Communication Within Teams — Assertive, Aggressive, and Passive Styles

Effective communication is the foundation of safe patient care. When healthcare teams communicate poorly, errors occur, concerns go unheard, and patients suffer. The UCAT SJT tests your understanding of how to communicate — not just what to say.

This lesson covers the three main communication styles (assertive, aggressive, and passive), explains why assertive communication is almost always the correct SJT answer, and provides frameworks you can apply to any team scenario.

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Why Communication Style Matters in the SJT

The SJT does not just ask "what is the right thing to do?" It asks "how would you do it?" Two candidates might both know that a concern should be raised, but one might describe doing so aggressively (shouting at a colleague) while the other describes doing so assertively (speaking calmly and clearly). The assertive approach will always score higher.

Communication style	How the SJT rates it
Assertive	Almost always appropriate — clear, respectful, professional
Aggressive	Almost always inappropriate — confrontational, undermining, damaging
Passive	Usually inappropriate — avoids the issue, fails to protect patients

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The Three Communication Styles

1. Passive Communication

A passive communicator avoids conflict, does not express their needs or concerns, and defers to others even when they disagree.

Characteristic	Example in healthcare
Avoids eye contact	Looking at the floor when asked a question in a ward round
Speaks quietly or hesitantly	Mumbling a concern that nobody hears
Agrees with others to avoid conflict	Saying "yes, that sounds fine" when you believe the plan is wrong
Does not raise concerns	Noticing a prescribing error but saying nothing because the prescriber is senior
Apologises excessively	"Sorry, I might be wrong, but maybe, possibly, the dose could be, I do not know, slightly high?"

Why passive communication is problematic in healthcare:

• Patient safety concerns go unraised
• Errors are not caught or corrected
• The passive person becomes resentful and disengaged
• The team loses a valuable perspective
• Patients may not receive the care they need

SJT implication: Passive responses like "say nothing," "hope someone else notices," or "wait to see if the problem resolves itself" are almost always rated as inappropriate or very inappropriate when patient safety or professional standards are involved.

2. Aggressive Communication

An aggressive communicator expresses their views forcefully, often at the expense of others. They may shout, blame, interrupt, or belittle.

Characteristic	Example in healthcare
Raised voice or hostile tone	Shouting at a nurse in front of patients
Blaming language	"You are incompetent — this is your fault"
Interrupting others	Cutting off a colleague mid-sentence during a handover
Public humiliation	Criticising a junior doctor in front of the whole team
Threatening behaviour	"If you do not do this, I will report you" (as a first response)
Dismissive of others' input	"I do not care what physiotherapy thinks — I am the doctor"

Why aggressive communication is problematic in healthcare:

• It creates a culture of fear where people are afraid to speak up
• It damages team cohesion and morale
• It is a form of bullying that can lead to disciplinary action
• It models unprofessional behaviour for trainees
• It can directly harm patients if staff are too intimidated to raise concerns

SJT implication: Aggressive responses like "confront the colleague loudly," "demand an explanation in front of the team," or "shout at the person responsible" are almost always rated as very inappropriate.

3. Assertive Communication

An assertive communicator expresses their views clearly, confidently, and respectfully. They advocate for themselves, their patients, and their colleagues without being aggressive or passive.

Characteristic	Example in healthcare
Clear, calm speech	"I have a concern about this patient's medication that I would like to discuss"
Respectful but direct	"I understand your perspective, but I believe the dose needs reviewing"
Uses "I" statements	"I am worried about this patient" rather than "You are doing it wrong"
Active listening	Hearing the other person's view before responding
Appropriate body language	Good eye contact, open posture, professional tone
Acknowledges others' expertise	"I value your experience, and I want to share what I have observed"
Focuses on facts, not personalities	"The blood results show..." rather than "You clearly missed..."

Why assertive communication is the gold standard in healthcare:

• Concerns are raised clearly and heard
• Colleagues feel respected, even when challenged
• Patient safety is protected without damaging relationships
• It models professional behaviour for the whole team
• It is the communication style taught in medical education and expected by the GMC

SJT implication: Assertive responses are almost always rated as very appropriate or appropriate, but not ideal. They are the default correct answer whenever communication is involved.

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Comparing the Three Styles in Practice

Scenario: You notice a colleague has prescribed the wrong dose of a medication

Style	Response	SJT rating
Passive	Say nothing and hope the pharmacist catches it	Very inappropriate
Aggressive	"You have made a dangerous error — what is wrong with you?" (said loudly in front of others)	Very inappropriate
Assertive	"I have noticed the dose on this prescription and I am not sure it is correct. Could we check it together?"	Very appropriate

Scenario: A senior colleague dismisses your concern about a deteriorating patient