Intended for healthcare professionals


Answering questions in clinical scenarios

BMJ 2019; 365 doi: (Published 02 May 2019) Cite this as: BMJ 2019;365:l1291
  1. Chris Yates, core training year one, year one acute care common stem in anaesthetics
  1. Royal Victoria Infirmary, Newcastle
  1. chris_yates111{at}

Five tips for students starting placements

One of the most common teaching encounters you will come across in medical school is the clinical scenario, or “viva.” These scenarios usually require you to present a clinical case you have seen and to answer questions that test your understanding of the differential diagnosis, investigation, and management of the case. A viva may take place ad hoc while on a ward attachment, or in small groups after clinical encounters with patients.

As a medical student you will face questions from senior clinicians on topics with which you might not be familiar. No one knows all the answers. Senior clinicians are more interested in your ability to take a structured history, perform a thorough examination, formulate a differential diagnosis, and suggest appropriate investigations and management. Importantly, you need to demonstrate a safe approach, and seek appropriate help when you need it. Answering viva style questions in medical school helps you to develop the key abilities to become a competent junior doctor.

Medical students might dread the stress of answering a question on the spot, especially if feeling the pressure to impress an examiner or senior colleague. The following five tips will not give you specific answers, but they will help you to structure and frame your answers in high stress situations.

1. Volunteer first

  • You may prefer to blend into the crowd, relying on the most extrovert or knowledgeable students to volunteer answers. But there are four ways that you will benefit by volunteering first in clinical vivas or teaching sessions.

  • Clinical vivas are an opportunity to …

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