Managing Fatigue & Impairment

SJT Textbook: Managing Fatigue & Impairment

Managing Fatigue and Impairment GMC

This managing fatigue and impairment GMC guide explains how tiredness, illness and impairment are tested in MSRA SJT scenarios, including escalation, SBAR handover, and securing competent cover.

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🎯 THE CORE PRINCIPLE

Fatigue and impairment (illness, substances, severe stress, or sleep loss) reduce alertness, increase error risk, and jeopardise safe care. GMC standards require doctors to recognise when they are unfit, stop unsafe practice, and take steps to protect patients.

In SJT questions, the highest scoring response is the one that immediately removes risk: escalation, competent cover, safe handover, and honest communication. The exam penalises “powering through”, concealment, unsafe driving, or leaving clinical areas without structured handover.

The principle is simple: patient safety is more important than embarrassment, workload, or fear of judgement.

The managing fatigue and impairment GMC standards require doctors to stop unsafe practice immediately.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Recognise impairment early (near-miss, micro-sleep, acute illness).
2. Escalate to senior or rota coordinator immediately.
3. Arrange competent cover to protect patient safety.
4. Transfer care using clear SBAR handover.
5. Document decisions, incidents, and support sought.
6. Use Occupational Health or Practitioner Health when needed.
7. Pause or stop unsafe tasks until safe cover arrives.

MSRA SJT frequently tests failures in managing fatigue and impairment GMC through concealment or “powering through”.

Avoid any option that conceals impairment, delays escalation, or leaves patients without safe cover.

Near-misses during night shifts are classic managing fatigue and impairment GMC red flags.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I’ll give a concise SBAR handover of urgent tasks so care continues safely.”
* “I had a near-miss which may be fatigue-related and will complete an incident report.”
* “For safety I will not drive; I will use rest facilities or a taxi as per policy.”
* “I’ll contact Occupational Health or Practitioner Health for assessment and support.”

Recognise • Escalate • Switch to safe cover • Transfer care • Sleep/recover • Access support • Form prevention plan • Enter a record

📋 QUICK FAQ

What if I am the only doctor on site?
Call the duty consultant or site manager immediately. Focus on emergencies only until cover arrives and document the situation.

Should I tell patients I am unwell?
Be honest where it affects timing or safety, but ensure a competent colleague delivers care promptly.

Too tired to drive home — what should I do?
Do not drive. Use rest facilities, taxi, public transport, or a lift according to local policy.

Do I need an incident report after a near-miss?
Yes. It supports governance and improvement, and prevents recurrence.

What support options exist?
Occupational Health, Practitioner Health, supervisors, and local wellbeing services.

SBAR handover is essential in managing fatigue and impairment GMC scenarios.

📚 GMC ANCHOR POINTS

• Do not work while impaired; patient safety first (Good Medical Practice 2024).
• Raise concerns and act promptly to protect patients (Raising and acting on concerns).
• Manage your health responsibly and seek appropriate support (Your health as a doctor).
• Maintain clear, accurate documentation (Good Medical Practice).

Practitioner Health support is part of managing fatigue and impairment GMC guidance.

💡 MINI PRACTICE SCENARIO

You are halfway through a night shift and realise you miscalculated a drug dose. You feel overwhelmingly drowsy and have had two micro-sleeps. The site is very busy.

Best action: Inform the duty registrar or site manager now, request immediate cover, and hand over urgent tasks using SBAR.
Why: It removes immediate risk by providing competent cover, ensures safe continuity, and fulfills GMC duties around impairment and escalation.

🎯 KEY TAKEAWAYS

✓ Patient safety outweighs service pressure
✓ Do not work while impaired
✓ Escalate early and arrange competent cover
✓ Use SBAR for clear, safe handover
✓ Document actions and seek support

🔗 RELATED TOPICS

* → Self-awareness & Insight
* → Safe Handover & Escalation
* → Managing Personal Stress & Burnout
* → Raising Concerns
* → Delegation and Supervision

📖 FULL PRACTICE QUESTIONS

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

You are halfway through a night shift and feel dangerously drowsy after catching a near-miss prescribing error. You recognise you may be unsafe to continue. Several unwell patients still need reviews, and the site is stretched.

Options:
A. Push on and finish the remaining list quickly.
B. Drink strong coffee and try to “power through” until the shift ends.
C. Leave the ward quietly and rest in your car.
D. Inform the duty registrar or site manager now, request cover, and give an SBAR handover.
E. Ask a nurse to observe patients while you take an unsupervised rest.
F. Phone a colleague from another ward to cover everything without informing seniors.
G. Document the near-miss later but continue working now as it is busy.
H. Switch non-urgent tasks to the morning team but continue reviewing unwell patients yourself.

Example SJT — Rank 5 (best → worst)

During an on-call shift you develop vomiting and fever. Three urgent tasks remain. The night registrar is covering theatres and cannot attend immediately.

Options:
A. Call the duty consultant or site manager, declare you are unwell, request immediate cover, and provide a concise SBAR handover.
B. Finish the remaining jobs quickly before going home.
C. Leave the ward without telling anyone and email later.
D. Ask a nurse to “keep an eye” on patients while you rest in the doctors’ room.
E. Take over-the-counter medication and continue the shift.