I know the directory is a living document, so I'd always look at the current version rather than relying on memory.

 

Why this answer works

The answer explains the purpose of the Genomic Medicine Service in plain language and links the directory to everyday lab decisions. It stays at the level of principles, avoids quoting specific codes or numbers that might be wrong, and shows awareness of devolved arrangements.

 

Key points to include

• Purpose: equity and consistency of access across England
• Genomic Laboratory Hubs working with clinical genetics and mainstream specialties
• The directory defines indications, technology, eligibility and requesters
• How it shapes daily lab decisions
• Awareness that the devolved nations differ and the directory is updated

 

Common mistakes to avoid

• Confusing the Genomic Medicine Service with the 100,000 Genomes Project
• Quoting clinical indication codes or numbers you are not sure of
• Describing the directory as a list of genes rather than of tests and indications
• Forgetting that eligibility criteria exist and matter

 

NHS values and standards

Everyone counts; Commitment to quality of care; Working together for patients

 

Further reading

• NHS England: National Genomic Test Directory
• NHS England: NHS Genomic Medicine Service
• NHS Constitution for England
• Genome UK: the future of healthcare

 

 

Question 3: Talk us through how you would assess a novel missense variant found in a gene that fits the patient's phenotype.

Clinical Scenario question  ·  Variant interpretation

 

What the interview panel is assessing

This is a core technical question. The panel wants to hear a structured, evidence-based approach that follows ACGS best practice guidance, uses population, computational, functional, segregation and phenotype evidence appropriately, and recognises when the evidence is not enough to call the variant pathogenic.

 

Model answer

I'd start by making sure the variant is real and correctly described before I spend time interpreting it. I'd look at the read depth, the allele fraction and the quality metrics, check it in the alignment viewer for strand bias or a messy region, and confirm the HGVS nomenclature against the right transcript. If our policy is to confirm by an orthogonal method before reporting, I'd flag that.

Then I'd check the gene itself. Is there good evidence of a gene disease relationship for this condition, and is the mechanism loss of function or something else? That matters, because a missense variant in a gene where disease is caused by haploinsufficiency is a very different question from a gene with known missense hotspots.

Next I'd go through the evidence in the way the ACGS guidance sets out, which builds on the ACMG and AMP framework. Population data first: is the variant absent or extremely rare in gnomAD, bearing in mind the inheritance pattern and the frequency of the condition? Then whether it sits in a critical functional domain or a known hotspot, whether other pathogenic missense variants affect the same residue, and what the in silico predictors say, using them carefully and only at the strength the guidance allows. I'd search ClinVar, DECIPHER, the literature and our own internal database for previous observations. If parental samples are available, I'd want to know whether it's de novo, and whether paternity and maternity are confirmed. And I'd check how specific the patient's phenotype is for this gene, because a very distinctive phenotype counts for more than a non-specific one.

I'd apply each criterion at the right strength, making sure I'm not double counting the same evidence, and reach a classification. I'd also check whether a ClinGen expert panel has gene-specific rules, because those take precedence.

If it lands as a VUS, I wouldn't push it into likely pathogenic because it fits the clinical picture. I'd think about what would help: parental testing, segregation in the family, a more detailed phenotype from the clinician. As a Band 6 I'd document my evidence clearly and take it to the scientist signing out, or the variant review meeting, so the reasoning can be checked.

 

Why this answer works

The answer is structured, starting with technical validity, then gene-level evidence, then criteria in the order the guidance uses. It avoids over-claiming the strength of computational evidence and shows integrity about VUS. It also respects scope by taking the work to a senior reviewer.

 

Key points to include

• Confirm the variant is technically real and correctly described
• Check gene disease validity and disease mechanism
• Apply ACGS criteria: population, computational, functional, de novo, segregation, phenotype
• Avoid double counting and use gene-specific rules where they exist
• Accept VUS honestly and identify what extra evidence would help
• Document reasoning and use peer review

 

Common mistakes to avoid

• Jumping straight to in silico predictions as if they were decisive
• Upgrading a variant because the phenotype fits
• Assuming de novo status without confirmed parentage
• Forgetting to check transcript, nomenclature and data quality

 

NHS values and standards

Commitment to quality of care; Everyone counts; HCPC Standards of proficiency for clinical scientists

 

Further reading

• ACGS Best Practice Guidelines for Variant Classification in Rare Disease
• ACMG/AMP Standards and guidelines for the interpretation of sequence variants
• ClinGen Sequence Variant Interpretation recommendations
• HGVS nomenclature recommendations

 

 

Question 4: How would you write a report for a variant of uncertain significance so that a non-genetics clinician understands what to do with it?

Communication question  ·  Reporting uncertain results

 

What the interview panel is assessing

The panel wants to see that you understand the clinical risk of a VUS being misread as a diagnosis. They are looking for clear, unambiguous wording, appropriate recommendations and awareness of how the report will be used by mainstream clinicians and shared with families.

 

Model answer

The biggest risk with a VUS is that someone reads the gene name, sees that it fits, and treats it as the answer. So my whole aim when writing the report is to make it impossible to misread.

I'd make the headline clear: no pathogenic or likely pathogenic variant has been identified that explains the clinical presentation, followed by a separate statement that a variant of uncertain significance was found. I'd avoid wording like 'possibly causative' that leans one way. Then, in plain English, I'd say that there's currently not enough evidence to say whether this variant causes the condition, and that it should not be used on its own to make clinical decisions, including predictive testing of relatives.

The recommendations matter most. If parental samples or segregation testing in affected relatives could help resolve it, I'd say exactly which samples would be useful and how to send them. If more detailed phenotype information would help, I'd ask for it. And I'd include our lab's position on reclassification, so the clinician knows the classification may change as evidence emerges and how that would be communicated.

I'd also think about who's reading it. If the request came from a mainstream clinician, say a cardiologist or an oncologist, I'd make sure the report suggests discussion with or referral to clinical genetics where that's appropriate. And I'd remember the report may be shown to the patient, so I'd avoid jargon where I can.

Whether a VUS is reported at all depends on lab policy and the evidence. The ACGS guidance allows some discretion, and many labs only report VUS that have some supporting evidence and are relevant to the phenotype. As a Band 6 I'd follow our reporting policy and have the wording checked by the authorising scientist, and if a clinician phoned to ask what it meant, I'd be happy to talk it through.

 

Why this answer works

The answer is built around the real-world risk of misinterpretation, which shows clinical awareness. It gives specific wording choices, actionable recommendations and a nod to reclassification, while respecting lab policy and authorisation.

 

Key points to include

• Make clear no diagnosis has been confirmed
• Plain statement that a VUS should not guide clinical management or predictive testing
• Specific recommendations, such as parental or segregation samples
• Mention reclassification and referral to clinical genetics where appropriate
• Follow lab reporting policy and authorisation

 

Common mistakes to avoid

• Using hedged wording that implies the variant is probably causative
• Writing only for geneticists and ignoring mainstream requesters
• Leaving out actionable recommendations
• Suggesting cascade testing of relatives for a VUS

 

NHS values and standards

Commitment to quality of care; Working together for patients; Respect and dignity

 

Further reading

• ACGS Best Practice Guidelines for Variant Classification in Rare Disease
• ACGS General Genetic Laboratory Reporting Recommendations
• Joint Committee on Genomics in Medicine: Consent and confidentiality in genomic medicine
• UKAS ISO 15189 requirements for reporting

 

 

Question 5: You are booking in samples and notice that the name on a blood tube doesn't exactly match the request form. What do you do?

Patient Safety question  ·  Sample identity

 

What the interview panel is assessing

The panel wants to see that you understand identity errors are among the most serious risks in a genetics lab, because results can affect a whole family and may not be repeatable. They are listening for strict adherence to acceptance criteria, escalation, documentation and an awareness of irreplaceable samples.

 

Model answer

I'd stop and not process it. In genetics, a wrong blood in tube error isn't just a wrong result for one person. It could mean a family is told they carry a variant they don't, or someone is falsely reassured, and that can go on to affect cascade testing and decisions about pregnancy or surgery. So I take minor mismatches as seriously as big ones.

First I'd check exactly what's different. Is it a spelling difference, a missing middle name, a different date of birth, a different NHS number? I'd compare against our sample acceptance criteria, which set out which identifiers must match. I wouldn't correct anything myself or assume the form is right, even if it looks like an obvious typo.

If it doesn't meet the criteria, I'd put the sample on hold, record the discrepancy in the LIMS and contact the requesting team to explain that it can't be processed as it stands. In most cases the right outcome is a repeat sample, and I'd say that clearly and kindly, because clinical teams sometimes push back.

There's an important exception that I'd escalate rather than decide alone. Some samples are irreplaceable, like amniotic fluid, a chorionic villus sample, cord blood, or a sample from someone who has since died. Most labs have a policy for those, where a senior scientist can decide to process while the identity is resolved, with the requester formally confirming the details and everything documented, and with a disclaimer on the report if needed. I'd go straight to the senior on duty for that decision.

Finally, I'd report it on the incident system. It's not about blame. Labelling errors often have a pattern, such as a particular clinic or a pre-printed label process, and the incident data helps fix that upstream.

 

Why this answer works

The answer shows the candidate understands why identity errors carry extra weight in genetics, follows acceptance criteria without improvising, and knows when to escalate. The irreplaceable sample point shows real lab experience, and the incident reporting shows a learning culture.

 

Key points to include

• Do not process or correct the sample yourself
• Check against the lab's sample acceptance criteria
• Hold, document in the LIMS and contact the requester
• Escalate irreplaceable samples to a senior for a documented decision
• Report as an incident so patterns can be addressed

 

Common mistakes to avoid

• Correcting an apparent typo without confirmation
• Processing first and sorting out the labelling later
• Treating a minor mismatch as not worth reporting
• Refusing an irreplaceable sample outright without escalating

 

NHS values and standards

Commitment to quality of care; Everyone counts; HCPC Standards of conduct, performance and ethics

 

Further reading

• Your laboratory's sample acceptance policy
• UKAS ISO 15189 Medical laboratories: requirements for quality and competence
• NHS England Patient Safety Incident Response Framework (PSIRF)
• Human Tissue Act 2004

 

 

Question 6: An urgent prenatal sample arrives late on a Friday with a request for rapid testing. How would you manage it?

Operational Scenario question  ·  Urgent and prenatal testing

 

What the interview panel is assessing

The panel wants to see that you understand why prenatal turnaround times matter, and that you can prioritise safely without cutting corners. They are listening for awareness of maternal cell contamination, consent, communication with the fetal medicine team and escalation when capacity is stretched.

 

Model answer

I'd start by recognising what's riding on it. Behind a prenatal sample there's a family waiting in a really anxious place, and often decisions with time limits attached. So a prenatal sample on a Friday afternoon goes to the front of my mind, not the back of the queue.

Practically, I'd check the sample and paperwork straight away: identifiers, gestation, sample type, what's been requested, and that the request matches the indication. I'd make sure a maternal blood sample has come with it, because we need it to check for maternal cell contamination, and if it hasn't I'd ring the fetal medicine unit immediately so it can be sent. I'd also check that consent is documented for what's being requested, since a rapid aneuploidy test is quite different from rapid exome sequencing, and the family should know what could be found.

Then I'd book it in as urgent, start the initial processing and let the duty senior scientist know it's arrived, because out of hours cover and weekend working arrangements differ between labs. I'd check whether the service specification and our local turnaround targets mean it needs weekend processing, and follow our on-call arrangements rather than guessing.

I wouldn't let urgency change the quality steps. Contamination checks, controls and second checks still happen. A fast wrong result in a pregnancy is far worse than a result a few hours later.

Finally, I'd keep the fetal medicine team informed. If I knew there'd be a delay, or a culture was needed and that would take longer, I'd tell them early so they could plan what to say to the family. And I'd hand over clearly to whoever was picking it up next, in person and on the LIMS.

 

Why this answer works

The answer balances urgency with safety, which is exactly the tension the question tests. It shows specific knowledge of maternal cell contamination and consent for different prenatal tests, and it stays within scope by involving the senior scientist and following local arrangements.

 

Key points to include

• Recognise the clinical and emotional stakes of prenatal results
• Check identity, gestation, sample type, maternal sample and consent
• Escalate to the duty senior and follow local out-of-hours arrangements
• Never drop quality checks for speed
• Communicate proactively with the fetal medicine team and hand over clearly

 

Common mistakes to avoid

• Leaving it until Monday without escalating
• Skipping contamination or second checks to save time
• Not checking whether a maternal sample has been sent
• Promising the clinical team a turnaround time you can't guarantee

 

NHS values and standards

Compassion; Commitment to quality of care; Working together for patients

 

Further reading

• NHS England: National Genomic Test Directory (prenatal indications)
• ACGS best practice guidance on prenatal testing and maternal cell contamination
• Your laboratory's urgent sample and out-of-hours procedures
• NHS Fetal Anomaly Screening Programme handbook

 

 

Question 7: A woman phones the lab saying her sister has been tested for a BRCA variant and asks you to tell her the result so she can get tested too. How do you respond?

Confidentiality question  ·  Confidentiality of genetic data

 

What the interview panel is assessing

The panel is checking that you understand genetic results are confidential to the person tested even when they are relevant to relatives. They want to hear a kind, non-defensive response that protects confidentiality while pointing the caller to the right route, and an awareness of how familial information is handled in practice.

 

Model answer

I'd be warm with her, because what she's asking is completely understandable. She's worried, she wants to look after her own health, and genetics feels like it belongs to the family. But I wouldn't confirm whether her sister has been tested, let alone the result. I can't verify who I'm speaking to over the phone, and even if I could, her sister's result belongs to her sister.

I'd say something like: 'I can hear this really matters to you, and I want to help you get the right advice. I'm not able to share anything about another person's tests, or even confirm whether we hold any, but there's a good route for this.' I'd explain that the usual way is for her sister to share her result letter, or for the family to be seen by clinical genetics, and that her GP can refer her to the regional genetics service. Often the person tested has been given a family letter specifically for this purpose.

I'd also explain that if the variant is known in the family, testing for relatives is usually targeted to that specific variant, which is why the genetics team needs the details through the proper route rather than from a phone call to the lab.

After the call I'd make a brief note according to our policy and let my senior or the clinical genetics team know if it seemed relevant, especially if she sounded distressed.

I'm aware that this area has real complexity. Genetic information has a familial dimension, and there's professional guidance and case law about when it might be appropriate to share information with relatives without consent. But those are decisions for the responsible clinician and the Caldicott Guardian, made carefully, not something for a lab scientist on the phone.

 

Why this answer works

The answer shows compassion while holding a firm line on confidentiality. It gives the caller a practical route, shows understanding of family letters and targeted testing, and correctly places any decision to disclose without consent with the clinical team rather than the lab.

 

Key points to include

• Don't confirm whether the sister has been tested
• Acknowledge the caller's concern kindly
• Signpost to family letters, GP and clinical genetics
• Explain why targeted testing needs the proper route
• Recognise that disclosure without consent is a clinical and Caldicott decision

 

Common mistakes to avoid

• Confirming the sister was tested while refusing to give the result
• Being abrupt or hiding behind data protection jargon
• Sharing information because the caller seems genuine
• Not offering any route forward

 

NHS values and standards

Respect and dignity; Compassion; Everyone counts; HCPC Standards of conduct, performance and ethics

 

Further reading

• UK GDPR and Data Protection Act 2018
• The Caldicott Principles
• Joint Committee on Genomics in Medicine: Consent and confidentiality in genomic medicine
• GMC Confidentiality: good practice in handling patient information

 

 

Question 8: You notice that a senior colleague has been authorising reports without completing the required second check. What would you do?

Conflict question  ·  Raising concerns

 

What the interview panel is assessing

The panel wants to see that you would act on a patient safety concern even when it involves someone more senior. They are looking for a proportionate approach that starts with checking facts and speaking directly where safe, escalating appropriately, and knowing the formal routes, including Freedom to Speak Up.

 

Model answer

This would make me uncomfortable, and I'd be honest about that, but I wouldn't ignore it. The second check exists because interpretation and reporting errors in genetics can follow a family for years, and the whole quality system depends on everyone doing it.

First I'd make sure I've understood what I saw. I'd check the LIMS audit trail and our standard operating procedure to see whether there's an alternative check I'm not aware of, like a different sign-off route for certain test types. I don't want to raise a concern based on a misunderstanding.

If it's clear the check is being skipped, I'd speak to my colleague privately, and I'd keep it about the process rather than about them as a person. Something like: 'I noticed a few reports went out without the second check logged. Is there something I've missed, or has the workload got on top of things?' Quite often there's a pressure behind it, like a backlog or a staffing gap, and that's something the team needs to fix together.

If it carried on, or if I'd already found a report with an error in it, I'd go to my line manager or the quality lead. If a report had gone out with a possible error, I'd raise that urgently, because the priority is checking whether any patient could be affected, and recording it as an incident. I'd keep factual notes of what I'd seen and when.

If I felt I couldn't raise it locally, or nothing changed, I know there's a Freedom to Speak Up Guardian in the trust, and as a registrant I have a professional duty under the HCPC standards to raise concerns about safety. I'd hope it wouldn't get that far, but I'd use those routes if I needed to.

 

Why this answer works

The answer is proportionate and fair: it starts with checking the facts, then a respectful direct conversation, then escalation, with urgency when a patient might be affected. It shows awareness of workload pressures as a system issue and knows the formal routes and professional duty.

 

Key points to include

• Patient safety comes before hierarchy or awkwardness
• Check facts and procedures first
• Raise it directly and respectfully where safe
• Escalate to the line manager or quality lead, urgently if a report may be wrong
• Know Freedom to Speak Up and your professional duty to raise concerns

 

Common mistakes to avoid

• Saying you'd ignore it because the colleague is more experienced
• Going straight to a formal complaint without checking facts
• Discussing it with other colleagues as gossip
• Forgetting to check whether issued reports need reviewing

 

NHS values and standards

Commitment to quality of care; Respect and dignity; Working together for patients; HCPC Standards of conduct, performance and ethics

 

Further reading

• HCPC Standards of conduct, performance and ethics
• National Guardian's Office: Freedom to Speak Up guidance
• UKAS ISO 15189 Medical laboratories: requirements for quality and competence
• NHS England Patient Safety Incident Response Framework (PSIRF)

 

 

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