Managing Emotional Impact of Clinical Work

SJT Textbook: Managing the Emotional Impact of Clinical Work

Managing Emotional Impact MSRA

This guide covers the psychological reality of Managing Emotional Impact MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate that you can process trauma professionally—acknowledging it without letting it paralyse your practice.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Clinical work is emotionally demanding: distressing deaths, errors, complaints, conflict, and cumulative stress affect even the most resilient clinicians. Managing the emotional impact means recognising that these responses are normal, sharing the load, and using structured support rather than suppressing or denying how you feel.

High-scoring SJT responses show that you name and validate feelings, provide or seek debriefs and Schwartz Rounds, and look out for colleagues as well as yourself. They treat post-incident emotions as a shared team issue, not a personal weakness.

The SJT also tests whether you can distinguish normal, time-limited reactions from red-flag patterns suggestive of PTSD or significant mental ill health. Good options signpost to GP, NHS Practitioner Health, or other formal support when symptoms persist or impair functioning, all while maintaining a just culture and feeding learning into governance.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Acknowledge and validate emotional reactions after difficult cases or incidents.
2. Arrange or attend brief debriefs; use Schwartz Rounds or supervision when available.
3. Offer compassionate check-ins to colleagues and ask directly how they are coping.
4. Watch for PTSD red flags such as nightmares, flashbacks, avoidance, or hyperarousal.
5. Signpost to GP, NHS Practitioner Health, BMA counselling, or local wellbeing services.
6. Adjust duties temporarily if concentration or functioning is impaired, to protect safety.
7. Use just-culture language that focuses on systems and learning rather than blame.
8. Record anonymised reflections and feed themes into PSIRF or governance processes.
9. Build self-care habits (sleep, nutrition, movement, boundaries) after traumatic shifts.
10. Set a clear review point to check whether symptoms are persisting or improving.

Traps either dismiss emotions, promote unhealthy coping, or fuel blame culture. Safer options combine compassion, structured support, and clear escalation when symptoms persist.

💬 MODEL PHRASES (Use These in SJT Logic)

* “If these nightmares or flashbacks continue, we should follow PTSD guidance and link you in with your GP or Practitioner Health.”
* “I will arrange a Schwartz Round so we can reflect on the emotional side as a team, not just the clinical details.”
* “I am concerned this is affecting your concentration; let us adjust duties today and involve Occupational Health.”
* “I have documented the themes from our debrief (without identifiers) and will share them through our patient safety and learning forum.”

Check-in • Acknowledge • Rounds/debrief • Escalate if persistent • Monitor impact • Embed learning

You can also remember HALT before big decisions: Hungry, Angry, Lonely, Tired — if yes, pause and reset.

📋 QUICK FAQ

Is it normal to feel upset after a bad outcome or complaint?
Yes. Strong emotional reactions are common and not a sign of weakness. What matters is recognising them, talking about them, and using support.

When should I worry about PTSD or longer-term impact?
If intrusive memories, nightmares, avoidance, or hyperarousal persist beyond a few weeks, worsen, or impair daily functioning or work, follow PTSD guidance and arrange formal assessment and support.

What structured supports can I use at work?
Debriefs after critical events, Schwartz Rounds, supervision, team huddles, and PSIRF engagement meetings can all provide safe spaces to process emotions and learn.

How can I support a colleague who seems affected?
Ask privately how they are, validate their feelings, encourage debrief and formal support, help adjust duties if needed, and check back later rather than assuming they are fine.

How do I balance emotional support with candour and learning?
Use a just-culture approach: be open and honest with patients while protecting staff from blame, focus reviews on systems and contributory factors, and involve staff compassionately in learning processes.

📚 GMC ANCHOR POINTS

• Promote a culture that supports safety, learning, and respectful teamwork (GMC Good medical practice 2024).
• Look after your own health and seek support when needed; do not work when you are not fit to practise (GMC: Your health as a doctor).
• Be open and honest when things go wrong, while supporting colleagues involved (GMC candour guidance).
• Take part in systems that improve quality and safety, including reflection and learning from incidents.

💡 MINI PRACTICE SCENARIO

After a traumatic cardiac arrest in a young parent, you notice you feel numb and detached. A colleague later tells you they are having nightmares and feel anxious coming to work. The ward is busy and there is pressure to get back to routine tasks.

Best action: Arrange a short debrief at the end of the arrest, validate how people feel, encourage attendance at a Schwartz Round or similar forum, and for the colleague with nightmares at 4 weeks, signpost to their GP or Practitioner Health, consider PTSD guidance, adjust duties if needed, and plan a follow-up check-in.
Why: This approach acknowledges normal reactions, uses structured support, screens for red flags, and protects patient safety and staff wellbeing.

🎯 KEY TAKEAWAYS

✓ Emotional reactions to clinical work are normal; ignoring them is not.
✓ Support starts with naming feelings and offering debriefs or Schwartz Rounds.
✓ Watch for PTSD red flags and escalate promptly to formal help.
✓ Protect safety by adjusting duties and supervision if functioning is impaired.
✓ Capture anonymised learning and route it into PSIRF or governance, not gossip.

🔗 RELATED TOPICS

* → Supporting Colleagues After Incidents
* → Seeking Help for Stress/Mental Health
* → Recognising Burnout
* → Reflective Practice After an Error
* → Learning from Adverse Events

📖 FULL PRACTICE QUESTIONS

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

A paediatric cardiac arrest ends in the death of a child. You and the team are emotionally affected. One nurse is tearful and says they keep replaying the event in their head. The crash bleep is quiet for the moment.

Options:
A. Tell everyone to get back to work immediately and “park” their feelings for later.
B. Arrange a brief structured debrief now, acknowledging emotions as well as clinical learning.
C. Suggest the nurse goes home immediately without telling anyone and comes back to their next shift as normal.
D. Encourage the nurse to speak with their GP or Practitioner Health if nightmares or intrusive memories persist.
E. Email the whole department criticising the team’s performance to “drive improvement”.
F. Propose that the case is discussed at the next Schwartz Round or similar reflective forum.
G. Tell the nurse that everyone feels like this and they should toughen up.
H. Suggest having a drink after work as the main way to cope with the distress.

Example SJT — Rank 5 (best → worst)

Six weeks after a traumatic obstetric haemorrhage and neonatal death, a registrar reports frequent nightmares, avoids the labour ward, and struggles to concentrate on CTG interpretation. They are worried this will be seen as weakness.

Options:
A. Meet privately, validate their experience, adjust high-risk duties temporarily, signpost to GP/Practitioner Health and BMA counselling, and arrange a review in two weeks while encouraging involvement in a Schwartz Round or similar forum.
B. Acknowledge the event was difficult and suggest they “see how it goes” without any changes or follow-up.
C. Insist they continue full labour ward duties immediately to “get over it”.
D. Email the department highlighting their errors in detail to show “lessons learned”.
E. Avoid talking about the case altogether to prevent upsetting them further.