Balancing Clinical and Non-Clinical Workload

SJT Textbook: Balancing Clinical and Non-Clinical Workload

Clinical vs Non-Clinical Workload MSRA

This guide addresses the common dilemma of Clinical vs Non-Clinical Workload MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate that while training is important, patient safety is non-negotiable.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Balancing clinical and non-clinical workload means meeting your responsibilities to patients while still contributing to teaching, supervision, governance, QI and admin. Safe doctors do not treat non-clinical work as optional, but they never allow it to compromise care of deteriorating or high-risk patients.

It matters because leaving wards or clinics without safe cover, unclear roles or documentation leads to delays, missed deterioration and avoidable harm. Conversely, repeatedly cancelling all non-clinical commitments without recording the impact undermines training, quality improvement and fairness across the team.

The SJT tests whether you scan clinical risk, secure appropriate cover, set explicit thresholds for escalation and return, inform relevant leads, and document the plan and outcomes. High-scoring options show safety-first decision making with transparent negotiation; low-scoring options prioritise meetings over patients, leave secretly, delegate unsafely, or rely on vague promises to “catch up later”.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Scan current acuity, NEWS2 and pending high-risk tasks before deciding whether you can leave.
2. Arrange competent cover of appropriate grade and skills, briefing them with SBAR and clear responsibilities.
3. Inform key stakeholders (nurse in charge, clinic/education lead, rota/site team) about where you will be and who is covering.
4. Set explicit escalation thresholds (for example, NEWS2, new chest pain) and a clear regroup/return time.
5. Document the cover plan, thresholds, contact details and outcomes in the notes, rota system or email trail.
6. Be prepared to abandon or reschedule non-clinical activity and return to clinical duties if acuity rises.
7. Log repeated loss of non-clinical time and raise with your supervisor or rota lead as a systems/QI issue, not just a personal failing.

Traps typically prioritise meetings over safety, rely on unqualified cover, or omit clear communication and documentation.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Cover plan: Alex holds the bleep from 14:00–15:00; escalate to me or the registrar if NEWS2 is 5 or above or if pain is uncontrolled.”
* “I have documented the cover arrangement, thresholds and contact details in the notes and emailed the nurse in charge and rota coordinator.”
* “If the ward becomes unsafe again, I will return immediately and we can rebook the meeting or teaching session.”

B – Bedside first
A – Arrange competent cover
L – Let stakeholders know
A – Agree escalation thresholds and return time
N – Note the plan and outcomes in writing
C – Check back at regroup time
E – Escalate persistent problems as a rota/QI issue

📋 QUICK FAQ

Can I ever leave the ward for teaching or a meeting?
Yes, if it is clinically safe, with competent cover, clear escalation thresholds, and key people informed. If acuity rises, you should return and reschedule.

Who counts as “competent cover”?
A colleague of appropriate grade and skills who is briefed, agrees to cover, knows how to escalate, and has the capacity to do so; students and HCAs cannot hold overall clinical responsibility or the on-call bleep.

What if I am repeatedly pulled from non-clinical time?
Log each occurrence, discuss with your educational supervisor and rota coordinator, and suggest rota or staffing changes as a QI issue. The aim is to balance service and training fairly.

Do I always have to cancel non-clinical work during busy periods?
Not always. You may still attend if a safe cover plan is in place and acuity is manageable. The key is honest risk assessment, explicit cover, and readiness to return if needed.

What exactly should I document?
Who is covering, the time window, escalation thresholds, how to contact you and seniors, and what was agreed about rescheduling teaching/QI; add any outcomes or lessons learnt afterwards.

📚 GMC ANCHOR POINTS

* Putting patient safety first and working within your competence and limits (GMC Good medical practice 2024).
* Delegating appropriately, ensuring those who take on tasks are suitably qualified and supervised (GMC Delegation and referral).
* Working effectively within teams, communicating changes in responsibility and availability (GMC Good medical practice 2024 — teamwork).
* Keeping clear, accurate, contemporaneous records, including significant decisions and handover information (GMC Recording information).
* Raising concerns when service pressures or rota problems undermine safe care or training (GMC Raising and acting on concerns).

💡 MINI PRACTICE SCENARIO

You are scheduled to deliver a 14:00 teaching session for juniors. At 13:40, two ward patients trigger NEWS2 of 6 and a third has newly suspected sepsis. No cover has been arranged for your bleep. The education lead messages to say the teaching is “really important”.

Best action: Cancel or postpone teaching, inform the education lead, review the deteriorating patients, arrange competent cover with clear thresholds and times, and document the plan and outcomes in the notes and rota/clinic system.
Why: Patient safety and deterioration take precedence over non-clinical duties. You must ensure safe cover, clear escalation and documentation before leaving, which aligns with GMC standards on prioritisation, delegation and record-keeping.

🎯 KEY TAKEAWAYS

✓ Patient safety always takes priority over meetings, teaching and admin.
✓ Never leave wards or clinics without competent, clearly briefed cover.
✓ Inform the nurse in charge, rota/clinic lead and others who need to know.
✓ Set explicit escalation thresholds and a clear return/regroup time.
✓ Record cover plans and outcomes so the team knows who is responsible.
✓ Escalate persistent rota or training problems as a systems/QI issue, not by cutting corners.

🔗 RELATED TOPICS

* → Managing Multiple Demands
* → Working Under Time Pressure
* → Prioritising Clinical Tasks
* → Delegation and Supervision
* → Teamwork, Leadership and Escalation

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

You are the medical registrar on a busy ward. From 15:00–16:00 you are scheduled to lead a governance meeting about recent incidents. At 14:40, two patients trigger NEWS2 of 6 and one new admission with chest pain arrives on the ward. You currently hold the on-call bleep; nursing staff look concerned. The clinical director emails asking you to ensure the governance meeting goes ahead as planned.

Options:
A. Attend the governance meeting as planned, turn your phone off to avoid interruptions, and deal with clinical issues afterwards.
B. Ask a foundation year medical student to hold the on-call bleep while you attend the meeting.
C. Cancel the governance meeting unilaterally and delete the calendar invite without telling anyone why.
D. Review the deteriorating patients and chest pain, escalate to the on-call consultant, and then arrange a competent colleague to hold the bleep with clear thresholds while you briefly attend if safe.
E. Inform the governance lead and clinical director that you will need to delay or shorten the meeting due to acute safety issues and propose an alternative date.
F. Leave for the meeting but ask nursing staff to “keep an eye on things” and call you only if patients arrest.
G. Document the acuity, your decision to prioritise clinical care, and the plan to reschedule governance in the clinical notes and an email trail.
H. Ignore NEWS2 triggers for now so as not to delay the governance work, as “both are important”.

Example SJT — Rank 5 (best → worst)

You are a core trainee covering a medical ward. You have three overlapping demands at 11:00: an outpatient clinic you are due to attend for training, a scheduled QI meeting about prescribing errors, and a ward surge with multiple new admissions and one patient awaiting urgent senior review. There is one other SHO on the site who may be able to help. Your educational supervisor has emphasised the importance of attending clinic and QI.

Options:
A. Discuss the situation with the nurse in charge and the other SHO, agree that they will cover clinic or ward with clear SBAR, thresholds and times, inform clinic and QI leads, and prioritise acute ward care if safe cover cannot be arranged.
B. Go to clinic on time and turn the ward phone to silent, trusting nursing staff to cope and leaving no explicit cover plan.
C. Skip both clinic and QI without telling anyone, staying on the ward but failing to document or raise ongoing workload issues.
D. Ask a medical student to attend the QI meeting on your behalf and report back, while you go to clinic and leave the ward minimally covered.
E. Attend all meetings and clinic, leaving the ward briefly unattended several times and dealing with any resultant backlogs later.

Options:
A. Plan cover and prioritise acute ward care with explicit communication.
B. Prioritise clinic, leaving the ward in effect uncovered.
C. Stay on ward but do not communicate or escalate lost training time.
D. Use a student as de facto cover and meeting representative.
E. Attempt to attend everything, leaving patient care intermittently unsafe.