Psychiatry Board Interview Questions for Stage 2 Training in New Zealand
Core Interview Structure
Expect questions that systematically assess your ability to conduct comprehensive psychiatric evaluations, with emphasis on mental status examination, risk assessment, and clinical reasoning in real-world scenarios. 1, 2
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Stage 2 interviews focus on critical thinking in clinical practice, requiring you to demonstrate competence in psychiatric assessment and management. 2
Mental Status Examination Questions
You will be asked to describe and demonstrate systematic assessment of:
General appearance and physical observations - including nutritional status, coordination, gait, involuntary movements, and skin examination for stigmata of trauma, self-injury, or substance use 1
Speech characteristics - evaluating fluency, articulation, rate, rhythm, volume, and abnormalities such as pressured speech, poverty of speech, or dysarthria 1
Mood and affect assessment - both through patient report and clinical observation, including specific assessment for hopelessness as a critical suicide risk factor 1, 3
Thought content and process - demonstrating ability to evaluate logical flow, coherence, tangentiality, circumstantiality, flight of ideas, or thought blocking 1, 3
Perception and cognition - including orientation, memory, attention, and executive function 1, 4
Risk Assessment Questions
You must demonstrate systematic evaluation of suicide risk with specific attention to actionable factors, not just screening questions. 5
Expect detailed questioning about:
Suicidal ideation assessment - including both active and passive thoughts, with specific inquiry: "Have you ever thought about killing yourself or wished you were dead?" followed by "Have you ever done anything on purpose to hurt or kill yourself?" 5
Comprehensive suicide risk factors - patient's intended course of action if symptoms worsen, access to suicide methods (specifically firearms in the home), possible motivations for suicide, reasons for living, and quality of therapeutic alliance 5, 1
Aggressive ideation - thoughts of physical or sexual aggression or homicide 1, 3
Documentation requirements - estimate of suicide risk with influencing factors, and estimated risk of aggressive behavior with rationale 1
Clinical Scenario Questions
Be prepared to justify your clinical decisions broadly, not just list differential diagnoses. 2
You will encounter questions requiring:
Developmental considerations - comparing behaviors to developmental age rather than chronological age, particularly in child and adolescent cases 5
Collateral information gathering - demonstrating when and how to obtain information from caregivers, schools, or other providers, especially when evaluating patients with limited verbal ability or cognitive impairment 5, 4
Environmental and psychosocial factors - identifying how changes in routine, educational placements, stressful life events, sleep disturbance, trauma, or bullying contribute to psychiatric symptoms 5
Diagnostic overshadowing - recognizing co-occurring psychiatric disorders rather than attributing all symptoms to intellectual disability or other primary conditions 5
Interview Technique Questions
Expect assessment of your interviewing approach:
Confidentiality management - explaining limits of confidentiality when safety concerns arise, particularly with adolescents 5, 6
Question structure - using open-ended questions initially, avoiding leading questions, allowing time for processing, and monitoring for comprehension to avoid rote responses or echolalia 5, 7
Directive vs. free-style approaches - directive style with specific probes and requests for detailed descriptions obtains better-quality factual information than free-style approaches 7
Separate interviews - interviewing patients and caregivers both together and separately to facilitate honest disclosure 5
Assessment Tool Knowledge
You should know when and how to use:
Depression screening - PHQ-9 (cutoff ≥8) and PHQ-2 for initial screening, with full 9-item questionnaire if either item scores ≥2 5, 3
Cognitive assessment - Mini-Cog (76% sensitivity, 89% specificity), MoCA, or SLUMS, with interpretation considering education level, language barriers, and cultural factors 4, 3
Behavioral assessment - Neuropsychiatric Inventory-Questionnaire (NPI-Q) for behavioral and mood changes 3
Medical Evaluation Questions
Demonstrate focused medical assessment based on history and physical examination rather than routine laboratory testing. 5, 1
Be prepared to discuss:
When medical workup is indicated - altered mental status, unexplained vital sign abnormalities, new-onset or acute changes in psychiatric symptoms 5
What to assess - vital signs, neurologic examination, cardiac and respiratory systems to detect underlying medical conditions presenting as psychiatric disorders 5, 1
When testing is unnecessary - clinically stable patients (alert, cooperative, normal vital signs) with non-contributory history and physical examination do not require routine laboratory or radiographic testing 5
Treatment Planning Questions
You must articulate:
Shared decision-making - discussing treatment-related preferences, explaining differential diagnosis, and collaborating on treatment decisions 3
Rationale documentation - specific factors influencing treatment choice, not just listing options 1, 3
Disposition decisions - criteria for inpatient psychiatric hospitalization (continued desire to die, severe hopelessness, inability to engage in safety planning, inadequate support system, high-lethality attempt) versus outpatient or partial hospitalization 5
Critical Pitfalls to Avoid
Never dismiss suicidal thoughts as unimportant - this is a required component of every psychiatric evaluation 5, 1
Do not rely solely on symptom counts - incorporate risk factors and functional impairment in assessment 3
Avoid pathologizing developmentally appropriate behavior - psychiatric diagnoses consist only of symptoms in excess of or atypical for developmental level 5
Do not interpret screening results without context - consider education level, language barriers, and cultural factors 1, 4, 3
Never conduct evaluations without collateral information when cognitive impairment or behavioral changes are suspected 4, 3
Examination Strategy
Read scenarios and questions carefully, answer broadly with justification, manage time effectively, and limit anxiety's impact on performance. 2
The Modified Essay Question format requires critical thinking and the ability to justify clinical decisions, which are essential skills for competent psychiatric practice. 2