RCPCH START - how it works (structure and specimen papers)

START means Specialty Trainee Assessment of Readiness for Tenure, and it guides trainees as they prepare for completion of training and practice as a new consultant. Here is how it works and what to expect on the day. Take a look at our example scenarios - you can download examples of what is handed out on the day, and watch videos of sample discussions.
Last modified
6 April 2023

Structure and specimen questions

We have a circuit with stations testing different skills. These include:

  • Can you hand over to a colleague?
  • Can you take a ward round?
  • Can you safely prescribe?
  • Can you make decisions in a clinical situation where the diagnosis is not clear?
  • Can you lead the team on the ward?
  • Do you understand safeguarding children and the ethics that underpins our practice?
  • Can you read a paper and take away the clinically important messages?

Circuit and scenarios

Update The October 2020 START was held online. It had 10 stations (scenarios) rather than the usual 12. As before, each station was eight minutes long.

The 12 stations are:

  • Scenario based discussion - up to four stations
  • Ward round and handover
  • Logistic and organisation
  • Safeguarding children
  • Critical review of literature
  • Safe prescribing
  • Ethics, consent, law
  • Conflict and risk management
  • Teaching

You can download example scenarios below. These relate to the specimen trainee feedback report, also below.


Update The format for START is being reviewed.

  • The sequence in which you take the stations in the circuit varies.
  • Each station is eight minutes long.
  • There are four-minute breaks between each station, in which you will read the next scenario.

Feedback sheet

At the end of each station the assessor will make an overall judgement of your performance, with these categories:

  • Above competence
  • Meets competence
  • Development needed to achieve competence
  • Significant concerns

Remember, we are not assessing to find outstanding trainees. We are looking for those trainees who meet the standard required: trainees who can perform at the level of a newly-appointed consultant.

Example scenarios

Scenario based discussion

In this video, two assessors are standard setting for a scenario, and what they will expect from a trainee. You can download the scenario (0042) below.




Here, a trainee discusses the scenario with an assessor.



Safe prescribing




In this video, an assessor and trainee discuss the safe prescribing scenario, looking at the completed prescribing chart. You can download the scenario (0135) and prescribing chart example below.



Here, the trainee reflects on the assessor's feedback he has received in the safe prescribing scenario. You can download his feedback below.







The ‘anchor statements’ for each station enable the assessors to make judgements on trainees, and the trainees to understand the expected standards. You can download these benchmarking standards below.




Contact information




If you have any questions, please contact us at training.services@rcpch.ac.uk.