Working Under Pressure is one of three scored domains in the clinical judgement station, worth 5 marks from each of two assessors. ANRO's 2026 scoring guidance describes the domain as the capacity to make decisions under pressure and retain control, accompanied by an awareness of your own limitations. So the marks go to calm, prioritised decisions and to honesty about your limits, not to bravado.

Key takeaways

  • Working Under Pressure is a Clinical Judgement station domain worth 5 marks per assessor, alongside Clinical Judgement and Decision Making and Reflective Practice
  • ANRO defines the domain as making decisions under pressure and retaining control, with an awareness of your own limitations
  • A score of 5 reads 'relaxed and comfortable with demands of situation with extremely clear decisions' and 'maintained calm clear perspective throughout, clear task prioritisation and decision making'
  • A score of 1 reads 'was tense and agitated and hesitant all of the time, no clear decision making' and performance 'hindered by fixation on immediate concerns'
  • The Royal College of Anaesthetists makes non-technical skills a Stage 1 learning outcome: situation awareness, task management, decision making and team working
  • The Clinical Human Factors Group defines human factors as the understanding of what affects behaviour and performance in the workplace

What does the working under pressure domain actually score?

Working under pressure scores three things: whether you decided, whether you stayed calm while the scenario developed, and how you behaved when you were challenged. ANRO's 2026 scoring guidance splits the domain into exactly those three rows.

The first row is about decisions. The second is about perspective as tasks develop. The third is about challenge, and it is the one candidates prepare for least, even though it is a third of the domain.

According to ANRO, the two assessors score independently, each giving 5 marks for working under pressure plus 5 for each of the other two domains and a global rating out of 10. Two stations of 50 marks make 100, and 60 is appointable.

What separates a 5 from a 3 in ANRO's own words?

In working under pressure, a 3 stays calm most of the time and reaches a clear decision; a 5 is comfortable with the demands of the situation and prioritises tasks out loud. The gap is visible prioritisation rather than extra knowledge.

  • ANRO's 3: 'Remained calm most of the time, was able to make a clear decision', 'Maintained perspective through developing scenario', 'Showed some insight into own limitations within scenario. Mostly calm when challenged'
  • ANRO's 4: 'Remained calm all of the time and made clear decisions', 'Clear calm perspective maintained throughout, moved quickly through developing tasks', 'Confident, insight into own limitations within scenario. Flexible and calm when challenged'
  • ANRO's 5: 'Relaxed and comfortable with demands of situation with extremely clear decisions', 'Maintained calm clear perspective throughout, clear task prioritisation and decision making. Appears to be working beyond level of Foundation Dr', 'Confident, always flexible, open and calm manner when challenged. Effective strategy to deal with opinion and disagreement or differing opinion'
  • ANRO's 1: 'Was tense and agitated and hesitant all of the time. No clear decision making', 'Performance hindered by fixation on immediate concerns', 'Was rude OR offensive to when challenged'

Two phrases are worth noticing. 'Working beyond level of Foundation Dr' is the bar for a 5, which means the standard is a good foundation doctor and not a consultant. 'Fixation on immediate concerns' is the failure mode, and it is a human factors term.

What are human factors, and why do they belong in this answer?

Human factors are the influences on how people behave and perform at work. The Clinical Human Factors Group defines human factors, also called ergonomics, as a discipline that considers both the physical and mental characteristics of people as well as the organisational factors or wider socio-technical system.

The same charity summarises it more plainly as the understanding of what affects behaviour and performance in the workplace, and describes human factors as the application of scientific methods to the design of tasks, jobs, equipment, environments and systems so they fit people.

It belongs in a working under pressure answer because the Royal College of Anaesthetists puts it in the curriculum. The 2021 curriculum sets a Stage 1 key capability to demonstrate the importance of the non-technical aspects of care such as situation awareness, task management, decision making and team working in anaesthetic practice.

What does a worked answer sound like out loud?

A worked working under pressure answer names the pressure, names the decision, names the help and names the reflection, in about a minute. Here is one you could say aloud.

'On a night shift I was bleeped to a patient in recovery who was becoming hypoxic while I was already reviewing a patient on the ward. My priority was the recovery patient, because a threatened airway is time-critical and the ward patient was stable.'

'I asked the ward nurse to repeat observations and bleep me in ten minutes, told the recovery nurse I was coming and asked them to put out a call to my registrar. I went straight there, started an A to E assessment and gave high-flow oxygen while I looked for a cause.'

'The pressure was having two patients and one of me, so I made the prioritisation explicit and I said out loud what I would do if the saturations did not come up, which was to call the consultant and prepare for a definitive airway. My registrar arrived within five minutes.'

'Afterwards I realised I had not told the ward team which patient I had gone to, so they could not escalate to anyone else. I now give a named alternative person whenever I hand a task back, and I raised it at our departmental morbidity meeting.'

How do you show task prioritisation without sounding rehearsed?

You show prioritisation under pressure by saying the reason out loud, not the ranking. 'Airway first because it kills fastest' is prioritisation; 'I would do A, then B, then C' is a list.

ANRO's descriptor for a 5 asks for 'clear task prioritisation and decision making', and the failure descriptor is fixation on immediate concerns. In practice that means naming the task you are deliberately deferring and when you will come back to it.

Resuscitation Council UK's ABCDE guidance, updated July 2024, gives the template: treat life-threatening problems before moving on, use team members simultaneously, and communicate with a structure such as situation, background, assessment and recommendation.

How do you handle being challenged during the station?

You handle challenge in a working under pressure station by treating it as new information rather than as an attack. ANRO's top descriptor asks for a candidate who is 'always flexible, open and calm manner when challenged' with an effective strategy for disagreement.

A usable strategy in three moves: acknowledge the point, say what would change your mind, and say what you would do in the meantime. 'That is a fair challenge. If the gas showed a normal lactate I would revise my plan. Until it is back I would keep treating this as sepsis.'

However, the descriptors punish two opposite errors equally. Being rude or offensive when challenged is a 1, and so is being hesitant and slow to adapt to a changing circumstance which may have been critical.

How do you show insight into your own limitations?

You show insight under pressure by naming the point at which you stop and call, before the assessor asks. ANRO writes awareness of your own limitations into the definition of the domain itself.

For a doctor about to start CT1 the honest limits are useful ones to say: an airway you cannot secure, a drug dose you would check, a decision that needs a consultant. The Royal College of Anaesthetists notes that trainees new to the specialty are directly supervised at all times until they pass the Initial Assessment of Competence.

That said, insight is not the same as helplessness. Say what you will do while help is coming, because a candidate who calls and then stops has demonstrated the limitation without the decision.

What should you never say in a working under pressure answer?

Avoid the answers that describe pressure without describing a decision, because the domain is scored on decisions.

  • 'I just get on with it.' There is no decision, no prioritisation and no limitation in that sentence
  • 'I would manage it myself.' The descriptors reward insight into limitations and seeking team input
  • An example where nothing was at stake. The station is looking for a developing scenario, not a busy afternoon
  • Arguing with the assessor. ANRO scores rudeness when challenged as a 1, and behaviour concerns are a separate veto
  • Speeding up. Assessors hear pace before content, and ANRO's 1 is 'tense and agitated and hesitant all of the time'
  • A human factors lecture. Name situation awareness or fixation once, then show it in the example

How this comes up at the CT1 anaesthetics interview

Working under pressure is scored in the clinical judgement station, which lasts 15 minutes after 5 minutes of reading. Two assessors score it independently, and the domain sits alongside clinical judgement and decision making and reflective practice at 5 marks each per assessor.

  • It is scored continuously, not asked as one question, so the whole station is the evidence
  • The scenario will change part-way through, which is where ANRO's 'maintained perspective through developing scenario' is won or lost
  • A global rating of 1 from both assessors in a station can be discussed as a potential veto with the clinical lead, and a station scored at or below 25% is another
  • Notes on paper are permitted in the station, so the prioritisation you plan in the reading time can be written down

anaestheticinterview marks spoken answers by AI against the same domains across 340 questions, which is the only practical way to hear whether you sound calm rather than merely feel calm.