Professional Dilemmas with Conflicting Priorities

SJT Textbook: Professional Dilemmas with Conflicting Priorities

Professional Dilemmas MSRA

This guide covers the complex terrain of Professional Dilemmas MSRA scenarios. In the Professional Dilemmas paper, you must prove that your moral compass points true north (Patient Safety) even when magnetic fields (Managerial Pressure, Loyalty) try to deviate it.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Professional dilemmas arise when competing priorities collide—for example patient safety vs organisational targets, honesty vs loyalty to seniors, or compassion vs professional boundaries. The SJT tests whether you can navigate these conflicts using the GMC moral compass, not workplace politics.

Across scenarios, the high-scoring options protect patients first, then uphold integrity, transparency, and fairness. The exam strongly penalises dishonesty, concealment, or actions that prioritise convenience, reputation, or efficiency above standards.

Often, none of the available options is comfortable. Safe practice requires you to hold professional boundaries, decline inappropriate requests, escalate when needed, and document concerns objectively. The SJT rewards calm, proportionate, factual reasoning—not heroics, avoidance, or retaliation.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Uphold professional, legal, and consent standards even when pressured.
2. Decline dishonest or unsafe requests politely but firmly.
3. Offer constructive alternatives that maintain quality and fairness.
4. Escalate concerns to seniors or governance leads when patterns repeat.
5. Keep clear, factual records of concerns or inappropriate requests.
6. Maintain professional boundaries with patients, including gifts.
7. Use objective language, dated addenda, and accurate timelines.
8. Seek support from duty of candour/IG/safeguarding teams when appropriate.
9. Avoid blame, gossip, or shaming colleagues publicly.
10. Protect trust in the doctor–patient relationship above convenience or politics.

Trap answers usually prioritise convenience, politics, or loyalty over honesty, safety, and integrity.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I need to ensure consent meets GMC standards—I can’t shorten essential steps.”
* “I’ll escalate this to the consultant/governance lead so we can manage this safely.”
* “I appreciate the gesture, but I’m unable to accept expensive gifts—perhaps a charity donation instead?”
* “I’ll document what happened factually to maintain transparency.”

Tell the truth • Respect boundaries • Uphold standards • Escalate when needed

📋 QUICK FAQ

What if a senior pressures me to alter notes?
You must decline, offer to add a factual addendum, and escalate if the pressure continues.

Is it ever acceptable to backdate consent or documentation?
No. All entries must be honest, timestamped, and factual.

Can I accept high-value gifts if I declare them?
No. Decline politely and offer an alternative like a charity donation.

Should I blame managers if patients ask why processes feel rushed?
No. Do not undermine colleagues; provide a calm, factual explanation without apportioning blame.

Do I always need to escalate?
Escalate if behaviour is unsafe, dishonest, repeated, or part of a wider pattern.

📚 GMC ANCHOR POINTS

• Honesty, integrity, and candour (GMC Good medical practice 2024).
• Maintaining boundaries and avoiding conflicts of interest (GMC Conflicts guidance).
• Accurate, clear, and timely records (GMC Record Keeping).
• Consent and shared decision-making (GMC Consent guidance).
• Raising and acting on concerns (GMC Raising concerns).
• Treating colleagues fairly and respectfully (GMC Teamworking).

💡 MINI PRACTICE SCENARIO

A consultant asks you to “tidy” notes to remove reference to a delay in treatment.
Best action: Decline to alter the record, offer to add a factual, dated addendum, and inform the consultant you may need to escalate if pressured.
Why: Documentation must be honest and traceable; concealing delays breaches candour and patient safety guidance.

🎯 KEY TAKEAWAYS

✓ Uphold integrity even when pressured.
✓ Decline unsafe or dishonest requests calmly.
✓ Offer safe, constructive alternatives.
✓ Escalate if patterns persist or pressure continues.
✓ Maintain professional boundaries with patients.
✓ Document objectively and transparently.

🔗 RELATED TOPICS

* → Dealing with Errors & Complaints
* → Self-awareness & Insight
* → Duty of Candour
* → Documentation & Record Keeping
* → Managing Conflict in a Team

📖 FULL PRACTICE QUESTIONS

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

You are asked by your service manager to reduce your consent discussion to “a quick summary” so that the clinic can meet throughput targets. They hint that “everyone else does it.”

Options:
A. Politely decline and explain GMC consent requirements.
B. Do as asked to support the team.
C. Suggest a group education + individual consent structure to preserve quality.
D. Backdate previous consent forms to “look compliant.”
E. Raise the pattern with the consultant/clinical governance team.
F. Ignore the request and continue your day.
G. Tell patients the manager is forcing unsafe practice.
H. Document concerns and the conversation.

Example SJT — Rank 5 (best → worst)

A senior doctor asks you to “soften” your documentation about a delay in review to avoid making the team look bad.

Options:
A. Decline to alter facts; offer to add a factual, dated addendum.
B. Edit the original entry retrospectively without timestamp.
C. Raise with duty of candour lead/consultant if pressure continues.
D. Make a personal notebook at home instead.
E. Record a clear, objective timeline in the notes.
F. Send a sarcastic email to the team.