ST4 psychiatry interview questions and format
Higher psychiatry (ST4) recruitment uses one standardised 15-minute online interview for every psychiatry specialty. Two clinical assessors ask you 2 scenario-based questions, spending 6 minutes on each with a series of follow-up questions on the topic. The questions test your knowledge of core skills and attributes for ST4 psychiatry and are answered without supporting evidence.
The published stem questions (Round 3, February 2027 intake)
NHS England's interviews page gives the two stem questions for the Round 3 interviews (February 2027 intake), 6 minutes each: Part A, managing a complex case, and Part B, working or training within a stretched system.
Part A: “You have just taken over care of a patient and are meeting with her for the first time. The patient says that she is unhappy with her care and that she disagrees with her management plan. You have been informed that the patient’s case is complex, and that she, her relatives and the team involved in her care, have regularly disagreed as to the best way forwards. Assume she has capacity to make her own decisions. How would you approach the situation?”
Part B: “You have begun your ST4 training at a Mental Health Trust. The hospital you work in is extremely busy and psychiatric teams are understaffed. You have seen some poor examples of teamwork and patient care as a result of this. How might this affect your work, and what would you do in response to this?”
How the interview runs
All eligible applicants are invited to book a 15-minute online interview on Microsoft Teams; slots are booked first come, first served. The interview focuses on your suitability and commitment to higher training.
One panel of 2 clinical assessors asks both questions; an administrator, and possibly a lay representative or other observer, may also be in the virtual room. About 6 minutes are spent on each question.
The page says not to rely on a scripted answer or detailed notes: the interview explores your understanding of the issues, and your engagement in the conversation matters.
When you join, you show your ID on screen and show the administrator the room you are in, to confirm you are alone.
Practice questions: workplace and leadership scenarios
- A senior colleague asks you to independently assess and manage a patient whose presentation is genuinely outside your current level of competence, and there is no one immediately available to support you. How would you handle this?
- You notice a senior colleague on your team seems exhausted, is snapping at staff, and has started missing small but important details in patient reviews. Nobody else seems to have raised it. How would you handle this?
- You inherit an outpatient caseload for review that is far larger than is safe for one clinician to manage properly, and you are told there is no plan to reduce it in the near future. What would you do?
- You are trying to assess a patient whose first language is not English, but no interpreter is available due to a shortage of interpreting services, and the ward is under pressure to complete the assessment quickly. What would you do?
- You notice that colleagues on your team appear reluctant to submit exception reports about unsafe working hours, saying it is seen as complaining or will not change anything. How would you approach this culture?
Practice questions: patient care scenarios
- You take over the care of an inpatient who has capacity and wants to be discharged today, although the team has ongoing concerns about risk the patient may pose to a specific person outside hospital. How would you manage this?
- A patient transferred to your outpatient clinic has capacity and wants to be discharged from the service, while their adult child keeps contacting you to say the patient still needs support and should not be discharged. How would you approach this consultation?
- You take over the care of a patient on an inpatient ward who has capacity and refuses to continue a medication that was started by the previous team, saying it makes them feel unlike themselves, while the patient's spouse is phoning the ward daily insisting the medication must continue. How would you manage this situation?
- You take over a patient's care in the community and they have capacity but strongly object to you contacting their family, even though the previous team had been working closely with the patient's sister. How would you handle this?
The practice questions come from MedMock's own question bank, written for this interview's published format. They are not past interview questions.
Scoring and selection
- In the 2025 recruitment round there were 683 applications for 491 ST4 psychiatry posts across all psychiatry specialties, a competition ratio of 1.39.
Frequently asked questions
Is the ST4 psychiatry interview the same for every psychiatry specialty?
Yes. The questions are designed to give a standardised interview process for all applicants, whichever ST4 psychiatry specialties they want to be considered for.
How long is the ST4 psychiatry interview?
About 15 minutes: 2 scenario-based questions with about 6 minutes on each.
Are the ST4 psychiatry interview questions published?
For the Round 3 interviews (February 2027 intake), NHS England's interviews page gives both stem questions: managing a complex case, and working or training within a stretched system. The assessors then ask a series of questions on each stem.
Do you need to show evidence or your portfolio at the interview?
No. The questions are designed to be answered without any supporting evidence being provided or checked.
Checked on 13 October 2026 against Higher psychiatry training: interviews (NHS England) and 2025 competition ratios (NHS England). Recruitment changes each year: confirm on the official pages before you apply.
Practise these questions out loud
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