Worked Examples: Colleague Impairment (Fatigue, Substance, Illness)

One of the most challenging scenario types in the UCAT SJT involves a colleague who may be impaired — whether through fatigue, substance use, or illness. These scenarios are difficult because they create a tension between loyalty to a colleague and duty to patients. The SJT consistently rewards candidates who prioritise patient safety while handling the situation with compassion.

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Why Colleague Impairment Matters

An impaired healthcare professional is a patient safety risk. The GMC is clear:

"If you have concerns that a colleague may not be fit to practise... you must take steps to protect patients."

This applies equally to medical students observing impaired colleagues. You have a professional duty to act, even if the colleague is senior to you.

Types of Impairment

Type	Signs	Risk Level
Fatigue	Yawning, difficulty concentrating, errors in routine tasks, irritability	Moderate to High — fatigue impairs judgement and reaction time
Substance use	Smell of alcohol, slurred speech, unsteady gait, dilated/constricted pupils, erratic behaviour	High — substance impairment severely compromises patient safety
Physical illness	Coughing, vomiting, fever, visible infection, reduced mobility	Variable — depends on role and severity; infection risk to immunocompromised patients
Mental health	Tearfulness, withdrawal, inability to concentrate, expressions of hopelessness	Variable — depends on severity and impact on clinical performance

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The Key Tension: Colleague vs Patient

SJT scenarios involving impaired colleagues deliberately create a conflict:

• On one hand: You care about your colleague, you do not want to get them in trouble, you recognise the pressures they are under
• On the other hand: Patients depend on competent, alert professionals for their safety

The SJT resolution is always the same: patient safety comes first, but handle the situation with compassion and professionalism.

This means:

• You DO raise the concern
• You DO NOT ignore it out of loyalty
• You DO approach the colleague first if safe to do so
• You DO escalate if they refuse to step back
• You DO NOT gossip about the colleague to others

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Worked Example 1: The Exhausted FY1

Scenario:

You are a medical student on a busy surgical ward. It is 7pm and the FY1, Dr Patel, has been on duty since 7am. She tells you she stayed up all night studying for an exam and did not sleep before her shift. You notice she has been staring at the same drug chart for five minutes and appears to be struggling to focus. She is responsible for the evening drug round.

Applying the SAFE Framework:

S — Spot the Risk: Dr Patel is severely fatigued (24+ hours without sleep) and is about to perform a drug round — a safety-critical task. Fatigue at this level impairs cognitive function comparable to a blood alcohol level of 0.10%, well above the legal driving limit. This is a significant patient safety risk.

A — Act Appropriately: Approach Dr Patel privately and with empathy. Express concern for her wellbeing as well as patient safety.

F — Follow the Right Path:

1. Speak to Dr Patel privately: "I can see you're really struggling. I'm worried about you, and I'm worried about the drug round. Is there someone who could help or cover for you?"
2. If Dr Patel acknowledges the problem and seeks help, support her in doing so.
3. If Dr Patel insists she is fine and continues, escalate to the registrar or the nurse in charge: "I'm concerned about Dr Patel — she hasn't slept in over 24 hours and is about to do the drug round. I think she might need some support."
4. If nobody is available to take over, alert the on-call team or the site coordinator.

E — Ensure Follow-Up:

• Check that someone has taken over the drug round or is supervising Dr Patel
• This situation may highlight a working pattern issue — excessively long shifts or inadequate rest facilities
• Consider whether the Guardian of Safe Working Hours should be informed

SJT Question — Rate the Appropriateness:

Action	Rating	Reasoning
Speak to Dr Patel privately about your concerns	Very Appropriate	Compassionate, direct, gives her the opportunity to act
Inform the registrar that Dr Patel appears too fatigued to safely conduct the drug round	Appropriate	Correct escalation if Dr Patel does not acknowledge the issue
Offer to do the drug round yourself to help Dr Patel	Very Inappropriate	You are a medical student — you are not qualified to conduct a drug round
Say nothing because Dr Patel is a qualified doctor who can assess her own fitness	Inappropriate	Fatigue impairs self-assessment; you have a duty to raise safety concerns

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Worked Example 2: Suspected Alcohol Use

Scenario:

You arrive at the hospital for a morning teaching session. In the doctors' mess, you encounter Dr Khan, a registrar on your team, who is about to start his shift. You notice he smells strongly of alcohol. His speech seems slightly slurred. He says, "Rough night — I'll be fine once I've had a coffee."

Applying the SAFE Framework:

S — Spot the Risk: A doctor who smells of alcohol and has slurred speech is potentially intoxicated. They are about to start a clinical shift where they will be making diagnostic and prescribing decisions. This is a serious and immediate patient safety risk.

A — Act Appropriately: This is more serious than fatigue because:

1. The impairment may be more severe
2. Working while intoxicated is a fitness to practise issue
3. There is no "just push through it" option — alcohol impairment does not resolve with coffee

You cannot simply talk to Dr Khan and hope for the best.

F — Follow the Right Path:

1. You MAY choose to speak to Dr Khan: "I'm concerned about you starting your shift — I can smell alcohol and your speech seems different. I really think you should speak to someone before you start seeing patients."
2. Regardless of Dr Khan's response, you MUST escalate this to a senior colleague — the consultant on the team, the clinical director, or the duty manager. This is not optional.
3. If you feel unable to approach Dr Khan directly (which is understandable — he is senior to you), go straight to escalation.

E — Ensure Follow-Up:

• Dr Khan should not start his clinical shift until assessed
• The hospital will have procedures for managing fitness to practise concerns
• This is not about punishment — it is about ensuring patient safety AND getting Dr Khan the support he may need

SJT Question — Rate the Appropriateness: