The ST3 T&O prioritisation station is a 10-minute exercise in which two interviewers independently score you on five domains worth 10 marks each, giving 50 of the 234 marks available in 2027.
The station is won by a spoken method rather than a memorised order: name the sick patient first, delegate by name, communicate up and across, safety-net, and say all of it out loud.
Reviewed and updated 10 September 2026. The 2027 applicant handbook has not yet been published by NHS England North East and Yorkshire, so the station description comes from the 2025 handbook and the 2027 scoring matrix.
Key takeaways
- The ST3 T&O prioritisation station is worth 50 of the 234 marks in the 2027 matrix, or 21% of the total selection score.
- Two interviewers score the station independently across five domains of 10 marks, after five minutes of reading time with brief notes allowed.
- The five-step method that scores is: sick patient first, delegate by name and grade, communicate up and across, safety-net with a trigger and a time, and verbalise every reason.
- According to the British Orthopaedic Association, an open fracture needs antibiotics within one hour of injury and debridement within 12 hours for a high-energy injury.
- Ortho Interview (orthointerview.com) holds 108 prioritisation and list-planning questions across 20 scenarios in the ten-minute format, marked aloud on the five 2027 domains.
How is the ST3 T&O prioritisation station marked?
The ST3 T&O prioritisation station is marked out of 50 by two interviewers scoring independently across five domains, each worth 10 marks, as the table shows.
| Domain (2027 scoring matrix, Appendix 3) | Marks |
|---|---|
| Judgement under Pressure | 10 |
| Situational Awareness | 10 |
| Organisation and Planning | 10 |
| Problem Solving and Decision Making | 10 |
| Communication (Information Gathering) | 10 |
| Station total (of 234) | 50 |
However, the 2025 applicant handbook listed Communication (Information Giving) in place of Problem Solving and Decision Making, so check the domain list in the 2027 handbook the week it lands.
What is each marking domain looking for?
NHS England's 2027 person specification defines the domains, quoted below.
Judgement under pressure is the "capacity to operate effectively under pressure and remain objective in highly emotive and pressurised situations".
Situational awareness is the "ability to monitor developing situations and anticipate issues", which here means changing your order when the facts change.
Organisation and planning is the "ability to manage/prioritise own and others' time effectively", scored through named delegation rather than intent.
Problem solving and decision making is "strong problem-solving skills, with a scientific approach to problem solving", meaning a stated reason behind every position in your order.
How long is the station, and what may you take in?
The prioritisation station lasts 10 minutes after five minutes of reading time with brief notes allowed, one of four stations in a 60-minute online slot, according to the 2025 handbook. Ortho Interview runs a voice mock interview across all four.
What does the ST3 T&O prioritisation scenario look like?
The ST3 T&O prioritisation scenario puts you on call or on a trauma list with between four and eight competing demands, deliberately more than one registrar can do.
Those demands typically include a deteriorating ward patient, an ED or GP referral, a phone call, a colleague needing a decision, and a non-clinical pressure such as a relative. A candidate who tries to do it all has not prioritised.
Which framework should you use in the prioritisation station?
Use the same five steps every time, in this order, and name each step out loud as you reach it.
- Sick patient first. Scan the whole list, then name anything that threatens life or limb: instability, a pulseless limb, compartment syndrome, cauda equina, necrotising infection, or an open fracture without antibiotics.
- Delegate by name and grade. Say who does each task you are not doing, and what you have asked. Unspecific delegation is not scored as organisation.
- Communicate up, across and down. Up to the consultant early with a one-line summary and a specific question; across to anaesthetics, theatres, ED and plastics; down to the SHO and nurse in charge.
- Safety-net. Say what would change the order, when you will reassess, and what you are documenting.
- Verbalise. Narrate the reasoning continuously, because silence while you think scores nothing in any domain.
Which clocks should you name out loud?
Name the time-critical clocks by number, because a stated deadline is what separates a scored answer from a plausible one.
| Problem | The clock | Where the number comes from |
|---|---|---|
| Open fracture, antibiotics | Within 1 hour of injury | BOA Standard, Open Fractures |
| Open fracture, debridement | Within 12 hours (high energy), 24 hours (low energy) | BOA Standard, Open Fractures |
| Hip fracture surgery | Within 36 hours of admission | BOA Standard, the older or frail trauma patient |
| Suspected compartment syndrome | Immediate clinical decision, no pressure reading needed | BOA Standard, compartment syndrome |
| Suspected cauda equina syndrome | Emergency assessment and MRI, not an outpatient scan | GIRFT national suspected cauda equina pathway |
The British Orthopaedic Association states in its Open Fractures standard that antibiotics go in within one hour and debridement within 12 hours for a high-energy injury. Each standard has an article at /knowledge.
What does a safety-net actually sound like?
A safety-net is a named trigger, a named person and a named time, not a statement of vigilance. "If the pain does not settle within 30 minutes of splitting the cast I will take him to theatre" is a safety-net; "I would keep an eye on him" is not.
Worked scenario 1: how do you handle compartment syndrome during a theatre list?
The first ST3 T&O prioritisation scenario puts a possible compartment syndrome on the ward while you are scrubbed, which is a judgement problem rather than a knowledge problem.
What does the theatre list brief give you?
Tuesday, 11:20, scrubbed with your consultant mid dynamic hip screw. The ward phones: a 24-year-old with a closed tibial shaft fracture in a backslab has escalating pain despite morphine and pain on passive stretch. The list is 40 minutes behind, ED has a 78-year-old with a hip fracture, and the SHO is in fracture clinic.
What would you say out loud?
"The priority is the ward patient. Pain out of proportion and on passive stretch in a tibial shaft fracture is compartment syndrome until proven otherwise, and the BOA standard is clinical diagnosis and urgent decompression. Split the backslab to skin now, limb at heart level, reassess in 30 minutes."
"I cannot leave a scrubbed case, so I tell my consultant immediately and call the SHO out of clinic to assess the ward patient now. The next case is the tibial nail brought forward, or a fasciotomy first. The ED hip fracture is stable and inside 36 hours: ED completes the proforma, bloods, analgesia and block."
"Safety-net: I document the call and findings, the fasciotomy decision is the consultant's if I am still scrubbed at 30 minutes, and the ward calls me directly."
Which domains did that answer score?
Judgement under Pressure scored on recognising a scrubbed registrar cannot leave while still getting senior hands to the patient; Organisation on three named delegations; Problem Solving on the 30-minute decision point. Revise our compartment syndrome article, then answer a timed version aloud in the Ortho Interview bank.
Worked scenario 2: how do you handle an open fracture with a hip fracture waiting?
The second ST3 T&O prioritisation scenario tests whether you know that an open fracture is urgent without being an overnight emergency, which is where most candidates lose marks.
What does the Saturday night brief give you?
Saturday, 19:45. ED bleeps about a stable 31-year-old motorcyclist with a high-energy open tibial fracture and a 10 cm wound. On the ward an 84-year-old with a hip fracture, cancelled twice, is approaching 36 hours. A laparotomy is going in, your SHO wants help with a shoulder dislocation, and the consultant is at home.
How would you answer the open fracture scenario?
"I go to ED first, because the open fracture needs decisions in the next hour. Before I leave I ask ED to give intravenous antibiotics now, because the standard is within one hour of injury. In ED I confirm the ATLS assessment, document neurovascular status, remove gross contamination only, photograph, dress and splint."
"This is high energy, so the BOA standard is debridement within 12 hours by a combined orthoplastic team, not overnight. It goes tonight only if heavily contaminated, with a vascular injury or a compartment syndrome. I phone plastics now so a joint plan exists before morning."
"The hip fracture has been bumped twice against a 36-hour standard, so I escalate to my consultant now with a specific request: first on the Sunday list, or tonight after the laparotomy. The SHO reduces the first-time dislocation with ED sedation. Safety-net: ED repeats the neurovascular examination hourly and calls me with any change."
Why does the timing of debridement score?
The candidate who sends the open fracture to theatre tonight loses Judgement marks, because the panel wants the standard applied and the conditions under which it changes. Escalating the delay scores Situational Awareness. Revise open fractures of the lower limb and hip fractures and the 36-hour target first.
Worked scenario 3: how do you handle an angry relative and a GP referral?
The third ST3 T&O prioritisation scenario mixes a clinical emergency with a complaint, and it is scored on whether you handle both rather than choosing one.
What does the Thursday afternoon brief give you?
Thursday, 16:30, consultant in clinic. The daughter of Mr K, 79, is shouting at the nurses' station because his hip fracture surgery has been cancelled twice. A GP is on the line about a 46-year-old with new bilateral sciatica, saddle numbness and difficulty passing urine. The SHO texts about a suspected scaphoid with normal films, and a controlled drug needs prescribing.
How would you answer the cauda equina scenario?
"The GP call is the clinical emergency: bilateral leg symptoms, saddle anaesthesia and new urinary symptoms are red flags for cauda equina syndrome, and the national pathway is emergency assessment and MRI. First I ask the nurse in charge to take Mr K's daughter to a quiet room and promise her fifteen minutes, which I honour."
"I tell the GP to send her in immediately by ambulance, that I have accepted her, and that I will warn ED and radiology so the MRI is arranged before she arrives."
"With the daughter I listen first, apologise for the cancellations and the silence, explain honestly, and tell her how to contact PALS. If a cancellation breached the 36-hour standard I tell my consultant, because duty of candour is his call as well as mine. The scaphoid goes home in a splint with clinic review; I prescribe the drug on my way. Safety-net: I phone ED to confirm she has arrived."
Why does taking the GP call first score?
Taking the GP call before the relative, without leaving the relative unattended, is the whole station in miniature: Judgement on the cauda equina clock, Organisation on the sister and the fifteen minutes, Information Gathering on the red-flag questions. Getting It Right First Time publishes the pathway, updated March 2026, summarised in our cauda equina article.
What loses marks in the ST3 T&O prioritisation station?
Most lost marks in the ST3 T&O prioritisation station come from how the answer is delivered rather than from clinical error.
- An order without reasons. "Patient A, then B, then C" scores nothing in Judgement or Problem Solving, because every position needs a because.
- Doing everything yourself. The SHO, the nurse in charge, ED and the consultant are on the page for a reason.
- Not calling the consultant. The most reliable Situational Awareness mark, provided the call has a one-line summary and a specific request.
- Ignoring the non-clinical items. The phone call, the relative and the teaching session are scored; park them explicitly, with a time.
- Failing to re-prioritise. Interviewers add information mid-station, and not changing your order when the facts change loses Situational Awareness marks.
- Vague safety-nets. "Monitor closely" is not a plan. Say what, by whom, by when, and what triggers a change.
How should you practise the prioritisation station aloud?
Practise the ST3 T&O prioritisation station out loud, to time, with interruptions, because the station scores what you say rather than what you would have done.
Set a timer for five minutes of reading and ten of answering, speak the whole answer including delegations and safety-nets to a colleague who adds new information at the four-minute mark, and record yourself.
Then rehearse against scenarios in the ten-minute format: the 108 prioritisation and list-planning questions on orthointerview.com, OrthoRevision's free trauma list scenario, or a mock circuit such as the ORUK course on 5 February 2027. Our rated comparison scores each, and there are free sample questions.
What should you check when the 2027 ST3 T&O handbook publishes?
Check three things when the 2027 applicant handbook publishes, because each could change how you prepare for the prioritisation station.
- The domain list for the prioritisation station, which is either Problem Solving and Decision Making or Communication (Information Giving).
- The reading time and whether brief notes are still permitted, which in 2025 was five minutes with notes allowed.
- The T&O interview days. NHS England's national timetable puts the 2027 ST3 interview window at 11 January to 9 April 2027; in 2026 the T&O days were Tuesday 24 to Friday 27 March.
The application overview summarises the process as it stands, and Ortho Interview will update this article the week the handbook lands.