SJT: Free Mastering the MSRA SJT (1 of 3): Professionalism, Safety, Communication & Leadership Fundamentals

Episode Transcript
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(00:00):
All right, let's untack this. You're gearing up for the MSRA
situational judgement test. Yeah.
And that exam isn't just about what you know, it's really about
how you think in those tricky real world clinical dilemmas.
Exactly. Today we're diving deep into the
core principles that guide good practise, the common traps, the
test sets and those handy mnemonics that will help you ace

(00:21):
it. Indeed.
Oh, the SJT is designed to assess your judgement against,
well, the bedrock of UK nationalstandards.
Your fundamental mindset always should be to prioritise patient
safety, act with honesty and integrity, ensure legality and
all your actions, and apply proportionality to every
situation. Crucially, remember to escalate

(00:43):
concerns early and document everything meticulously.
That's our mission today then, to give you that shortcut to
being truly well informed for this vital exam.
We've distilled essential UK guidance straight from sources
like the GMC and the SEA into high yield Nuggets for your
revision. That's the plan.
And a quick note, you can find thefreesjttextbookandmoredeepdives@passm-sra.com

(01:06):
and subscribe to their YouTube channel at at Pass MSRA.
Definitely worth checking out. OK, let's jump straight into
professionalism and integrity, kicking things off with
maintaining professional boundaries.
What exactly are we talking about here?
Well, professional boundaries are those ethical and practical
limits. They keep the doctor patient
relationship appropriate and safe.

(01:27):
Why do they matter so much? They're absolutely crucial for
building and maintaining trust, which is really the foundation
of patient care. Makes sense.
And the GMC Good Medical Practise 2024, paragraphs 5457,
explicitly states that doctors must maintain appropriate
personal and professional boundaries.
With patients and colleagues, Yes, both.

(01:48):
That means never pursuing sexual, emotional or
inappropriate financial relationships.
Full stop. And the SJT loves to test this,
doesn't it? Especially scenarios involving
gifts or maybe social media contact.
Oh, absolutely. Classic scenarios.
It can feel tempting, can't it, to accept a gift just to avoid
offending someone. It can, but that's precisely the
wrong move. Why is that?

(02:09):
Because it risks A perceived influence, you know, and it can
really erode trust in the long run.
OK, so how do we remember that under pressure?
Is there a mnemonic? There is think boundary, be
objective, understand power, no dual role, avoid gifts,
redirect, yes, escalate. Boundary got it so quick

(02:29):
checklist for the exam. Right in the exam, do politely
decline any risky interactions, redirect communications to
professional channels only, and always document the encounter
and your rationale. OK, clear redirect decline
document. Right then, moving on from
safeguarding that individual trust, let's look at something
that upholds the integrity of the entire profession.

(02:50):
Honesty and candour. The duty of candour.
Yes, this is fundamental. It means being open and honest
with patients when things go wrong.
Even if the harm seems minimal. Even then, yes, especially if
the error is significant from the patient's perspective, it's
all about building and preserving trust.
And the GMC guidance backs this up.
Very clearly, the GMC Candour guidance states you most

(03:12):
promptly acknowledge significanterrors.
Apologise, explain what happenedand outline the next steps.
What about apologising? Does that admit legal liability?
That's a common worry. It's a very common worry.
But no, apologising does not admit legal liability.
In fact, it often fosters greater trust.
Right. It can actually reduce

(03:32):
complaints because patients feelrespected.
Exactly. They feel involved in the
learning process. And the SJT loves this area too.
Like a wrong dose medication error the patient doesn't know
about. That's a classic.
It's tempting to delay disclosure, you know, Hope it
just goes away. But that's the wrong approach.
Absolutely wrong. Yeah, it erodes trust and
prevents vital, timely learning for the whole system.

(03:53):
Is there a mnemonic for candour?Yes, candour, confirm,
apologise, notify, document, offer support, update, plan,
review, learning. Candour, confirm, apologise,
notify OK SO exam checklist. In the exam, make the patient
safe first, acknowledge the error promptly apologise,
sincerely explain clearly what happened and meticulously

(04:14):
document everything. Make safe, acknowledge,
apologise, explain, document. Got it.
So beyond these specific duties,there's this kind of overarching
commitment to how we conduct ourselves professionally that
brings us to upholding GMC standards.
Precisely this is about the consistent application of Good
Medical practise 2024 in your daily work.

(04:37):
It means choosing patient safety, honesty, competence and
professionalism. Over what?
Convenience pressure. Over convenience or even tame
pressure? Yes.
Here's a critical high yield rule for you if a local policy,
convenience, or even hierarchy conflicts with GMC guidance.
You choose the GMC standard. You must always choose the GMC

(04:57):
standard and patient safety every single time.
No exceptions. And this comes up in the SJT.
Oh definitely think about being asked to backdate notes maybe or
discharge unsafe patients because of bed pressure.
Right, the pressure to keep the team harmonious.
Exactly. It's tempting to comply with
inappropriate instructions, but it's wrong.
It compromises accuracy and, crucially, patient safety.

(05:18):
So how do we stand firm? Any memory aid?
Think stand standards first. Tell the Truth Act for safety,
Notify Seniors documents. Standards first good one
checklist for the exam. OK, Refuse unsafe or dishonest
actions, Escalate your concerns respectfully through the proper
channels and document every stepyou take.

(05:39):
Refuse. Escalate respectfully, Document
makes sense. Now for something maybe a bit
more subtle, but still incredibly critical for trust
and integrity. Conflict of interest.
Yes, this refers to any situation where your personal
interest may be financial. Maybe something else could
potentially influence your professional judgement or
decisions. And that could undermine patient

(06:00):
care. Potential yes.
GMC guidance, particularly underMaintaining Professional
Boundaries, states you must actively identify and manage any
conflicts of interest. Including things like gifts or
requests. Yes, exactly.
The rule is clear. Never let these personal
interests influence patient care.
And always follow your local gift policy.
Your hospital have one. And the SJT?

(06:20):
How does this appear back to gifts again?
Often, yes. Scenarios about accepting gifts?
Well, it might seem polite to accept something high value.
It's the wrong choice. It's the wrong choice.
It creates that perception of influence and again, a roads
trust. Is there a mnemonic for this?
We can adapt one from professional boundaries, Redoc,

(06:42):
redirect, decline, offer safe alternative, communicate and
record. Redoc redirect decline exam
checklist. For the exam, declare any
potential interests, decline offers that could be
influential, and document your rationale for those decisions.
Clear documentations key. Declare, decline.
Document rationale. Got it.

(07:03):
Oh good, right, moving on. Your conduct, everything from
how you dress to your digital presence, that's all part of
your professional identity. Let's talk professional
appearance and behaviour. Absolutely, your conduct,
whether offline or online, must always justify the trust placed
in the medical profession and ensure patient safety.
So it's about professionalism across the board.
Exactly. GMC Good Medical Practise 2024

(07:25):
clearly states your conduct mustalways be professional.
This means being honest, accurate and trustworthy in all
your communications, whether you're in the hospital corridor
or interacting online. And Sgt questions often bring
this up like ward selfies. Yes, ward selfies where patient
information might be identifiable, or maybe being
consistently late for clinic. These things matter.

(07:47):
It's tempting, isn't it, Postingfrom clinical areas on social
media? It might be, but it's wrong.
It risks breaching confidentiality and really
undermines public confidence in the profession.
So a mnemonic to keep us on track here.
Think polite policy first. Open ID, listen and apologise.
Integrity and notes, tidy digital professionalism.
Escalate early. Polite.

(08:08):
OK, rapid checklist. Always adhere to attire and ID
policy, communicate courteously and ensure impeccable digital
professionalism and here. Communicate courteously.
Digital professionalism. So knowing your outward conduct
is vital, but what about understanding your internal
capabilities? This sounds like self-awareness
insight. Exactly this is the crucial
ability to recognise your own limits.

(08:31):
To know what you don't know. Precisely to work strictly
within your competence, to actively seek supervision when
you need it, and importantly, togenuinely learn from feedback.
And this impacts patient safety directly.
Directly, the GMC Good Medical Practise 2024 states you must
work within your limits and ask for help where necessary, always
protecting patient safety. So what's a typical SJT

(08:53):
scenario? Being asked to do something new.
Yes, imagine being told to perform a procedure you've never
done live. Tempting to just have a go on
bluff confidence. Very tempting for some perhaps,
but absolutely wrong. It directly risks patient harm.
Is there a mnemonic for self-awareness?
Yes. Aware, assess limits, Warn,
scalate, ask for help, Refrigerate educator, reflect.

(09:15):
Aware assess limits, good exam checklist.
Quickly assess your competence for the task at hand, seek
immediate help or supervision ifyou're unsure and always
prioritise protecting the patient patient safety first.
Assess competence, seek help, protect patient right, and
building on that self-awareness,this leads us naturally to that
proactive journey of lifelong learning, maintaining

(09:36):
competence, and continuous professional development.
CPD. Yes, this is about consistently
practising within your abilities, continuously updating
your knowledge and actively seeking supervision when needed.
It's a core GMC duty, isn't it? Absolutely a core duty To ensure
safe, effective care, your CPD activities must be planned and

(09:56):
properly evidenced. What's a high yield rule here?
Expired certifications. That's a key one.
If a critical certification likeILS or BLS expires, you
absolutely must not cover dutiesunsafely.
So what do? You do you arrange competent
cover immediately and book an urgent renewal.
Patient safety cannot be compromised.
And SJT scenarios test this expired certificates or being

(10:19):
asked to do things beyond your training.
Frequently, it might seem tempting to work a shift with
lab certification to avoid hassle.
But it's wrong. Fundamentally wrong.
It risks patient safety. Mnemonic for CPD.
CPD safety check Confidence planlearning document supervise act
for safety feedback evaluate. CPD haif E OK and the checklist.

(10:41):
Plan and evidence your CPD refuse to work if you are
impaired or uncertified for a required task and escalate
concerns about any unsafe situations you encounter.
Plan evidence, refuse if unsafe,escalate.
Clear. Good.
OK, we've covered a lot on individual professionalism.
Fantastic. Now let's shift our focus a bit
to collective responsibility. Our next major theme, patient

(11:03):
safety, starting with escalatingclinical concerns.
Right. This is all about prompt
communication, getting information about any developing
or actual patient risk to someone who has the competence
and authority to help. It's about timely action then.
Timely action to protect patients?
Yes, the GMC Good Medical Practise 2024 makes it crystal
clear patient safety must be your first concern.

(11:24):
And you act without delay. Without delay using structured
communication. SP hour is the standard here.
Situation Background assessment recommendation.
Exactly. And the SJT, how does it test
escalation? Deteriorating patients.
Very common scenario, perhaps suspected sepsis, a rising new
WS2 score, and maybe the senior doctor is unresponsive or busy.
The temptation is to watch and wait or send a vague text.

(11:49):
Yes, but that's absolutely wrong.
It critically delays it and putsthe patient directly at.
Risk mnemonic for escalating. Raise AT Recognise, assess risk,
inform using SBR safeguard, Intervene yourself if needed,
Escalate further incident report.
Track Fall. Raise IT.
Recognise, Assess Inform. OK exam checklist.

(12:12):
Stabilise the patient within your confidence, call the right
person early, always use SBR forclear communication and escalate
up the chain of command if you face a blockage or no response.
Call early SPR Escalade if blocked, got it perfect now.
When safety is seriously compromised, knowing exactly how
and when to raise those concernsis absolutely paramount.

(12:33):
This brings us to speaking up whistleblowing.
Yes, this means raising concernsabout unsafe practises or
significant risks to patient safety, especially if the usual
internal routes for addressing them seem to be failing.
That sounds like a really important mechanism.
It's vital, it protects patientsand upholds professional
standards and there's protectionfor those who speak up.
Like the public interest disclosure?

(12:53):
Act exactly the GMC raising and Acting on Concerns guidance and
the Public Interest Disclosure Act 1998.
PID protect workers making protected disclosures from
detriment or unfair dismissal. Do you need absolute?
Proof. That's a crucial point, Yeah.
No, you do not need proof to raise an honestly held concern.
And in the SJT, what kind of scenario?

(13:15):
Unsafe staffing. That's a possibility.
Repeated drug chart errors due to unsafe staffing levels, for
instance. What's the wrong approach?
Waiting for more proof, posting on Facebook.
Definitely wrong. Patient safety requires prompt,
formal action through the correct channels, not social
media rants. Mnemonic for speaking up.
Speak safety now, proper route evidence, be objective.

(13:37):
Anti retaliation awareness keep records.
Speak safety now. Proper route.
OK checklist. Assess the risk immediately.
Use the correct formal route like the freedom to speak up,
guardian in your trust and document all your actions
meticulously. Assess risk.
Use formal route document Check.OK, let's turn inwards for a
moment. Your own well-being isn't just

(13:57):
personal, is it? It's a key component of patient
safety. Let's discuss managing fatigue
and personal impairment. Absolutely critical.
This is about recognising any condition, fatigue, illness,
stress, even substances that might make you unsafe to
practise. And your duty is to act.
Your professional duty is to protect patients by acting
promptly. The GMC Good Medical Practise

(14:20):
2024 is very clear on this. You must not practise if your
judgement or performance may be compromised.
Patient safety comes before embarrassment or service
pressure. Always.
Patient safety must take precedence, no question.
And the SJT drowsiness on a night shift after a near miss.
Classic scenario. It might be tempting to push
through or try to hide your impairment, but that's wrong.

(14:42):
Totally wrong. It directly increases the risk
of error and patient harm. How to remember handling this?
Use rest, safe, recognise, escalate, switch to safe cover,
transfer care, proper handover, sleep cover, access support,
form a prevention plan, Enter a record.
Rest safe, recognise, escalate, switch.
Good checklist. In the exam, assess your safety

(15:02):
to practise honestly, escalate your concerns early, arrange for
competent cover and ensure a safe handover of all your
duties. Assess safety, escalate early,
arrange, cover safe handover done right.
Reinforcing that fundamental principle.
Again, prioritising patient safety over personal
organisational interests. This feels like a recurring

(15:23):
theme. It is the core theme, really.
It means making decisions that put Patient Protection first.
Always. Yeah, even when they conflict
with your personal convenience, maybe team politics or hospital
targets. Even things like bed pressure
targets. Especially things like bed
pressure targets. The GMC Good Medical Practise
2024 mandates putting patients 1st and acting promptly if

(15:44):
safety is compromised. You can't let hierarchy or
target pressures delay necessaryaction.
So the SJT scenario of pressure for an unsafe life discharge.
Is a perfect example tempting tocomply to reduce bed pressure
Maybe please a manager but. Wrong.
Fundamentally wrong patient safety is the absolute non
negotiable priority. Mnemonic for this.

(16:04):
First flag risk, intervene report, Escalate secure record,
Track outcomes first. Flag risk OK checklist.
Treat any immediate risk first. Use formal communication
structures like SPRR and escalate if you find your
actions or concerns are being blocked.
Treat risk, use SPR, escalate ifblocked.
OK, so patient safety isn't justabout preventing harm, it's also

(16:28):
about learning when things unfortunately do go wrong.
Which leads us to incident reporting, datex, etcetera.
Exactly. This is the formal process for
documenting adverse events, nearmisses, or unsafe conditions.
It's not about blame. It's about learning.
It's critical because it triggers system improvement and
learning. Always make the patient safe
first. Be candid about what happened,

(16:49):
report factually avoiding blame,and use that report to trigger
system wide improvement. What about near misses?
Do they need reporting? Absolutely.
Near misses must be reported. They reveal valuable system
risks before someone gets hurt. And the SJT test this like a
medication error the patient is unaware of or equipment failure.
Yes, tempting perhaps to quietlycorrect an error without

(17:10):
reporting it. But that prevents learning.
Precisely, it prevents systemic learning and misses a crucial
opportunity to improve safety for future patients.
Mnemonic for reporting. Report reduce risk now explain
to patient duty of candour link present facts, escalate
appropriately. Outcomes and learning focus
record timing accurately. Report.

(17:32):
Reduce risk. Explain.
OK. Checklist in the exam, make the
patient safe, be candid with them, report factually via
approved systems like Dedex and document all your actions.
Make safe, Be candid. Report factually, document,
check. Good.
Now Sometimes the threat to patient safety might come from

(17:52):
within the team itself. This brings us to dealing with
unsafe colleague behaviour. Yes, this means recognising and
appropriately addressing a colleague's behaviour, health or
performance. Maybe impairment, bullying,
repeated errors that risks patient safety.
This sounds difficult. It can be extremely difficult,
but GMC guidance is unequivocally clear.

(18:13):
Your primary duty is always to protect patients first, so.
What do you do? Use formal escalation roads and
ensure fair support for the colleague involved.
Perhaps referral to occupationalhealth.
You don't gossip. Do you need absolute proof here
either? No, again, you do not need proof
to raise an honestly held concern about safety.
SJT Scenarios a colleague smelling of alcohol or a junior

(18:35):
making repeated errors. Those are plausible examles
Temting. Maybe to keep it between us or
gossip on WhatsApp? But that's wrong.
Comletely wrong. Patient safety is paramount and
requires formal, confidential action.
Mnemonic for this. ACT fair.
Assess risk immediately call senior help take colleague off
unsafe duties if necessary. Formal reporting route.

(18:57):
Assist colleague SCG Occupational health impartial
record keeping Review the outcome.
ACT Affaira. Assess risk.
Call senior checklist. Protect patients immediately,
escalate your concerns via formal channels, and document
everything objectively. No opinions, just facts.
Protect patients. Escalate formally.
Document objective OK and ensuring that continuous patient

(19:17):
safety relies heavily on effective team communication,
doesn't it? Which leads nicely to safe
handover. Absolutely essential.
This refers to the structured and reliable transfer of patient
information and responsibility between healthcare
professionals. It ensures continuity of care.
Yes, seamless continuity. Always use a structured
communication tool like SPR Situation, background

(19:39):
assessment, recommendation. Very specific.
Very specific. Clearly name the person
responsible for any follow up task, set clear time frames for
action and document the handovercontemporaneously at the time it
happens. SJT scenario A patient
deteriorating near the end of your shift.
Classic. Tempting to just write for
review in the notes without speaking to anyone directly.

(20:00):
Huge mistake. It creates dangerous ambiguity
and risks patient safety. SBR is the core principle here.
Remember SBR? SBRSBRSBR got it checklist.
Use SBR. Specify a named owner and
deadline for tasks and document the handover thoroughly in the
patient record. Use SPRR.
Specify owner deadline, Documentcheck Perfect.

(20:21):
OK, shifting gears now, we're moving into the absolutely
crucial area of confidentiality and data protection, starting
with the basics, patient confidentiality principles.
Right. This is your professional, legal
and ethical duty to keep identifiable patient information
private. You only disclose it with
consent or when there's a very clear, justified legal or

(20:43):
ethical basis. What guides us here?
GMC Principles. Caldecott.
Both the GM CS8 Confidentiality principles and the Caldecott
principles are your key guides. Core ideas are justify the
purpose for using data, use the absolute minimum necessary
information, access it only on astrict need to know basis and
ensure all information is kept secure.

(21:04):
And the SJT requests for info from pharmacists, relatives.
Yes, those types of requests. It might be tempting to refuse
all sharing because you're worried about GDPR.
But that can be wrong too. It can be, yes, because refusing
necessary information sharing can actually compromise direct
patient care. It's about finding the right
balance. Mnemonic for sharing safely.
Min Share minimum necessary infofor direct care.

(21:26):
Safety, need to know access secure methods.
Honesty. No surprises for the patient
where possible. Authority, right person asking,
receiving record and rationale. Ethical legal justification.
Min Chair. Minimum necessary.
OK checklist. Share the minimum necessary
information, ensure there's a clearly justified purpose for
sharing, use secure channels only, and always document your

(21:49):
rationale for sharing or not sharing.
Minimum necessary, justified purpose, secure channels,
document rationale. Got it.
Good and understand the legal framework behind that
confidentiality. We need to touch on data
protection. U kg DPR in healthcare sounds
complex. It can seem complex, but the
core idea is applying U, KG, DPRand the Data Protection Act 2018

(22:10):
to identifiable patient data. Health data is special.
Special category data. Exactly, yeah, Which means you
need both a general lawful basisunder Article 6 and a specific
condition for processing specialcategory data under Article 9.
OK, so 2 hurdles to clear. What about for direct NHS care?
For direct care in the NHS you generally we rely on Article 61
E Public Task plus Article 92-H health or Social care, which is

(22:32):
supported by Schedule One of theData Protection Act 2018.
Right. So there's a standard pathway
for direct care data. Yes, but you still need to meet
all the other data protection principles like minimization,
security, etcetera. And the SJT tests this sharing
for research remote working. Common scenarios Tempting to
send clinical data via your personal e-mail just this once,

(22:54):
for convenience. Absolutely not.
Absolutely not. Big breach of beta security
principles. Monica for the legal side.
Lof UL9, Lawful basis art. Six, Article 9.
Condition met minimum necessary data.
Secure processing transparent with patient record.
Retain appropriately 72 hour breach notification rule
awareness. Lof UL9OK checklist.

(23:14):
Identify your lawful basis for processing, ensure data
minimization and always, always use secure, approved NHS systems
for handling any patient information.
No shortcuts. Identify bases.
Minimise data. Use secure systems.
Understood. Now the cornerstone of ethical
information sharing is usually patient consent.
So let's discuss sharing information with consent.

(23:36):
Right. This is when you disclose
identifiable patient informationbecause the patient who has the
capacity to decide gives you valid permission for a specific
purpose. When is explicit consent most
needed? Not for direct care usually.
Generally not for sharing withinthe direct care team, no, but
for uses beyond direct care or for disclosures to the third

(23:58):
parties. Think relatives asking for
details, employers, insurance companies, the media.
Explicit informed consent is almost always required unless a
specific lawful exception applies.
And consent needs to be. Voluntary, informed, specific to
the disclosure, documented clearly and importantly.
The patient can withdraw it at any time.

(24:18):
Classic example, Employer requesting health details
without permission. Classic example.
Tempting maybe to send a brief diagnosis just to be helpful.
Wrong. Completely wrong without
explicit consent for that specific disclosure.
Mnemonic for consent. Consent 5.
Capacity assessed. Objective information provided.
Narrow and specific scope. Secure sharing method used.

(24:40):
Entry made in the record. Consent 5.
Capacity objective info OK checklist.
Confirm the patient has capacity, seek explicit consent
for any third party sharing, anddocument the scope and details
of that consent clearly. Confirm capacity.
Seek explicit consent. Document scope clear, Good.
But there are times aren't therewhen confidentiality must yield

(25:02):
to a greater public good or a legal imperative.
These are the exceptions to confidentiality.
Yes, there are specific, limitedsituations where information may
or sometimes must be shared without the patient's explicit
consent, like safeguarding. Safeguarding children or adults
at risk is a key one. Also, situations involving a
clear public interest, like preventing serious harm or

(25:23):
crime, or fulfilling statutory legal duties like reporting
notifiable diseases. Do you need consent for
safeguarding referrals? Generally, no ICO guidance is
clear. The consent is not required for
sharing information. For safeguarding purposes, the
risk of harm usually overrides the duty of confidentiality.
What are the rules when sharing without consent?
You must share the absolute minimum necessary information

(25:45):
only with the correct relevant authority like UKHSA for
notifiable diseases, the DVLA for medically unfit drivers.
Always use secure channels and meticulously document your legal
or ethical justification for breaching confidentiality.
Should you tell the patient? You should usually inform the
patient about the disclosure unless doing so would put them

(26:06):
or someone else at risk of harm or undermine a criminal
investigation, for example. SJT Examples.
Notifiable diseases. Unfit drivers.
Yes, diagnosing measles where parents want privacy, or a
patient with poorly controlled seizures who insists on driving.
Tempting to respect their privacy?
Absolutely. It is, but it's wrong.
In these cases, statutory dutiesor overriding public safety

(26:27):
concerns take precedence over confidentiality.
Mnemonic for these exceptions. Lawful share Legal duty?
Public interest? Identified authority.
Share with the right one. Why record your rationale?
Few facts? Minimum necessary shared?
Use secure method? Let patient know you're safe and
appropriate. Lawful share Legal duty
authority. OK checklist.

(26:48):
Assess the risk of harm carefully, identify the specific
legal or statutory duty or public interest justification,
share only the minimum necessaryinformation with the correct
authority and document fully. Assess risk.
Identify justification. Share minimum document, right?
And extending all these principles into our digital

(27:08):
lives brings us to social media and digital professionalism.
It's everywhere now. It is, and it requires careful
thought. This means applying GMC
standards to all your online activity.
So protecting confidentiality online.
Yes, protecting confidentiality,maintaining professional
boundaries, being honest and accurate in what you post or
share, and always using secure, approved systems for any patient

(27:30):
information. Never personal accounts or
unsecured platforms. What does the GMC social media
guidance advise specifically? Key things are never share
patient identifiable informationor images on personal platforms,
avoid giving individual medical advice on public forums or
threads, and keep those professional boundaries clear so
no accepting patient friend requests on personal accounts.

(27:50):
SJT scenarios, Ward selfies again, patients messaging you
privately. Both common examples that's
selfie with patient info visiblein the background, or a patient
direct messaging you on your personal Instagram.
Tempting to ignore the message or give brief advice.
Both are wrong. Ignoring might seem safe but
isn't helpful, and giving advicebreaches boundaries and

(28:12):
potentially confidentiality, plus lacks proper context and
documentation. You need to redirect them to
proper channels. Mnemonic for online safety.
Post safe. Protect patient identity always
on policy systems only secure. Stick to facts of commenting
professionally. Transparency about any interest.
Set clear boundaries. Act quickly.

(28:32):
Remove, mitigate if issues arise.
Flag escalate concerns if needed.
Enter a brief record if relevant.
Professional interaction occurs.Post safe protect identity.
Good checklist. Always protect patient identity,
use only secure approved channels for any patient related
communication, and maintain clear professional boundaries
online at all times. Protect identity, UC.
Secure channels, maintain boundaries.

(28:54):
Check. OK, we've talked a lot about
handling information safely. Now let's pivot to something
equally vital in clinical practise.
Mastering sensitive communication.
Our next major theme is communication and interpersonal
skills, starting with a tough one.
Breaking Bad news? Yes, a core skill.
This refers to a structured, compassionate approach to

(29:15):
delivering difficult news to patients and their families.
The aim is to ensure understanding, reduce distress
as much as possible and build trust even in difficult
circumstances. Is there a framework for this
like spikes? SPIKES is a widely recognised
and very helpful framework. Yes, you prepare the setting,
assess the patient's perception,what they already know or

(29:36):
suspect and their invitation, how much detail they want.
Give a clear warning shot beforedelivering the knowledge
plainly. Show empathy, pause, acknowledge
and validate their emotion, and then outline a clear strategy or
plan moving forward. And the GMC supports this
approach. Very much so, it aligns
perfectly with the principles inGMC Good Medical Practise 2024.
How might the SJT test this a new cancer diagnosis?

(29:59):
That's a very common scenario, tempting perhaps to rush it, get
it over with by delivering the diagnosis immediately.
But that bypasses crucial steps.Exactly.
It bypasses those crucial steps for ensuring patient
understanding and helping them begin to cope.
Is there another mnemonic perhaps?
Warm plan could be helpful. Warn first, ask their

(30:19):
understanding, respond to emotion.
Make a clear plan. Paperwork.
Document the conversation and provide leaflets.
Link them to the wider team likespecialist nurses.
Arrange definite follow up. Next steps clearly agreed.
Warm plan, warn, ask, respond. OK checklist.
Prepare yourself in the setting,check the patient's current
understanding, give that warningshot, state the news clearly and

(30:41):
simply pause and show genuine empathy, and then collaborate
with them on a clear plan. Prepare, check, understanding,
warn, state clearly, pause and empathise, plan.
Got it. Good.
Now the foundation of all good communication, surely is truly
hearing the patient. Which brings us to active
listening. Absolutely.
Fundamental active listening isn't just hearing, it's a

(31:02):
deliberate communication skill. It combines focused attention,
empathy, reflection, and clarification.
And the goal to. Fully understand a patient's
concerns, build that crucial trust, and ultimately make safe,
shared decisions. How do you do it?
Any techniques? Solar ice.
Yes, those are great tools. Be present.

(31:22):
Use the solar posture. Sit facing open posture, lean in
slightly, eye contact relaxed manner.
Start broadly with open questions.
Explore their ice ideas, concerns, expectations.
And responding nurse? Reflect and validate their
feelings using nurse. Name the emotion, understand it,
respect their feeling, support them, explore further and

(31:43):
always, always check understanding using Teach back
before agreeing clear next steps.
What about SJT scenarios? Busy triage?
Anxious patients. Very common busy situations with
anxious patients talking rapidly, tempting maybe to
interrupt or reassure them prematurely.
But that stops you understandingproperly.
Exactly. It prevents full understanding
and gets in the way of true shared decision making.

(32:04):
Mnemonic for active listening. Listen, let them speak fully,
invite their concerns using ICE,show empathy using nurse, test
understanding chunk and check, teach back, explain and plan
collaboratively. No down the key points
accurately. Listen, let's speak.
Invite concerns. OK checklist.

(32:25):
Invite the patient to tell theirfull story first, reflect their
feelings back to them to show you've heard, clarify and
summarise what you've understood, and always check
their understanding using Teach.Back Invite story, reflect
feelings, clarify, summarise, teach back Check.
Excellent. Now sometimes conversations
become heated or patients are very distressed.
Specific techniques are vital then to restore a safe

(32:46):
environment. Let's talk dealing with angry or
distressed patients. Yes, a challenging but important
area. This involves using non
threatening posture, maintaininga calm tone of voice, using
empathic listening, and setting fair clear limits to reduce risk
and restore a safe environment for care.
Safety first. Always safety first, scan for
risks, maintain a safe distance,ensure you have an exit route if

(33:08):
needed, maybe have a league nearby.
What about a structured approach?
Calmer. Yes, the calmer steps can be
very helpful. Remember to separate the person
from their behaviour. The behaviour might be
unacceptable, but the person still needs care.
And crucially, always document the incident and report any
abuse through formal channels like Datix.
Nice Ng 10 also offers guidance here.

(33:30):
Sgt Scenario A relative shoutingabout delays in a busy A&E.
Very plausible. Tempting, perhaps, to argue back
or match their volume. Oh escalates things.
Exactly. It escalates the situation and
creates an unsafe environment for everyone's staff and other
patients included. Mnemonic.
Is it calmer itself? Yes.
Calmer, calm stance and approach.

(33:50):
Acknowledge their feelings. I can see you're upset.
Listen actively to their concerns.
Map out the core issue together.Explain the limits or boundaries
clearly. Resolve with choices or a plan.
Calmer, calm stance. Acknowledge.
OK. Checklist Ensure immediate
safety, acknowledge their feelings without judgement, set
clear limits for acceptable behaviour, offer realistic
choices or next steps, and document the encounter

(34:12):
thoroughly. Ensure safety, Acknowledge
feelings, Set limits, offer choices.
Document right now Family carersare often absolutely integral to
patient care, aren't they? This means we need thoughtful
communication and clear boundarysetting when working with
relatives and carers. Indeed, it's about building a
partnership with relatives and unpaid carers, focusing on the

(34:33):
patient's goals while rigorouslyprotecting patient
confidentiality and autonomy. So how do you balance that?
What's the key rule? A high yield rule stressed in
GMCGMP 2024 is to establish early on who the patient wants
involved in their care and exactly what information can be
shared with whom. Then document these preferences

(34:54):
clearly. What if the patient lacks
capacity? Then you must follow the Mental
Capacity Act MCA best interest process involving relevant
people as appropriate under the Act.
It's also good practise to identify carers and signpost
them to support NICE. Ng 150 highlights this.
Sgt Test a partner asking for details when the patient's

(35:14):
capacity fluctuates. Yes, that's a tricky 1.
Tempting maybe to over share because they seem concerned, or
conversely refuse all information because you're
unsure. Both potentially wrong.
Both potentially wrong. You must respect the patient's
wishes, past or present, if known.
If capacity is lacking, you share only the minimum necessary
information for the patient's direct care or benefit within

(35:36):
that best interest framework. Mnemonic for working with
carers. Carer consent Check patient
preferences first. Assess capacity accurately.
Relevant minimum information Share only Engage carers
appropriately as partners. Record all decisions and
communications. Care, care Consent.
Assess capacity. OK checklist.
Check patient preferences early on, verify the identity and

(35:58):
consent basis before sharing, share only the minimum necessary
information and document your decisions and rationale.
Check preferences, verify consent, share minimum document.
Got it. Good.
Ensuring clear, equitable communication for all patients
is a fundamental duty. So let's tackle communicating
with non-english speakers, specifically using interpreters.
Yes, this is about using a professional interpreter, face

(36:20):
to face, phone or video to ensure that patients fully
understand their situation and can properly participate in
decisions about their care. It's a core professional duty.
What guidance covers this GMC Accessible Information standard?
Both. The GMC expects you to arrange
interpreting services when needed.
The Accessible Information Standard requires NHS services

(36:42):
to identify and meet patients communication needs, including
things like British Sign Language, BSL interpretation.
What about using family members,especially children?
A definite no, no, do not use children as interpreters.
Avoid family members too, exceptperhaps in very limited
emergency situations, and even then it must be carefully
documented and ideally followed up with a professional

(37:03):
interpreter. It's inappropriate, risks safety
due to potential misinterpretation or bias, and
undermines confidentiality. SJT scenario getting consent
from a non-english speaker and achild offers to translate.
Very common trap, tempting to use the child or another family
member for speed. But it's wrong.
Completely wrong for all the reasons mentioned.
Inappropriate, unsafe, lacks confidentiality and assurance of

(37:26):
true understanding. Mnemonic for using interpreters.
Interpret Identify the need early part of AIS.
Engage a professional interpreter triad setup
positioning so you talk to the patient.
Explain plainly short sentences,Avoid jargon.
Review understanding with teach back via the interpreter.
Privacy assured. No children used.
Record the details. Interpreter ID, language

(37:49):
evidence provided, translated leaflets if available.
Track need for follow up interpreting.
Interpret, identify, need, engage professional.
Great checklist. Book a professional interpreter.
Always speak directly to the patient, not the interpreter.
Use plain language and check understanding using Teach back
through the interpreter and document the details of the
interpreting session. Book professional, speak to

(38:11):
patient, plain language, teach back document check.
Perfect. Let's take a closer look now at
the specific tools for managing those heightened emotions we
talked about earlier, your de escalation techniques.
Right, this is the deliberate use of non threatening posture,
a calm tone of voice, empathic listening and setting fair
limits. The goal is always to reduce
risk and restore a safe environment for care.

(38:32):
Safety first again. Always safety first.
Maintain distance. Ensure you have an exit, involve
A colleague if you feel unsafe. Use nonverbal control.
Things like a relaxed stance, keeping your hands visible.
And verbally. Listen, validate.
Summarise their concerns to showyou're hearing them.
Set clear, neutral boundaries about behaviour, not the person,

(38:52):
and offer practical, realistic choices to help them regain
control and move forward. Follow nice Ng 10 principles.
SJT scenario. Patient, standing up, invading
your space, clenched fists raised voice.
Yes, a clear escalation. Tempting, maybe to match their
volume or ignore the threateningbehaviour.
Wrong and unsafe. Exactly unsafe and likely to

(39:12):
escalate the situation further. Mnemonic for de escalation.
De escalate distance and safety first.
Empathise what they're feeling. Slow, calm voice.
Set clear limits firmly but fairly.
Clarify the core issue. Alternative choices offered.
Leave time, space to cool down. Agree a plan transfer to record
document. Escalate for security help if
risk remains high. De escalate distance, empathise,

(39:33):
slow voice. OK checklist.
Make a situation safe. Adopt A calm stance and tone.
Acknowledge their feelings, set clear limits on behaviour, offer
choices and document the incident.
Make safe, calm stance. Acknowledge feelings, set
limits, offer choices. Document.
Right now, let's just refine that compassionate response

(39:56):
slightly. We need to be clear about the
difference between being empathetic versus being
sympathetic. Is there a difference?
There is a subtle but important difference.
Empathy is about understanding and acknowledging another
person's feelings and perspective and then responding
helpfully from their viewpoint. And sympathy.
Sympathy tends more towards pityor feeling sorry for someone.
While well-intentioned, it can sometimes accidentally distance

(40:19):
you or minimise their genuine concerns.
All your fourth thing isn't usually as helpful as that
sounds really difficult. Which does guidance favour?
Both GMCUK and Nice Ng 197 strongly value empathy and
shared decision making. Empathy connects.
Sympathy can sometimes separate.So how do you show empathy
effectively? A good approach is to notice the

(40:39):
emotion. Name it.
I guess you're feeling worried. Validate it.
It's understandable you feel that way given the situation.
Explore briefly why they feel that way and then collaborate on
options and next steps using Teach Back to check
understanding. Avoid jumping to premature
reassurance or pitying language.SJT example, a tearful patient

(41:00):
saying I'm terrified the scan means it's spreading.
Exactly. Tempting to say.
Don't worry, I'm sure it's fine.Or oh, poor you.
But that dismisses their fear. Precisely.
It dismisses or minimises their valid fears.
An empathic response would be more like it sounds like you're
really frightened about what thescan might show.
Can you tell me more about what's worrying you?
Mnemonic for empathy. Think empathy or maybe NEVER.

(41:24):
Notice the emotion. Give it an empathic name.
Validate their feeling. Explore briefly.
Respond collaboratively with a plan.
NEVER notice name validate Hickscode checklist.
Name the feeling the patient is expressing, validate that
feeling is understandable, briefly explore the root of
their concern, and then move towards developing a
collaborative plan together. Name feeling validate.

(41:45):
Explore, collaborative clan. Excellent.
So what does all this communication skill mean for
working effectively as part of aclinical team?
That brings us neatly to our final theme, teamwork and
leadership. And effective teamwork really
starts with safe delegation. Absolutely.
Delegation means asking someone else to perform a task, but

(42:05):
crucially, you as the delegator retain overall responsibility
for ensuring that task is done safely and correctly.
Why is it so? Important.
It's absolutely vital for patient safety and for team
efficiency, but it has to be done right.
How do you do it right? The five rights.
Exactly. Delegate safely using the five
rights. Right task.
Is it suitable for delegation? Right person?

(42:27):
Are they competent? Right circumstances?
Is the situation stable? Are resources available?
Right communication, clear briefopportunity for questions, check
back and right supervision Is the level appropriate?
This is all outlined in GMC GoodMedical Practise 2024.
Remember, you remain accountable.
SJT examples delegating bloods or cannulation.
Yes to junior for HCA. Tempting, maybe, to delegate a

(42:51):
complex task just to save yourself time without properly
checking competence or ensuring adequate supervision is
available. Wrong and risky.
Very wrong and very risky for the patient.
Mnemonic for delegation. Delegate to find the task
clearly, evaluate their competence and confidence, level
of supervision decided and communicated, Explain the why
and when, give necessary resource info, Agree on the

(43:13):
check back or feedback mechanism, track completion and
document. Escalate if issues arise.
Delegate. Define task, evaluate competence
OK checklist. Check the supervisee's
competence for the specific task, give clear closed loop
instructions, ask them to repeatback, ensure appropriate
supervision is available, and document your delegation

(43:35):
clearly. Check competence, clear
instructions, loop, ensure supervision, document, check
good and delegation works best, doesn't it, in a truly
supportive team environment. So let's talk about supporting
colleagues under pressure. Hugely important.
This means actively helping yourcolleagues manage their
workload, stress or perhaps competence challenges.

(43:55):
It's about fostering A respectful and Fair Work
environment. And this contributes to safety.
Directly contributes to team safety and everyone's
well-being. GMC Good Medical Practise 2024
Domain 3 really emphasises creating a respectful, fair
environment and working collaboratively.
This includes respecting others workload, ensuring your

(44:15):
delegation is reasonable, and supporting colleagues if they
need to push back against tasks that feel unsafe or are
genuinely beyond their capacity right now.
SJT scenario A colleague resisting a task because they
feel overwhelmed or showing signs of stress.
Plausible scenarios, tempting maybe to just push harder or
ignore their distress. But that's counterproductive.

(44:35):
Very counterproductive. It can lead to unsafe practise
errors or contribute to burnout.Not helpful for anyone.
Is there a quick way to think about supporting them?
Maybe call? That's a good way to frame it,
though not an official mnemonic from our sources.
Think, call, communicate openly.Ask how they are and if you can
help. Listen actively to their
response and help manage the situation together.

(44:57):
For example, reprioritize, seek senior input.
KLM communicate, ask, listen, manage good principal checklist.
Offer practical help if you can,check in on their capacity and
well-being genuinely, and escalate concerns through
appropriate channels if you think patient safety is being
put at risk by the situation. Offer help, check in, escalate

(45:18):
of safety risk. Right now, even in the most
supportive teams, disagreements happen.
We need ways to resolve them constructively.
This brings us to managing conflict in a team.
Yes, conflict will arise. The key is addressing
disagreements promptly and fairly to protect patient
safety, staff well-being and theteam's workflow.
It's about fostering a just culture where issues can be

(45:39):
discussed openly without blame. What's the guiding principle?
GMC Domain 3 again. Yes, GMC domain three about
creating a respectful environment is key.
When conflict arises, try to address it privately first.
State the shared aim, which is always good patient care.
Use open questions and objectiveSPR facts to understand the
different perspectives. Then agree on clear actions with

(46:02):
named owners and specific time frames and document the
discussion and agreed plan. When do you escalate?
Escalate proportionately if the risk to patient safety persists
despite your efforts or if the conflict involves bullying or
harassment. SJT conflict examples disputes
over scan priority nurses challenging a discharge plan.
Both very common. A dispute between an SHO and a

(46:23):
radiographer about scan priority, perhaps, or a nurse
loudly challenging a discharge plan on the ward round.
Tempting to argue publicly or blame the other person.
Yes, but that's wrong. It undermines the team, creates
a poor atmosphere and ultimatelyisn't focused on the patient.
Mnemonic for resolving conflict.Compact.
Find a calm private space. Agree on the patient goal.

(46:45):
First. List the objective facts as PR
helps map out the different options or perspectives.
Plan agreed Actions with clear owners and timelines.
Agree a review point. Capture the discussion and plan
in the notes. Trigger escalation formally if
needed. Calm space agree.
Patient goal. OK checklist.
Move to a private space if possible.
Focus the discussion on the shared patient goal.

(47:07):
Use SPR to keep it factual, agree on specific owned actions,
and document the revolution. Private space Patient goal SPR
Facts Agree Actions document Check Good.
OK, so beyond just managing conflict, there's a broader
sense of owning the collective results of the team's efforts.
This is about taking responsibility for team
outcomes. Exactly.

(47:29):
This means coordinating the people and processes effectively
so that patients receive safe, effective care.
It also means accepting accountability for decisions
made, for escalation, for documentation, and for learning
from what happens. Where does guidance mention
this? GMCGMP 2024 Domain 3 again
highlights clear responsibility and accountability as a leader.

(47:51):
Even informally, you need to help define clear objectives for
the team or task, allocate work fairly with named owners and
realistic deadlines, set clear escalation points, and use
frameworks like PSIRF. The patient safety incident
response framework. Yes, PSIRF for learning properly
from incidents, not just reporting them.
SJT scenario. A missed result for a

(48:13):
deteriorating patient and you are nominally in charge.
Perfect example. Tempting maybe to blame a junior
colleague who was meant to check.
Or just fix the air quietly yourself.
But the leader retains responsibility.
The leader, formal or informal, retains overall responsibility
for ensuring the team systems work and for ensuring learning
happens. When they don't, blame isn't the
answer. Understanding why it happened

(48:34):
is. Mnemonic for owning outcome.
Own the outcome We've made clearwork allocated appropriately.
Name specific owners or tasks. Time scale set realistically
helps escalation pathways. Define evidence documented in
notes. Outcomes review for learning.
Own the outcome objectives, clear work allocated checklist.
Acknowledge your role and responsibility in this

(48:55):
situation. Ensure clear own plans are in
place. Document all actions and
decisions and connect any incidents firmly to team
learning and the PSIRF process. Acknowledge role set owned plans
document link to learning PSIRF got it excellent now.
Leveraging the diverse expertisewithin the healthcare team is
absolutely crucial for good outcomes.

(49:18):
This is all about recognising roles and responsibilities of
MDT members, the multidisciplinary team.
Precisely, it means utilising the MDT effectively by assigning
the right task to the right professional at the right time.
It's about efficiency and expertise.
What's the key principle respecting scope?
Clear referrals. Yes, respect each professional
scope of practise and their competence.

(49:38):
Make clear SPR referrals with specific questions or asks and
realistic time frames, and always define clearly who owns
each subsequent action. Can you give some examples?
Pharmacist physio O dot salt dotOT.
SURE pharmacist for medicines reconciliation or complex drug
interactions. Physiotherapist for mobility
assessment and rehab planning. Salt, speech and language

(49:59):
therapist for swallow assessments or communication
aids. OT occupational therapist for
assessing activities of daily living and planning home
adaptations for discharge. SJT test a frail patient.
Recurrent falls. Complex discharge needs.
Very common, attempting maybe toask a healthcare assistant just
to check if she can manage the stairs.

(50:19):
But that's not their role. Exactly.
That's a specialist assessment requiring A physiotherapist or
an occupational therapist, potentially both.
Using the wrong person is inefficient and potentially
unsafe. No specific mnemonic, but focus
on right person. Right person, right task is the
core idea here. Checklist for MDT working.
Clearly define the patient's problem or need first, identify

(50:42):
the most relevant professional within the MDT to address that
specific need, and then make a clear, concise SBR referral to
them. Define problem, pick relevant
professional, make clear SBR referral simple.
When done well, yes. OK, final couple of topics.
When time is absolutely critical, effective leadership
becomes paramount. Let's talk leadership in
emergencies. Cardiac arrest, sepsis,

(51:03):
anaphylaxis. Yes, high pressure situations.
This means coordinating people, information and equipment
effectively under extreme time pressure to ensure the best
possible patient outcomes. What are the high yield rules
here? Calling for help early
allocating roles. Absolutely.
Call early for help. Use the emergency buzzer, dial
2222, allocate roles aloud. Clearly you take airway, you

(51:25):
start compressions, you get IV access and drop drugs.
You scribe everything. Closed loop communication
following algorithms. Yes, use closed loop
communication. Can you give one milligramme
adrenaline? Giving one milligramme
adrenaline now to confirm tasks,follow relevant algorithms
rigorously. ALS Reese's counsel sepsis
guidelines based on nice Ng 51 anaphylaxis protocols Maintain

(51:47):
situational awareness, what's happening, what needs to happen
next, and escalate proactively based on triggers like the new
WS2 score. What about paediatric
emergencies? Any key differences?
Yes, crucial differences. Uniquely for kids.
Focus on airway and breathing first.
The initial 5 rescue breaths in CPR are vital.
Use the national PUWS paediatricearly warning score.

(52:08):
Apply age and weight based dosing and equipment
meticulously. Use resources like the BNFC or
local apps and importantly, involve parents appropriately
and always consider safeguarding.
SJT scenario award arrest. You arrive first.
Classic test. Tempting, maybe, to just start
compression silently, or wait passively for a senior doctor to

(52:29):
arrive. Wrong.
Need to take charge? Absolutely wrong.
Immediate leadership, clear roleallocation, and strict adherence
to the relevant algorithm are crucial for patient survival
from the very first seconds. Mnemonic for emergency
leadership. Leader Lead confidently and call
for help early. Establish roles clearly and
allowed algorithms followed strictly.
Dialogue uses closed loop communication.

(52:50):
Evaluate situation continuously.Record everything accurately,
Escalate appropriately. And for paediatrics?
Maybe you think kids lead call early ID roles clearly drugs
gear must be by weightage support parents appropriately.
Look at the PUWS score escalate early algorithms followed
precisely document everything. Leader and kids lead got it

(53:11):
checklist. Call for help immediately.
Assign roles allowed to your team members, follow the
relevant algorithm precisely, use closed loop communication
and ensure meticulous documentation throughout.
Call help, assign roles, follow algorithm, closed loop document,
check perfect. And finally, good leadership
also involved developing the next generation of clinicians,

(53:33):
which brings us to our last point, supervision of junior
staff. Yes, a vital part of being more
senior. This is about providing
appropriate oversight, support and feedback to a supervisee,
carefully matching it to their level of competence and the risk
inherent in the task they're undertaking.
And the supervisor remains accountable.
As a supervisor, you retain accountability for ensuring safe

(53:53):
systems are in place. Supervision can range from
direct being in the room to indirect being available for
advice. What does GMC guidance say?
GMC Good Medical Practise 2024 states you must set clear
expectations for your supervisees, be available and
approachable for support, match the level of supervision
accurately to their competence and the tasks complexity.

(54:15):
Explicitly invite early escalation of any concerns or
uncertainty, and document the supervision provided.
Use clear closed loop delegationwith explicit thresholds for
when they must call for help. SJT scenario.
Yeah, and FY1 wanting to do their first LP overnight on a
septic patient. Good example.
Tempting, perhaps to say, OK, give it a go and call me if you

(54:35):
struggle. Wrong and unsafe.
Completely wrong. That's an unsafe approach for a
potentially high risk procedure,especially out of hours and on
an unwell patient. It requires much closer
supervision for first attempt. Mnemonic for supervision.
Supervise, set the appropriate level of supervision, Understand
their skills and confidence. Plan a clear brew for the task.
Escalation routes made explicit.Call me if XY or Z happens.

(54:57):
Review time agreed upon. Validate understanding by
cheque. Back in reach.
Be physically available or easily contactable.
Support and educate through feedback.
Supervise set level, understand skills.
Great checklist. Match the level of supervision
accurately to the risk of the task and the Super.
These competence set very clear escalation thresholds.

(55:18):
You must call me before, Ensure you are genuinely available for
support and document the supervision plan and discussion.
Match supervision to risk competence.
Set clear escalation thresholds.Be available.
Document done. Excellent.
Wow. OK, let's pause there.
We have covered a tremendous amount of ground today, really
distilling that essential wisdomfor the MSRASJT.

(55:41):
We've taken a proper deep dive, haven't we, from the nuances of
professional boundaries all the way through to leadership in
emergencies. Indeed, it's a lot to take in,
but hopefully broken down helpfully to consolidate.
Maybe we can recap those absolute golden rules you want
to carry with you into the exam.Good idea.
What are the absolute must remembers?
OK, well. Patient safety always, always
comes first. Escalate your concerns early and

(56:03):
without hesitation. Be open and candid, especially
when things go wrong. Duty of candour.
Protect patient data fiercely. Confidentiality and GDPR key.
What else? Always use professional
interpreters when needed for communication barriers.
Document everything meticulously.
If it isn't written down, it didn't happen.
Respect the diverse roles and expertise within your

(56:24):
multidisciplinary team. Know your own limits and work
strictly within your competence.Ask for help.
And that point about impairment?Crucially, yes.
Never practise when your judgement or performance might
be impaired by fatigue, illness or anything else.
These principles really are yourcompass for ethical and safe
practise, both in the exam and beyond.

(56:46):
So what does this all mean for you, the listener, heading into
this exam? It means you can approach it and
actually your future clinical practise too, with confident
ethical judgement. Keep these high yield Nuggets
handy, review them and you'll bewell informed and ready to
shine. As you reflect on all of this,
maybe consider how these principles aren't just about
passing an exam, are they? They're really about fostering a

(57:08):
lifetime of compassionate, safe and effective patient care.
So here's a thought. What's 1 area from today's Deep
Dive that you'll perhaps reflecton improving in your own
practise this week? And just a reminder, you can
find thefreesjttextbookwhichcoversallthisandmoreplusotherdeepdocs@passthemslra.com
and do subscribe to their YouTube channel as well.
That's it at pass them SRA. Great resources and finally just

(57:31):
that necessary reminder, this deep dive is for educational
purposes only. Always, always follow your local
hospital policies and national guidance.
The MSRASJT is designed to test your judgement lined with
current UK national standards. Good luck with your revision.

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