Situational Judgement Test

- Practice Paper -

Instructions:
o This paper is designed to take 140 minutes.
o In Part One (Q1-47), rank in order the five responses to the situation. Marks
are available for near-misses. There can be no tied ranks, i.e. you should not
use the same rank more than once.
o In Part Two (Q48-70), choose THREE from eight possible responses, which
address the situation when done together. You must only select three
options.
o Answer what you should do as a Foundation Year One (FY1) doctor.
o You may sometimes feel you would like more information before answering,
but please answer each question based only on the information provided.

Please note:
o There is no negative marking. You should therefore attempt all questions.
o A glossary is provided. The glossary terms are marked with an asterisk (*) the
first time they appear in the question.
o The corresponding question paper without the answers and rationales is
available for download from the UKFPO website if you would like to practice
as if you are completing the live test.

© MSC Assessment 2017

 Glossary

Acute An Acute Admissions Unit (AAU), or Acute Assessment Unit

Admissions (AAU), or Medical Assessment Unit (MAU) is a short-stay
Unit ward that may be located within the emergency department,
although a separate department. The AAU acts as a gateway
between a patient's general practitioner (GP*) and the
emergency department, and the wards of the hospital.
Bleep/bleeped A simple electronic device used to alert a doctor in a hospital
that they should ring the displayed phone number as
someone is trying to contact them; usually about a patient or
a task that requires their attention.
British Medical The British Medical Association (BMA) is a professional
Association association and trade union for doctors working in the UK.
British National The British National Formulary (BNF) is a widely available
Formulary reference book that is used extensively in the UK and
contains information and advice on prescribing and
pharmacology, as well as details about many medicines
available on the NHS.
Care Quality An organisation with responsibility to inspect and assess
Commission (CQC) whether healthcare providers are meeting expected
standards.
Chronic Obstructive The term for a collection of lung diseases characterised by
Pulmonary Disease chronic obstruction of lung airflow that interferes with normal
(COPD) breathing.
Clinical The professional responsible for teaching and supervising
supervisor Foundation doctors. Each Foundation doctor will have at
least one named clinical supervisor.

A clinical supervisor is responsible for: supervising day to

day clinical and professional practice; supporting the
assessment process; ensuring the appropriate range and
mix of clinical exposures; and arranging a work programme
to enable attendance at fixed educational sessions.
Critical/clinical incident A form completed to alert the patient safety team of an
form incident in which harm was done or could potentially have
been done to a patient /staff member.

© MSC Assessment 2017

 Glossary (cont…)

CT Computerised Tomography (CT) is a method of medical

imaging.
Do Not Attempt Do Not Attempt Resuscitation (DNAR) is a legal order that is
Resuscitation placed in the medical notes and states that cardiopulmonary
resuscitation/advanced cardiac life support should not be
performed if the patient’s heart and/or breathing were to
stop.
Educational supervisor The professional responsible for making sure Foundation
doctors receive appropriate training and experience. The
educational supervisor is involved in teaching and training,
and should assist in professional and personal development.
Each Foundation doctor will have a named educational
supervisor for each placement.

The educational supervisor is responsible for: undertaking

regular formative appraisal; providing support in the
development of the learning portfolio*; ensuring
understanding and engagement in assessment; being the
first point of call for concerns/issues about training; and
ensuring appropriate training opportunities are available for
learning and gaining competences.
Exercise tolerance Refers to the maximal exercise capacity of an individual. This
can be measured by the peak workload achieved during
exercise or their ability to endure prolonged exercise.
Falls clinic A specialist clinic to review patient at risk of falls or following
falls.
Four-hour target A target in the emergency department to see, treat, and
admit or discharge patients in under four hours.
Foundation The Foundation Programme Director is responsible for the
Programme Director management and quality control of the foundation
programme together, ensuring that a group of foundation
doctors have the appropriate supervision and training.
Foundation teaching Regular mandatory teaching sessions are provided for
sessions foundation doctors. Sufficient attendance at these sessions
is required to complete the Foundation Programme.

© MSC Assessment 2017

 Glossary (cont…)

General Medical Every doctor practising in the UK must be registered with the
Council General Medical Council (GMC). It is the principal regulatory
body and aims to protect the wellbeing of all patients by
ensuring proper standards in medical practice.
GP A General Practitioner (GP) is a primary care physician or
community based family doctor.
Healthcare Assistant A Healthcare Assistant (HCA) supports nurses with the day-
to-day care of patients. They are generally not qualified to
provide the same level of medical care that nurses are.
Hospital’s Rota Co- A hospital’s rota co-ordinator is an individual responsible for
ordinator maintaining the daily medical rotas for FY1 and FY2 doctors.
Human Resources Human Resources (HR) is the department within a hospital
(HR) that is responsible for the administration and management of
personnel, including recruitment.
ICU Intensive Care Unit (ICU), or Critical Care Unit (CCU) or
Intensive Therapy Unit (ITU) is the specialist ward where
high level monitoring and treatment is provided to unstable or
critically unwell patients.
Infection Control Infection Control is the practice of clinical microbiology,
which is principally concerned with the prevention and
management of hospital-acquired infections.
Information The team responsible for the management of information at
governance team an organisational level.
Information technology The department responsible for all computer processes and
(IT) department communications within an organisation.
Intensive Care Team The team of medical professionals who work in the Intensive
Care Unit (ICU*) of a hospital.
Junior Specialty A junior doctor undergoing training within a certain specialty
Trainee (also see Specialty Trainee*).
Learning portfolio A learning portfolio is an electronic means of recording
learning experience and achievements. It is designed to help
foundation doctors plan and manage their time, in order to
maximise their learning. It also acts as evidence of
achievement and is underpinned by the Foundation
Programme Curriculum.

© MSC Assessment 2017

 Glossary (cont…)

Locum A locum is a doctor who temporarily fulfils the duties of

another doctor if, for example, a regular doctor is absent or if
the hospital is short-staffed.
Medical Assessment See Acute Admissions Unit*
Unit
Medical Admissions See Acute Admissions Unit*
Unit
Medical Defence Medical defence organisations are mutual indemnity
Organisation organisations that provide 24-hour access to medico-legal
advice and support in clinical issues. They also provide
indemnity and legal representation if required.
Medical Director The most senior medical person in an organisation
responsible for medical leadership and delivery of medical
care.
Medical Emergency A team of medical practitioners called to see patients who
Team are either at risk or in cardiac or respiratory arrest.
Medical Staffing Medical staffing is a specialist division of the Human
Resources department (HR*) that is responsible for providing
operational human resources service specifically to medical
personnel.
Multidisciplinary team Multidisciplinary teams (MDTs) consist of a variety of medical
specialists and allied medical staff. MDT meetings are often
arranged to discuss and plan complex aspects of patient
treatment and to formulate safe discharge plans.
MRI Magnetic resonance imaging (MRI) is a method of medical
imaging.
MRSA Methicillin-resistant Staphylococcus Aureus (MRSA) is a
bacterium with antibiotic resistance and is therefore difficult
to treat. It is a cause of significant morbidity and mortality.
Newborn Physical A newborn physical examination is an examination that is
Examination conducted on a newborn baby to check for problems or
abnormalities within 72 hours of birth and again between six
and eight weeks. It includes a general all over physical
check, as well as specific screening elements which involve
examination of the baby’s eyes, heart, hips and testes.

© MSC Assessment 2017

 Glossary (cont…)

Occupational The Occupational Health (OH) department in a hospital is

Health responsible for protecting and promoting the safety, health
and welfare of employees.
Occupational Therapy Occupational therapy/therapists aim to rehabilitate patients
and promote independent function in all aspects of daily life.
Patient Advice and A service that offers confidential advice, support and
Liaison Service information on health-related matters. It provides a point of
(PALS) contact for patients, their families and their carers.
Performance appraisal Performance appraisals occur at regular intervals throughout
the FY1 year. They are designed to be a positive process;
providing structured and constructive feedback on
performance, as well as monitoring progress and identifying
development needs.
Phlebotomist A healthcare professional who is trained to take blood from a
patient for clinical tests in a safe and sanitary manner.
Specialty trainee Middle grade doctor below the level of consultant.
Switchboard The central communication hub of a hospital which co-
ordinates internal and external telephone enquiries.
Ward clerk A ward clerk is an individual who provides general
administrative, clerical and support services for wards, units
and departments within a hospital.
Workplace based Regular workplace based assessments are undertaken and
assessment documented throughout the Foundation Year One (FY1).
These assessments provide evidence of achievements and
the opportunity for any problems to be identified. A number
of these assessments must be completed to a satisfactory
level in order to progress beyond the FY1 year.

© MSC Assessment 2017

 Part One
1. Your consultant Dr Jackson has asked you to prescribe a second antibiotic for a patient who
has a chest infection which has been slow to respond to initial treatment. Later that day, a
pharmacist informs you that the new antibiotic is not in the hospital formulary. She tells you
that the new antibiotic should not be used because of the risk of clostridium difficile infection.

Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).

A. Prescribe what the pharmacist advises

B. Explain that Dr Jackson requested the antibiotic and he would be the best person to speak
to about the prescription
C. Agree to contact Dr Jackson to discuss the prescription
D. Ask your specialty trainee* to review the patient to enable an informed decision
E. Do not change the prescription and make a record in the notes of the pharmacist’s
concerns

Answer: CBDAE

Rationale: This question assesses your professionalism and how to manage your working
relationships. The most appropriate action to take would be to contact your consultant (C). As Dr
Jackson, your consultant, made the decision about the antibiotics, it is courteous and also in the
patient’s best interest to inform him of the pharmacist’s advice. It is preferable for you to contact
your consultant yourself (C) rather than expect the pharmacist to have to repeat the same
information to multiple members of the same team (B). The next most appropriate action would be
to ask a registrar/specialty trainee, who has more experience, to review the patient (D) as there
may be complexities surrounding the patient of which you and the pharmacist are not aware. A
review by a senior doctor may enable a more robust clinical decision. Option A suggests that you
do what the pharmacist recommends without further discussion with her, your consultant or any
other member of your team. It is Dr Jackson’s team (of which you are part) who are directly
responsible for the patient’s care and there needs to be clear communication about changes to the
management plan (A). Option E is not addressing the problem (E).

Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5

C 4 3 2 1 0

B 3 4 3 2 1

D 2 3 4 3 2

A 1 2 3 4 3

E 0 1 2 3 4

© MSC Assessment 2017

2. On the morning ward round, your specialty trainee* said that Mrs Anderson is medically fit
following her total knee replacement and could be discharged if Occupational Therapy* feel it
is appropriate. The occupational therapist has assessed Mrs Anderson and believes it is safe
for her to go home with a care package that has been arranged. It is now 4pm and the nurse
informs you that Mrs Anderson is demanding to see a doctor as she does not feel that she is
ready to go home yet. An elective admission is waiting in the day room for Mrs Anderson's
bed.

Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).

A. Ask Mrs Anderson about her concerns

B. Ask a senior colleague to speak with Mrs Anderson
C. Ask the bed manager if he can find another bed for the elective patient
D. Explain to Mrs Anderson that the bed has already been allocated and she has to go home
E. Ask the occupational therapist to come and speak to Mrs Anderson with you

Answer: AEBCD

Rationale: This question looks at your ability to cope with pressure but also maintain a patient
focus Your primary duty is to alleviate the concerns that Mrs Anderson has in relation to her
discharge and reassure her that it is safe for her to go home (A). Understanding her concerns will
be the first step to reassuring her that it is indeed safe for her to go home. The occupational
therapist is likely to have a greater experience in dealing with questions raised by patients who
have anxieties over the safety of discharge once it has been clarified that the patient is medically
fit for discharge (E), although your senior staff may be able to assist you in dealing with Mrs
Anderson’s concerns (B). Keeping her in hospital without addressing her issues may actually
increase the risk to Mrs Anderson of suffering a hospital acquired infection and is an inefficient use
of hospital resources (C). Whilst not your highest priority, you should always be aware of how
patients are being allocated to beds and if it is clear there could be a delay in discharging Mrs
Anderson, it would be appropriate to ask the bed manager to find a different bed for the elective
patient. Trying to coerce Mrs Anderson to go home by suggesting that she is depriving another
patient of a hospital bed is inappropriate as Mrs Anderson’s concerns remain central to the
management of this situation (D).

Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5
A 4 3 2 1 0

E 3 4 3 2 1

B 2 3 4 3 2

C 1 2 3 4 3

D 0 1 2 3 4

© MSC Assessment 2017

 3. You are working on a busy paediatric ward. Your shift was meant to finish at 7pm, but it is
now 9pm on a Friday, and you are still trying to complete some of your routine tasks from
the day. This has happened on a number of occasions in the last month and you feel
exhausted as a result. Your workload is also having a negative impact on your social life.

Rank in order the importance of the following considerations in the management of this
situation (1= Most important; 5= Least important).

A. The impact on your own wellbeing if you are not able to take time to rest
B. The risk to patient safety if working whilst tired
C. Your right to finish at the designated time
D. That your consultant may give you a poor reference if you are not completing your tasks
E. That you are repeatedly disappointing your friends by not attending social events with them

Answer: BACDE

Rationale: This scenario is about maintaining a good work life balance to work effectively and
provide good patient care. As a doctor, the care of the patient is your main concern (B). Your own
health has to be looked after in order to provide good patient care (A). Finishing on time is
suggestive of an appropriate and achievable workload and indicates good work life balance (C).
Getting a poor reference may be important personally but it should have no direct or immediate
impact on patient care (D). Disappointing your friends will be the least important consideration in
these options as it does not affect the level of patient care and should not influence your decisions
on the ward (E).

Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5

B 4 3 2 1 0

A 3 4 3 2 1

C 2 3 4 3 2

D 1 2 3 4 3

E 0 1 2 3 4

© MSC Assessment 2017

 4. You are working on the Surgical ward and you are about to attend theatre to observe your
consultant undertake a complicated procedure. This will be a good learning opportunity for
you and you anticipate being in theatre for about two hours. As you are about to leave the
ward, one of the nurses tells you that a patient needs to have her medication reviewed prior
to receiving her next dose in three hours’ time. He tells you that he believes one of the
other FY1 doctors has been making prescription errors. You also notice one of the patients
on the ward beckon you over to his bed urgently. You know from experience that the
patient often just wants to have someone to talk to as he gets lonely.

Rank the order in which the following tasks should be undertaken (1= Do first; 5= Do last).

A. Review the patient’s dose, as requested by the nurse

B. Respond to the patient’s immediate question or query
C. Attend the theatre to observe the procedure
D. Take steps to investigate the nurse’s allegations about prescription errors further
E. Spend more time with the patient if he wants someone to talk to

Answer: ABCDE

Rationale: Preventing a potential medication error and ensuing patient harm should be the
absolute first priority (A). The patient beckoning you may have a very valid and important question
and therefore this should be acknowledged as a priority (B). Attending theatre is a good learning
opportunity which will help you deliver better patient care (C). Ensuring that the nurse’s concerns
about errors are addressed is very important, but not immediate (D). Spending time with a patient
is desirable but can be done by others if necessary – you will need to draw it to the attention of
another member of staff (E).

Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5

A 4 3 2 1 0

B 3 4 3 2 1

C 2 3 4 3 2

D 1 2 3 4 3

E 0 1 2 3 4

© MSC Assessment 2017

5. It is 6pm and you are clerking a patient who is to undergo an elective splenectomy the next
morning. Before he left, your consultant asked you to prescribe the antibiotics and
immunisations that need to be given that evening so that surgery can proceed tomorrow. You
now cannot find the folder containing the pre-operative protocols and it is not available on the
intranet. Your consultant has already gone home.
Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).

A. Seek advice from the on-call microbiologist

B. Look in the British National Formulary* and prescribe what is suggested
C. Refer to national guidance for pre-operative protocols
D. Ask the nurse in charge of the ward what is normally given
E. Seek advice from the surgical specialty trainee*

Answer: EABDC

Rationale: This question is assessing your ability to safely and responsibly clarify important
clinical information and select how and where to get help. In this scenario, the antibiotics and
immunisations clearly need to be administered that evening. The most logical person to contact
would be a senior member of your own team who is also responsible for the patient and who
would be likely to have knowledge and experience of prescribing these antibiotics in that hospital
and for that consultant (E). The second most appropriate thing to do would be to contact the on-
call microbiologist (A). Whilst they will certainly know which antibiotics are required and also be
aware of local hospital policy, they should not be the first point of contact for routine non-
emergency queries. The third most appropriate option is to look in the BNF and prescribe what is
suggested (B).This is less preferable than Option A as the BNF does not take into account local
policy and preferences. This behaviour would however be considered safe and appropriate (A).
The next correct option is to consult with the nurse in charge on the ward (D). Whilst the nurse in
charge may well be very knowledgeable and experienced, it is not appropriate to prescribe any
medication purely on the advice of a nurse without consulting further with a senior medical
colleague or confirming the dose etc in the BNF. National guidelines would be the last place to get
information in this situation (C). Local guidelines are based on the national ones but they will
include information specific to local circumstances. It is always best to use what has been locally
agreed first but as a last resort, the national guidelines may be helpful.
Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5

E 4 3 2 1 0

A 3 4 3 2 1

B 2 3 4 3 2

D 1 2 3 4 3

C 0 1 2 3 4

© MSC Assessment 2017

 6. You are looking after Mr Kucera who has previously been treated for prostate carcinoma.
Preliminary investigations are strongly suggestive of a recurrence. As you finish taking blood
from a neighbouring patient, Mr Kucera leans across and says “tell me honestly, is my cancer
back?”

Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).

A. Explain to Mr Kucera that it is likely that his cancer has come back
B. Reassure Mr Kucera that he will be fine
C. Explain to Mr Kucera that you do not have all the test results, but you will speak to him as
soon as you do
D. Inform Mr Kucera that you will chase up the results of his tests and ask one of your senior
colleagues to discuss them with him
E. Invite Mr Kucera to join you and a senior nurse in a quiet room, get a colleague to hold your
‘bleep’*, then explore his fears

Answer: DCEAB

Rationale: This question places you in a challenging situation and explores your communication
skills. It is not an FY1’s responsibility to break bad news to a patient in this context with incomplete
information as the full results are not available yet. It would be most appropriate for a senior
colleague to speak to Mr Kucera with regards to his diagnosis (D). Informing Mr Kucera that you will
speak to him as soon as you get the test results back would still be appropriate as you are giving
him some information, although this may not necessarily mean that you would be providing him with
the diagnosis (C). It may be appropriate to discuss Mr Kucera’s fears with him, but by doing this you
may not be attending to other ill patients and are asking a colleague to take on your responsibility by
holding your bleep (E). It may also become a difficult conversation when you do not have full details
of the results. It would not necessarily be appropriate to tell Mr Kucera that his cancer is back as this
has not been confirmed (A), however it would be inappropriate to provide false hope to a patient
when preliminary investigations are strongly suggestive of a recurrence (B).

Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5

D 4 3 2 1 0

C 3 4 3 2 1

E 2 3 4 3 2

A 1 2 3 4 3

B 0 1 2 3 4

© MSC Assessment 2017

 7. At your morning handover/briefing you are reminded by Infection Control* that all hospital
staff should wear shirts with short sleeves. When wearing long sleeves, they must be rolled
up and secured, particularly when having clinical interaction with patients. During your shift,
you notice that your FY1 colleague always has her long sleeves down.

Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).

A. Tell Infection Control that your colleague is not complying with their policy
B. Speak directly to your FY1 colleague about your observation
C. Raise your observation with the nurse in charge of the ward
D. Do not say anything immediately but monitor the situation over the course of the next
few days
E. Discuss the situation with your specialty trainee*

Answer: BCEDA

Rationale: This question is looking at your communication with team members and patient focus.
All doctors have a duty to raise concerns where they believe that patient safety is being
compromised by the practice of colleagues. However, doctors strive to provide the best care
possible to their patients and this situation may have arisen out of some misunderstanding. It is
best therefore to speak directly to your colleague to explore the issue (B). Infection control is not
just the responsibility of doctors but the whole team of staff and indeed the organisation. The
nurse in charge of the ward although not a direct line manager will have a key role in ensuring
standards are met and so would be a sensible person to alert (C). Your specialty trainee may be
able to help address this situation, though this option is less likely to explain directly the reason for
your colleague keeping her sleeves down (E). Monitoring the situation (D) is less appropriate as it
does not immediately address the problem. However, it is more appropriate than involving
Infection Control at this stage (A) as this would risk damaging your professional relationship with
your colleague and does not explore the cause of the problem.

Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5

B 4 3 2 1 0

C 3 4 3 2 1

E 2 3 4 3 2

D 1 2 3 4 3

A 0 1 2 3 4

© MSC Assessment 2017

 8. You recently discharged two patients from your ward with similar names, who had
undergone similar procedures. Arrangements have been made for both patients to receive
follow up care in the community. When checking the patient records, you realise that you
mixed up their discharge letters and sent each letter to the wrong patient. This means that
each patient will receive the other patient’s treatment advice.

Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).

A. Inform the consultant of the mix up

B. Seek advice from an FY1 colleague about what you should do
C. Adjust the original letters in the patients’ records
D. Trust that health care professionals providing follow up care in the community will correct
the error, apologising to the patients for the mistake
E. Contact both patients to explain that there was a mix up

Answer: EABCD

Rationale: Although the patients have had similar procedures, we can be sure that they are very
different individuals. Their subsequent need for information and management may be very
different. The mix up with the letters causes two significant problems – the potential for the
occurrence of inappropriate clinical management based upon inappropriate information, and a
breach of the professional responsibilities regarding patient confidentiality. Management of the
former requires some urgency. The latter requires an apology to both patients. Only answers A
and E address both of these problems. Choosing Option (E) makes inappropriate clinical
intervention less likely to happen. Then the consultant must also be informed of the mix up (A).
The other three options fail to address the primary concerns. Seeking advice from a peer is an
appropriate thing to do (B), but a more senior team member would be more appropriate. It would
be appropriate to enter information that there had been an error into the case notes and indicate
that the specified information did not relate to this patient (C). However, alteration of the case
notes with the intention or effect of covering up an error, e.g. removing evidence, would be an
extremely inappropriate and unprofessional act. Option (D) does not address the situation or put
safe patient care foremost and is an inappropriate act.

Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5

E 4 3 2 1 0

A 3 4 3 2 1

B 2 3 4 3 2

C 1 2 3 4 3

D 0 1 2 3 4

© MSC Assessment 2017

 9. You are working on a surgical ward and are on your way to check the discharge of a post-
operative patient, Joan, who is due to be transferred to a rehabilitation hospital. You have
been advised by the ward manager that Joan’s bed is needed urgently for a newly arrived
patient. When you arrive at Joan’s cubicle, her daughter, Allie, tells you that her mother has
been complaining about her chest and is struggling with a cough. You review the
observation chart and listen to Joan’s chest, which does not indicate a problem. Allie insists
that her mother has a chest infection and should not be discharged.

Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).

A. Ask the ward nurse to inform the rehabilitation hospital that Joan’s condition needs
assessing on arrival
B. Inform Allie that she should insist on a further review of Joan’s condition when she arrives
at the rehabilitation hospital
C. Advise Allie that you will delay the transfer in order to consult with a senior member of your
team
D. Advise Allie of the urgent need to discharge her mother to create space on the ward
E. Contact the rehabilitation hospital and write detailed notes outlining Joan’s symptoms and
possible investigations to send with her

Answer: CEABD

Rationale: This scenario is about understanding roles and responsibility, communication skills and
understanding of the wider teams in the NHS. As an FY1 the roles and responsibilities include
decision making with assistance. The FY1 should seek an opinion of a senior colleague, if not a
consultant, when there is uncertainty whether the patient’s situation has changed and the family is
involved. The FY1 should inform the patient/daughter of a possible delay while the team decides
on a plan (C). Ensuring that there is good handover and communication to enable the
rehabilitation hospital to conduct possible investigations is also appropriate but it defers the
responsibility to the rehabilitation hospital (E). Involving the nursing team at both the discharging
and admitting hospital is next in being appropriate (A). Counselling the daughter that the hospital
will have been informed already and that they could expect an early review of the patient is a fair
point (B). Option (D) is the least appropriate as it does not address the patient’s safety and is
never an acceptable explanation if an adverse event were to occur.
Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5

C 4 3 2 1 0

E 3 4 3 2 1

A 2 3 4 3 2

B 1 2 3 4 3

D 0 1 2 3 4

© MSC Assessment 2017