Question 1

Why do you want to work in intensive care medicine?

Accepted Answer

I think the honest answer is that intensive care is where I feel most useful, and it took me a while to understand why. When I first rotated through the unit as a junior, I assumed the appeal would be the procedures: lines, airways, the monitors. Those are part of it, but what actually hooked me was a night shift where I was called to the ward to see a man in his sixties with pneumonia who was tiring. Within an hour we'd brought him to the unit, started non-invasive ventilation and called his wife in. He did well. But what stayed with me was the conversation my registrar had with his wife that night, explaining calmly what we were doing, what might happen and what we would and wouldn't do if things got worse. That's when I realised intensive care is really about decisions. Who will benefit from what we can offer, how much is too much, and how we keep the person and their family at the centre when everything is noisy and frightening. I like the physiology, and I like that you can see the effect of what you do in real time, but I value just as much the slower work of sitting with a family and being honest. I also like the way the unit works as a team. The nurse at the bedside often knows before anyone else that something isn't right, and the best consultants I've worked with listen to that. I want to be that kind of doctor. I'm not naive about it. I've been involved in withdrawals of treatment that were very hard, and I've had shifts where there were more referrals than beds.…

Question 2

Which NHS value matters most to you in intensive care, and how have you shown it?

Accepted Answer

The NHS values are working together for patients, respect and dignity, commitment to quality of care, compassion, improving lives, and everyone counts. In intensive care I think respect and dignity is the one that's most at risk, because so many of our patients are sedated, intubated and can't speak up for themselves. It's very easy for a bed space to become a set of numbers. One example that comes to mind was a woman in her forties who'd been ventilated for about a week with pneumonia. She was being lightened from sedation, and on the ward round we stood at the end of the bed discussing her sedation holds and her chest X-ray as though she wasn't there. Her nurse quietly pointed out that she was opening her eyes to voice. I went to the bedside, introduced myself, told her where she was and what day it was, and explained that the tube was helping her breathe and that we were hoping to take it out soon. She squeezed my hand. After that, the round carried on but we spoke to her first. It made me change a couple of small habits. I always introduce myself to a patient whatever their sedation score, I draw curtains properly for examinations, and I try to learn something about the person from their family, what they did for work, what music they like, so that the team sees a person. Some units use a short 'about me' sheet by the bed and I've found that really helps. Dignity also matters at the end of life. When treatment is withdrawn, I want the family to have privacy, time and no…

Question 3

Tell us about a time you spoke to a family about a patient who was deteriorating despite full intensive care treatment.

Accepted Answer

One I think about often was a man in his seventies with faecal peritonitis after emergency surgery. He'd been on the unit for four days, on high-dose noradrenaline, ventilated, and his kidneys had failed and he was on filtration. Despite everything, his lactate was climbing and he was needing more support each day. The consultant and I agreed the family needed an honest update that afternoon, and the consultant asked me to lead it with her in the room. Before we went in, we agreed the key message: he was very unwell, he was not responding to treatment, and there was a real chance he would die in the next day or two. We also agreed what we'd say if they asked about stopping treatment, and we brought his nurse with us. I started by asking his wife and two daughters what they understood. His wife said she thought he was 'turning a corner' because the surgeon had said the operation went well. So I gently explained that the operation had done what it needed to, but the infection had made his whole body very sick, and that the machines were now doing the work of his heart, lungs and kidneys. I said, quite plainly, 'I'm worried he's dying,' and then I stopped talking. That silence was the hardest part, but it gave them space. His daughter asked whether there was anything else we could do. I was honest that we were already giving everything that might help, and that if he got worse we would not want to put him through CPR, because it wouldn't work and would take away a peaceful…

Question 4

You are called by the medical registrar about a ward patient with suspected septic shock. Talk us through how you would handle the referral.

Accepted Answer

The first thing I'd do on the phone is get a quick, structured picture using SBAR: who the patient is, why they're in, their observations and NEWS2, what's been done so far and what the registrar is worried about. I'd also ask straight away whether there's a treatment escalation plan or a DNACPR decision, and what the patient's baseline function is like. But I wouldn't let that conversation delay me. If the story sounds like septic shock, I'd say I'm coming to see them now. At the bedside I'd do an ABCDE assessment and make sure the basics of the sepsis bundle are moving in parallel: high-flow oxygen if hypoxic, blood cultures and then antibiotics without delay according to the trust's guideline, a lactate, fluids given as boluses with reassessment after each one, a urine output plan, and a hunt for the source. I'd be asking early whether there's something that needs source control, like an obstructed kidney, an abscess or a perforation, and getting the right team involved. If the patient remains hypotensive or the lactate stays high despite appropriate fluid, they're likely to need vasopressors, and that means critical care. Some trusts allow peripheral noradrenaline for a short period while a central line is placed, so I'd follow local policy. I'd aim for a mean arterial pressure target, usually around 65, adjusted for the individual. Alongside all this, I'd speak to the patient if they can talk, and to the family, about what we're worried about and what we're offering.…

Question 5

A decision has been made to withdraw life-sustaining treatment. What is your role in making sure this happens well?

Accepted Answer

I think the most important thing to say is that withdrawing treatment isn't the moment we stop caring. It's the moment the focus of our care changes, and it deserves the same planning as any procedure. By the time we get to withdrawal, the consultant will usually have led the decision and the family meeting. My role as a Clinical Fellow or Specialty Doctor is to make sure what follows is calm, comfortable and dignified. First, I check the basics: that the decision and the reasons are clearly documented, that there's a DNACPR decision recorded, and that we've referred to the specialist nurse for organ donation, because that referral should happen before treatment is withdrawn whatever we think the outcome might be. Then I sit down with the bedside nurse and agree a plan. Who does the family want present? Are there religious or cultural needs, such as a chaplain or particular prayers? Is there a time that matters to them, like waiting for a son to arrive from abroad? I'd prescribe medication to manage breathlessness, agitation and secretions according to the unit's end of life protocol, with doses titrated to symptoms rather than given to hasten death. We'd stop unnecessary monitoring, blood tests and infusions, switch off alarms and move the family's chairs close to the bed. When it comes to the ventilator, units differ on whether they extubate or reduce support gradually, so I'd follow the plan the consultant has agreed and explain to the family what they might see, such as…

Question 6

How do you work with the nursing team on an intensive care unit?

Accepted Answer

In intensive care the nurse is with one or two patients for twelve hours, and I might be looking after twelve or more. So in practice, the nurse often knows the patient better than I do on any given shift. I try to work on that basis. At the start of a shift I like to catch each nurse at the bedside during or after handover and ask, 'What are you worried about?' That question often brings out the things that don't appear in the numbers: the patient who seems more agitated than yesterday, or a family member who's struggling. On the ward round I make sure the nurse is part of the discussion rather than standing behind us, and I'll read back the plan with them so we both agree what's happening and what the triggers for calling me are. A good example was a night where a nurse told me she wasn't happy with a post-operative patient whose observations looked broadly fine. She said he was 'just not right' and his drain output had changed colour. I went straight in, examined him and agreed something was wrong, and we called the surgical team. He went back to theatre that night with an anastomotic leak. If I'd brushed her off because the numbers were OK, it could have been much worse. I also try to make life easier in small ways: writing clear prescriptions for infusions with the right concentration, not ordering unnecessary bloods at four in the morning, helping turn or reposition a patient when I'm free, and thanking people at the end of a hard shift. When there are disagreements,…

Question 7

Tell us about a mistake you made and what you learned from it.

Accepted Answer

This happened when I was fairly new to the unit. I was asked to prescribe potassium replacement for a ventilated patient whose potassium had dropped after diuresis. I wrote it up as an intravenous bolus in the format I'd used in another hospital, but this unit had a standard concentrated preparation given only via a central line through a pump, and my prescription wasn't clear about the route, concentration or rate. The nurse caught it before anything was given. She came to me and said, very calmly, that she couldn't give it as written. My first feeling was embarrassment, and honestly a bit of a sinking feeling, because I knew how dangerous concentrated potassium can be. I thanked her, cancelled the prescription and rewrote it properly using the unit's protocol, checking it with her. Even though no harm came to the patient, I completed an incident report that afternoon, because it was a near miss and I thought it might be a system issue as much as an individual one. I also told my consultant. When the incident was reviewed, it turned out that the electronic prescribing system allowed free-text potassium prescriptions, and a couple of other doctors new to the unit had done something similar. The pharmacist worked with the unit to create a set of standard order sets for electrolyte replacement, which removed the option for an ambiguous prescription. What I learned was twofold. Personally, when I move to a new unit I now make a point of learning their standard infusion…

Question 8

A surgical consultant insists their patient needs an ICU bed after surgery, but you feel the patient is unlikely to benefit. How would you handle this?

Accepted Answer

The first thing I'd remind myself is that we both want the best for the patient, and the surgeon may know things I don't. So rather than taking a position on the phone, I'd try to understand their reasoning. Why do they feel ICU is needed? What is the planned operation, what are the risks, and what are they hoping critical care will add? Then I'd want to see the patient myself, read the notes and talk to the patient if they're able. Things I'd consider include their baseline function and frailty, their other illnesses, their own goals and wishes, and whether there's a reasonable chance that organ support would get them to an outcome they would value. Sometimes what looks like a poor candidate on paper turns out to be a very independent person with a clear wish to try. Other times, the honest picture is that we'd be prolonging dying. As a Specialty Doctor I wouldn't make a contested decision like this on my own. I'd discuss it with the ICU consultant, and if there's still disagreement, I'd suggest a direct conversation between the two consultants, ideally before surgery rather than at the end of the operation. That conversation might lead to a middle ground, for example admission for a time-limited trial of organ support with clear goals and a review point agreed in advance, and a clear ceiling of care, such as no CPR or no renal replacement therapy. Throughout, I'd stay respectful. I wouldn't argue in front of the patient or on the ward, and I'd document the discussion, the…

Intensive Care Medicine Interview Questions & Answers

About this NHS interview question bank

Free NHS interview questions and model answers

Question 1: Why do you want to work in intensive care medicine?

Question 2: Which NHS value matters most to you in intensive care, and how have you shown it?

Question 3: Tell us about a time you spoke to a family about a patient who was deteriorating despite full intensive care treatment.

Question 4: You are called by the medical registrar about a ward patient with suspected septic shock. Talk us through how you would handle the referral.

Question 5: A decision has been made to withdraw life-sustaining treatment. What is your role in making sure this happens well?

Question 6: How do you work with the nursing team on an intensive care unit?

Question 7: Tell us about a mistake you made and what you learned from it.

Question 8: A surgical consultant insists their patient needs an ICU bed after surgery, but you feel the patient is unlikely to benefit. How would you handle this?

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