Conflict Resolution Frameworks for SJT — The DESC Method and Assertive Communication

Having a structured approach to conflict resolution is one of the most powerful tools you can bring to the SJT. Rather than improvising an answer for each scenario, you can apply a proven framework that consistently produces the highest-rated responses.

This lesson covers the DESC method in detail, along with other frameworks and techniques that are directly applicable to SJT conflict scenarios.

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Why Frameworks Matter in the SJT

The SJT does not expect you to be a natural diplomat. It expects you to apply a systematic, professional approach to difficult situations. Using a framework ensures that:

Benefit	How it helps in the SJT
Consistency	You apply the same approach regardless of the scenario details
Structure	Your responses follow a logical sequence that markers recognise as best practice
Completeness	You do not miss critical steps (like addressing the impact on patients)
Professionalism	Frameworks prevent emotional, aggressive, or passive responses
Speed	In the real exam, you can quickly identify the best answer by matching it to the framework

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The DESC Method

DESC stands for Describe, Express, Specify, Consequences. It is a structured assertive communication framework used in healthcare for addressing interpersonal conflicts.

Step 1: Describe

What: Describe the specific behaviour or situation objectively, using facts rather than judgements.

Effective	Ineffective
"I have noticed that you have arrived 30 minutes late for the last three shifts"	"You are always late"
"During the ward round, the patient's pain was not addressed"	"You do not care about patients"
"The drug chart shows a dose of 500mg; the BNF recommends a maximum of 250mg"	"You prescribed the wrong dose"

Rules for Describe:

• Use specific facts: dates, times, quantities, observations
• Avoid generalisations ("always," "never," "everyone says")
• Describe the behaviour, not the person's character
• Be objective — describe what a camera would have recorded

Step 2: Express

What: Express the impact of the behaviour on you, the team, or patients. Use "I" statements.

Effective	Ineffective
"I am concerned because the patients are waiting longer for their morning reviews"	"You are making everyone's life difficult"
"I feel uncomfortable because I am managing the workload alone"	"You are lazy and selfish"
"I am worried about patient safety"	"You are going to kill someone"

Rules for Express:

• Use "I" language: "I feel," "I am concerned," "I am worried"
• Focus on the impact, not the intent
• Be honest about your feelings without being dramatic
• Connect the impact to patients or the team, not just to yourself

Step 3: Specify

What: Specify what you would like to change. Be clear and specific about the desired behaviour.

Effective	Ineffective
"Could you arrive by 8am so we can start the ward round together?"	"Just be better"
"Could we check the dose together before it is administered?"	"Do not prescribe things you do not know about"
"Could you take over the admission assessments this afternoon while I complete the discharge summaries?"	"Do more work"

Rules for Specify:

• Be specific and actionable
• Frame it as a request, not a demand
• Make it achievable
• Focus on future behaviour, not past failings

Step 4: Consequences

What: Explain the positive consequences of making the change (or, if necessary, the negative consequences of not changing).

Effective	Ineffective
"If we can start together, the patients will be reviewed sooner and we will both finish on time"	"If you do not change, I will report you" (as an opening gambit)
"If we check doses together, we will both feel more confident that the prescriptions are safe"	"If you keep doing this, you will get struck off"
"If we share the workload, the team will function better and patient care will improve"	"If you do not help, I will tell the consultant"

Rules for Consequences:

• Lead with positive consequences wherever possible
• Negative consequences should only be mentioned if the positive approach has already failed
• Keep consequences realistic and professional
• Focus on outcomes for patients and the team, not personal threats

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DESC in Practice: Full Worked Example

Scenario: A fellow FY1, Dr Ahmed, has been leaving the ward 30-45 minutes early for the past week. You have been staying late to finish tasks that should have been shared, and two patients had delayed medication administrations as a result.

Applying DESC:

Describe: "I have noticed that you have been leaving about 30-45 minutes before the shift ends over the past week."

Express: "I am finding it difficult because I am having to finish the remaining tasks alone, and there have been two occasions where patient medications were delayed."

Specify: "Could we agree to both stay until the end of the shift, or if you need to leave early, could we hand over the remaining tasks properly so nothing is missed?"

Consequences: "If we can do that, the patients will get their medications on time and neither of us will be overwhelmed at the end of the day."

Why This Works in the SJT

The DESC response above would score highly because:

• It is specific (30-45 minutes, two delayed medications)
• It is factual (no accusations about character or motivation)
• It uses "I" language (I am finding it difficult, I am having to)
• It focuses on patient impact (delayed medications)
• It proposes a constructive solution (agree to stay or hand over properly)
• It highlights positive consequences (patients get timely care, balanced workload)

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Other Conflict Resolution Frameworks

The LEAPS Model

LEAPS is used in conflict de-escalation, particularly useful when someone is upset or angry.