Show how you think, listen and take responsibility as a psychiatry registrar.
Build a clear opening, practise being challenged, and make room for a conversation. Use this guide with a colleague or supervisor to prepare for the national higher psychiatry training interview.
15 minutesApproximately, online on Microsoft Teams
2 scenariosSix minutes on each question
2 assessorsOne clinical panel for both scenarios
The interview explores suitability for higher training across psychiatry specialties. Expect probing questions during each scenario. Supporting portfolio evidence is not checked in the interview, and a rehearsed monologue leaves little room to demonstrate your reasoning. Official interview format and current stems.
How is the interview scored?
Part A and Part B each carry 20 raw marks, with 10 for communication: 50 in total. The published appointability threshold is at least 25/50 overall and at least 6/20 in each scenario. A strong portfolio cannot compensate for missing the interview threshold.
The current scoring table allocates 25% to interview, 25% to verified self-assessment and 50% to adjusted CASC. Its explanatory text names the August 2026 round; confirm the applicable weighting in your current-round guidance. Read the scoring overview.
02 / Build your answer
Give the panel a clear line of reasoning
A useful opening identifies the central difficulty, the immediate priority and the people you need to involve. Aim to organise your thinking in about two minutes, then practise responding to interruptions. That is a rehearsal technique, not a guaranteed uninterrupted speaking slot.
Orientate. State what makes the situation difficult. Separate what the stem tells you from what you still need to establish.
Prioritise. Explain what you would address now, what can wait, and what would make you seek urgent senior help.
Understand the people. Explore the patient’s priorities and the perspectives of relatives, colleagues and the wider team. Describe what you would actually ask.
Make a workable plan. Explain your own role, who else is needed, how decisions will be communicated, and how you will review progress.
Reflect. Acknowledge uncertainty and the limits of your role. Use a brief, anonymised example when it clarifies your judgement.
Replace a list of labels with actions. For example, explain how you would establish a shared priority and check understanding, rather than stopping at “I would communicate with the MDT”.
03 / Explore the current themes
Two situations. Several defensible perspectives.
The summaries below reflect the February 2027 stems. Read the complete official wording before you rehearse. The frameworks and follow-up prompts are practice material, not an official mark scheme.
Part A
Managing a complex case
A patient with decision-making capacity disagrees with her care plan; relatives and the clinical team also have conflicting views.
Explore before proposing
Review the history, previous approaches and the reasons trust may have broken down.
Ask what matters to the patient, what she understands and what she wants to change.
Distinguish disagreement from lack of capacity. Respect the capacity assumption in the stem.
Consider safety and the clinical context without using them to bypass the patient’s voice.
Involve relatives appropriately, with attention to consent and confidentiality.
Agree achievable next steps, clarify responsibilities and arrange review; seek supervision where uncertainty remains.
Common traps to rehearse around
Taking sides before listening; promising a particular treatment; treating family agreement as the goal; or arranging a meeting without explaining its purpose, the patient’s role and what happens afterwards.
Part B
Working in a stretched system
You join an understaffed, busy service and encounter poor teamwork and concerning patient care.
Work at three levels
Today: identify immediate concerns, prioritise clinical work and clarify who is responsible for urgent tasks.
The team: understand workload, skills, supervision and handover arrangements before assuming individual failure.
Your contribution: communicate clearly, ask for help early and support colleagues within your competence.
Escalation: describe the concern, its impact and the support required through local clinical and training channels.
Improvement: propose one feasible change, a way to assess it and a review date.
Sustainability: protect supervision and training, recognise fatigue and reflect on your own limits.
Common traps to rehearse around
Making “work harder” the whole solution; blaming colleagues; jumping to a large QI project while immediate safety concerns remain; or saying “escalate” without naming what you would communicate and how you would follow it up.
04 / Say it out loud
Six-minute practice room
Choose a theme. Give a short opening, then let your partner select follow-up questions. Practise changing direction when challenged. The timer and prompts run on this page; there is no microphone recording or answer submission.
Opening phase: identify the problem, priorities and your approach.
Practice follow-up
Ask your partner to reveal a prompt when you are ready to be challenged.
Review your practice
Did I answer the actual question and explain my priorities?
Did I make the patient's or team's perspective visible?
Was I specific about my own role and when I would seek support?
Did I listen and adapt when challenged?
What one change will I try in my next rehearsal?
Ask your partner for one effective moment and one concrete improvement.
05 / Prepare with a purpose
A focused 30-day plan
Days
Your task
Finish with
1–4
Read the current stems, person specification and invitation.
A list of the capabilities each scenario could reveal.
5–8
Build a brief opening for each theme.
A flexible outline you can explain without reading.
9–12
Choose examples of conflict, teamwork, improvement and reflection.
A clear account of your role, impact and learning.
13–17
Practise follow-ups with a colleague who interrupts you.
Two places where your reasoning needs to be clearer.
18–23
Run both scenarios on video with a supervisor or peer.
Feedback on content, judgement and communication.
24–28
Repeat your weaker scenario and test the technical set-up.
An opening that works naturally and a reliable connection.
29–30
Review the invitation, prepare ID and keep rehearsal light.
A practical plan for interview day.
If you have less time, prioritise the official stems, one observed practice of each scenario and a technology check. If you have longer, repeat the cycle using the feedback rather than memorising longer answers.
Keep self-assessment preparation alongside interview work
Interview rehearsal and portfolio verification are separate jobs. Match every claimed achievement to the current evidence requirements, label documents clearly and remove patient-identifiable material. Ask for supporting letters early and check that uploads are complete. Use the ST4 score calculator to organise your review, then confirm claims against the official self-assessment guidance.
06 / Arrive ready
Make the practical details uneventful
Check the time in your invitation, your ID and the joining instructions.
Test webcam, microphone, lighting and internet in the room you will use. Check workplace firewall restrictions in advance.
Use a quiet, private room. Be ready for the identity and room checks.
Practise looking towards the camera while still listening and responding naturally.
Keep the surrounding morning or afternoon flexible in case of technical disruption.
Follow the current rules on notes and assistance. Practise independently; do not use a script or live AI assistance during the interview.
This independent guide draws on the September 2026 CT3 development session, “ST4 Interview Preparation and Higher Training Application”, and the official resources below. Its rehearsal activities are educational suggestions; recruitment instructions and scoring decisions come from the recruiting body.
