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This lesson contains 10 detailed SJT-style scenarios covering the full range of team dynamics and conflict themes from this course. Each scenario includes a realistic NHS healthcare context, four options with ratings, and detailed explanations of why each option is rated the way it is.
Work through these carefully. For maximum benefit, try to rate each option yourself before reading the analysis.
You are an FY1 on a medical ward. Your colleague, Dr Lewis (also an FY1), has been making errors recently — forgetting to order blood tests, missing tasks on the handover list, and looking visibly distressed. Today they nearly gave the wrong medication to a patient, but a nurse caught the error in time.
| Option | Your rating? |
|---|---|
| A: Report Dr Lewis to the clinical supervisor immediately for unsafe practice | |
| B: Speak to Dr Lewis privately, express your concern, and ask if they are OK | |
| C: Take over Dr Lewis's patients yourself to prevent further errors | |
| D: Say nothing because everyone makes mistakes |
| Option | Rating | Reasoning |
|---|---|---|
| A | Inappropriate, but not awful | While the errors are concerning, you have not yet spoken to Dr Lewis. A near-miss is serious, but the correct first step is direct communication. If the conversation reveals that Dr Lewis needs support, you can help them access it. If the behaviour continues, escalation becomes appropriate |
| B | Very appropriate | This is the correct first step. Dr Lewis appears to be struggling, and the empathetic approach may uncover a cause (personal problems, mental health, burnout) that can be addressed with support. This protects Dr Lewis and, through support, protects patients |
| C | Inappropriate | This is covering, not supporting. Taking over their patients hides the problem, does not help Dr Lewis, and is unsustainable. It also means you are managing twice the workload, increasing the risk of your own errors |
| D | Very inappropriate | A near-miss medication error is not just "everyone makes mistakes." Combined with a pattern of errors and visible distress, this requires action. Doing nothing allows the situation to deteriorate |
You are a medical student assisting on a ward round. The registrar is reviewing a patient and decides to increase the dose of warfarin. You recall from your pharmacology lectures that this patient's recent blood results showed an INR that was already above the therapeutic range. You mention this to the registrar, who says, "I have been doing this for years — I think I know how to manage warfarin."
| Option | Your rating? |
|---|---|
| A: Accept the registrar's expertise and say nothing more | |
| B: Persist respectfully: "I understand, but I am still concerned about the INR result. Could we check the most recent value before making the change?" | |
| C: Go to the consultant immediately to report the registrar | |
| D: Find the nurse and tell them not to administer the new dose |
| Option | Rating | Reasoning |
|---|---|---|
| A | Inappropriate | While the registrar is more experienced, an elevated INR combined with a warfarin increase is a direct patient safety risk. Deferring when you have specific safety information is not appropriate |
| B | Very appropriate | This uses the CUS technique — you are escalating from "concerned" to persisting. The request to check the INR is constructive and non-confrontational. Even if you are wrong, asking to verify is never inappropriate |
| C | Inappropriate, but not awful | Over-escalation. You have only raised the concern once and it was dismissed. Persist first (option B), then escalate if still dismissed |
| D | Inappropriate | Going around the registrar to the nurse undermines the team structure and creates confusion. It is also asking the nurse to make a clinical decision that is not theirs to make |
You are a third-year medical student working on a group presentation with four others. One member, Priya, insists on structuring the presentation her way, dismisses everyone else's suggestions, and has rewritten sections that other members had already completed.
| Option | Your rating? |
|---|---|
| A: Let Priya take charge because it is not worth the argument | |
| B: Speak to Priya privately and use DESC: describe the behaviour, explain the impact, suggest a fairer process, and outline the benefits | |
| C: Exclude Priya from the next meeting to get the work done without her interference | |
| D: Email the module tutor to complain about Priya |
| Option | Rating | Reasoning |
|---|---|---|
| A | Inappropriate | Allowing one person to dominate undermines the collaborative process and means the group does not benefit from diverse perspectives. It is also passive — you are not asserting the group's needs |
| B | Very appropriate | DESC is the ideal framework here. Describe: "You have rewritten sections others completed." Express: "The group feels their contributions are not valued." Specify: "Could we agree that changes to completed sections need group approval?" Consequences: "That way everyone feels ownership and we produce the best work" |
| C | Very inappropriate | Excluding a team member is unprofessional and does not resolve the conflict. It creates a worse dynamic and models poor teamwork |
| D | Inappropriate, but not awful | Escalation before direct communication is premature. If the DESC conversation fails, involving the tutor becomes appropriate |
You are an FY1 on a night shift. A nurse calls you about a patient with a temperature of 38.5°C. You assess the patient and want to take blood cultures and start antibiotics. Your FY1 colleague, who is also covering the ward, disagrees and says, "It is just a temperature — give paracetamol and review in the morning."
| Option | Your rating? |
|---|---|
| A: Follow your colleague's advice because they seem more confident | |
| B: Explain your reasoning: "I am concerned that this could be sepsis. The temperature with the patient's recent surgery makes me want to investigate now rather than wait. Could we discuss this, or should we call the registrar?" | |
| C: Call the registrar without discussing it further with your colleague | |
| D: Give paracetamol as suggested and plan to review in two hours |
| Option | Rating | Reasoning |
|---|---|---|
| A | Inappropriate | Confidence is not the same as correctness. Deference to a peer's confidence when you have a genuine clinical concern is passive and could endanger the patient |
| B | Very appropriate | You explain your specific concern (sepsis, post-surgical context), propose an action, and offer to involve a senior. This is assertive, clinical, and collaborative |
| C | Appropriate, but not ideal | Calling the registrar is reasonable given the potential severity, but you should first explain your reasoning to your colleague. Going over their head without discussion can damage the working relationship |
| D | Inappropriate, but not awful | Paracetamol is not wrong for the temperature, but if this is sepsis, delaying investigation by several hours could be life-threatening. The safest option is to investigate now |
During a teaching session on the ward, the consultant makes a sarcastic comment about a medical student's answer: "Well, that is the stupidest thing I have heard all week. Did you even open a textbook?" The student looks visibly upset. You are another medical student present.
| Option | Your rating? |
|---|---|
| A: Laugh with the rest of the group to defuse the tension | |
| B: Speak to the upset student afterwards to offer support, and consider raising the consultant's behaviour with your educational supervisor | |
| C: Challenge the consultant in the moment: "I do not think that comment was fair or helpful" | |
| D: Do nothing because the consultant is senior and this is normal |
| Option | Rating | Reasoning |
|---|---|---|
| A | Inappropriate | Laughing condones the behaviour and increases the humiliated student's distress |
| B | Very appropriate | Supporting the student is the immediate priority. Raising the behaviour with your educational supervisor is the appropriate channel — challenging a consultant in a group teaching setting is difficult and may not be productive |
| C | Appropriate, but not ideal | Challenging in the moment is brave and valid, but it may escalate the situation and the power imbalance makes it difficult for a medical student to do this effectively. If you do challenge, keep it factual: "That felt quite harsh — could we approach this differently?" |
| D | Inappropriate | Demeaning comments are not "normal" and should not be normalised. The GMC expects professional behaviour from all doctors, including consultants. This is a form of bullying |
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