Situational Judgement

In a clinical setting, you witness a senior colleague make an error in drug dosage that has not yet harmed the patient. The colleague doesn't notice. What is the most appropriate immediate action?

• ADocument the error in your own personal notes and monitor the patient for any effects
• BCorrect the error yourself without telling anyone to avoid embarrassing the colleague
• CReport the colleague to the General Medical Council immediately
• DInform the colleague of the error so it can be corrected promptly✓

Answer: Patient safety is the priority. Informing the colleague immediately allows the error to be corrected without delay. Involving the colleague respects professional relationships while addressing the safety issue.

A patient tells you in confidence that they are planning to stop taking their prescribed medication because of side effects, but asks you not to tell their GP. As a junior doctor, what is the most appropriate response?

• AImmediately break the patient's confidence and telephone the GP about the decision without telling the patient first
• BExplore the patient's concerns about side effects and explain the importance of discussing this with their GP✓
• CRespect the patient's confidentiality completely and say nothing at all to the GP about the decision to stop the medication
• DDischarge the patient as they are non-compliant

Answer: The best approach addresses the patient's concerns while encouraging open communication with their GP. Immediately breaking confidentiality or ignoring the issue are not appropriate first responses.

During your first week as a foundation doctor, you are asked by a nurse to prescribe a medication you are unfamiliar with. What is the most appropriate action?

• ARefuse outright to prescribe any medication that you have not already seen being prescribed on the ward at some point
• BPrescribe the medication as the nurse must know best
• CAsk the nurse to go and find a more experienced doctor somewhere else who will write the prescription instead of you
• DLook up the medication, consult relevant guidelines, and seek senior advice if uncertain before prescribing✓

Answer: Safe prescribing requires understanding what you are prescribing. Seeking information and senior guidance before prescribing demonstrates appropriate professional behaviour and prioritises patient safety.

You discover that a friend who is a medical student has been sharing patient details on social media, claiming they are anonymised, but some details are potentially identifiable. What should you do?

• AConfront them publicly on social media
• BIgnore it as they probably know the rules
• CSpeak to your friend privately about your concerns and the potential breach✓
• DReport them immediately to the medical school without speaking to them first

Answer: Speaking to the friend privately first is the most proportionate initial response. This allows them the opportunity to understand and correct their behaviour, which may be the result of poor judgement rather than malice.

A patient becomes aggressive and verbally abusive towards you during a consultation. How should you respond?

• ARemain calm, acknowledge their distress, try to de-escalate, and if necessary end the consultation safely✓
• BTerminate the consultation straight away and call hospital security before attempting any de-escalation at all
• CApologise for whatever has upset them and simply give them exactly what they are asking for so that they calm down
• DMatch their tone and raise your own voice in order to assert your own authority over them in the consultation room

Answer: The priority is to de-escalate the situation calmly and safely. Ending the consultation is an option if necessary, but should not be the first step. Matching their aggression or giving in to demands is inappropriate.

You notice that a fellow medical student consistently arrives late to clinical placements and misses learning opportunities. This has been going on for three weeks. What is the most appropriate course of action?

• ASpeak to them privately and express your concerns about their attendance✓
• BSay nothing as it is not your business
• CTell other students and let the rumour reach staff naturally
• DReport them to the dean without speaking to them

Answer: Approaching the student privately is the most proportionate and supportive first step. It allows them to explain their situation and may resolve the issue without formal escalation.

A patient with capacity refuses a blood transfusion on religious grounds, despite doctors believing it is necessary to save their life. What is the ethically correct response?

• ASeek a court order to force the transfusion
• BContact the patient's family to get permission instead
• COverride the refusal as saving life is the highest priority
• DRespect the refusal and document it, exploring all alternative treatments✓

Answer: A competent adult has the absolute right to refuse treatment, even life-saving treatment. This must be respected, documented, and alternative options explored.

You are on a night shift and are exhausted after 12 hours. A patient needs a complex procedure that you have limited experience with. What should you do?

• ADelay the procedure until morning regardless of the patient's condition
• BAsk a nurse to assist you with the procedure
• CAttempt the procedure to avoid disturbing your senior colleague
• DAssess the urgency and contact your senior for guidance or assistance✓

Answer: Patient safety requires honest assessment of your competence. Contacting a senior for guidance or assistance is the correct approach, balancing patient need with safe practice.

During a ward round, your consultant makes a clinical decision you believe is incorrect based on your learning. What is the most appropriate action?

• ASay nothing at all to anyone, on the basis that you are junior and are probably wrong about it anyway
• BGo straight to the medical director to raise your concern without speaking to the consultant at all first
• CPolitely raise your concern with the consultant at an appropriate moment, privately if possible✓
• DCorrect the consultant publicly in front of the patients and the rest of the assembled ward round team

Answer: Raising concerns through appropriate channels and in a respectful, private manner is professional. This allows for open discussion without undermining the team dynamic, while still prioritising patient safety.

A terminally ill patient asks you directly: 'How long do I have to live?' You are a junior doctor and do not know the answer. What is the most appropriate response?

• ATell them it is not something doctors can predict at all
• BAcknowledge their question, express empathy, and arrange for their senior team to have this conversation✓
• CChange the subject to avoid causing distress
• DGive a confident estimate to reassure them

Answer: Honesty and compassion are both important. As a junior, referring this sensitive conversation to the appropriate senior while acknowledging the patient's question is the most appropriate response.

You are working in a team and one colleague is not completing their fair share of work. This is affecting patient care. What is the most appropriate first step?

• AReport them to management immediately
• BComplete their share of the work for them without saying anything to anyone
• CRaise your concern with the colleague directly and professionally✓
• DComplain about them to other team members

Answer: The first step is direct, professional communication with the colleague. This may resolve the issue without formal escalation and is consistent with professional standards.

A patient asks you not to share information about their drug use with their partner, who is present in the consultation. You believe the drug use does not pose an immediate risk to others. What should you do?

• ARespect patient confidentiality and do not disclose to the partner✓
• BTell the partner anyway as they have a right to know
• CRefuse to treat the patient unless they agree to disclosure
• DLie to the partner and tell them that nothing of any significance was discussed

Answer: Patient confidentiality must be maintained unless there is a serious, imminent risk to others. The information concerns the patient's own health and there is no such risk described.

You are on a ward and notice a colleague appears to be under the influence of alcohol. They are about to assess a patient. What is the most appropriate immediate action?

• AIntervene immediately to prevent the colleague from seeing the patient, and escalate to a senior✓
• BSay nothing as you could be wrong
• CConfront the colleague aggressively in front of the patient and the rest of the nursing staff on the ward
• DWait until after the consultation to raise the concern

Answer: Patient safety takes absolute priority. If a colleague may be impaired, immediate action is required to prevent harm to patients. This must be escalated to a senior immediately.

You are completing a research paper and realise your supervisor has asked you to present data in a way that makes the results appear more significant than they are. What should you do?

• ASubmit the paper with the altered presentation of the data but add a short disclaimer in the discussion section
• BFollow your supervisor's instructions in full simply because they are far more experienced than you are
• CPresent the data accurately and raise your concerns with your supervisor about research integrity✓
• DWithdraw from the research without raising the issue

Answer: Research integrity is fundamental. You must present data accurately and raise concerns about any practices that could misrepresent findings, even with a senior colleague.

A patient discloses to you that they are experiencing domestic violence at home. They say they are safe at the moment and do not want you to contact anyone. What is the most appropriate response?

• ADischarge them as they do not want help
• BBreak confidentiality immediately and call the police
• CRespect their wishes, provide information about support services, and document the discussion✓
• DInform the patient's partner that you are aware of the situation

Answer: When a competent adult is not in immediate danger, their autonomy must be respected. Providing information about support services and documenting the disclosure is the appropriate response.

You are presenting a poster at a medical conference and realise your data contains a significant error that could mislead clinicians. The conference begins in one hour. What should you do?

• AWithdraw the poster and notify the organisers about the error✓
• BAdd a handwritten note to the poster explaining the error and present it anyway
• CPresent the poster and fix the error after the conference
• DPresent only the correct parts of the data verbally

Answer: Scientific integrity requires that erroneous information is not presented to clinicians who may use it to inform patient care. Withdrawing the poster and informing organisers is the correct action.

During a history-taking session, a patient becomes upset and begins to cry. What is the most appropriate immediate response?

• AApologise for having upset them and bring the consultation to an end immediately afterwards
• BCall a nurse into the room immediately because emotional support falls outside your role
• CHand the patient a tissue, pause, acknowledge their distress, and offer them time✓
• DCarry on taking the history at exactly the same pace so that the clinic still runs to time

Answer: Demonstrating empathy by pausing, acknowledging the patient's distress, and giving them time is central to compassionate care and good communication.

A parent refuses to allow their 10-year-old child to receive a recommended vaccine. The child is present and tells you they want the vaccine. What is the most appropriate action?

• AOverride the parent's refusal on the basis that the wishes of a ten-year-old child always take priority over theirs
• BTell the family you will refuse to see the child again in the clinic until the parent agrees to the vaccination
• CAdminister the vaccine straight away, without the parent's agreement, because the child has said that they want it
• DExplore the parent's concerns, provide clear information, and involve the appropriate senior if needed✓

Answer: Parental consent is required for children under 16 who are not Gillick competent. Exploring concerns and providing information is the best first step; involving a senior or safeguarding team is appropriate if concerns persist.

You receive a gift of significant value from a grateful patient. What should you do?

• AAccept it gratefully without telling anyone, because it is simply a kind gesture from a patient
• BReport the patient to the hospital authorities for what amounts to attempted bribery of a clinician
• CPolitely decline or check your organisation's policy on accepting gifts before deciding✓
• DAccept and share it with the team

Answer: Professional guidelines advise caution with gifts. Checking organisational policy and potentially declining or declaring the gift is the appropriate response to avoid conflicts of interest.

A patient's family member approaches you in the corridor and demands to know their relative's diagnosis. The patient has not given consent for this disclosure. What should you do?

• AShare the full diagnosis with them there in the corridor because the family clearly care a great deal about the patient's welfare
• BRefer them to the ward manager without explanation
• CTell the family member that they should improve the way they approach members of staff before asking anyone about the diagnosis again
• DExplain that you cannot share patient information without the patient's consent and direct them to speak with the patient✓

Answer: Patient confidentiality applies to all third parties including family members. Explaining the constraint and directing the family to speak with the patient directly is the correct approach.

You are the on-call foundation doctor and receive 5 tasks simultaneously from different wards. One patient has a dropping blood pressure, another needs a routine cannula, a third has a mildly elevated temperature, a fourth needs a prescription renewed, and a fifth has a blocked catheter. In what order should you prioritise?

• ARoutine cannula, elevated temperature, dropping blood pressure, blocked catheter, prescription renewal
• BDropping blood pressure, blocked catheter, elevated temperature, prescription renewal, routine cannula✓
• CPrescription renewal, dropping blood pressure, blocked catheter, elevated temperature, routine cannula
• DDropping blood pressure, elevated temperature, blocked catheter, routine cannula, prescription renewal

Answer: Dropping blood pressure is the most immediately life-threatening and must be seen first. A blocked catheter and an elevated temperature both need assessment next, while a prescription renewal and a routine cannula are non-urgent.

You overhear two nurses laughing about a patient's condition in a public corridor. What is the most appropriate response?

• AJoin in with the conversation there in the corridor in order to build up a bit of rapport within the team
• BApproach the nurses privately and explain why such discussions in public spaces are inappropriate✓
• CIgnore what you heard entirely, on the basis that it is not your place to comment on the behaviour of nurses
• DReport them immediately to the ward manager

Answer: Patient dignity and confidentiality apply in all settings. Addressing the behaviour privately and constructively is the most proportionate and professional response.

You are asked to complete a death certificate for a patient who died under your care. You are not entirely sure of the cause of death. What should you do?

• AWrite your best guess and sign the certificate quickly
• BConsult your senior and, if necessary, refer to the coroner✓
• CList every condition the patient had to cover all possibilities
• DLeave it blank and see if someone else fills it in

Answer: Death certificates must be completed accurately and honestly. If the cause of death is uncertain, consulting a senior and potentially referring to the coroner is the correct course of action.

A patient with dementia is unable to consent to a procedure. Their next of kin insists on refusing the procedure on their behalf, but you believe it is in the patient's best interests. What framework should guide your decision?

• AGo ahead with the procedure regardless of the family's wishes and without carrying out any formal assessment of their capacity
• BThe family's wishes override clinical judgement
• CDelay the procedure indefinitely so that any disagreement with the next of kin about the decision can be avoided altogether
• DApply the Mental Capacity Act and determine what is in the patient's best interests, involving appropriate parties✓

Answer: The Mental Capacity Act requires that decisions for patients lacking capacity are made in their best interests, taking family views into account but not treating them as binding.

During a consultation, your patient asks you what you personally think they should do about their lifestyle. You believe they should stop smoking. What is the most appropriate response?

• AStrongly insist that they stop smoking immediately and refuse to see them again in the clinic if they choose not to do so
• BProvide evidence-based information about the risks of smoking and support them in making an informed decision✓
• CRefuse to share any opinion at all with the patient, on the basis that giving a personal view is not part of your role
• DSimply agree with whatever lifestyle choice they say they prefer, purely in order to maintain the therapeutic relationship

Answer: Respecting patient autonomy while providing evidence-based information is central to good medical practice. The aim is to empower informed decision-making, not coerce or withhold guidance.

In a clinical audit, the infection rate on a ward is found to be 8%. The national benchmark is 3%. Which is the most appropriate next step?

• AInvestigate the causes of the higher infection rate and implement improvement measures✓
• BClose the ward immediately
• CDismiss the audit finding entirely on the grounds that the sample size may have been too small
• DReport every single member of staff on the ward to senior management for a disciplinary hearing

Answer: A clinical audit finding above benchmark requires investigation and quality improvement action. Immediate closure or blame without investigation is disproportionate.

A patient asks you, a medical student, to explain the results of a complex scan that you do not fully understand. What is the most appropriate response?

• AExplain that you will ask a qualified clinician to discuss the results with them✓
• BReassure the patient that everything on the scan looks fine so that they do not worry about it
• CTell the patient that the results are confidential and refuse to discuss them any further
• DGuess at an interpretation of the scan so that the patient is not left waiting for news

Answer: Acting within your competence is essential. Directing the patient to a qualified clinician ensures accurate information and patient safety, without false reassurance or guessing.

You notice a fellow student has not washed their hands between patients on a busy ward. What is the most appropriate immediate action?

• AIgnore it as it is not your responsibility
• BReport them straight to the consultant in front of the entire ward round team
• CPost about the poor hygiene standards on the ward on your own social media account
• DQuietly remind them about hand hygiene before they see the next patient✓

Answer: A discreet, prompt reminder addresses the infection-control risk directly while maintaining a respectful professional relationship. Ignoring it risks patient safety; public escalation is disproportionate as a first step.

A close friend asks you to access their relative's medical records through the hospital system to check on their condition. How appropriate is it to do so?

• AAppropriate as long as you tell nobody else in the hospital about what you have looked at in the system
• BInappropriate - accessing records without a legitimate clinical reason breaches confidentiality✓
• CAppropriate whenever the relative is seriously ill and the rest of the family are genuinely worried about them
• DVery appropriate, because a request from a close friend about their own family is a purely private matter

Answer: Accessing records without a legitimate care relationship breaches patient confidentiality and data protection rules, regardless of personal relationships or intent. It is inappropriate.

A GP refers a patient for a specialist opinion. The patient's symptoms have persisted for 3 months, worsening despite initial management. Choosing to refer is best described as:

• AA waste of NHS resources
• BAbandoning the patient
• CAn admission of failure
• DAppropriate escalation within the limits of your competence✓

Answer: Recognising the limits of your own competence and referring appropriately is a fundamental aspect of professional medical practice and patient safety.

You are a medical student on placement and are asked to consent a patient for a procedure you have not performed and don't fully understand. What should you do?

• ARefuse and inform your supervising doctor that you cannot consent for a procedure you don't understand✓
• BRead about the procedure quickly and then consent the patient
• CConsent the patient as directed
• DAsk the patient to sign the form and explain you will get the doctor to answer questions

Answer: Informed consent requires that the person obtaining consent fully understands the procedure and its risks. A medical student cannot ethically consent a patient for a procedure they don't understand.

You notice that your own tiredness may be affecting the care you provide. It is late in a long shift. What is the most appropriate action?

• ATake a short break if patient safety allows, and inform your senior that you are fatigued✓
• BContinue working and hope the shift ends soon
• CHand all your patients to a nurse and go home
• DPrescribe yourself stimulants from the hospital pharmacy

Answer: Healthcare professionals have a duty of care to patients and themselves. Disclosing fatigue to a senior and taking a break if possible is both safe and professionally appropriate.

A patient with capacity wants to self-discharge against medical advice. You believe leaving is dangerous for them. What is the correct course of action?

• AArrange for them to be sedated so that they become physically unable to leave the ward against medical advice tonight
• BPhysically prevent them from leaving the ward until a senior doctor has agreed that they may safely be discharged
• CCall the police and ask them to detain the patient on the ward until they have changed their mind about going home
• DEnsure they understand the risks, document their decision, and allow them to leave if they still wish to go✓

Answer: A competent patient has the right to self-discharge. The duty of care requires ensuring they are fully informed of the risks, documenting the decision, and respecting their autonomy.

A junior doctor is unsure whether a patient requires urgent investigation. What is the most appropriate course of action?

• ADiscuss the case with a senior colleague promptly✓
• BLook up similar cases online and act on the findings
• COrder every test available to be safe
• DDo nothing and review the patient in the morning

Answer: When uncertain, discussing with a senior is the safest, most appropriate course of action — it ensures the patient receives appropriate care while supporting the junior doctor's learning.

A clinical guideline recommends drug X for a condition. A patient asks for drug Y instead, which has less evidence. After discussion, they still prefer drug Y. What should the doctor do?

• APrescribe drug Y if the patient has capacity and is informed of the risks and evidence✓
• BRefuse to treat the patient any further because they are not complying with the clinical guidelines
• CAlways follow the clinical guideline regardless of what the patient tells you they would prefer
• DPrescribe drug Y without making any written record of the discussion in the patient's medical notes

Answer: Patient autonomy means an informed patient can choose a less evidence-supported option. The doctor should document the discussion and prescribe if there is no clinical contraindication.

During a ward round, a consultant gives an instruction you believe may be unsafe for a particular patient. What is the most appropriate action?

• APolitely raise your concern with the consultant and seek clarification✓
• BCarry out the instruction without comment to avoid conflict
• CRefuse to do anything and walk away
• DWait until after the round and tell another patient

Answer: Raising a concern respectfully and seeking clarification protects patient safety while respecting the team hierarchy. Staying silent risks harm; the other options are unprofessional or unhelpful.

A patient who has capacity refuses a recommended treatment after being fully informed of the risks. What is the most appropriate response?

• AAsk the family to override the decision
• BTell the patient they are being irresponsible
• CRespect the patient's decision and document it✓
• DAdminister the treatment anyway because it is in their best interest

Answer: A competent, fully informed adult has the right to refuse treatment. Respecting and clearly documenting that decision is the appropriate and lawful response; overriding it would breach autonomy.

You are asked to observe a procedure that involves a conscious patient who has not been informed you will be present. What should you do?

• ALeave the room without explaining why
• BObserve the whole procedure but stand out of the patient's line of sight so that they do not notice that you are there
• CObserve the whole procedure as you have been instructed, on the basis that your own clinical learning is important
• DAsk the supervising clinician to obtain the patient's consent for your presence before the procedure begins✓

Answer: Patients have the right to consent to who is present during their care. Ensuring consent is obtained before observation is the correct ethical approach.

'Palliative care focuses on improving quality of life for patients with life-limiting illness, rather than pursuing cure.' A patient with terminal cancer asks for all possible life-prolonging treatments, despite their consultant advising they are unlikely to help and may cause suffering. What is the most appropriate response?

• AExplore the patient's wishes and values, explain the likely benefits and burdens of treatment, and involve the palliative care team✓
• BAdminister all requested treatments immediately
• CRefuse all further treatment as it is futile
• DTransfer the patient to another doctor who agrees with their request

Answer: This scenario requires balancing patient autonomy with honest communication about the burdens of treatment. Involving palliative care and exploring the patient's values is the most holistic and appropriate approach.

You are running behind in a busy clinic and a patient becomes upset about the long wait. What is the most appropriate way to respond?

• AIgnore the complaint and call the next patient
• BApologise for the delay, acknowledge their frustration, and give a realistic update✓
• CTell them everyone is waiting and they must be patient
• DBlame the booking system and other staff

Answer: Acknowledging the patient's frustration, apologising, and offering a realistic update shows empathy and professionalism while managing expectations. Dismissing or deflecting damages the therapeutic relationship.