When reading the question

What is the main issue  which domain  professionalism

What is the time frame?  is the issue urgent? also think does it solve the immediate concerns, longer term solutions
may be appropriate but are less often favoured in the rationale when compared to more immediate ones.

What should you do  do not let awkw
When looking at the response

Does the response deal with issue at hand/is this a local and direct solution

Does it put the patient/patient safety first – including is it within the correct timeframe

How would you categorize the options in isolation e.g. some what appropriate vs somewhat in appropriate

Does it maintain professionalism

Try to resolve things locally and directly raise to senior when necessary, after giving the colleague a chance to respond +
finding out some initial info, and when it relates to patient safety, confidentiality or data handling.
Dificult encounters  taking distressed relatives to a side room can be somewhat appropriate
When picking between two in the SJT

Addresses the issue  pick whichever addresses the issue more in isolation, also think which is more Appropriate in
isolation.

Benefit of the doubt  if it’s an isolated incident give you colleague a chance to respond, finding out some initial info
unless there is an imminent threat to patient safety

Confrontational  pick which ever is less confrontational in the example below BD and are very appropriate as
neither break confidentiality, A is some what appropriate as it is confrontational



Direct  choose whichever is more direct.
Delay  choose whichever introduces the least amount of delay especially when it is marked urgent e.g. it is better
to phone someone then ask them to come to the ward, also if a patient has a concern this is important try not to delay
and in general choose those that solve the issue more immediately
Doing something appropriate but delayed is better than doing nothing e.g. in a scenario where you are been given
more jobs than others “it is better to talk to your reg. in one month” then “continue to do jobs to the best of your
ability” both are inappropriate but at least the first option addresses the issue more than the second
Doing nothing is better than doing something inappropriate.
Delegating a task that was originally your is less likely to be appropriate unless the delegation improves patient safety
Don’t make assumptions “I hope you are ok – if you want to speak to me about what happened earlier let me know” “I
can tell your upset let me know if you want to speak about it” you may be able to tell If they are upset but that doesn’t
mean you know why.
Don’t prioritse an unknown over a known, i.e. do not prioritise a patient that might be a sick over one you know is sick
Everyone’s responsibility  for following hospital protocols e.g. patient safety, right to work in a respectful
environment, safeguarding (although this should be referred onto the consultant!)
Explore then reassure, giving reassurance without a discussion may result you not gaining a full understanding

Escalate issues with patients appropriately FY1 = decision











making with assistance, seek an
opinion of a senior colleague when there is uncertainty whether the patient’s
situation when discharing.
Find information  information gathering is a key first step.
Fatigue is fatal  if it says you are a colleague is exhausted is very inappropriate to keep working!
Gather information before talking to patient e,g, Read the patients notes before answering questions/Speak to your
reg. about the management, and before you report someone to a senior you should take responsibility for finding out
why something has happened and take some action before escalation.
Handovers  should be done directly to the person in charge, leaving a message is highly inappropriate as you do
not know if the person will read it thus may compromise patient safety
Section 1

2 minutes per each scenario, 18 scenarios so 36 minutes

Choices are independent

Think of this section as a spread out Ranking section.
Rules
 Whether someone else has seen a bad act occur also is not relevant what it is important is that it has occurred and is
thus your responsibility to deal with it.
When confronted with someone asking you person the status of their friend/relative
 very appropriate remind them you cannot give out personal information

Appropriate to say why don’t you visit them as long as you aren’t giving info.

somewhat inappropriate To say why don’t they speak to their doctor as this is delagting the tasks not very
inappropriate as you aren’t breaking co nfidentiality
Section 2

1.5 minutes per question, 20 questions so 30 minutes

Questions considered together
Section 3
Ranking

2 minutes per question = 74 minutes

Choices are supposed to independent

Do the most and least appropriate then rank the rest.
When choosing between two options ask yourself

which is MORE direct

How would you categorize the options in isolation e.g. some what appropriate vs somewhat in appropriate,

Which response is more confrontational/blunt “Explain to the consultant that his record keeping is inadequate” is
confrontational “Ask Jacob why he lied” also confrontational

Which response addresses the issue more e.g. in a scenario where you are been given more jobs than others “it is
better to talk to your reg. in one month” then “continue to do jobs to the best of your ability” both are inappropriate but
at least the first option addresses the issue eventually even if it is delayed whereas the second does address it all.

Choose options that are less speculative e.g. If a nurse thinks a family is concerned it is better to ask the nurse to talk
to the family and gather more info than asking for further feedback from the nurse without asking her to talk to the
patients

Questions to ask when looking at a question

Who  remember who you are and your competency, who is the question addressing does the patient or the
relative have the concerns?

What  is the question asking you appropriateness vs importance etc , what are the key domains being tested, what
is the problem

Why  are they asking the question what key principle are they getting across

When  when does the task need to be done by, how urgent is it?  if the patient is acutely unwell you need to
choose the option that responds to situation quickly, if you are the end of your shift and the task is likely to take along
time you may have to delagte

Where?  is the scenario taking place A+E? (has protected breaks etc)
Medical communication

Continually explain your actions and rationale to the patient this demonstrates your involving the patient in their
care, helps to ensure you are treating the patient with dignity and respect

Involve the patient in any decision making and ensure you have their consent when undertaking any actions

Build a rapport  listen and respond to their concerns

Don’t overreach  if a patient asks for something outside the scope of your role as an FY1 do not feel you have to
oblige them always say you will need to check, but if it is within your competency you should try to make an effort.

Talk through what you are doing but do so with authority

Important words

Urgent  this will change your approach  options that are more direct/introduce less of a delay or more
appropriate, the answers in the scenario often focus on the immediate concerns
Positive words
“Have you thought” offer a constructive solution that
addresses the iusse
“I understand,
“apologise”
“I understand”
“Is there something specific”
““Is there is a particular reason”
“Is there anything in particular that you are worried you are
not doing well?”
“Is there anything in particular that you are worried you are
not doing well?
“Politely”
“Explore”
“Explain
“address”
Suggest  good but less direct
“sorry but you know I am not allowed to give the information”
More negative words
Complaining” = trying to resolve the issue and not working
collaboratively with others
“Since”
“decline” – unless you are being asked to do something in
appropriate
Confront
Reprimand
Demand
“Perhaps
suspect he may  you do not know for sure
ignore
inform  less active
Tell  less active
Look for the word may this implies it is based on an
assumption the option may still be some what appropriate
but less likely to be very appropriate.
Very important
When responding to a
hazard e.g. a spill, that
could cause harm the risk
someone could hurt
themselves it very important
as is that it is hazardous
If a patient states that
another member of staff’s
behaviour has made them
uncomfortable it is very
important as patient safety
and wellbeing should be the
main concerns at at all
times.
If a joke/performance/social
media post may cause
offense besmirch the
medical profession it is very
important might reflect
badly.
Following clinical guidelines
e.g. wearing a name badge
Important
If something is based on an
assumption, it is less likely
to very important more likely
to be important e.g. other
patients may have
overheard the consultant
and may be upset
Whether or a staff member
has a previous hx of
inappropriate behaviour is
important BUT should be
followed up regardless of
who can support or refute it
hence not very important
Of minor importance
The relationship between
colleagues and yourself
should be considered when
making decision however it
is of minor importance
when relating to patient
safety/portrayal of the
medical profession as it will
not affect your behavior
If other members of a team
do not find a joke/post
offensive it is of minor
importance if you think it is,
it is reassuring but should
not affect your behaviour if
there is a chance of
negative portrayal of the
profession
Not at all important
When you see a hazard e.g.
a spill it is your responsibility
to respond appropriately for
the benefit of staff and pts it
is of no importance that it is
not your job.
Whether not a colleague is
marking your assessment is
of no importance when
responding to patient
safety/concerns, although
their may be apparent
concerns for rasing the
issue with the consultant the
overriding consideration
should be that over the
patient. Assessments
should be marked
professionally and
objectively
I
is very important! Clinical
guidelines protect the
patient and public and
ensure standardised, effect,
safet patient care.
It is very important to be
clear on your training level.
If an a situation has been
medical emergency
It is very important that it
has been declared as such.
Very appropriate  it is the
optimal approach and
addresses a key issue in the
scenario
When working in teams it is
very appropriate to suggest
people speak up as
encourages good
It is very appropriate to
explain to patients/families
why there has been a delay
It is very appropriate to give
patients reassurance if it is
information given in the
stem “makes no difference
to safety”
It is very appropriate to
speak to a colleague about
a problematic interaction
with another colleague, later
in the day when they have
calamed down as it
recognises the situation
needs addressing but mean
the person is less likely to
be defensive at this time
Trying to calm a colleague
down if they are anxious is
very appropriate  they
shold be relaxed +
reassured
It is very appropriate when
being asked confidential
information by a
colleague/friend to politely
remind the person you are
not allowed to divulge the
information “sorry I am not
allowed to give out patient
information.
Suggesting someone to visit
their friend/relative is very
appropriate when being
asked to divulge confidential
information as it is a
practical solution that
Appropriate but not ideal 
useful but not optimal,
If a colleague has been
upset by another colleague
it is appropriate to apoligse
on their behalf it is not ideal
as it should be the person
apologising, doesn’t address
root of the problem
Apologising on some else
behalf is appropriate but not
ideal e.g. a colleague says
something rude in front of
patient, it is not very
appropriate as they should
be the ones to apologise.
Somewhat inappropriate, in
appropriate but not awful

 not solving it yourself
when it is in your
competency to do so is often
somewhat inappropriate
When asked information
about a patient from a friend
it is some what inappropriate
to ask another doctor to
speak to them as you are
passing the responsibility on
to someone else when you
can deal with it yourself, not
very inappropriate as
confidential information is
not divulged.
when coming across a lost
child after seeing a patient
with a minor issue it is
somewhat inappropriate to
take him to a secretary  as
you are not taking
responsibility and are
stopping the person from
working
If someone says something
rude in front a patient it is
somewhat inappropriate to
tell them infront of the
patient, more appropriate to
do this in private as having
the discussion publicly is
unprofessional but not
awful/.
Patient have a right to
complain but are less likely
to do so if you explore their
concerns, thus this option is
often somewhat
inappropriate
Asking the patient to calm
down is likely to antagonise
them
Very inappropriate
 ignoring patient concerns,
false promises, breaching
confidentiality, not taking
responsibility for patient
safety,
Very inappropriate to ignore
patient concerns, especially
if they are anxious
Making false promises in
very inappropriate  trust in
the medical/surgical team.
Divulging confidential
information to friend of a
patient when asked is very
inappropriate , breach of
candour and data protection
laws.
Very inappropriate when
coming across a lost child
after seeing a patient with a
minor issue take him to play
area, as this doesn’t resolve
the issue i.e. it is doesn’t
reunited him with his parent.
If you see an issue you are
responsible
If someone is anxious and
has voiced their concerns it
is very inappropriate to
leave them on their own as it
will make them feel
unsupported
f a patient has a complaint
about the nurse and the
nurse is still there it be very
inappropriate to ask her to
leave as that assumes she
has done something wrong.
doesn’t involve a breach of
confidentiality
If you come across an issue
e.g. lost boy, it very
appropriate to communicate
with the patient you were
seeing that you need to sort
the other issue out if that
patient is not in immediate
har, e.g. sprained ankle
It is very appropriate to
comfort a lost boy!
If a person is struggling with
exams it very appropriate to
suggest they seek help from
their senior “have you
thought about seeking
support or advice from the
university of what to do?”
It is also very appropriate to
suggest “I think you should
take some time to think
about what to do” this will
give some time to readdress
the issue later on.
If a patient has a complain
about a nurse it is very
appropriate to ask the
patient to explain more
about the behavior
21 Rules of the SJT
1. Solve the problem posed in the question - all parts of the problem if possible and if it is in your competency
2. Solve the problem or carry out the task yourself but know your rights, your competency level,
your responsibilities, your priorities and your place as a junior doctor, be self aware if you are exhausted/end of a
shift you are much more likely to make mistakes
3. Answer every question keeping in mind you are an FY1 doctor! thus the most appropriate answer will the one
most appropriate for a doctor at your level, you are link in the team, you do tasks such as prescribing, discharges
under close supervision, not expected to break bad news, you are expected to make an initial assessment, give
appropriate treatment and inform the reg if it is an emergency
4. Solve the problem keeping in the mind the four core ethical principles of medicine  autonomy, beneficence, nonmaleficence, justice
5. View every option independently  for both rating and ranking questions
6. Always have a patient centred approach  patient’s time is also valuable, work with them
7. Patient safety is ALWAYS your number one priority! Exhaustion is a patient safety concern as you are more likely to
make mistakes
8. Don’t hesitate to involve your seniors in order to safeguard your patients
9. Never take a patients concerns lightly or dismiss them – if a patient wants to talk to you, ever has a concern,
doesn’t want to be discharged or has a symptoms you, have to take their concerns seriously. Even if you have listen
to their chest etc remember you are an FY1 it is much better to be safe
10. Explore the patients concerns over reassuring them blindly  even if it is a minor issue, do not reassure them
blindly “it’s fine” “nothing to worry about”. You can provide appropriate reassurance if you are certain
11. Go with the information in the question if the question says “this will not affect their safety” or “their pain is cardiac
origin” then trust this information and be confident in relaying it to a patient
12. Always talk to the patient directly over the relative when possible keeping in mind autonomy and maintaining
patient confidentiality
13. With prescribing if errors/questions arise consult these people in the given order  prescribing doctor  other
senior doctor  pharmacist – be cautious about giving prescribing without further medical advise,
14. When making any decisions involving medications to be prescribed local guidelines  BNF  national guidelines
15. Time is an important consideration when choosing which option would be most appropriate in order to solve the
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52.
problem posed in a given scenario  is the task urgent, do you need to see the patient straight away is it time
critical?
Delegating a task that was originally yours will probably not be the most appropriate option in a ranking
scenario BUT can be considered high up in the order when patient safety is at risk.
Delegation of one your tasks is preferred to another doctor than a nurse.
Handovers should 1) be done in person preferably over sending a message through another person/over the
phone, 2) directly communicated with the hospital or person that you are handing over care of a patient when
possible, i.e. writing something down even if you tell them face to face that you will write it down is not as good as
telling them the information or handing it over to an appropriate colleague
When raising concerns or solving conflicts you should primarily explore the problem with person concerned, if a third
person shares their concerns with you about a colleague ask them to handle it directly within themselves
Reporting someone for an isolated incident without sufficient knowledge is often inappropriate, initially you should
take responsibility for finding out why something has happened and take some action before escalation/Do not
complain or escalate a concerns about someone to a senior without having proof or confronting the person directly
first – also do not be confrontational or judgemental this will never be the most appropriate option in a scenario,
reporting to the nurse in charge should probably be left to the consultant
Take responsibility when you witness wrong practices i.e. know when to be a whistle blower  do not think it is
not part of your responsibility because it is  scenarios of when to whistle blow  1. not following infection control
procedures. and other potential risks to patient safety 2.Staff member being aggressive to another staff member 3.
racist/discriminatory comments. It is everyone responsibility to report concerns.
Use the chain of command reg  consultant
The choice that involves immediate intervention is usually first place, especially in an emergency scenario, with
choices that delay action being taken being lower on the list
A choice that involves doing nothing is normally one place above doing something totally wrong/inappropriate
The patient is more important than you and your colleagues unless this involves exhaustion e.g. at the end of
night shift/any shift, which would endanger other patients
An Fy1 role is decision making under guidance so if there is any uncertainty or family is involved consult a senior
do not transfer responsibility to another doctor via a nurse
Do not prioritise an unknown over a known e.g. leaving a sick patient to deal with a patient that might be sick
if your colleague has witnessed something it is their responsibility not yours
if a colleague is underperforming do not offer to do their jobs for them this reinforces bad practice and does not
solve the issue
With regards to confidentiality the best to worst answer rely on leaking the least amount of information, it is ok to
repeat something they already know
If there is an organisational problem e.g. nurses are busy rather than an emergency you do not have to stay late
Having a discussion about their concerns is better than falsely reassuring them
Where possible give colleagues a chance to rectify/defend themselves i.e. talk to them first before escualting
Sex between an under 13 y/o and over 13 y/o is illegal
16-17 year olds can consent to treatment but cannot reject it if it is in their best interests
you cannot delay certifying death until the next day
Never take annual leave to fix a medical problem
If you see a hazard e.g. a spill, or a potential patient harm e.g. a lost boy, you must take action it is very inappropriate
to do nothing and somewhat inappropriate to leave it to someone e.g. receptionist.
Do not dismiss patient or staff concerns make sure you address the issue e.g. if someone has failed an exam saying
“I’m sure you will find it easier next time” is somewhat inappropriate as it doesn’t address core issue,.
if you have received feedback from a colleage it is inappropriate but not awful to ask if others have had similar
feedback, receiving negative feedback is part of the process, the feedback others have given is irrelevant.
The consultant has ultimate responsibility for the patient you have to inform them if there is a change to a care plan
e.g. if you suspect child abuse, if a patient operation is going to be delayed etc
Whether someone else has seen a bad act occur also is not relevant what it is important is that it has occurred and is
thus your responsibility to deal with it.
Patient safety> patient confidentiality > relative concern
doing nothing > doing something inappropriate
Patient > Relative > team > you – unless your tired then you might make a mistaker and hurt a patient
Work within the limits of your competency, if you have not observed a procedure before you should at observe one
before attempting, see one, do one, teach one.
When dealing with patient concerns  there is no reason initially to ask for senior help or to put the nursing staff in a
similar position, first try to attempt. A reason to involve staff would be if you do not fully understand the case.
if options are supportive e.g. Explain to colleague that you are there if he needs someone to talk to or needs some
support but do not address the underlying problem do not choose them!
When two colleagues have made allegations about each others professionalism it is not your place as an FY1 to
initiate an investigation e.g. inappropriate to obtain further details about the incident, explore with other nurses if they
heard, fill out critical incident form
When dealing with issues with another member of staff more appropriate to ask your supervisor and a senior nurse
than your cohort of F1s (B) or the entire nursing team
The most appropriate method to address this problem is to discuss your concerns directly with the individual involved
53.
Other bits of advise

SJT takes place in an ideal world i.e. GP and clinical appointments have minimal waiting times, referrals are readily
accepted, a senior is always available so breaking bad news is NOT your job, if a colleague is in your team they
know the patient

If you have a concern/problem with a colleague approaching them directly is usually the best option

Frameworks
Professionalism
 Lack of learning opportunities  1. talk to senior i.e. assist with your own team 2. help colleagues on another ward
3. escalate to foundation programme lead. 4. stop working change job 5. do nothing
 Colleague abusing patient/not being professional 1. approach colleague directly 2. escalate appropriately e.g.
colleagues line manager or your line manager mostly likely your clinical supervisor 4. escalate to the extreme e.g. call
head of deanery 5. do nothing
 Dealing with blood test/treatment error 1. immediate intervention. 2. escalate appropriately 3. consultant another
fy1 4. correct retrospectively 5. leave it someone else
 Medical assistance in public 1. intervene immediately but make your limitations known. 2. ask people to present to
find someone more senior. 3. don’t respond but have a look and see if you can help. 4. wait and see if anyone else
steps up. 5. do nothing
Coping with pressure
 Asked to consent patient for a procedure: 1. colleague doing treatment should consent not your role as an fy1. 2. do
colleagues other tasks so they are available to consent. 3. get another qualified staff to consent. 4. consent but
involve an unqualified colleague e.g. a nurse 5. consent the patient yourself
 Patient asks you a specific question about their care: 1. placate/stall them and find out the plan yourself 2. offer to
ask senior to come and talk to them 3. tell them that the nurse can infrom them. 4. research/learning about the topic
5. give an answer you’re not sure about
Communication
 Patient wants to stop/start/change treatment but does not want family to know e.g. terminal pt wanting to stop chemo
1. listen and respond honestly 2. discuss with MDT. 3. discuss with GP 4. Break confidentiality and tell family 5. go
against patients wishes goes against autonomy
Patient focus
 Your friend/family is in hospital and asks for special treatment 1. explore their concerns 2. refuse politely as it is
inappropriate 3. ask senior if it is ok 4. report your friend to security/ward 5. punish your friend by doing the opposite
of what they asked
 You noticed your patient has been given the wrong treatment 1. check if the treatment has been given 2. tell the ward
manager immediately 3. tell the patient they have received the wrong treatment 4. complete a clinical incident form 5.
write in the notes but do not tell the patient
Working in a team
 Colleague says they have a chronic physical disease 1. explore how they feel 2. advise them to see educational
supervisor 3. keep an eye on them 4. advise them to get counselling 5. tell the consultant – you should ask for their
permission
 Colleague has done something illegal and is not going to report it 1. approach them directly 2. approach a senior 3.
report them to GMC 4. investigate what has happened 5. do nothing
A clinical incident is any unplanned event which causes, or has the potential to cause, harm to a patient 5.
Raising concerns you should first raise your concern with your manager such as the consultant in charge of the team
You must be clear, honest and objective about the reason for your concer
Should keep a record of your concern