Recognising Burnout

SJT Textbook: Recognising Burnout

Recognising Burnout MSRA

This guide covers the crucial skill of Recognising Burnout MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate the insight to know when “working harder” becomes “working unsafely.”

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Burnout in ICD-11 is an occupational phenomenon, not a medical diagnosis. It has three dimensions: energy depletion or exhaustion, increased mental distance or cynicism about work, and reduced professional efficacy. It arises from chronic, unmanaged workplace stress and is common in healthcare settings.

For doctors, burnout is both a personal and patient-safety issue. The GMC expects you to recognise your limits, work within them, and seek help when your health or workload risk safe care. Hiding burnout, “pushing through”, or normalising unsafe fatigue increases error risk, undermines team functioning, and harms you.

In the MSRA SJT, high-scoring answers show you noticing early signs (in yourself or colleagues), prioritising patient safety, being honest about impairment, escalating to the nurse in charge or senior, adjusting workload, and using support services (Occupational Health, NHS Practitioner Health, supervisors). Good options also include documenting the agreed plan and setting a review time.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Recognise early signs of burnout (exhaustion, dread of work, irritability, errors, detachment).
2. Prioritise immediate patient safety by escalating concerns to the nurse in charge and senior doctor.
3. Reassign or pause high-risk tasks (e.g. prescribing, procedures) when your concentration is impaired.
4. Request short, planned breaks and help with bleeps or task redistribution during acute fatigue.
5. Arrange a conversation with your educational or clinical supervisor to review workload and support.
6. Access formal support services such as Occupational Health and NHS Practitioner Health.
7. Ask about temporary rota or flexible working adjustments where appropriate to restore safe functioning.
8. Keep brief, factual documentation of concerns, agreed adjustments, and clear review dates.
9. Encourage a team culture where discussing workload, stress, and safety is normal and supported.
10. Reflect on burnout warning signs and coping strategies in a balanced, anonymised way.

Burnout-related traps tend to value stoicism, speed, or image over safety and support. High-scoring options are honest about risk, request help, and put in place concrete protective actions.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I need a brief break and some help with the bleeps so I can safely review our sickest patients.”
* “I will contact Occupational Health and NHS Practitioner Health today, and arrange a meeting with my supervisor.”
* “I have documented the changes we have agreed and a time to review how I am coping and whether further adjustments are needed.”
* “I am flagging this because working at this intensity feels unsafe for the team and our patients.”

Escalate risk • Adjust workload • Reach out for help • Look after yourself • Your plan documented and reviewed

📋 QUICK FAQ

Is burnout a medical diagnosis?
No. ICD-11 describes burnout as an occupational phenomenon with three dimensions: exhaustion, mental distance from work, and reduced efficacy. It is not coded as a medical disease, but it still has real safety and wellbeing implications.

Can I step back from tasks during a shift?
Yes. If you are not safe to practise, you must escalate and arrange competent cover before stepping back. This is aligned with GMC expectations to work within your limits and protect patients.

Who should I talk to if I suspect burnout?
Start with the nurse in charge and your senior doctor for immediate safety. Then speak to your educational or clinical supervisor, Occupational Health, and consider self-referral to NHS Practitioner Health.

What should I document?
Record key risks, any errors or near misses, agreed workload adjustments, who is providing cover, referrals to support services, and a time for review. Keep the record factual and focused on safety.

Is asking for rota changes or flexible working acceptable?
Yes. Requests can be reasonable when linked to patient safety and your health. GMC guidance supports working within your limits and seeking adjustments where needed.

What about colleagues who seem burnt out?
You should check in with them, raise safety concerns if they appear unsafe, encourage them to seek support, and escalate to a senior when necessary, in line with your duty to protect patients and colleagues.

📚 GMC ANCHOR POINTS

• Work within the limits of your competence and health, and seek help when needed (GMC Good medical practice 2024).
• Take prompt action if patient safety may be compromised (GMC Good medical practice 2024).
• Look after your own health so you can provide safe care (GMC guidance on your health as a doctor).
• Support colleagues and raise concerns if their health or workload risks patient safety (GMC Good medical practice 2024).

💡 MINI PRACTICE SCENARIO

You are on a busy medical take. It is 03:00 and you have been up since 06:00 the previous day. You have just caught your second prescribing slip in an hour. You feel exhausted, detached, and are struggling to concentrate on the sickest patients. Two bleeps are routine; a patient with NEWS2 of 6 is waiting to be reviewed.

Best action: Raise your concerns with the nurse in charge and registrar, explain that fatigue is affecting your judgement, prioritise the NEWS2=6 patient, arrange redistribution of lower-risk jobs and a short break, and plan to contact Occupational Health and NHS Practitioner Health after the shift, documenting the adjustments and review plan.
Why: This prioritises immediate patient safety, recognises your limits, uses team support, and initiates formal help and documentation, in line with GMC expectations.

🎯 KEY TAKEAWAYS

✓ Burnout is an occupational phenomenon with a triad of exhaustion, distance, and reduced efficacy.
✓ Safety beats stoicism: speak up when fatigue affects care.
✓ Redistribute high-risk work and agree short breaks rather than silently pushing through.
✓ Use formal support routes (OH, NHS Practitioner Health, supervisors).
✓ Document the risks, adjustments, and a clear review time.
✓ Supporting colleagues with suspected burnout is also part of your duty to protect patients.

🔗 RELATED TOPICS

* → Seeking Help for Stress and Mental Health
* → Recognising Own Limitations
* → Supporting Colleagues After Incidents
* → Learning from Adverse Events
* → Managing Emotional Impact of Clinical Work

📖 FULL PRACTICE QUESTIONS

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

You are an ST1 on a general medical night shift. It is 02:30. You have worked several long days in a row, have not had a proper meal break, and are now feeling exhausted and irritable. You have just caught a dose error on a warfarin prescription you wrote. There are several outstanding jobs, including routine bloods, discharge summaries, and a NEWS2=5 patient waiting for review.

Options:
A. Say nothing to anyone, work faster to clear the list, and hope you will not make more mistakes.
B. Tell the nurse in charge and the medical registrar that you are worried your fatigue is affecting safe care, and ask to prioritise the sickest patients while someone else picks up routine jobs.
C. Leave the hospital for a rest without telling anyone and come back when you feel better.
D. Ask for a short, planned break to eat and hydrate, after agreeing which urgent patients will be covered by a colleague.
E. Start an audit of prescribing errors to “channel” your frustration and stay awake.
F. Email your supervisor immediately, explaining you are burnt out, but carry on working as before.
G. Contact Occupational Health and plan to self-refer to NHS Practitioner Health later that morning.
H. Blame the nurses for not checking your prescriptions properly and continue at the same pace.

Example SJT — Rank 5 (best → worst)

You are a GP trainee in a busy training practice. Over several months, you have been doing frequent extra clinics. You feel emotionally drained, cynical about patients, and are making more administrative mistakes. Your trainer notices you are quiet and staying late most evenings. At a supervision meeting, different approaches are suggested.

Options:
A. Explore your symptoms of burnout, agree to reduce extra clinics temporarily, schedule regular supervision, encourage self-referral to Practitioner Health, and review in one month.
B. Encourage you to keep doing extra clinics “to build resilience” and avoid any discussion of your feelings.
C. Agree a short-term rota adjustment and protected admin time, and document the plan and review date.
D. Suggest you ignore how you feel because “everyone is tired” and change nothing.
E. Advise you to resign from the programme immediately without speaking to Occupational Health or looking at adjustments.