MSRA MSRA Situational Judgement 2 — Questions and Answers
Question 1: A patient tells you in confidence that they drove themselves to the hospital despite being informed they should not drive following a seizure. They refuse to inform the DVLA. What should you do?
- Respect confidentiality and take no action
- Advise the patient of their legal duty, document the discussion, and consider notifying the DVLA if they continue to refuse and risk to others is serious (Correct answer)
- Immediately contact the police
- Discharge the patient and notify the DVLA without telling the patient
Correct answer: Advise the patient of their legal duty, document the discussion, and consider notifying the DVLA if they continue to refuse and risk to others is serious
DVLA notification guidance states doctors should advise patients of the legal obligation to report, document refusal, and can notify the DVLA in the public interest if the patient continues to drive against medical advice.
Question 2: During handover, the outgoing team has not completed clerking for two patients. You are already overwhelmed. What is the most appropriate action?
- Leave the patients unclerked until the morning team arrives
- Prioritise and triage the two patients, perform emergency clerking, and flag the situation to the night registrar (Correct answer)
- Refuse the handover until the outgoing team completes the clerking
- Ask the ward nurse to clerk the patients
Correct answer: Prioritise and triage the two patients, perform emergency clerking, and flag the situation to the night registrar
Patient safety requires triaging outstanding patients and completing essential clerking; escalating to the registrar ensures appropriate senior oversight of a workload-overloaded situation.
Question 3: A family member of a patient insists on receiving a telephone update on their relative's condition, but you cannot verify they are the named next of kin and the patient has not given consent for disclosure. What should you do?
- Provide a general update as it is probably the next of kin
- Verify identity, check patient consent, and only share information within the scope of what the patient has authorised (Correct answer)
- Refuse all communication and hang up
- Ask a nurse to speak to them instead
Correct answer: Verify identity, check patient consent, and only share information within the scope of what the patient has authorised
Confidentiality requires verification of identity and patient consent before disclosing information to third parties, even those claiming to be family members.
Question 4: A consultant asks you to document a clinical finding in the notes that you did not personally observe or verify. What should you do?
- Document it as the consultant is more experienced
- Decline and offer to document only what you have personally observed or assessed (Correct answer)
- Document it but add an asterisk
- Raise it with the GMC immediately
Correct answer: Decline and offer to document only what you have personally observed or assessed
Medical records must be accurate and personally verified; documenting a finding you did not make is falsification of records and a serious breach of professional standards.
Question 5: You are the on-call FY2 and receive multiple simultaneous bleeps. How should you prioritise?
- Answer bleeps in the order received regardless of content
- Rapidly triage all bleeps by clinical urgency and attend to the most life-threatening situation first (Correct answer)
- Attend to your existing patient before responding to any bleep
- Ask the nurses to handle the less urgent bleeps
Correct answer: Rapidly triage all bleeps by clinical urgency and attend to the most life-threatening situation first
On-call prioritisation requires rapid triage of all outstanding tasks by clinical urgency — life-threatening situations take precedence over time-based order of receipt.
Question 6: A patient who is Jehovah's Witness and has capacity consents to surgery but refuses any blood products. The surgical team believes transfusion will almost certainly be needed. What should happen?
- Proceed with surgery and transfuse if needed without telling the patient
- Inform the patient of the realistic likelihood of transfusion need, and proceed only if they reaffirm refusal having understood the risk of death (Correct answer)
- Cancel the operation as it cannot be performed safely
- Seek a court order to override the refusal
Correct answer: Inform the patient of the realistic likelihood of transfusion need, and proceed only if they reaffirm refusal having understood the risk of death
The patient must be fully informed of the clinical risk their refusal creates; if they reaffirm a capacitated refusal, this must be respected and documented thoroughly before proceeding.
MSRA MSRA Situational Judgement 2
A patient tells you in confidence that they drove themselves to the hospital despite being informed they should not drive following a seizure.
They refuse to inform the DVLA.
What should you do?