SJT: Free Mastering the MSRA SJT 2 of 3: Consent, Capacity, DNACPR, Safeguarding & Exam Technique

Episode Transcript
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(00:00):
Welcome to the deep dive. You know, preparing for the MSRA
Situational Judgement Test. The SJT can feel a bit like to
solve a medical ethics Riddle while, well, juggling flaming
chainsaws, right? Something.
Like that? It's not just about what you
know, it's about how you think under fire.
Today we're cutting through the noise to give you some real
world mental tools, the high yield rules, the traps to dodge,

(00:24):
and those golden mnemonics so you can ace those tough
professional dilemmas with confidence.
Absolutely. And we're really trying to cut
through the jargon here. We're taking those dense UK
guidelines, everything from GMC principles to the, you know,
the, the specifics of the MentalCapacity Act and boiling them
down into something you can actually use right here.

(00:44):
This deep dive. OK, consider it your essential
shortcut to being well informed and confident for this vital
part of your journey. OK, let's practise.
Before we dive into the specificscenarios, we need a quick
Michael primer on how to approach the SJT.
What's the core mindset that guiding * for our listeners?
Right. Your guiding star in the SJT and
frankly in all of medicine is consistently prioritising

(01:06):
patient safety above all else. Every single decision, every
action, it should loop back to how it impacts the well-being
and safety of the patient. That's number.
One, and flowing from that core principle, I suppose, remember
to always act with honesty, adhere strictly to legal
frameworks, apply proportionality in your actions,
and crucially, escalate concernsearly when a situation is truly

(01:27):
beyond your capacity or competence.
It's about being pragmatic whileholding true to your ethical
compass. And here's perhaps the simplest
but most overlooked rule. If it's not documented, it
didn't happen. Clear, contemporaneous
documentation is your shield andyour guide, and, well, pretty
much every scenario. It validates your actions and
ensures continuity of care. Absolutely vital.

(01:48):
OK, with that fundamental mindset firmly in place, let's
begin our deep dive into our first major area, ethics and
law. We're starting with the absolute
bedrock of patient care consent in adults.
OK, so for the SJT, the core insight with consent is really
moving beyond the idea of just asigned form.
Right, it's more than ticking a box.

(02:08):
Exactly, it's a dynamic process.It's about a voluntary informed
decision made by a patient with capacity after a genuine two way
conversation. This ensures patient autonomy
and shared decision making. Which are, you know,
cornerstones of UK healthcare? So what are the absolute must
knows from UK guidance on consent?
What should people really focus on?

(02:30):
Well, First off, the GM CS decision making and consent
framework really pushes shared decision making.
It's about tailoring informationand supporting the patient's
understanding rather than delivering A monologue, you
know? And that leads directly to
Montgomery 2015. For the Supreme Court made it
crystal clear it's not enough tolist generic risks.
You must highlight material risks, those risks a reasonable

(02:53):
person in that patient specific position would find significant.
Right, patient specific. Precisely, and discuss
reasonable alternatives, including the option of no
treatment. That's a huge shift demanding a
real conversation, not just a formality.
I've seen this one trip people up so many times, judging a
patient's refusal as incompetentsimply because you disagree with

(03:14):
their decision. That's a crucial distinction,
isn't it? It's tempting to think, oh, they
don't understand. But.
It absolutely is tempting, but wrong.
An adult with capacity has the right to refuse treatment even
if that decision risks serious harm or death.
An unwise decision, as you see it, does not equate to a lack of
capacity. If capacity is in doubt, then

(03:36):
you follow the Mental Capacity Act MCA 2005 principles.
Always presume capacity first, actively support decision
making, and only if truly absent, act in their best
interests using the least restrictive option.
And the pitfalls relying on the form.
That's a major one, relying purely on assigned form without
that genuine discussion, or giving generic risks instead of

(03:56):
patient specific ones as Montgomery demands.
It's paternalistic and legally insufficient.
OK, let's run through a classic scenario.
You're explaining two different management options for a
patient, say surgery versus conservative management, both
with different risk profiles. What's the best next step?
The optimal approach, the one the SJT is looking for, is a
thorough shared decision making process.

(04:18):
Clearly explain all material risks for both options,
including no treatment and reasonable alternatives.
Explore what matters most to this patient, their values,
their priorities. And checking they've understood.
Yes. Use the teach back method to
ensure understanding. Then respect and document their
informed choice and the agreed plan.
Simply explaining only the procedure you think is best is

(04:41):
paternalistic, outdated, and legally insufficient.
That's often the tempting but wrong answer in the exam.
Got it. To help you remember this, we
have a mnemonic for you materialthat's meaningful Risks
alternatives tailored info involve values enough time
record as teach back law at Cam Montgomery.
And for your rapid checklist in the exam, think one, prepare,

(05:04):
what's the decision alternatives, even no treatment.
And what matters to this patient?
Two, dialogue, explain material risks, benefits, uncertainties.
Using plain language aids like diagrams can help to check
capacity. If in doubt, apply the MCA's two
stage test for this specific decision.
Now address any reversible causes first.
And finally. Document record everything,

(05:27):
discussion risks highlighted, alternatives offered, patients,
values and questions, their final decision and the agreed
plan meticulously. Find
thefreesjttextbookandpodcasts@passthemsra.comand subscribe at youtube.com at
Pass Them SRA. So we've talked about adult
choices, but what about our younger patients?
Consent in children and young people involves a whole

(05:48):
different set of rules, doesn't it?
A bit more nuanced, perhaps. It really does.
Consent for under eighteens is complex, hinging on age,
competence, parental responsibility and always their
best interests. For under sixteens, their
ability to consent depends on Gillett competence, right?
While specific Fraser guidelinesapply to sensitive areas like
contraception and those aged 1617 are generally treated as

(06:10):
adults for consent purposes. OK, so let's break that down.
What are the key rules for undersixteens?
Well for under sixteens they canconsent if deemed Gillett
competent, meaning they have sufficient understanding and
maturity for that specific decision at hand.
And if they're not competent? Then consent must be sought from
someone with parental responsibility, PR, and you must
act in the child's best interests.

(06:31):
OK. And for the 1617 year olds?
They are legally presumed able to consent to treatment as if
they were adults as per the Family Law Reform Act FLRA 1969
Shell .8, However. Was a however.
Right. In cases of serious disagreement
or refusal of life saving treatment, that's when you'd
need urgent senior or even legalinput, potentially court

(06:54):
intervention. And the Fraser guidelines,
they're specifically for things like contraception for under
sixteens, right? Even without parents knowing.
Exactly. They provide that very specific
framework for providing contraception or sexual health
advice to under sixteens, even without parental knowledge or
consent. If strict criteria are met, such
as such as they understand the advice, they can't be persuaded

(07:15):
to involve parents, they're likely to continue having sex.
Their health is at risk without care and it's in their best
interest. You have to meet all those
criteria. That's a high bar.
What are the common mistakes people make here in SJT
scenarios? A big one is assuming the Mental
Capacity Act rules for adults apply unchanged to under
sixteens, Tempting but wrong because children's consent

(07:36):
follows the specific Gillick andFrazier competence principles.
Another is insisting on parentalconsent when a young person has
been assessed as Gillick competent.
Again, tempting but wrong. A competent minors decision
should be respected, within the bounds of safeguarding, of
course. And confidentiality.
Reaching a young person's confidentiality without a clear

(07:57):
safeguarding basis or without discussing its limits first is a
major pitfall and providing contraception without rigorously
applying those Fraser criteria. Let's consider a classic
scenario. A 15 year old requests
contraception and explicitly refuses to involve their
parents. What's the best next step?
Right. You should thoroughly assess
their Gillick competence for this specific decision.

(08:19):
If they are deemed competent, you must then apply the Fraser
guidelines. So you encourage parental
involvement, but don't insist. Exactly.
Encourage it, but respect their confidentiality with an
appropriate safeguarding limits.Offer contraception, maybe
condoms to STI screening and meticulously document the entire
assessment, the discussion and your decision.

(08:40):
And the wrong answers. Refusing to provide
contraception until a parent attends, or immediately telling
their parents regarding 3rd listof competence.
These ignore both Gillick competence and Fraser
guidelines, potentially leading to unsafe outcomes and, well, a
massive breach of trust. OK, so for your memory use
Gillick Adam. Gauge maturity information.

(09:01):
Understood. Look at risks.
Alternatives involve parents. Encourage confidentiality
limits. Keep best interest central.
And for your rapid checklist in the exam, remember to one
identify age and urgency, determine their age and if it's
an emergency under 16, assess Gillick competence for the
specific decision. Encourage parental involvement

(09:22):
but don't insist of competent. 3Fraser pathway.
If it's for contraception, STI or termination, rigorously apply
the Fraser criteria. 4 Age 1617 Take consent as from an adult.
If refusing potentially life saving treatment, seek urgent
senior legal advice. And five.
Document Record your assessment info given, who is present,

(09:42):
competence finding, concentrifusal plan and safety
netting. Find
Pass Them SRA. Following on from Gillett
Competence and Adult Consent, the Mental Capacity Act provides
A robust and specific framework for assessing decision making
ability when capacity is in question for those aged 16 and

(10:05):
over. Yes, capacity under the MCA
2005. It's about a person's ability to
make a specific decision at the time it needs to be made.
It's absolutely fundamental for ensuring decisions for adults 16
plus who might lack capacity aremade legally, ethically and,
importantly, in their best interests.
Right. And those 5 core principles are
key, aren't they? Absolutely foundational.

(10:25):
Let's run through them quickly. You must presume capacity unless
proven otherwise. Start there.
Two actively support decision making.
Do everything you can to help them make their own choice. 3.
Recognise that an unwise decision does not mean a lack of
capacity. This trips people up constantly.
4 If capacity is lacking, you must act in the person's best

(10:46):
interests. And five.
Always choose the least restrictive option that achieves
the purpose. Yeah, OK.
And then there's the two stage test for actually assessing
capacity. Can you break that down for?
Us sure. Stage 1.
Is there an impairment or disturbance in the functioning
of the mind or brain? Think delirium, dementia, severe
learning disability, intoxication.

(11:07):
OK. If yes, then stage 2.
Can the person functionally understand, retain, use or weigh
and communicate the relevant information for this specific
decision? Now it's always decision
specific and time specific. So you can lack capacity for one
decision but not another. Exactly.
You might lack capacity to consent to complex surgery but

(11:27):
retain capacity for, say, deciding what to have for lunch.
It's not a blanket judgement. What are the common pitfalls
here? You mentioned unwise decisions.
Yes, equating an unwise or riskychoice with a lack of capacity.
The MCA explicitly allows individuals to make decisions
others might consider unwise if they have capacity.
Skipping essential support measures before assessing, You

(11:50):
know, providing extra time, communication aids,
interpreters, a quiet environment, pain relief.
You must try to maximise capacity first.
That's tempting to skip one busy, but it's wrong.
And being specific. Right, using broad labels like
the patient has no capacity instead of making decision
specific findings like lacks capacity for this treatment
decision today and making best interest decisions without

(12:12):
clearly showing you considered their past wishes or values or
reason why it's the least restrictive option.
And the IMCA, the independent mental capacity advocate.
Yes, forgetting the crucial stepof instructing an IMCA when the
legal criteria are met. That's usually when someone
lacks capacity for serious medical treatment or a change in
accommodation and they have no appropriate family or friends to

(12:34):
consult. It's a safeguard.
OK, classic scenario time. A delirious hypoxic patient
refuses urgent IV antibiotics. They're agitated and
disoriented. Best next step?
First you must optimise their physiological state and
environment to maximise any fluctuating capacity.
So oxygen, maybe fluids, pain relief if needed, quiet space.

(12:57):
Try and clear the delirium a bitfirst.
Exactly. Then apply the two stage test
for capacity for this specific decision.
Now, if after support they stilllack capacity, you must treat
them in their best interest, using the least restrictive
option necessary to prevent serious deterioration, and
document every single step your assessment, your rationale and a
plan to review capacity once thedelirium hopefully improves.

(13:19):
And the wrong approach. Simply respecting the refusal
without assessment is unsafe andneglects your MCA duty.
Calling security and proceeding without assessment or
documentation is disproportionate, potentially
unlawful, and fails to uphold patient rights.
Got it. For your memory, we have the
mnemonic 4C best. That's 'cause impairment.

(13:40):
Continue, retain, compare a use way.
Communicate then for action if lacking capacity.
Best interests, least restrictive Share views Time to
review. And the rapid checklist for the
exam One consider triggers and safety.
If a choice has serious risk or the person seems confused,
delirious consider capacity. Treat emergencies first while
assessing. 2 Maximise capacity, optimise Physiology, timing,

(14:03):
privacy, provide interpreter said use small chunks of info.
Teach back. Three apply two stage test
identify impairment, then apply the four functional abilities.
Understand, retain, use way. Communicate for this decision.
Now record evidence for each bit.
If lacking capacity, follow the S .4 best interest checklist.
Involve those close Consider ADRTSLPAS.

(14:26):
Choose least restrictive option.Document reasoning record
thoroughly Detail support given findings for each limb of the
test. Who was consulted, best interest
reasoning and plan for review. Find the free SJT textbook and
podcasts at Pass Them sra.com and subscribe at youtube.com at
Pass Them SRA. Understanding capacity is

(14:47):
absolutely paramount, particularly when we approach
the profoundly sensitive subjectof end of life decision making,
where patient wishes and legal instruments carry really
significant weight. Yes, end of life decisions
involve such a delicate balance,don't they?
Clinical judgement, legal requirements, individual patient
values. We're talking about things like
DN, A/C, PR orders, ADR, TS advanced decisions to refuse

(15:08):
treatment, and LP, PAS lasting powers of attorney.
Understanding these is crucial to ensure care aligns with
patient wishes and, well, the law.
Absolutely. And crucially for the SJT, Let's
nail this. A DN A/C PR order applies only
to attempted cardio pulmonary resuscitation.
That's it. So all other care continues.
Yes, all other appropriate medical care like antibiotics,
oxygen, analgesia, fluids, general escalation should

(15:30):
continue. Decisions must be
individualised, avoiding those blanket policies.
That's a huge pitfall, isn't it?Assuming DNA CPR means stop all
active treatment. It's a massive 1, tempting
perhaps if you're rushed, but wrong it can lead to withholding
vital appropriate care and implementing blanket DN A/C PR
order, say for all residents in a care home is unlawful and

(15:53):
discriminatory. OK, what about ADR, TS and LP as
an? ADRT, an advanced decision to
refuse treatment can be legally binding if it's valid and
applicable. Big if If it refuses life
sustaining treatment, it must bein writing, signed by the person
witnessed and explicitly stated applies even if their life is at
risk. A Lasting Power of Attorney LPA

(16:14):
for Health and Welfare allows a named person their attorney to
make decisions when the patient lasts capacity.
It was always act in the patient's best interest and
within the authority granted in the LPA document.
Importantly, though, LP as cannot demand clinically
inappropriate treatment and the GMC guidance on treatment and
care towards the end of life. Really presses involving
patients early in these discussions, being honest about

(16:37):
uncertainties, regularly reviewing goals of care,
respecting valid ADR, TS and Lpas, and meticulously recording
everything. OK, classic exam scenario.
A capacitated patient with advanced heart failure asks you
about signing ADNR. What's the best next step?
Right. You need to explore their values
and goals of care first. Then explain what CPR

(16:59):
realistically involves and it's likely outcomes for someone with
their specific condition. Crucially, clarify that a DNA
CPR applies only to attempted resuscitation and that all other
appropriate treatments will continue.
Then what? Then you agree on and review a
personalised care plan, maybe using a respect form or similar,
and ensure everything is meticulously documented.

(17:19):
And the wrong answer. Explaining DNA CPR, it has no
active treatment from now on. That's just fundamentally wrong
and misleading. Or refusing to discuss it
because it's distressing. That avoids your professional
responsibility. OK for a quick memory hook,
remember DNA, CPR, AD and T do not treat CPR only other
appropriate care continues. And the rapid checklist for the

(17:40):
exam one check it passions wishes first explore goals
values, ask about ADR TSL Pas offer advanced care planning.
Discuss DNS EPR early and sensitively Explain realistic
CPR outcomes, Clarify other treatments.
Continue Avoid blanket decisions.
If capacity lacking, follow MCA best interest checklist Consult
family attorneys consider ADRTSLPA Choose least

(18:03):
restrictive document rationale 4.
Respect lawful instruments adhere to valid applicable ADR
TS work with LP as within their authority and best interest duty
5. Document clearly record who was
involved, info given, decisions made, DNA, CPR, respected RETLEA
and review triggers. Find the free SJT textbook and
podcast is Pass them npr.com andsubscribe at youtube.com at Pass

(18:27):
them SRA. As we plan for individual
patients, we absolutely must also consider the broader
ethical challenge of how finite healthcare resources are fairly
distributed across the population.
That's a constant tightrope walkin the NHS, isn't it?
It really is fair allocation or resource allocation, and
fairness as a topic means using finite time staff, equipment,
beds, you name it, to maximise patient benefit, reduce harm and

(18:50):
crucially, avoid unlawful discrimination.
It requires transparent decisionmaking and clear escalation when
limits are reached. So what guidance helps us here?
GMC Good Medical Practise 2024 is clear.
You must treat patients fairly, avoid discrimination, make good
use of resources and choose sustainable solutions when
clinically possible without compromising care.

(19:12):
The NHS Constitution also upholds principles of fairness
and quality. And what about tackling health
inequality specifically in resource decisions?
That's where the equality and health inequalities duties come
in. NHS organisations have to
consider protected characteristics and health
inequalities. This includes using frameworks
like Core 20P, Lu S5 to target resources towards deprived

(19:33):
populations and priority clinical areas aiming to reduce
those inequalities. So a common pitfall would be.
Hidden discrimination based on things like age or disability,
or just ignoring the wider health inequalities.
Duty when allocating resources. It's tempting maybe to go with
first come first served or the loudest voice, but that's wrong
because it can be unlawful and worsen inequities.

(19:56):
You need objective clinical needand potential benefit as your
guide. And failing to escalate.
Yes, failing to escalate capacity risks to seniors or
operational leads like bed managers when limits are
genuinely reached is another bigone.
OK classic exam scenario. 2 CT slots left in a busy Ed Patient
A has suspected PEPERC positive tachycardic.

(20:17):
Patient B has a chronic back pain.
MRI request from weeks ago. How do you prioritise?
You must use clinical urgency and potential benefit.
The CT for suspected PE for patient A has to be done now.
It's an immediate, potentially life threatening condition.
And patient B. The MRI request for Patient B
should be deferred, but with clear safety netting advice and
a realistic time frame for rescheduling in this decision.

(20:38):
The rationale? Any escalation plan, if more
acute cases appear, must be thoroughly be documented.
So scanning based on who arrivedfirst is wrong.
Completely ignores clinical need, Demonstrates poor clinical
judgement and resource stewardship.
Right for a memory hook, think brand plus benefits or risks.
Alternatives do nothing. Applying that to resource

(20:59):
decision, plus thinking about equity and evidence.
And the rapid checklist for the exam one clarify criteria,
define clinical urgency, expected benefit risk if delayed
equality inequality factors apply consistently be
transparent. Document your logic, communicate
timeframes. Offer safety netting basically
early if demand exceeds safe thresholds involves seniors,

(21:22):
operational leads, bed managers,you share decision making, SDM.
Discuss reasonable options. If clinically equivalent,
consider lower burdens, safer orgreener pathways.
Thinking greener NHS 2 alley inequalities lens.
Actively check for and mitigate barriers, for example, language
disability using AIS principles.Find

(21:47):
Pass Them SRA. Our duty to fair resource
allocation naturally extends into ensuring equality,
diversity and inclusion in everyaspect of healthcare delivery,
doesn't it? Creating a system that works for
everyone. Absolutely so Equality,
diversity and inclusion. EDI and healthcare means
treating people fairly and lawfully, respecting all those
protected characteristics, actively removing access

(22:08):
barriers whether communication, disability, language, and
proactively tackling discrimination and harassment.
It's fundamental for fair access, safe care and building
trust. The cornerstone here is the
Equality Act 2010. Right.
Yes, absolutely key. It makes discrimination unlawful
based on 9 protected characteristics age, disability,

(22:29):
gender reassignment, marriage, civil partnership, pregnancy,
maternity, race, religion or belief, sex and sexual
orientation. You need to know those.
And GMC guidance. GMC Good Medical Practise 2024
sets out your professional duty to treat patients and colleagues
fairly, actively help tackle discrimination and communicate
clearly and kindly with everyone.
And nice guidance on patient experience reinforces respect,

(22:50):
dignity, empathy, and accessibleinformation.
You mentioned Accessible Information, the AIS standard.
Again, yes, the Accessible Information Standard AIS is so
important. It's a legal requirement for NHS
and publicly funded adult socialcare.
You must identify, record, flag,meet and review the
communication needs of patients.That means providing BSL

(23:11):
interpreters, easy read materials, large print, whatever
is needed. What are the common traps the
SJT sets here? A big one is using relatives or
worse, children as interpreters,except in the most extreme life
threatening emergencies. It's tempting when you're busy,
but it's wrong. It risks accuracy,
confidentiality and puts undue burden on family.

(23:31):
What else? Ignoring microaggressions or
discriminatory jokes in the workplace.
Again, tempting to let it slide,but wrong because it normalises
harmful behaviour. Implementing blanket policies
that inadvertently cause indirect discrimination, like
having only online booking available and refusing care
based on perceived lifestyle choices, which the GMC
explicitly prohibits. OK, classic scenario.

(23:54):
A deaf patient attends a non urgent clinic appointment and a
BSL interpreter isn't there despite being requested.
Best next step? You have to intervene
immediately, arrange for a qualified BSL interpreter to
attend the earliest safe opportunity as per the AIS,
provide accessible written info in the meantime, safety net any
urgent concerns, and meticulously document what

(24:16):
happened and the plan. And just trying to shout or lip
read. Ineffective, disrespectful, and
fails your AIS duties. Proceeding using the patient's
child is unsafe and breaches guidelines.
Got it for a quick memory hook. Remember AIS 5 Ask record flag
meet review communication needs.And the rapid checklist for the

(24:36):
exam. Spot barriers early.
Actively identify potential communication access barriers.
Language, sensory loss, learningdisabilities.
Arrange adjustments promptly perAIS to use professional
interpreter. Always arrange qualified
interpreters. Avoid family unless extreme
emergency. Documenting rationale 0.
Tolerance of discrimination. Challenge inappropriate remarks

(24:57):
clearly support those affected. Know how to report, escalate,
support shared decisions, ensureinfo is understandable, use
teachback, offer decision needs,escalate and record.
Follow local policy for reporting the example datix.
Document facts, actions, outcomes Find
thefreesjttextbookandpodcast@passthemsra.comand subscribe at youtube.com at

(25:19):
Pass Them SRA. Right, so beyond simply avoiding
discrimination, actively managing cultural differences
helps us deliver truly patient centred care, acknowledging and
integrating their unique beliefsand values into the plan.
So managing cultural differencesmeans proactively working with
patients values, beliefs and practises to Co produce a safe
and acceptable plan of care. This requires balancing respect

(25:42):
for diversity with adhering to equality law, safeguarding
duties and core clinical standards.
Yes, and GMC Good Medical Practise 2024 stresses treating
patients fairly kindly without discrimination and adapting your
communication style. And the GMC guidance on personal
beliefs in medical practise is crucial here too.
How so? It clarifies.
You must not deny access to appropriate services based on

(26:03):
your personal views, nor should you impose your own beliefs on
patients. You need to manage any
conscientious objections appropriately.
And using interpreters is still key here.
Absolutely critical. The accessible information
standard, AIS and interpreting guidance.
Use qualified professional interpreters, avoid family
children except in genuine emergencies, and always document

(26:24):
why if an exception is made. What are the pitfalls here?
Dismissing beliefs. Yes, dismissing deeply held
beliefs or trying to coerce a patient into a decision that
conflicts with their values is amajor one.
Relying on relatives as interpreters is another
recurring pitfall. Ignoring subtle safeguarding
cues related to cultural practises.
Failing to document the rationale for decisions

(26:45):
accommodating cultural preferences and stereotyping.
Assuming all patients from X will want.
Y OK classic scenario. A patient clearly and
consistently refuses blood products for religious reasons
and an elective surgical procedure is planned.
Best next step? Right.
First, respectfully explore their beliefs, fully understand
their reasons, then discuss and plan reasonable alternatives

(27:07):
with the patient. This involves the anaesthetics
and surgical teams to explore blood sparing strategies.
Assuming they have capacity. Yes, confirm their capacity for
this decision. Ensure a fully informed consent
is given for the alternative plan and meticulously document
the discussion and the agreed care, including any advance
planning. And the wrong answers.
Proceeding as planned because you deem the refusal unwise or

(27:30):
refusing to treat the patient outright.
Both are breaches of autonomy and professional duties,
unethical, and potentially illegal for a memory hook.
Respect report. Explore beliefs, Support
understanding, propose options, ethics, law, consent, capacity,
Traceable notes. And the rapid checklist for the
exam explore first ask open questions like what matters to

(27:53):
you about this? Understand beliefs key decision
makers to support understanding Use professional interpreter
culturally appropriate materialsTeach back method Co produce a
safe plan Offer reasonable alternatives respecting beliefs
where possible clearly explain non negotiable legal or safety
boundaries Safeguard if culturalbeliefs practises raise risk of

(28:14):
harm, escalate to safeguarding. Share info lawfully document
reasons document and follow up meticulously record who was
present discussion agreed plan review points safety netting.
Find thefreesjttextbookandpodcasts@passthem-sra.com
and subscribe at youtube.com at pass the MSRA.
OK, so we've covered a lot on ethics and law.

(28:36):
Now, as doctors are ethical and legal duties are constant, but
the practicalities of busy NHS environment demands skilled time
and resource management. Let's dive into how you can
effectively juggle those demands.
Right, Section 7. Time and resource management,
starting with prioritising clinical tasks.
This means ordering your work tominimise harm and maximise

(28:57):
benefit. It's fundamentally about
addressing the sickest first, always handling time critical
issues before routine ones, ensuring clear ownership,
providing appropriate supervision and escalating early
when needed. All underpinned by thorough
documentation. And sickest first means what in
practise? It means always assessing
patients using the ABCDE approach, responding immediately

(29:17):
to high new DWS 2 triggers, looking for sepsis red flags,
managing acute chest pain ACS, adhering to stroke windows, and
addressing immediate threats like anaphylaxis or active
bleeding. That's your absolute priority.
And chasing results. Time critical results?
Yes, act on and chase critical values.
Urgent radiology alerts significant ECG changes

(29:38):
immediately and document your actions clearly.
How do you keep track when it's chaotic?
Using a visible plan helps like a now, next, later board.
Assign clear owners and deadlines for each task.
Ensure regular checkbacks. Delegate safely, right task,
right person, clear brief appropriate supervision.
Check understanding and escalateearly.

(29:58):
Involve your registrar, consultant or site team when
acuity or volume exceeds your resources or competence.
OK, what are the major pitfalls the SJT loves to test here?
Prioritising tasks on a first come, first served basis rather
than by clinical risk and benefit temp when you're
overwhelmed but wrong because itcompromises patient safety.
Chasing low value admin tasks orcritical results or

(30:20):
deteriorating patients are waiting, operating with hidden
work, no visible plan, no assigned owners, failing to
escalate, and of course failure to document critical decisions
or safety netting advice. Classic scenario time.
You received 2 simultaneous urgent bleeps, one for a new
chest pain patient. With dynamic the ECG changes and

(30:41):
another for a routine drug chartrewrite.
Best next step? Your immediate priority is the
chest pain patient with ECG changes.
Initiate the ACS protocol concurrently.
Ask the nurse in charge to pausethe paperwork for the drug chart
and delegate that rewrite to a safe and available colleague
with a clear deadline and brief.And doing the drug chart first.
Rewriting a routine drug chart first to clear quick jobs, or

(31:03):
worse, finishing your emails before responding to a
potentially life threatening cardiac event is a dangerous
MIS. Prioritisation shows poor
clinical judgement. OK, memory hook now, next, later
plus ODT which is owner deadlinethreshold to call.
And the rapid checklist for the exam one scan for lifelim
threats immediately assess usingABCDE list tasks by harm time

(31:24):
categorised by potential harm ifdelayed and time critical
windows organol sepsis, antibiotics within one hour 3
Make a visible plan now, next, later.
Board list assign owner deadline.
Agree escalation thresholds 4 Delegate safely Delegate routine
clerical tasks appropriately, reserving focus for high risk
decisions. Deteriorating patients 5.

(31:46):
Review and document Recheck taskboard frequently update items.
Close loop on completed tasks. Ensure clear handover
documentation. Find
passthemsra. Even with excellent
prioritisation, working under time pressure is just, well,

(32:07):
part of the job. In clinical practise, it's how
you manage that pressure with calm and structure that defines
your safety and effectiveness. Exactly.
So working under time pressure. This means adopting short
deliberate structures to reduce the risk of error.
Techniques like initiating microhuddles, using timers,
deliberately single passing critical steps and employing
clear communication. These strategies help maintain

(32:27):
safety and efficiency when time is really short.
Can you give examples of those structures?
Well, pause, plan, prioritise. Even for a quick decision, take
a brief 32nd pause. Maybe huddle mentally or with a
colleague to decide your now, next, later priorities.
It sounds simple, but it stops reactive chaos.
And single tasking. Yes, single task critical

(32:48):
actions during high risk procedures or moments,
prescribing Defibrillation, complex consent talks and
dedicate your full attention to that single task.
Avoid multitasking then. It's a major pitfall engaging in
chaotic multitasking during highrisk activities, tempting when
you feel rushed, but wrong because it significantly

(33:08):
increases error risk. Closed loop communication is
important too, isn't? It hugely.
When delegating or handing over,ensure clarity, state the name
of the person clearly defined the task, specify a time for
completion or check back and crucially ask for confirmation
back. Nurse Smith, please confirm you
will prepare the fluids within 5minutes.
And escalating still key. Absolutely know and communicate

(33:29):
your escalation thresholds. If you anticipate missing
deadlines or safety thresholds due to workload, involve a
senior colleague or the site team immediately failing to
escalate when overwhelmed. Trying to suffer in silence is
another major pitfall. OK, classic scenario.
You're managing a busy ward. Three urgent bleeps arrive
simultaneously. One for a deteriorating patient,

(33:52):
One routine query when a call from a relative.
Best next step? Your immediate best action is to
call a brief 62nd huddle, even if it's just a mental one in
your head. Rapidly allocate tasks by risk.
You attend immediately to the deteriorating patient, ensuring
they're stable. You might ask a colleague to
handle the less urgent bleeps orcalls, setting a clear, say, 20

(34:12):
minute regroup time to check in.Document this plan on your task
board or in your notes. And just answering them 1 by 1.
Answering each bleep sequentially without a plan
wastes critical time for the sickest patient.
Switching tasks every minute to do a bit of everything leads to
fragmented attention, increased error risk, and likely means no
task is completed effectively. Got it.
Memory hook, pace, pause, assignclock timers escalate.

(34:39):
And the rapid checklist for the exam?
One, call a huddle Initiate A brief 62nd huddle or mental
pause to list top three safety risks. 2 Assign tasks Clearly
assign tasks with owners and deadlines.
Set a specific regroup time to review progress.
Three Protect focus safeguard focus windows for high risk

(34:59):
steps. Politely deflect lower value
interruptions during these times. 4 Use scripts.
Employ phrases like I'll call you back in five with an update
to manage expectations and interruptions effectively Record
and escalate Document key to decisions and update your task
board. Escalate to a senior if slippage
threatens patient safety. Find the free SJTU textbook and
podcasts that pass them there our guy and com and subscribe at

(35:21):
youtube.com at pass them SRA. Time pressure is often, as we
said, a symptom of managing multiple demands simultaneously.
So let's explore how to stay on top of that mountain of tasks
efficiently and safely. Right Managing multiple demands.
This involves the structured triage of all incoming inputs,
whether it's bleeps, calls, results, requests from relatives

(35:42):
using a visible plan, safe delegation and timely
escalation. This system prevents tasks from
getting missed and helps you maintain control in a busy
environment. What's the core principle here?
A single intake list. All incoming work should land on
one central board or list. Avoid multiple private lists
scattered around. Each item should ideally have an

(36:03):
ODT assigned owner dead line threshold for escalating and.
What's a common mistake people make?
Maintaining multiple private to do lists.
It's easy to do, but often leadsto important jobs being lost or
forgotten. Another is answering every
interruption instantly without any form of triage or
prioritisation. Tempting.
Maybe. Seems efficient but wrong
because it destroys focus and prevents efficient task

(36:25):
completion. So how do you handle
interruptions then? You need focus windows.
Actively protect periods of timefor high risk tasks like
prescribing or complex consent. Politely deflect lower value
interruptions during these crucial windows and use
batching. Group similar lower value tasks
together like making all resultscalls at once or writing
multiple discharge letters. Dedicate specific time boxes for

(36:49):
these sprints. Escalation thresholds again.
Yes pre agree clear thresholds with your team or seniors for
escalation. Like if we have UDA 2
deteriorating patients or weights exceed X minutes, call
the registrar site manager. Failing to escalate despite a
growing backlog and rising patient risk is a major pitfall.
OK, classic exam scenario. While you were in the middle of

(37:09):
prescribing insulin, 3 simultaneous demands arrive.
Your phone rings, your bleep goes off, and a relative
approaches you. That's next step.
Your priority is to protect the prescribing step from
interruption. Politely tell the nurse or
relative that you are in the middle of a critical task and
will call back in 5 minutes for non urgent matters or ask for an
SBAR if the bleep is urgent. Log all incoming demands onto

(37:31):
your single task list with ODT owner deadline threshold to
ensure nothing is missed. And what not to do?
Answering the phone on loudspeaker while prescribing or
abandoning prescribing to attendto a non non urgent query
significantly increases the riskof medication errors.
These actions demonstrate poor task management and compromise
patient safety. Got it.
Memory hook ODT board equals owner deadline threshold on

(37:55):
every item. And the rapid checklist for the
exam. One queue single direct all
incoming inputs to 1 central list or task board.
Avoid side queues. 2 triage urgency, rapidly triage tasks by
risk benefit assign owners, set clear return.
Call windows for non urgent items.
Three execute batches. Group similar lower value tasks
and time box them. For example, 15 minute sprints.

(38:18):
Review progress, make focus windows protect dedicated time
for high risk tasks. Politely deflect lower value
interruptions 5. Escalate if capacity is exceeded
or risk thresholds crossed. Escalate to senior site team
clearly requesting help or task reallocation.

(38:39):
Effective management of multipledemands often means being
resourceful and innovative, doesn't it?
Especially when faced with genuinely limited resources.
Exactly. Which brings us to effective use
of limited resources. This means delivering the best
possible patient outcomes with finite staff time, beds,
diagnostic capacity, while consistently maintaining

(39:01):
fairness, safety and thorough documentation.
It's about being a good steward of NHS assets really.
So what's the guiding principle?Clinical value first.
Only order tests or interventions that will
genuinely change patient management.
Avoid unnecessary duplication oftests.
Always check prior results first.
And if there are equivalent options.
If two options are clinically equivalent in benefit and

(39:22):
safety, choose the one with lower risk burden or cost.
For example, opting for an ultrasound before a CT if it can
answer the clinical question adequately.
Think flow too. Flow thinking, yeah.
Proactively engage in early discharge planning, ensure
timely completion of Ttos, make early referrals to therapy
services to prevent patient bottlenecks and improve bed

(39:42):
flow, and coordinate. Maintain active communication
with pharmacy radiology site managers.
Use booking windows wisely. What are the common pitfalls
here? Ordering just in case tests with
no clear impact on management. Tempting.
Seems thorough maybe, but wrong because it wastes resources and
delays care for others. Unnecessarily repeating labs or

(40:03):
imaging without checking prior results.
Ignoring coordination with pharmacy or therapy leading to
last minute discharge delays andfailing to document resource
constraints or escalate when delays.
Create significant patient risk.OK, classic scenario.
The CT list is completely full but you have a patient with
right upper quadrant RUQ pain where a focused ultrasound is

(40:23):
indicated and can safely answer the clinical question.
Best next step? You should book an urgent
ultrasound that directly addresses the clinical question,
provide appropriate safety netting advice if the ultrasound
is negative, and document your decision thoroughly.
If the patient's condition deteriorates, escalate
immediately. And not the CT.
Ordering ACT because it's more comprehensive when a simpler,

(40:45):
quicker test is sufficient, wastes of valuable resource and
delays care for other patients. Delaying all imaging until
tomorrow is unsafe if a diagnosis is time critical.
Got it. Memory hook bran benefits,
risks, alternatives do nothing applied to test treatments.
And the rapid checklist for the exam.

(41:06):
Verify prior results. Always check for existing test
images to avoid repeats. Ask management impact.
Define the clinical question. Choose tests interventions that
will actually change management.Three lease burden equivalent.
If clinically equivalent optionsexist, select the one with lower
risk, patient burden or cost. Core unite teams flow.
Coordinate proactively with pharmacy therapy site teams for

(41:29):
smooth patient flow and timely district charges.
Escalate and document promptly. Escalate when resource
constraints threaten safety. Document choices and constraints
thoroughly. Find
thefreesjttextbookandpodcasts@pastmsray.comand subscribe at youtube.com at
past MSRA. Speaking of resources, one of
the most precious is of course your own time and energy.

(41:52):
Balancing your clinical workloadwith your non clinical duties
like teaching or quality improvement is a constant and
often challenging act of self management.
Yes, balancing clinical and non clinical workload.
This involves effectively meeting your primary clinical
duties while simultaneously maintaining commitments to non
clinical responsibilities, teaching, supervision,
governance, admin without compromising patient safety or

(42:15):
fairness to colleagues. What's the absolute number for
one rule here? Safety first.
Your overarching principle must be that clinical care and
attending to deteriorating patients always take immediate
priority over any pre plan non clinical work.
No exceptions. So planning is key.
Absolutely plan ahead, be proactive in ring festing your
non clinical time, arrange appropriate cover for meetings

(42:36):
or teaching sessions well in advance and clearly communicate
your objectives and the cover plan to your team.
Negotiate and communicate and form your team.
The nurse in charge and I see relevant roto leads about your
commitments. Transparency avoids surprises.
And document the cover. Plan yes, document agreements,
always record agreed cover plans, who is covering what

(42:56):
when, how to escalate e-mail or notes on the roto work and
remain flexible. Flexible how?
Review and flex If clinical acuity on the ward suddenly
rises significantly, be preparedto return to clinical work
immediately and reschedule your non clinical duties.
Patient safety Trump's the meeting or teaching session.
Common pitfalls leaving the wardshort.
Yes, leaving the ward short staffed or compromising patient

(43:18):
safety to attend a non clinical meeting without arranging
appropriate cover. Tempting to just slip away, but
wrong because it prioritises convenience over safety.
Insisting on delivering teachingduring a ward surge is another.
Failing to document cover plans,leading to confusion and secret
swaps of shifts without informing leads undermine safety

(43:38):
and fairness. OK, classic scenario.
You are booked to deliver an important teaching session, but
simultaneously 2 patients on your ward begin to deteriorate
rapidly. Best next step?
Your immediate priority is the deteriorating patients.
You should cancel or postpone the teaching session, inform the
relevant stakeholders like the education lead, your consultant

(43:59):
and perhaps offer to send materials or reschedule.
Your primary responsibility is to remain on the ward to manage
the clinical emergency. Document the decision.
I'm just going to the teaching anyway.
Leaving the ward with your phoneoff to avoid interruptions or
trying to deliver the teaching and cash up later demonstrates a
dangerous disregard for immediate patient safety.
Got it Memory hook. Use the Urgent Important grid to

(44:22):
help prioritise. Do now schedule delegate.
Drop and the rapid checklist forthe exam.
Scan clinical risk. If safe, proceed with non
clinical. If not, immediately cancel a
range cover to arrange appropriate cover.
Identify suitable colleague brief clearly using SBR 3.
Inform stakeholders. Notify Clintus education lead

(44:43):
Nic switchboard if on call. Manage non clinical tasks.
Keep a short to finish list time.
Box them. Review progress 5.
Record outcomes and lessons. Document changes to plan.
Reflect on lessons for future planning.
Find thefreesjttextbookandpodcasts@pastthemsra.com
and subscribe at youtube.com at past MSRA.

(45:04):
Right. Even the most meticulous
doctors, the most organised ones, will encounter errors or
complaints in their careers. It happens.
How you handle these situations is really a mark of true
professionalism, turning challenges into opportunities
for trust and improvement. Exactly.
Section 8. Dealing with errors and
complaints starting with responding to patient
complaints. A complaint is any expression of

(45:25):
dissatisfaction that requires a response.
How you handle it is critical. It's an opportunity to restore
trust, improve patient experience, and drive learning.
Complaints must be handled promptly, compassionately and in
line with standards. What are the key standards?
The NHS complaint standards set by the Ombudsman mandate you
listen, respond, effectively, learn, set clear plans, time

(45:45):
scales and offer fair remedies. The 2009 NHS Complaints
Regulations outline the formal process, acknowledgement,
investigation, response, signposting to ombudsman if
unresolved and GMC. Good Medical Practise 2024
advises clear communication, being fair, non defensive and
actively using complaints to improve practise.
And apologising. Crucially, NHS resolution

(46:07):
confirms offering apology is strongly encouraged and is not
an admission of legal liability.It's just good professional
practise and active compassion. Common pitfalls Getting
defensive. Yes, becoming defensive or
immediately blaming others when confronted.
Tempting may be instinctive but wrong as it immediately erodes
trust, maintaining silence or delaying a response without a

(46:29):
clear plan, ignoring the learning opportunity, refusing
to log a complaint because it seems minor or informal, and
improvising a solution instead of signposting to the formal
complaints pathway or palace. OK, classic scenario.
A patient's relative approaches you upset, reports a
receptionist was rude and asks how to complain.

(46:49):
That's next step. Immediately listen
empathetically to their concernsand thank them for raising the
issue. Offer a sincere apology for
their experience with without admitting liability.
Clearly explain the complaints process, including typical time
scales, and provide details for Palace interface, patient advice
and liaison service. Crucially, you must record the
concern and ensure it's shared for organisational learning.

(47:11):
And what not to do? Advising them to call head
office and walking away, or immediately defending the
receptionist and refusing to logthe concern is unprofessional,
unhelpful and contrary to NHS standards.
Memory hook 3A S Acknowledge, apologise action plan.
One Listen and acknowledge. Thank them actively listen to

(47:32):
understand their desired outcome2.
Apologise meaningfully. Offer sincere apology for
experience. Outline next steps named contact
time scales Offer Palais detailsimmediate fixes.
Resolve simple issues quickly. For example, rebooking while
formal investigation proceeds record and escalate.
Follow local policy to log complaint record for learning

(47:54):
example LFPSC. If safety related, escalate per
trust procedure. Close the loop.
Ensure timely written response explaining findings, learning
remedies. Signpost Ombudsman if needed.
Find the free SJT textbook and podcasts that Past Them isra.com
and subscribe at youtube.com at Past Them SRA.
Sometimes, of course, the complaint stems from a direct

(48:15):
medical mistake. In these instances, the ethical
principle of candour, open and honest disclosure becomes
absolutely paramount. Yes, disclosing mistakes.
Candour means being open and honest when things go wrong.
It involves promptly telling theaffected person what happened,
apologising, explaining what is known, outlining the next steps

(48:35):
for investigation and learning, and ensuring recurrence is
prevented. This builds trust, fosters a
learning culture, and it's a professional duty.
What's the key guidance here? The GMC and MC Candour guidance
outlines the professional duty to tell patients when
something's gone wrong, apologise, offer remedy support,
share known facts, avoiding speculation and explain what

(48:57):
happens next. And the organisational duty.
That's CQC Regulation 20, the statutory duty of candour.
It's an organisational duty for healthcare providers.
It requires them to notify patients of notifiable safety,
safety incidents, provide a written apology and keep
records. As clinicians, you must escalate
promptly to enable your organisation to meet this duty.

(49:17):
And apologies again. Yes, NHS resolution explicitly
confirms apologising is the right thing to do and is not an
admission of legal liability andall patient safety events,
errors, near misses should be reported internally via LFPSE.
Learn from patient safety eventsand responded to proportionately
under PSIRF. Patient safety incident response

(49:38):
framework for learning. Common pitfalls delaying
disclosure. Yes, delaying disclosure or
offering a formulaic non genuineapology.
Tempting to put it off, but wrong breaches both professional
and statutory duties. Speculating about the cause or
blaming others, failing to accurately record the discussion
or report the incident internally, forgetting to offer

(49:58):
practical support or remedy, andignoring near misses because no
harm occurred. You should still be open if it
could have caused harm to stressand always report internally for
learning. OK, classic scenario.
You discover you mistakenly gavea patient 50 milligrammes
instead of five milligrammes of a critical drug.
Patient is stable. No adverse effects noted so far.
Best next step? Immediate priority, ensure the

(50:18):
patient remains safe, monitoringetcetera.
Then inform your senior or line manager promptly and candidly.
Apologise to the patient, explain what you know about the
incident. Outline next steps EG monitoring
review. Document this discussion
thoroughly in the notes. Crucially, report the incident
via the LFPSE system and ensure the Regulation 20 Duty of

(50:40):
Candour process is followed by your organisation if applicable.
And saying nothing. Saying nothing because no harm
occurred is a serious breach of the duty of candour and prevents
vital learning. Waiting for the consultant to
return next week delays crucial disclosure and reporting.
Got it. Memory hook, real apology,
regret, explain action learn no blame speculation.

(51:01):
And the rapid checklist for the exam one immediate safety,
ensure patients safe, inform senior manager promptly, stick
with candour, say sorry, share known facts, no speculation
blame. Explain next steps offer support
3. Document and notify Record
discussion meticulously in notesComplete internal reporting LF
PSE. Follow Reg 20 if needed.

(51:21):
Learn Actively contribute to review investigation under
PSIRF. Ensure feedback loops completed.
Close loop with patient if appropriate.
To share learning, find thefreesjttextbookandpodcasts@passthemsra.com
and subscribe at youtube.com at Pass Them SRA.
After an error, candour with a patient is essential, but

(51:41):
equally vital is your own internal reflective practise to
learn from the experience and prevent recurrence.
It's not just about the system, it's about your own development
too. Absolutely reflective practise
after an error Reflection is a structured, honest, and usually
anonymized account designed to help you understand what
happened, what you learn from it, and what you will do
differently in the future. It's a core professional

(52:04):
activity, improves care, builds resilience and fosters
continuous professional development.
What's the official guidance on this?
The GMC Academy reflective practitioner guidance is clear.
Reflective notes should be anonymized.
No patient identifiers balanced.Consider all factors, not just
self blame, focused on learning and improvement and can be
shared in summary form, perhaps with your supervisor.

(52:25):
And it's about learning, not blame.
Exactly. Reflection operates within a
just and learning culture. Its primary purpose is
improvement, not individual blame.
It should link to broader PSIRF learning processes where
relevant. Effective reflection often
follows A structured approach. What happened?
So what insights impact, and nowwhat concrete actions for the

(52:47):
future? And it should lead to actual
change. Ideally, yes.
Identifying guidelines to read, skills to practise, suggesting
system fixes. Learning should ideally be
shared with the wider team. Appropriately anonymized, of
course. Common pitfalls, including
patient details. Yes, including identifiable
patient data names, precise dates, unique characteristics in

(53:08):
your reflective notes. Tempting to be specific but
wrong as it breaches confidentiality and can have
serious consequences. Engaging in excessive self
criticism without clear learningpoints or actionable steps.
Keeping insights entirely private, preventing wider
learning and confusing personal reflection with formal incident
investigation. OK, classic scenario.
You're tasked with writing a reflective note after being

(53:30):
involved in a recent prescribingerror.
Best next step? Use a structured approach.
Like what? So what?
Now what? Crucially, you must anonymize
the reflection. No patient identifiers.
Focus on identifying contributory factors, systems
issues, personal factors, and list concrete actions you will
take, maybe with target dates. Finally, consider how this

(53:51):
learning can be shared appropriately, for example, at a
safety huddle with your supervisor, without breaching
confidentiality. And what's definitely wrong?
Writing a blow by blow account with names and times severe
breach of confidentiality. Deciding not to write anything
in case you get into trouble misses a vital opportunity for
learning and professional development and might even

(54:12):
breach appraisal requirements. Got it.
Memory hook? WSN triangle what?
So what? Now what?
Use a structure. Employ what So what now what or
similar for clarity. 2 Anonymize.
Ensure no patient names, identifiers or excessive
clinical details. Keep it minimal and relevant to
learning. Three link to change.

(54:33):
Identify specific actions, Reading, practising, proposing
fixes. Share learning appropriately.
Look after yourself. Engage in debriefing with senior
supervisor. Signpost well-being support if
needed after an error. Find the free SJT textbook
bookandpodcasts@pastthemsra.com and subscribe at youtube.com at
pastthemsra. Individual reflection is one

(54:54):
part organisational. Learning from adverse events and
indeed even near misses is another critical piece of the
puzzle to continuously enhance patient safety across the board.
Yes, learning from adverse events.
This is a systematic process involving recording the event,
deciding on a proportionate response, compassionately
involving all those affected patients, families and staff,

(55:16):
identifying underlying system factors, implementing effective
actions and evaluating their impact.
This continuous cycle drives improvement in patient safety
across the NHS. What are the key systems here?
The LFPSE Learn from Patient Safety Events is the national
digital service for recording and analysis.
You should submit events promptly.
The PSIRF Patient Safety Incident Response Framework
guides organisations and responding with proportionate

(55:38):
systems focused approaches and it mandates compassion and
engagement with all affected parties, including staff.
And the culture. Adjust culture or being fair is
crucial. It means responding to incidents
fairly and consistently, supporting speaking up and
learning rather than immediatelyseeking to blame individuals.
Actions implemented should be smart, specific, measurable,

(55:59):
achievable, relevant, time boundwith clear owners and deadlines.
Common pitfalls Blaming individuals.
Yes, immediately seeking to blame individuals rather than
focusing on identifying and learning from system failures.
Tempting maybe, but wrong as it discourages reporting and
prevents true learning. Investigating every incident the
same way, regardless of severity.

(56:19):
PSIRF emphasises proportionality.
Failing to provide feedback to those affected about learning
and actions. Keeping findings confidential,
Preventing wider sharing and nottracking the implementation or
impact of actions, leading to noreal change.
OK, classic scenario. A wrong site surgical block
injecting local anaesthetic on the wrong side is identified and
averted at the timeout stage in theatre.

(56:41):
No harm occurred. Best next step?
You should immediately record this new miss on the LFPSC
system. It is also appropriate to inform
the patient with candour about the near miss, explaining what
happened and the steps taken to prevent harm and future
recurrence. Agree on a proportionate PSR
review to understand the system failures, why did it nearly

(57:01):
happen, and ensure the learning is shared with the theatre team.
And just carrying on. Carrying on is normal because no
harm occurred misses a critical learning opportunity that could
prevent actual harm next time. Blaming the anaesthetist in
writing is unprofessional, unhelpful and goes against just
culture principles. Got it.
Memory hook prism proportionate root system factors involve

(57:24):
smart actions monitor. And the rapid checklist for the
exam one Record submit event on LFPSE promptly capture facts
accurately 2. Engage, inform and involve
patients, families, staff. Compassionately agree contact
preferences 3. Annalise select proportional
investigation Huddle Review fullinvestigation focusing on system

(57:45):
factors, not just individuals. War Implement smart actions
Assign owners and deadlines Share and check feedback
learning to affected parties Monitor impact of changes
Revisit if risks persist. Find
Pass Them SRA. And finally, after an adverse

(58:06):
event, it's not just about system learning.
It's also, crucially, about compassion, supporting the
colleagues who are involved, whocan often become, as we say,
second victims of the incident themselves.
Yes, supporting colleagues afterincidents.
This means offering immediate compassionate check INS,
ensuring psychological safety, fair treatment based on a just
culture, and providing practicalhelp with both the candour and

(58:28):
learning processes. This is crucial because staff
involved can experience significant emotional distress
and professional impact. What guidance backs this up?
The PSIRF Engagement Guide specifically mandates the
compassionate involvement of patients, families and staff.
A just culture ensures responsesare fair and consistent,
supporting staff without fear ofunfair blame.

(58:50):
And you should support colleagues to meet their apology
and candour duties, reminding them apologising is right and
not an admission of liability. Offer structured support like
senior review, debriefings, formal supervision, and
signposts to confidential well-being services like
occupational health or their educational supervisor.
Common pitfalls? Gossiping.
Yes, gossiping or immediately assigning blame before facts are

(59:13):
established. Tempting perhaps, but wrong as
it creates a toxic environment and inhibits learning.
Leaving a distressed colleague to apologise alone without
support. Neglecting welfare follow up,
assuming they'll just get over it.
Ignoring distress or telling them to tough it out and
imposing immediate punitive measures without a full fair
investigation. OK, classic scenario.

(59:33):
An FY1 doctor is visibly tearfuland distressed after
inadvertently administering an insulin overdose.
The patient is now stable. Best next step?
You should immediately remove the FY1 from clinical duties if
they are distressed and arrange for a senior review and a
debriefing session for them. Support them in having a timely
coached candour conversation with the patient, ensure the

(59:53):
incident is documented and logged on LFPSE and crucially,
plan follow up for their welfare.
And telling them to just carry on.
Telling them to carry on and be more careful ignores their
distress and the learning opportunity and is potentially
unsafe if they're impaired by distress.
Emailing the entire department naming the FY1 is highly
unprofessional and shaming. Got it.

(01:00:14):
Memory Hook 3C's care for colleague.
Candour, culture, Jest. And the rapid checklist for the
exam one immediate check in. Ensure colleagues safe remove
from clinical tasks if distressed arrange cover
practical support Facilitate senior review, debrief.
Ensure access to supervision signpost well-being
servicization 3 fair process. Ensure incident handled per

(01:00:38):
PSIRF. Just culture.
Avoid premature blame, Focus on systems, enable candour.
Offer coaching support for patient conversation.
Be present if appropriate. Ensure documentation, reporting
duties met. Follow up conduct Check
insurance with colleague. Confirm learning actions
implemented. Ensure ongoing support.

(01:00:58):
Find thefreesjttextbookandpodcasts@pastthemsestway.com
and subscribe at youtube.com at Past Them SRA.
Moving from the critical processes of dealing with
errors, let's pivot now to something equally vital for your
long term career. self-care and resilience.
Taking care of our patients is of course the priority, but

(01:01:18):
taking care of ourselves is absolutely crucial to making
that possible sustainably. Indeed, Section 9 self-care and
resilience, starting with recognising burnout now.
Burnout as defined by I CD11 is specifically an occupational
phenomenon resulting from chronic unmanaged workplace
stress. It's not just feeling tired.
Right, it has those three key dimensions.
Exactly feelings of energy depletion or exhaustion increase

(01:01:42):
mental distance or negativity towards one's job and reduce
professional efficacy or accomplishment.
Recognising these signs early iscrucial to protect both yourself
and ultimately, your patients. What does the GMC say?
GMC Good Medical Practise 2024 is clear, you must recognise and
work within your limits of competence and capacity, seek
advice and supervision when needed and crucially act if your

(01:02:04):
own health or well-being could pose a risk to patient safety.
The HSE Management Standards forStress also highlight employers
duties to mitigate work related stressors.
So what are the key signs we should be looking out for in
ourselves or colleagues? Persistent exhaustion that
doesn't resolve with rest. Increased irritability or
cynicism. Maybe an increase in errors or

(01:02:25):
near misses. A pervasive dread of going to
work. Feeling emotionally detached
from duties or patients. These are all red flags.
And the big pitfall trying to power through?
Yes, attempting to push through significant fatigue or
impairment despite clear risks to patient safety.
Tempting. We all feel pressure, but wrong
as it endangers patients and yourself.
Hiding concerns due to fear of stigma or appearing weak.

(01:02:48):
Blaming individuals rather than acknowledging systemic factors
like workload and never taking leave or maintaining an
unsustainable workload. OK, classic scenario.
You're on an overnight shift, feel profoundly exhausted, maybe
made a couple of small slips or near misses already.
Best next step? Your immediate priority is
patient safety. You must inform the nurse in
charge or your senior colleague that you are feeling unsafe to

(01:03:11):
continue functioning properly. Request a redistribution of
urgent tasks, plan for proper breaks, document your concern,
and importantly, seek formal help, maybe through practitioner
health after your shift ends. And just carry on.
Saying nothing and carrying on risks serious patient harm.
Going home without informing anyone constitutes abandonment

(01:03:31):
of duty and is highly unprofessional and unsafe.
Got it. Memory hook 3DS DS 4 drain
distance drop in efficacy, the ICD 11 triad for burnout.
And the rapid checklist for the exam one notice signs.
Be vigilant for persistent exhaustion, irritability,
increasing errors, near misses, dread of work detachment,
protect safety if impaired pauseescalate workload risks to

(01:03:54):
senior ANIC. Arrange handover of time,
critical care. Get help Speak confidentially to
supervisor occupational health. Consider self referring to NHS
practitioner health confidentialservice for doctors 4.
Adjust work. Prioritise high risk tasks,
defer non urgent ones. Request temporary roto flexible
working adjustments if appropriate. 5.

(01:04:14):
Record and review Document your action plan and set a review
date. Continue engaging in reflective
practise about workload well-being.
Find thefreesjttextbookandpodcasts@passthemsra.com
and subscribe at youtube.com at Pass Them SRA.
Recognising burnout is that crucial first step.
The next is proactively seeking the specific help you need for

(01:04:35):
your stress and mental health, something that is thankfully
increasingly encouraged and seenas a hallmark of a professional,
not a weakness. Absolutely seeking help for
stress mental health. This means proactively accessing
appropriate support, whether clinical, occupational or
organisational, When stress, mental health issues or maybe
even substance misuse might affect your well-being or,

(01:04:57):
crucially, patient safety. It's a mark of professionalism
and responsibility. And the GMC reinforces this.
Yes, GMC Good Medical Practise 2024 explicitly states you must
recognise your limits, seek appropriate supervision and act
to protect patients if your health condition could impact
the care you provide. And where can doctors turn?
NHS Practitioner Health is vitalfree confidential mental health

(01:05:19):
and addiction service specifically for doctors and
dentists in England. It's self referral which is key.
The BMA services also offer free204 seven counselling and peer
support to all UK doctors and medical students, regardless of
BMA membership. These are excellent resources.
So the message is don't wait. Exactly.
A common pitfall is waiting until a crisis point or working

(01:05:40):
unsafely before seeking any help.
Tempting to delay, but wrong as it endangers patients and
yourself. Allowing fear of stigma to
prevent disclosure to a supervisor or appropriate
professional. Not using the dedicated
confidential services available and relying solely on informal
support without seeking professional guidance when
needed. OK classic scenario, you are mid
shift and begin to experience significant symptoms of anxiety

(01:06:03):
or panic, maybe feeling unable to practise safely.
You know a safe handover is needed.
Best next step? Again, immediate priority is
patient safety. You must inform your senior
colleague or the nurse in chargethat you are unable to continue
safely. Hand over any critical tasks
immediately. Try and take a short break to
compose yourself. Maybe step away for 5 minutes

(01:06:23):
and contact a confidential support service like NHS
Practitioner Health or the BMA counselling line as soon as
practicable. Document the handover and agreed
plan and agree on a review time with your senior.
And just leaving. Leaving without telling anyone
constitutes abandonment. Extremely unprofessional and
unsafe. Hiding your symptoms and trying
to carry on risks significant patient harm.

(01:06:45):
Got it. Memory hook 3 lines of support
Senior supervisor OH Practitioner Health BMA 247.
And the rapid checklist for the exam one immediate safety if
feel impaired inform senior enicshare workload arrange cover if
needed access support self referto NHS practitioner health
contact BMA counselling peer support Consider OH or GP3 plan

(01:07:08):
adjustments Discuss agreed temporary rota changes or
flexible working with supervisor.
Set clear review date record andconfidentiality document
decisions actions share info on need to know basis respecting
own confidentiality. Find
thefreesjttextbookandpodcasts@passthemessray.comand subscribe at youtube.com at

(01:07:28):
Pass Them SRA. A key aspect of self-care and
preventing the need for that kind of crisis intervention is
actively maintaining a healthy work life balance throughout
your career. Easier said than done sometimes,
but crucial. Definitely maintaining work life
balance. In medicine, this involves
achieving a sustainable workloadand ensuring predictable rest.

(01:07:48):
It's achieved through proactive roto planning, setting clear
professional boundaries and utilising NHS flexible working
arrangements fairly for both yourself and your colleagues,
all while ensuring safe staffinglevels are maintained.
Is there official support for flexible working?
Yes, the NHS people promise and it's flexible working policy
framework state you have the right to request flexible
working from day one of employment.

(01:08:10):
The policy focuses on ensuring per disability and fairness.
GMC Good Medical Practise 2024 also instructs you to work
within your competence and capacity and raise concerns
promptly if safety is at risk due to workload or fatigue.
And employer responsibilities. The HSE Stress Standards
highlight employers responsibilities to assess and
manage work related stressors impacting well-being and

(01:08:30):
personally. Proactively plan your annual
leave ring fence protected rest periods.
Avoid working unsafe consecutiveshifts.
Check your contract limits. Common pitfalls.
Secret shift swaps. Yes, engaging in secret swaps of
shifts with colleagues or leaving a shift without formal
cover leading to unsafe staffing.
Tempting for convenience but wrong as it compromises safety.

(01:08:53):
Practising presenteeism. Attending work despite being
impaired by fatigue or illness rather than taking time off.
Never taking annual leave or refusing rest time, which
massively increases burnout risk, and refusing flexible
working requests from colleagueswithout a fair, transparent,
documented reason based on service need.
OK, classic scenario. You need to attend a significant

(01:09:14):
once in a lifetime family event that falls on a date you're
scheduled for a clinical shift next month.
Best next step? Your best approach is to submit
a formal, flexible working or wrote a change request well in
advance. Crucially, you should
proactively propose named equivalent cover for your shift
and outline any mitigation plansfor a potential impact.

(01:09:35):
Ensure this agreement is confirmed in writing with the
rota coordinator or manager. And just swapping on WhatsApp.
Swapping shifts informally on WhatsApp without informing
anyone create safety risks. The rota might not reflect who
is actually working, which is dangerous.
Calling in sick on the day is unprofessional and undermines
trust. Got it.
Memory hook. Use the UID grid urgent

(01:09:56):
important delegate for workload,but also think about protecting
personal important events fairly.
And the rapid checklist for the exam one plan ahead plan
leverist avoid unsafe shifts request flexible working early
with impact mitigation plan be fair ensure transparency and
swaps. Confirm cover has equivalent
competent skills. Three protect breaks.

(01:10:17):
Actively take breaks. Escalate prom if repeatedly
unable to take safe breaks. Document and review.
Document agreed. Flexible working shift changes.
Regularly review, Adjust work life balance.
Find thefreesjttextbookandpodcasts@pasmsra.com
and subscribe at youtube.com at Pasam SRAA.

(01:10:37):
Maintaining work life balance involves proactively managing
your workload, but it also fundamentally relies on the
critical ability to recognise your own limitations as a
clinician, knowing when to ask for help.
Yes, recognising own limitations.
This means accurately matching tasks to your current confidence
and capacity. It involves proactively seeking
appropriate help and supervision, and, crucially,

(01:11:00):
protecting patients by escalating early when a
situation or task is beyond yourabilities or experience.
This is a core professional competency, not a failing.
And the GMC is very clear on this.
Explicitly, GMC Good Medical Practise 2024 says you must
recognise your limits. Only practise with suitable
supervision. Actively ask for help when
needed and always ensure patientsafety is your paramount

(01:11:21):
concern. The GMC guidance on raising and
acting on concerns also instructs you to take prompt
action if safety might be compromised, including when you
identify your own limitations impacting care.
So asking for help is good. Seeking help is not a sign of
weakness, it's fundamental professional practise and
contributes directly to safer patient care.
What are the common pitfalls then trying to wing it?

(01:11:43):
Exactly, attempting to wing it or have a go in high risk
procedures or complex clinical scenarios you've never performed
or been trained for. Tempting to seem capable but
wrong as it directly risks patient harm.
Delaying escalation to a senior to save face or avoid appearing
less competent. Poor or vague documentation of
decisions made when escalating, or the supervision received and

(01:12:07):
refusing to see a patient because you feel out of your
depth without taking responsibility to arrange safe
alternative cover. That's abandonment.
OK, classic scenario. You're asked to insert a
specific medical device, say a chest drain or a central line
that you have never performed before and you know you lack the
necessary experience and sign off.
Best next step? You should politely but clearly

(01:12:27):
explain your limitation to the senior colleague or team
requesting it. Your immediate action is to
ensure patient safety measures are maintained, for example,
monitoring. Then you must call an
experienced clinician, your registrar or consultant to
perform or supervise the procedure actively assist them
to learn from the situation and ensure the decision and

(01:12:49):
supervision level are thoroughlydocumented.
And just trying it. Attempting the procedure alone
to have a go is highly unsafe and unprofessional.
Refusing to see the patient without offering an alternative
plan or arrange and cover is abandonment of duty.
Got it. Memory hook stop, heat stop talk
options plan. And the rapid checklist for the
exam. One, assess risk.

(01:13:10):
If task situation is unfamiliar,high risk, complex, pause and
assess your capability honestly.Two, seek supervision
immediately, call senior consultant, consult relevant
guidelines if urgent, allocate task to competent colleague. 3
Be transparent, communicate clearly with patients about who
will be reviewing them or supervising and next steps.
Document Meticulously Document your decision to escalate,

(01:13:33):
advice received and plan implemented, including level of
supervision. Find
thefreesjttextbookandpodcasts@assamesra.comand subscribe at youtube.com at
assthemsra. And finally, in this section on
self-care, let's address the often unspoken yet profoundly
important aspect, managing the emotional impact of clinical

(01:13:55):
work itself. It can take a toll.
Absolutely managing emotional impact of clinical work.
This involves recognising normalstress reactions to challenging
situations, proactively accessing peer and
organisational support mechanisms, and acting
decisively if symptoms of distress persist or begin to
impair your professional or personal functioning.
Thinking about things like PTSD symptoms, this is crucial for

(01:14:17):
sustained well-being and safe practise.
What kind of support mechanisms are there?
Things like Schwartz rounds. These are multidisciplinary
forms designed for healthcare staff to reflect on the
emotional and social aspects of patient care.
Studies suggest they can reduce psychological distress and
improve team connection. And if things get more serious?
NICE guideline Ng 116 for PTSD provides guidance on recognising

(01:14:38):
symptoms, offering initial information, monitoring early
signs and referring for specialist support if symptoms
are persistent or impairing function.
The PSIRF engagement guidelines also emphasise compassionate
involvement and support of staffafter incidents, fostering that
just culture where learning is prioritised over blame.
And basic self-care. Vital prioritising fundamental

(01:15:02):
strategies adequate sleep, good nutrition, physical activity,
allowing yourself time off afterparticularly traumatic events
when possible. Common pitfalls.
Suppressing emotions. Yes, attempting to tough it out
or suppress emotions after traumatic cases.
Tempting maybe seems strong but wrong as it can lead to
unaddressed psychological distress and long term negative

(01:15:22):
consequences. Engaging in gossip or blame
culture after incidents rather than fostering a just learning
environment. Skipping follow up or assuming a
colleague is fine when distress persists beyond a few weeks.
Ignoring signs of distress in yourself or colleagues, or
telling them to move on or get over it.
OK, classic scenario. After a particularly traumatic
shift, maybe a paediatric death on call, a colleague starts

(01:15:44):
showing signs of persistent mayors and avoidance behaviours.
4 weeks later. Best next step?
You should compassionately offera debrief with a senior or peer
and maybe suggest attending a Schwartz round if available.
Advise your colleague about the information and monitoring
recommendations from NICE Ng 116for PTSD signs and crucially,

(01:16:05):
signpost them to confidential support services like their GP
or NHS Practitioner Health, ensuring a plan for follow up is
considered. And telling them to just move
on. Suggesting they move on and
avoid discussing it or telling them to toughen up is
unsupportive, unprofessional andcould potentially worsen their
distress. Got it memory hook HLT before
big decisions or when feeling overwhelmed?

(01:16:27):
Are you hungry, angry, lonely, tired?
If so, pause and reset before acting.
One name and normalise. Debrief with senior peer offer.
Attend Schwartz rounds to process emotions, self-care and
boundaries. Prioritise sleep, nutrition,
movement. Allow time off after trauma if
possible. Three, watch for red flags.

(01:16:47):
Be alert for persistent PTSD symptoms, nightmares, avoidance,
hyper arousal impairment. Signpost to GP Practitioner
Health consider NICE Ng 116 referral, support others check
in and distressed colleagues. Signpost BMA counselling, peer
support, facilitate supervision,access, document and learn.

(01:17:07):
Engage in anonymized reflective practise.
Feed insights into PSIRF learning processes if
appropriate. Find
thefreesjttextbookandpodcasts@pastm-sra.comand subscribe at youtube.com at
past MSRA right. Moving from the essential
self-care that sustains us as professionals, let's pivot to
our profound ethical duty to protect others.

(01:17:29):
Safeguarding This is the critical area of identifying and
responding to concerns for children and vulnerable adults.
Absolutely. Section 10.
Safeguarding and vulnerable groups, starting with child
safeguarding signs referral documentation.
This encompasses protecting children and young people from
abuse, neglect, exploitation andactively promoting their
welfare. For frontline clinicians, it

(01:17:50):
means recognising concerns, sharing info appropriately and
making timely referrals. What's the core guidance?
Practise is guided by working together to safeguard children.
2023 and the Children Act 1989. You must refer to children's
social care if there's one reasonable cause to suspect
significant harm that section 47or two, a child is a child in

(01:18:10):
need requiring support Section 17.
And information sharing, Consentneeded.
This is crucial. You do not need consent to share
information for safeguarding purposes.
Where there's a lawful basis like risk of harm and it's
necessary and proportionate, youmust record your rationale.
Share the minimum necessary information on a need to know
basis using secure channels. What about May H?

(01:18:33):
The FSH multi agency safeguarding hub usually acts as
the front door, the multi agencytriage and in face sharing hub
for new child referral. Any specific clinical red flags?
Yes, RCPCH evidence highlights that bruising in pre mobile
infants, babies not yet crawlingor walking, is rare and must be
treated as a red flag requiring urgent senior paediatric review
and safeguarding referral. Don't ignore bruises on babies

(01:18:56):
who can't move themselves. Common pitfalls.
Promising confidentiality. Yes, promising a child absolute
confidentiality or delaying referral to get consent from
parents. Tempting but wrong as it
compromises safety and is contrary to guidance.
Making minimal notes without verbatim quotes, body maps or
specific dates times. Trying to manage complex

(01:19:16):
concerns alone instead of promptly referring.
Not recognising any bruise on a pre mobile infant as high risk
and asking detailed leading questions that could contaminate
evidence. Just record verbatim disclosure
and refer. OK, classic scenario.
A four month old non mobile babypresents with a small
unexplained bruise on their cheek.
Cara says they knocked a toy bar, but it seems inconsistent.

(01:19:39):
Best next step? Given bruising in a pre mobile
infant is a red flag, you must immediately arrange a same day
paediatric Child protection medical review.
Simultaneously inform your safeguarding lead and make an
urgent referral to children's social pair MASH.
You must meticulously record theverbatim history and create a
body map as per local policy. And just watching and waiting.
Reassuring the carer and discharging or waiting to see if

(01:20:01):
another bruise appears is unsafeand ignores crucial evidence.
Asking for photos via WhatsApp is insecure and inappropriate
for documentation. Got it.
Memory hook child safe check safety Hear child alone
information share Need to know lead Consult safeguarding
document Section 47 Test Act on strategy Family support S17

(01:20:23):
Escalate. And the rapid checklist for the
exam Ensure immediate safety if imminent danger call police 999
Ensure child safe. Inform senior safeguarding team
Recognise signs. Be vigilant for injuries
inconsistent with history, developmental red flags,
disclosures, poor care, domesticabuse, exposure, neglect. 3.
Record well. Document verbatim quotes, Use

(01:20:44):
body maps. Differentiate fact opinion.
Ensure contemporaneous timing. Refer promptly contact M and SH
same day. If S 17 S 47 thresholds met
likely consider strategy discussion five share lawfully.
If consent refuse and safe shareunder safeguarding public
interest basis. Document lawful basis rationale.

(01:21:09):
Just as children require protection, so do vulnerable
adults. Understanding adult safeguarding
principles is equally crucial, often involving more complex
considerations around capacity and autonomy, which we touched
on earlier. Right Adult safeguarding
vulnerable adults Domestic abuseThis is about protecting an

(01:21:29):
adult who has care and support needs and is experiencing or is
at risk of abuse or neglect and who, as a result of those needs,
is unable to protect themselves.These specific criteria usually
trigger a Section 42 inquiry by the local authority under the
Care Act 2014 and. The principles guiding this.
All adult safeguarding should follow the six principles SCIE,

(01:21:49):
empowerment, prevention, proportionality of protection,
partnership and accountability. Think making safeguarding
personal centering on the adultsdesired outcomes.
What about domestic abuse specifically?
The Domestic Abuse Act 2021 gives a comprehensive legal
definition including controllingcoercive behaviour,
psychological, physical, sexual,economic abuse and crucially

(01:22:10):
recognises children as victims if they witness it.
You should use the DASH H risk checklist to assess risk.
High risk cases get referred to MAF for multi agency safety
planning. Common pitfalls not recognising
coercive control. Yes, not recognising subtle
forms like coercive control is serious.
Insisting on consent to share info when unsafe for example

(01:22:30):
perpetrator present. Failing to complete A-H or make
a merak referral for high risk cases.
Ignoring making safeguarding personal, interviewing the adult
with a suspected perpetrator present.
Never do that and not treating non fatal strength emulation as
a red flag emergency. OK, classic scenario.
A 32 year old woman with care needs attends with her partner
who answers all questions for her.

(01:22:50):
You notice feet bruises. She avoids eye contact, says
she's clumsy. Best next step?
You must find a reason to speak to her alone in a safe private
space. Validate her experience, explore
her safety. Non judge mentally ask what she
wants to happen, making safeguarding personal.
Assess risk using DISH if appropriate with her consent or

(01:23:11):
if risk is high and in public interest.
Share limited necessary info with safeguarding services.
Document everything meticulously.
Provide safety netting advice helpline numbers discreetly.
When accepting the partners version.
Accepting the explanation without private inquiry or
inviting the partner in to hear both sides directly compromises
safety and autonomy. Telling her you can't do

(01:23:32):
anything without written consentmight be wrong.
If risk is high, posting on WhatsApp is obviously
inappropriate. Memory Hook.
The six principles. PPPPP.
EPA. Prevention, Proportionality
protection, partnership, accountability, empowerment.
And the rapid checklist for the exam Make safe and listen.
Ensure immediate safety Conduct private non judgmental inquiry

(01:23:53):
consider capacity immediate risks 2.
Assess and act if S42 criteria likely met.
Refer to adult social care for domestic abuse.
Complete DHH. Consider MAR 3.
Information sharing Share without consent if threat of
serious harm. Public interest record lawful
basis proportionality. Support and signpost Identify

(01:24:14):
signpost Specialist support IDVAAISVA safeguarding team
Police help with safety planningDocument clearly accurate
contemporaneous notes Risks, wishes, actions Info Shared Find
thefreesjttextbookandpodcasts@passthemsray.comand subscribe at youtube.com at
Pass Them SRA. Both child and adult

(01:24:37):
safeguarding often involve recognising patterns of neglect,
which can be really subtle, can't they, but cumulatively
devastating and require specificattention.
Absolutely recognising neglect Child neglect is that persistent
failure to meet basic physical, emotional or psychological needs
leading to serious impairment ofhealth or development.
Adult self neglect is a broader Care Act category covering lack

(01:24:58):
of self-care for hygiene, health, home environment, often
including hoarding. Recognising patterns and acting
proportionately is vital. What's the key concept here?
Cumulative harm, multiple small signs of neglect, taken together
over time can meet safeguarding thresholds for significant harm.
Building a chronology, maybe using body maps if policy
allows, helps capture this pattern.

(01:25:18):
And adult self neglect? Is it always safeguarding?
It's assessed case by case. Whether a Section 42 inquiry is
needed depends on capacity, risklevel and ability to protect
themselves. Proper information sharing and
documentation are paramount. Lawful sharing is permitted for
safeguarding and clear contemporaneous notes are
essential. Referrals go to MASH for
children, S 17, S 47. Adult social care for adults.

(01:25:41):
Consider S 42. Common pitfalls Thinking
incident by incident. Yes, applying a single incident
mindset, failing to see the pattern and cumulative harm.
Tempting if each instance seems minor but wrong as it misses the
severity. Assuming adult self neglect
never triggers S42 leading to inaction in high risk cases.
Vague non chronological records.Monitoring only without active

(01:26:03):
interventions or referrals. Ignoring associated risks like
fire hazards and hoarding. OK, classic scenario.
A three-year old child repeatedly arrives at clinic or
Ed appearing hungry. Unwashed communisations
significantly delayed Mist. Best next step?
You must document a detailed chronology of concerns including
verbatim observations and quotes.

(01:26:24):
Make a same day referral to Children's social care mAh under
the child in need at 17 or significant harm S47 threshold.
Discuss with your safeguarding lead if unsure which, Liaise
with other professionals involved, health visitors,
school nurse and share information lawfully to protect
the child. And just suggesting vitamins.
Suggesting vitamins and rebooking in three months is

(01:26:46):
inadequate and unsafe. Waiting for explicit parental
consent to share info delays crucial safeguarding and isn't
required if there's a risk of harm.
Memory hook for adults. Self neglect, CHOA, Cleanliness,
Health organisation risk, fire engagement.
And the rapid checklist for the exam one recognise patterns
alert for signs, missed appointments, poor growth,
children poor hygiene, unsafe home hoarding, adults.

(01:27:09):
Record and chronologize, document clearly fact versus
opinion, verbatim quotes, body maps, photos per policy.
Build chronology 3 or escalate. Children to MSH S 17, S 47.
Adults to adult social care Consider S 42.
Follow self neglect guidance, multi agency liaison, Liaise
with schools, GPS, therapy, housing.

(01:27:32):
Consider specific risks, hoarding, fire.
Involve relevant services. Find
Pass Them SRA. All these safeguarding
responsibilities, as you mentioned, require pretty
seamless collaboration across various agencies and
professionals. Knowing who does what in that
multi agency landscape is reallycritical for effective

(01:27:55):
protection. Definitely multi agency
safeguarding rules. This involves coordinated work
across statutory partners and specialist panels to assess
risk, plan safety and learn fromcases.
Understanding who does what. Mash Lotto MARAC MAPA ensures
referrals go to the correct doorand are handled effectively.
Are the main players for children?
The statutory safeguarding partners are the local
authority, the Integrated Care Board, ICB and police.

(01:28:17):
They lead local arrangements as per Working Together to
Safeguard Children, 2023. And mAh is the front door.
Usually yes. MSH Multi Agency Safeguarding
Hub is the central triage and infrasharing hub for new child
safeguarding referrals and sometimes interfaces with adult
safeguarding too. Now Lau is important for
allegations against staff, right?

(01:28:38):
Critically important, you must inform the LAD U Local Authority
Designated Officer within one working day of any allegation
that a person working with children, staff or volunteer,
has behaved in a way that harms a child or is unsuitable to work
with children. A common pitfall is reporting
these allegations via normal safeguarding channels instead of
the specific LADO route. Tempting, but wrong.

(01:29:00):
What about Emma and Marifa? Maroc Multi Agency Risk
Assessment Conference is the keyform for managing highest risk
domestic abuse cases usually identified via DHH.
It coordinates a multi agency safety plan.
Marte Multi Agency Public Protection Arrangements is the
statutory framework for managingcertain sexual and violent

(01:29:20):
offenders in the community. Health engages via named leads
or SPO CS single points of contact.
More pitfalls not using DSH. Yes, referring high risk
domestic abuse without completing ADH assessment or
connecting with MRAC. Failing to document the lawful
basis for sharing info in multi agency contexts.
Sending vague emails to safeguarding instead of using

(01:29:42):
the specified mechanism. OK, classic scenario.
A student nurse reports witnessing a healthcare
assistant HCA roughly handling achild on the ward.
Best next step? You must immediately inform your
senior and ensure the child safety.
Then you are professionally obliged to contact the Leo
within one working day. You must thoroughly document the
incident and preserve any evidence and importantly support

(01:30:03):
the student nurse who raised theconcern.
Whistleblower protection applies.
And just telling the HCA off. Telling the HCA to apologise and
move on, or waiting to see if anyone else complaints, ignores
serious professional misconduct and a potential safeguarding
concern and bypasses the required LATO process.
Got it. Memory Hook 4M's of multi agency

(01:30:24):
Merak Merak Marigo. And the rapid checklist for the
exam one identify Wright wrote correctly identify mash lado
Merak mapa 2 Share proportionately and lawfully
minimum necessary info secure channels recurred lawful base
outcome 3 Use SPR in detail whenreferring use SPR include
chronology risk tools 4. Confirm and follow up confirm

(01:30:46):
referral receipt to understand next steps from receiving
agency. Find
thefreesjttextbookandpodcasts@passthemesra.comand subscribe at youtube.com at
Pass the Mesra. OK, our discussion on
safeguarding naturally leads us into the broader issues of
cultural awareness and equality,ensuring everyone receives the
care they need respectfully and without prejudice.
Absolutely. Section 11 Cultural awareness

(01:31:09):
and equality, starting with respecting cultural and
religious beliefs. This means actively exploring
how a person's culture or religion affect their healthcare
decisions and preference. It involves offering safe and
reasonable alternatives where possible and critically avoiding
assumptions or stereotyping. Vital for patient centred,
ethical, legally compliant care.The Equality Act 2010 is

(01:31:32):
fundamental. Religion or belief is a
protected characteristic, makingdiscrimination unlawful.
GMC Good Medical Practise 2024 requires fair treatment.
Ensuring personal views don't affect care, prioritising solely
by clinical need. NICE Ng 197 shared decision
making making encourages deciding with people, clear
communication using decision aids and the Accessible

(01:31:53):
Information Standard. AIS mandates meeting
communication needs, including professional interpreting.
Pitfalls. Stereotyping.
Yes, stereotyping patients basedon cultural religious background
is a big one. Tempting to make assumptions but
wrong as it denies autonomy. Using relatives as interpreters
without proper consent, documentation or involving

(01:32:13):
children in sensitive talks. Again, risks accuracy,
confidentiality, coercion, imposing your own personal
beliefs, poor documentation of preference plan, dismissing
beliefs or refusing care based on them.
Classic scenario again. Patient clearly refuses blood
products for religious reasons. Elective surgery planned, best

(01:32:34):
next step. Respectfully explore their
values, beliefs, confirm capacity, Discuss all reasonable
alternatives to transfusion and their risks.
Involve anaesthetic surgical teams to plan blood sparing
strategies. Document the comprehensive
discussion. Respect their decision.
Provide safety netting, Advancedcare planning.
And coercing them. Coercing consent because it's

(01:32:54):
safest or refusing treatment outright is a serious breach of
autonomy and ethics, delaying the discussion of Ward's
responsibility. Memory hook.
Ask a leaf. Ask a safety.
The options keep notes, beliefs,evidence, limits, interpreter,
exceptions. Follow up.
Ask first Initiate conversation with open questions.

(01:33:14):
Any beliefs, practises we shouldconsider 2.
Clarify impact Discuss specificsModesty chaperone, fasting,
blood refusal prayer diet shareddecision making Present options
risks, alternatives Use teach back support access Arrange
professional Interpret accessible info per AIS.
Allow time privacy Document and plan Record preferences agreed

(01:33:39):
safe plan Provide safety nettingFollow up.
Find the free SJT textbook and podcasts that pass
passthemessra.com and subscribe at youtube.com at Pass the Mess
RA. Respecting cultural and
religious beliefs is, of course,a core component of avoiding
discrimination, which is fundamental legal and ethical
duty for all healthcare professionals.
Exactly. Avoiding discrimination in

(01:34:00):
healthcare. This is unlawful, unfavourable
treatment based on a protected characteristic.
It directly harms access, compromises safety, erodes.
Trust. Your professional duty is to
actively prevent it and act decisively when it occurs.
Remind us of the protected characteristics.
The Equality Act 2010 prohibits discrimination across 9 age,
disability, gender reassignment,marriage, civil partnership,

(01:34:20):
pregnancy, maternity, race, religion or belief, sex and
sexual orientation. And GMC guidance.
GMC Good Medical Practise 2024 is clear.
Treat patients fairly. Don't refuse to lay care because
you disagree with their choices.Prioritise care solely by
clinical need, not personal bias.
Understand the different types of discrimination too.
Direct indirect harassment, victimisation and the specific

(01:34:43):
duty for reasonable adjustments for disability.
NHS bodies also have a public sector equality duty.
PSED to eliminate discrimination, advance
equality, foster good relations.Common pitfalls Letting jokes
slide. Yes, leaving derogatory jokes or
subtle microaggressions unchallenged.
Tempting to avoid confrontation but wrong as it normalises
discrimination. Implementing one-size-fits-all

(01:35:05):
processes causing indirect discrimination, EG only online
booking, failure to provide reasonable adjustments or AI
support, and judging a patient'schoices or lifestyle and
refusing delaying care explicitly prohibited by GMC.
Classic scenario, receptionist says we don't book interpreters
here. Bring a relative to a
non-english speaker. Best next step?

(01:35:25):
You must intervene immediately, politely but firmly explain.
This is unacceptable practise. It breaches the AIS.
Arrange for a professional interpreter and accessible
information as per the standard.Document the incident thoroughly
and escalate it to appropriate management.
And doing nothing. Doing nothing or asking the
patient's child to interpret is discriminatory, unprofessional,

(01:35:47):
compromises, safety and confidentiality.
Memory hook 4TS treat fairly, tackle bias, tailor access,
track outcomes. And the rapid checklist for the
exam one spot and stop challengediscriminatory remarks behaviour
courteously but clearly offer immediate support to those
affected. 2 Adjusted include actively make reasonable

(01:36:08):
adjustments, accessible info, physical access, longer
appointments. 3 Escalate and record.
Follow local policy to report incidents, fatigues, document
facts and outcomes, Reflect and learn.
Share learning from incidents toimprove processes and prevent
recurrence. Find

(01:36:30):
Pass Them SRHA. Avoiding discrimination is
really the baseline, isn't it? Providing truly equitable care
goes a step further, proactivelyaddressing individual patient
needs to ensure fair outcomes for everyone.
Yes, providing equitable care toall patients.
Equitable care is about tailoring, access, information
and follow up to a person's unique needs.
Language, disability, culture, health literacy, digital access

(01:36:52):
so that outcomes are fair. It's not removing barriers so
care is reachable, understandable, acceptable to
everyone. Recognising that equality
treating everyone the same doesn't always lead to equity
fair outcomes. What guidance supports this?
NICE Guideline CG138-ON patient experience stresses creating the
best experience, encouraging preferences, ensuring
continuity. NICE guideline NG197 focuses on

(01:37:15):
embedding shared decision makingand clear risk communication and
the accessible information standard AIS is mandatory.
Identify record flag meet reviewCommunication needs NHS
organisations also have legal duties to meet equality and
health inequalities duties. Common pitfalls Treating
everyone the same when needs differ.
Yes, giving equal time or resources when some patients

(01:37:38):
clearly need longer appointmentsor more tailored support,
leading to unsafe understanding.Tempting for efficiency, but
wrong as it fails equity. Failing to provide professional
interpreters or accessible formats.
Offering digital only access without clear alternatives.
Declining necessary adjustments due to policy or inconvenience.
Relying on family to interpret complex info without

(01:37:59):
professional oversight. OK, classic scenario.
A non-english speaker is booked for an urgent consent discussion
but no professional interpreter has been arranged.
Best next step? You must immediately rearrange
the appointment urgently to ensure professional interpreter
can be present. In the interim, provide any
translated or accessible writteninformation available.

(01:38:20):
Critically document the AIS flagand the patient's record and the
reasons for delay and the plan. And just trying with gestures.
Asking the patient's teenager totranslate places undue burden,
risks inaccuracies, breaches, confidentiality.
Attempting with gestures is unsafe and compromises true
informed consent. Memory hook?

(01:38:40):
Yeah, flag gate for equitable care.
Flag needs language access, guidance, decision aids
interpreter time. And the rapid checklist for the
exam one identify barriers actively ask about language
format, disability, transport, caring issues hindering access,
understanding 2. Adjust care.
Arrange professional interpreterProvide easy read BSL.

(01:39:01):
Offer quiet room Involve carers with consent.
Offer longer appointments if needed.
Share decisions and teach back. Confirm understanding using
Teach back use decision coordinate services, liaise with
GPS community teams provide safety netting clear follow up
plans 5 Document flags Record patient needs communication
preferences prominently in record e.g.

(01:39:23):
AIS flags. Find
thefreesjttextbookandpodcasts@passthemsray.comand subscribe at youtube.com at
Pass Them SRA. And providing that kind of
equitable care directly contributes to addressing the
wider health inequalities withinour communities, doesn't it?
Striving for a fairer and healthier society for.
All absolutely addressing healthinequalities.

(01:39:43):
These are those unfair, avoidable differences in health
status between different population groups.
The NHS uses frameworks like Core 20 PLUS 5 to focus action
on reducing these inequalities nationally and locally by
targeting specific populations and clinical priorities.
Addressing them is a core duty of all NHS bodies.
Breakdown Core 20. PLOS 5 for us.
Core 20 the most deprived 20% ofthe national population by index

(01:40:07):
of multiple deprivation IMD aim is to narrow health gaps for
this group. P Less locally defined groups
experiencing worse access, experience or outcomes like
inclusion health groups, rough sleepers, sex workers,
vulnerable migrants. The five clinical areas for
adults, current national priorities maternity care, SMI,
physical health cheques, chronicrespiratory disease, early

(01:40:30):
cancer diagnosis and hypertension case finding.
There's a similar version for children, young people.
And it's a legal duty. Yes, NHS Icbs and Trusts have
explicit legal duties to meet equality and health inequalities
duties in planning and delivery.In SJT scenarios you should
favour options that use data to identify disparities, target
support specifically, maybe Co design interventions with

(01:40:51):
communities and actively measureimpact.
Common pitfalls. One-size-fits-all again.
Yes, implementing one-size-fits-all clinics that
inadvertently whiten health gapsby not addressing specific
barriers. Attempting for simplicity but
wrong. Not monitoring service uptake or
outcomes by IMD, ethnicity or specific needs leading to blind
spots. Relying solely on digital access

(01:41:13):
without non digital alternatives.
Waiting for more funding insteadof taking immediate targeted
action. OK classic scenario, your
primary care network PCN is asked to improve hypertension
case finding and BP cheques in the most deprived estates in
your area. Best next step?
The most effective approach would be setting up accessible
walk in clinics, perhaps in evening or weekend slots,

(01:41:34):
ideally in community venues likecommunity centres, not just the
GP surgery. Use targeted invitations, not
just posters. Ensure professional interpreters
and accessible information AIS are available.
Crucially, monitor uptake by IMDquintile and ethnicity and
iterate your approach by workingclosely with community
connectors or link workers. And just putting up a poster.

(01:41:54):
Simply putting a generic poster up in the hospital canteen or GP
waiting room is passive and known to be ineffective and
reaching underserved groups waiting for next year's funding
delays vital public health action.
Got it. Memory hook T3 for inequalities
target core 20 PLUS Taylor barrier busting track access
experience outcomes. And the rapid checklist for the

(01:42:15):
exam one use data identify core 20 areas local PWS groups using
data scan waiting lists for disparities target offers design
outreach. Send targeted invites offer
longer appointments use community venues explore
transport solutions reduce access barriers ensure
interpreters AIO EE available. Provide non digital routes offer

(01:42:38):
flexible appointment times. Co design work with community
connectors VCSE organisations monitor patient experience track
impact measure up to take outcomes by deprivation,
ethnicity needs. Iterate strategies based on
findings. Find
passthemsra. Right now that we've covered

(01:43:00):
those core ethical, professionaland systems principles that
underturn the MSRASGT, let's turn our attention briefly to
how these principles are actually tested in the various
scenario formats you'll encounter in the exam itself.
Understanding the technique for each type is pretty crucial for
maximising your score. Yes, Section 12 Common SJT
scenario types. First up, best of three single

(01:43:23):
best answer scenarios. Here you get a clinical or
professional vignette and usually 8 potential actions.
AH, your task is to select the three best actions you would
take now or next. The options are largely
independent, not necessarily a sequence.
So how do you choose the best 3?The core strategy is to
prioritise based on a clear hierarchy #1 always patient

(01:43:43):
safety, address immediate threats to life or limb first.
ABCD 2. Honesty, candour 3.
Escalation supervision, Know when to get senior help 4.
Documentation, 5. Equity and dignity.
You should avoid options that involve delay, secrecy, just
abdicating responsibility, or breaching professional policy.
OK. Example 2.
Deteriorations. Short staffed.

(01:44:04):
Right surgical FY1 covering 28 patients, 2 bleeps
simultaneously. Nurse reports new WS.
Two of seven with hypotension. Radiology phones with positive
CTPE result for another patient.Phone keeps ringing.
Pick three best actions. The best three would likely be
ask nurse to repeat AB start O2 while you go immediately to the

(01:44:24):
new WS7 patient sick as first ABCDEB.
Call the Med Reg for urgent review of that patient and ask
for IV access, fluids prepared, early escalation, parallel
tasking D Ask the nurse in charge to allocate extra hands
and devote non urgent bleeps creating capacity shielding you.
And wrong options. Things like deferring action on
the positive CTPE result or finishing discharge letters

(01:44:46):
first. Unsafe delays, putting jobs on a
private To Do List without action or escalation is just
hidden work and unsafe. OK next type rank 5 from best to
worst action. This requires more granular
judgement. Yes, here you get a scenario and
five distinct actions AE. Your task is to rank all 5 from
absolute best rank one to the absolute worst rank 5.
How do you approach the ranking?Your ranking should consistently

(01:45:08):
lead with actions prioritising 1.
Immediate patient safety and time critical interventions 2.
Escalation to senior steams 3. Clear communication like candour
4. Thorough documentation and
learning. You must heavily penalise
options involving delay, unsafe delegation, dishonesty or
discourtesy. The worst options are usually

(01:45:30):
unsafe or dishonest. Example chest pain versus
paperwork. You're clerking new patient with
acute chest pain. ECG changes arrives versus
urgent request to rewrite a drugchart.
Rank the five options. The ideal ranking would be first
attend chest pain immediately start ACS protocol delegate drug
chart rewrite second inform registrar capsumic create
capacity document plan third finish discharges first lower

(01:45:53):
value but not actively harmful 4th Wait for an unrelated CT
result passive delay 5th Ask an HCA to keep an eye on chest pain
patient while you do tape work. Unsafe delegation, worse action
rationale life threat first thenpass the escalation, penalise
unsafe delays delegation most. OK, what about trickier ones?
Situations with no perfect option?
Yes, the classic dilemmas where all options have flaws.

(01:46:14):
Your task is usually to pick thethree actions that together best
protect safety, honesty, fairness, effectively minimising
harm. So the strategy is harm
minimization. Exactly.
Focus on actions that reduce immediate severe risks.
Rapid senior input is often key here.
Transparency about challenges inyour reasoning.

(01:46:35):
Documented reasoning why you chose this path.
Avoid unsafe delay. Disproportionate responses like
excessive restraint or outright abdication.
Example Impacity unclear. Urgent decision.
Elderly patient UTI delirium refuses urgent IV antibiotics.
Capacity fluctuates. Registrar 20 minutes away.
Pick three least harmful actions.

(01:46:56):
Best options are likely a explain risk benefits.
Simply recheck capacity for thisdecision.
Seek ascent maximise capacity B.If capacity clearly lacking in
delay risks harm. Start by the antibiotics under
best interest document thoroughly urgently informed
Registrar time critical best interest plus escalation G
Record capacity assessment and rationale for all decisions
contemporaneously Essential documentation.

(01:47:18):
Waiting hours are used in security without assessment
would be wrong. Yes, unsafe delay or
disproportionate response. OK, how about multiple?
Correct, but prioritisation required scenarios.
Lots of good options. These often appears rank 5
questions. Several actions seem reasonable,
but some are more urgent, impactful or strategic.
The key is ordering by time, criticality and risk reduction

(01:47:40):
first, then capacity creation, then communication, then routine
admin. Always stabilise, escalate
appropriately. Create capacity first when
facing competing urgencies. Example sepsis high K plus Kari
CT result, family update discharges all at once.
Ideal order first first start sepsis bundle now life threat
Second treat hyperkalemere AP ECG life threat Third ask Nic to

(01:48:05):
divert bleepsasyn help create capacity. 4th.
Update family after stabilising communication follows safety 5th
Call CT for non urgent result least time critical.
And finally, professional dilemmas with conflicting
priorities. These pit values against each
other. Patient interest versus team
pressure, targets versus integrity.
You need to identify actions best upholding GMC principles.
Safety and fairness. Often a pick three format.

(01:48:25):
What values win? Consistently prefer actions
demonstrating candour and integrity.
Respect patience, colleagues, process escalation for concerns
documentation. Avoid convenience, misplaced
loyalty, covering up or compromising ethic safety.
Example Pressure to cut corners on consent for targets.

(01:48:46):
Best actions a politely decline unsafe shortcut explains
standards uphold integrity C offer constructive alternative
problem solve E. If pressure persists, escalate
to consultant governance lead address systemic issue, not just
doing is asked. No, that compromises safety and
integrity. Backdating notes is dishonest.

(01:49:06):
Ignoring it is unprofessional. Great overview of the types.
Find thefreesjttextbookandpodcasts@passm-sra.com
and subscribe at youtube.com at pass MSRA for more examples.
All right, you've just We dive deep into the heart of the
MSRASJT. We've unpacked critical legal
frameworks, ethical dilemmas, practical strategies, the worst.
Let's try and distil our entire conversation into those golden
rules that will serve you well not just in the exam, but

(01:49:29):
frankly throughout your entire medical career.
OK, rapid fire golden rules 1. Safety first Always always
prioritise immediate patient safety above all other tasks,
pressures or personal considerations.
Non negotiable. Escalate early.
If a situation is beyond your competence or your workload
exceeds safe capacity, always speak up.

(01:49:50):
Escalate to a senior colleague or the site team promptly.
Don't wait. 3. Be open and honest candour when
things go wrong, however small, tell the patient.
Offer a sincere apology. Clearly explain the known facts
and the next steps. Build trust.
Protect patient data. Share information lawfully.
Minimum necessary, strict need to know basis, especially when

(01:50:11):
safeguarding. Respect, confidentiality, Use
interpreters, ensure equitable care.
Actively provide qualified professional interpreters and
accessible information formats when needed.
Don't rely on family, Document everything.
Clear, accurate, contemporary niece notes are your best
defence and communication tool. Record facts verbatim, quotes
where needed, your rationale andall plans if it's not written

(01:50:32):
down. It didn't happen.
Respect roles and boundaries, whether in consent, resource
allocation, professional conduct.
Always adhere to GMC guidance and legal frameworks like the
MCA and Equality Act. Know the rules.
And finally 8. Know your limits and seek help.
It is a mark of true professionalism to recognise
signs of burnout or stress in yourself or others and to

(01:50:53):
proactively access confidential support services available to
you. Look after yourself to look
after your patients. And that's our deep dive into
the MSRASJT. We really hope this
comprehensive breakdown has beenan incredibly useful shortcut to
mastering those crucial scenarios and boosting your
confidence. For even more high yield rules,
realistic scenarios, mnemonics, and those rapid checklists,

(01:51:15):
remember you can find thefreesjttextbookandothervaluablepodcasts@https.www.passthemsra.com.
And please don't forget to subscribe to
us@https.www.youtube.com at PassThem SRA to stay ahead in your
medical journey. We are genuinely here to help
you succeed. Just a final note, this deep
dive is for educational purposesonly.

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