MSRA MSRA Situational Judgement 1 — Questions and Answers
Question 1: You are an FY2 doctor and you notice that a nurse has administered 10-fold the prescribed dose of a medication to a patient who is currently asymptomatic. What should you do first?
- Wait to see if the patient develops symptoms before acting
- Assess the patient immediately, inform the nurse and senior, and complete an incident form (Correct answer)
- Inform only the nurse and ask them to handle it quietly
- Document it in the notes and review tomorrow
Correct answer: Assess the patient immediately, inform the nurse and senior, and complete an incident form
Patient safety requires immediate clinical assessment, transparent escalation to seniors, and formal incident reporting — delay or concealment are never appropriate.
Question 2: During a busy night shift, a colleague asks you to co-sign a drug chart for a medication you did not administer or check. What should you do?
- Sign as a professional courtesy to help your colleague
- Decline to sign and explain that co-signing implies you verified the medication was given correctly (Correct answer)
- Sign but add a note that you were not present
- Report the colleague to the GMC immediately
Correct answer: Decline to sign and explain that co-signing implies you verified the medication was given correctly
Co-signing a drug chart implies verification of administration; signing for something you did not witness is dishonest and constitutes a serious documentation and patient safety breach.
Question 3: A patient asks you directly whether the operation they are about to have carries a risk of death. The consultant has not discussed this. What is the appropriate response?
- Tell the patient to ask the consultant
- Confirm that significant risks exist and ensure the consultant discusses them with the patient before proceeding (Correct answer)
- Reassure the patient that the risk is negligible to avoid anxiety
- Proceed with the pre-operative checklist and do nothing
Correct answer: Confirm that significant risks exist and ensure the consultant discusses them with the patient before proceeding
Patients have a right to information about material risks; if consent is inadequate the clinician must ensure it is corrected before surgery — deceiving the patient breaches the duty of candour.
Question 4: You are called to see a patient who is clearly in pain but the nurse says no analgesia has been prescribed. The consultant is in theatre and not answering bleep. What should you do?
- Wait until the consultant is available
- Prescribe appropriate analgesia within your competence and escalate through the registrar (Correct answer)
- Ask the nurse to give a PRN paracetamol from another patient's prescription
- Document pain and review in 2 hours
Correct answer: Prescribe appropriate analgesia within your competence and escalate through the registrar
Providing timely analgesia is a patient safety and dignity obligation; if the responsible consultant is unavailable, the registrar or on-call senior should be contacted to authorise appropriate treatment.
Question 5: A medical student asks you to teach them a clinical skill on a patient who has not been asked for consent to be involved in student teaching. What should you do?
- Allow the teaching as it is standard practice
- Obtain explicit consent from the patient before involving the student in any clinical interaction (Correct answer)
- Ask the student to observe only without speaking to the patient
- Only involve the student if the patient is unconscious
Correct answer: Obtain explicit consent from the patient before involving the student in any clinical interaction
Patients have the right to decline involvement in teaching; explicit consent must be obtained before any student interaction with a patient, even for observation.
Question 6: You suspect a colleague who is an FY1 is struggling with serious personal problems affecting their clinical performance. The safest and most appropriate initial action is to:
- Report them to the GMC without delay
- Speak privately to the colleague to offer support and encourage them to seek help, and escalate if patient safety is at immediate risk (Correct answer)
- Ignore the situation as it is not your responsibility
- Inform the entire team to ensure patient safety
Correct answer: Speak privately to the colleague to offer support and encourage them to seek help, and escalate if patient safety is at immediate risk
The GMC recommends a supportive approach first — talking to the colleague and encouraging occupational health or senior support — while escalating only if patient safety is compromised.
MSRA MSRA Situational Judgement 1
You are an FY2 doctor and you notice that a nurse has administered 10-fold the prescribed dose of a medication to a patient who is currently asymptomatic.
What should you do first?