This is definitely the part of the interview I felt most nervous about, as do most residency candidates.

Clinical question tips:

• know they aren’t expecting you to be an expert, that’s the whole reason why you are pursuing residency right? they are looking to see how you critical think, act under pressure, and how you present information
• if you don’t know the answer, that is okay! but be prepared to answer in those situations. typically it is good to say you don’t know but you would check x, y, z resources to find the answer. if you offer to check and follow up with them, be sure to actually follow through (but in most cases I tried to avoid offering this because it just wasn’t necessary)
• questions can be asked in various ways
  • “typical” clinical question – such as a patient with x, y, z symptoms diagnosed with CAP and has a penicillin allergy. what do you treat them with? they may also add in follow-up questions such as what do you discharge them on, what is your duration of therapy, etc. 
  • priority management – such as 1 patient requiring discharge counseling, a call from a nurse who can’t locate a IV antibiotic medication, and an order for acetaminophen to verify in the computer, in what order do you approach these tasks and why?
  • patient counseling scenarios – teach how to use an inhaler, or injectable device, counseling someone starting warfarin or DOAC, etc
  • patient cases or fake patient visits including opportunity to gather information, ask the “patient” questions, formulate A/P and may ask you to write it out or present it verbally
  • there may be other variations of ways to ask clinical questions too (but don’t let this scare you, it usually is not meant to confuse you! and hopefully should be things you have at least seen during APPE rotations)
  • ambulatory care heavy residences may focus more on outpatient type questions while acute care heavy residencies may focus more on inpatient type questions, but be prepared for both
• You may or may not get access to resources. For most of mine, I did not!

How I studied for clinical questions:

• I personally study best by writing out a “study guide” to myself, so I approached this similarly. I started this in early January and continued through interview season mid-late February, adding things that came up from interviews if I wanted to review.
  
• I used the NAPLEX RxPrep book to review concepts. I highly recommend you split your book and get it spiral bound so it’s easier to study from and carry around if needed! (I talk about how I studied for the NAPLEX in-depth here).

What disease states or topics to study:

• CAP/HAP/VAP – 1st line, what to use if penicillin allergy, duration of treatment, inpatient vs outpatient therapy
• UTI – 1st line, what to use if penicillin allergy, duration of treatment, inpatient vs outpatient therapy
• COPD/Asthma – severity and which inhalers to use, how to use all the different inhaler types, treatment of COPD exacerbation
• Diabetes – basic guideline therapy options including compelling indications (HF, ASCVD, etc), A1c goals, monitoring and adverse effects, treatment of DKA
• Warfarin – INR goals for different indications, what increases/decreases INR, counseling
• DOACs – approved indications, dosing related to renal fuction and other dosing considerations
• HTN – drug class options and when to use them, monitoring, contraindications, compelling indications
• HLD – when statins and other agents are indicated, which are high vs mod vs low intensity, LDL goals
• HF – guideline-directed medication therapy, treatment of acute HF exacerbation
• DVT/PE management – selecting VTE agent, dosing, duration, precautions, IV to oral
• critical care concepts – treatment of acute hypotension, hypertension, hyponatremia, hyper/hypokalemia, ACLS, STEMI, stroke
• Afib – treatment with rate and/or rhythm control and anticoagulation (when indicated, agent options, dosing, etc)
• there could be more but these topics above were most of them!

PGY-2 specific advice

• my patient cases were way more advanced for PGY-2 interviews, which makes sense. for PGY-2 Ambulatory Care interviews, they were fully detailed patient cases, like you might get in clinic and I was expected to ask questions and formulate a full A/P for all pertinent problems. commonly patients had multiple disease state problems. common disease states – HTN, HLD, DM, COPD, asthma, depression/anxiety/PTSD, BPH, Afib, CAD, HF.
• Almost all my interviews had these style clinical questions in the form of patient cases, which was different compared to my PGY-1s which seemed less formal style questioning
• I didn’t actually prepare that much for clinical questions for PGY-2 interviews because I truthfully was too busy with PGY-1 responsibilities. I do think it would be good to really know the “bread and butter” of your specialty and expect to be asked clinical questions about it.