Recognising Own Limitations

SJT Textbook: Recognising Own Limitations

Recognising Own Limitations MSRA

This guide covers the critical safety skill of Recognising Own Limitations MSRA scenarios. In the Professional Dilemmas paper, examiners look for the “Conscious Incompetence” trait—knowing what you don’t know and acting on it to protect the patient.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Recognising your own limitations means matching what you do to your actual training, experience, and capacity, not to what you think you “should” be able to do. It is about protecting patients by stopping before you are out of your depth, bringing in the right supervision, and sharing responsibility safely.

Many serious incidents arise when clinicians delay escalation to avoid “bothering” seniors, attempt unfamiliar procedures alone, or gloss over uncertainty in documentation and consent. The safer route is to act early: call a senior, use guidelines, and ensure that someone with the right skills is involved while you help within your competence.

In the SJT, high-scoring options prioritise early escalation, clear ownership, and honest records. Low-scoring answers either push ahead beyond competence, abandon the patient, or obscure what really happened in the notes.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Scan the situation for risk and complexity, and stop before attempting tasks beyond your competence.
2. Contact the appropriate senior or specialist early (registrar, consultant, critical care, on-call team).
3. Put safe interim measures in place (ABCDE, monitoring, analgesia, basic treatment within your skills).
4. Allocate urgent tasks to someone competent if you cannot perform them yourself.
5. Be open with the patient that a senior will review and confirm the plan.
6. Clarify who is in charge of the patient and when they will review.
7. Record escalation attempts, advice given, and agreed plans with times and named individuals.
8. Use each episode as learning: seek supervised practice, feedback, and formal teaching.
9. Respect formal scopes of practice for different staff groups (students, HCAs, AHPs).
10. Raise a concern if unsafe expectations are placed on you (e.g. pressure to act outside your training).

Trap options either push you beyond competence without support, abandon responsibility altogether, or obscure what happened in the record. Safe options show shared care, clear ownership, and honest documentation.

💬 MODEL PHRASES (Use These in SJT Logic)

* “A senior will review you shortly; I will stay with you and start the initial treatment I am trained to give.”
* “I have escalated to the consultant at 10:45, and we agreed the plan documented here with a review at 11:30.”
* “I am not trained to insert this device alone; I can assist so I can learn while someone competent leads.”
* “I am uncomfortable with the level of risk; I need senior input before we proceed.”

Assess risk • Seek supervision • Keep notes (and the patient safe)

Use it as a quick check: have I honestly assessed my ability, called the right person, and documented what we agreed?

📋 QUICK FAQ

Does asking for help make me look weak?
No. GMC guidance expects you to recognise and work within your limits and to seek supervision. Failing to escalate when out of your depth is unprofessional and unsafe.

What if the senior is off-site or busy?
Contact them anyway, use any available escalation routes (site team, outreach, critical care), and manage the patient safely within your skills while you wait. Keep trying if you cannot get through and consider alternative escalation paths.

Can I consent for a procedure I have never done?
Only if you are appropriately trained, understand the procedure and its risks, and have adequate supervision. For complex or high-risk procedures, the person doing it or an equally competent colleague should usually take consent.

Is reading a guideline enough to proceed?
For low-risk tasks, guidelines plus basic training may be enough. For high-risk or invasive procedures, you usually need supervised practice and explicit sign-off before acting independently.

What exactly should I record?
Document the clinical situation, what you judged was beyond your competence, who you escalated to (name and role), times of contact, advice given, interim measures, and the agreed plan and review time.

📚 GMC ANCHOR POINTS

• Work within the limits of your competence and experience, and seek help when needed (GMC Good medical practice 2024).
• Make sure patients have a named clinician responsible for their overall care.
• Take prompt action if patient safety, dignity, or comfort may be compromised (raising concerns).
• Keep clear, accurate, and timely records of assessments, decisions, and actions (recording information).
• Supervise and delegate appropriately, ensuring colleagues are competent for the tasks they perform.

💡 MINI PRACTICE SCENARIO

A CT2 in acute medicine on nights is asked to insert a chest drain for a large pneumothorax. They have seen the procedure once but never performed it. The patient is breathless but stable on oxygen and monitoring; the registrar is covering another ward but is contactable.

Best action: Explain that you have not yet been signed off to insert a chest drain independently, call the registrar to attend or supervise, start safe interim measures (oxygen, monitoring, analgesia), prepare the equipment, and document the escalation and agreed plan.
Why: This recognises limitations, ensures senior support, keeps the patient safe in the meantime, and provides learning under supervision, which is exactly what the exam rewards.

🎯 KEY TAKEAWAYS

✓ Safety beats pride: stop when you reach the edge of your competence.
✓ Escalate early to seniors or specialists and involve them in decisions.
✓ Keep the patient safe with interim measures and clear ownership.
✓ Be open with patients about who will review and what will happen next.
✓ Document escalation, advice, plans, and review times in the notes.

🔗 RELATED TOPICS

* → Delegation and Supervision
* → Working Under Time Pressure
* → Seeking Help for Stress/Mental Health
* → Learning from Adverse Events
* → Reflective Practice After an Error

📖 FULL PRACTICE QUESTIONS

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

You are an FY2 in emergency medicine. A patient arrives with suspected cauda equina syndrome. You have never performed a full neurological assessment for this presentation alone and are unsure about urgent imaging pathways in this trust. The registrar is in resus but available by phone.

Options:
A. Attempt to manage everything alone to show initiative, decide against imaging, and discharge with safety-netting.
B. Call the registrar, explain your concern and your limited experience, perform an initial assessment within your competence, and ask them to review urgently.
C. Ask an experienced ED colleague to examine the patient while you call radiology to clarify the MRI pathway.
D. Leave the patient in the waiting room until the registrar is free.
E. Tell the patient you are inexperienced and advise them to attend another hospital without further assessment.
F. Check local guidelines, start analgesia, perform a basic neurological screen, and escalate to the on-call spinal or orthopaedic team via the registrar.
G. Record minimal notes to save time, assuming the registrar will fill in details later.
H. Ask a healthcare assistant to perform the neurological examination in your place.

### Example SJT — Rank 5 (best → worst)

You are the only surgical FY1 on an evening shift. A postoperative patient becomes hypotensive and tachycardic. You have limited experience managing shock but can start basic measures. The registrar is scrubbed in theatre but reachable by phone; the outreach team is available.

Options:
A. Call the registrar immediately, start ABCDE assessment, give oxygen, take bloods, start fluids as per protocol, and request review from outreach while the registrar finishes the case.
B. Try to manage alone without contacting anyone, because you know the registrar is busy.
C. Phone the registrar, briefly say the patient is “a bit unwell”, and then wait without starting any investigations or treatment.
D. Ask a healthcare assistant to decide on fluid boluses while you clerk another patient.
E. Transfer the patient to another ward without assessment, hoping they will be reviewed there.