Self-awareness & Insight

SJT Textbook: Self-awareness & Insight

Self awareness and Insight (GMC)

This self awareness and insight GMC guide explains how recognising limits, early escalation, supervision, and reflective learning are tested in MSRA SJT scenarios.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Self-awareness and insight mean recognising your limits, working within your competence, and seeking supervision early so that patients remain safe. It includes noticing when you feel out of depth, understanding how fatigue or stress affects your judgement, and being honest about your skills with colleagues and patients where relevant.

Overconfidence, pride, or fear of appearing weak can delay escalation and harm patients. The SJT rewards options where you stabilise the patient, ask for help promptly, and avoid misrepresenting your experience. It also rewards learning from feedback and near-misses by planning supervision, training, and reflection.

This topic often appears as: being asked to perform a procedure you have only done on a manikin, covering an unfamiliar ward with unwell patients, or being given critical feedback about your practice. High-scoring answers show early escalation, honest communication, documentation, and clear follow-up learning.

The self awareness and insight GMC standards require doctors to recognise limits early.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Assess your own competence honestly before accepting or continuing a task.
2. Escalate early to an appropriate senior when a task exceeds your skills or experience.
3. Stabilise the patient using ABCDE and local protocols while arranging senior input.
4. Be transparent about your level of experience where it materially affects risk or consent.
5. Document your assessment, the person you escalated to, and agreed plans or thresholds.
6. Use feedback, incidents, and near-misses to create a concrete learning plan (e.g. supervised lists, simulation).
7. Seek supervision actively for new or high-risk procedures rather than waiting to be offered it.
8. Delegate only to colleagues who are competent and available, with clear handover and oversight.
9. Raise concerns about unsafe staffing, supervision, or systems that put patients at risk.
10. Build regular reflection into your practice, focusing on specific changes and follow-up.

MSRA SJT frequently tests failures of self awareness and insight GMC through delayed escalation.

Avoid any answer that hides your limits, delays escalation, fails to stabilise the patient, or prioritises pride and convenience over safety and honesty.

Working beyond competence breaches self awareness and insight GMC expectations.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I’ll start ABCDE and monitoring while arranging an experienced clinician urgently.”
* “I want to be transparent about my experience so you’re properly informed; a more senior doctor will be involved.”
* “I’ve documented the assessment, who I escalated to, and the agreed thresholds; I’ll also arrange supervised training.”
* “I’m not comfortable doing this unsupervised; we need someone with more experience to review.”
* “This feedback highlights a gap; I’ll reflect and plan targeted learning to address it.”

Assess limits • Warn/escalate early • Ask for help • Refer/redirect appropriately • Educate/reflect on learning needs

📋 QUICK FAQ

No senior is immediately available — what should I do first?
Start ABCDE, increase monitoring, involve the most competent available team (e.g. outreach, ICU, on-call consultant), and continue escalating until safe cover is secured. Record what you did and who you spoke to.

Should I tell patients if I am inexperienced?
Yes, where your level of experience materially affects risk or consent. Reassure them that a suitably experienced clinician will supervise or perform the procedure, and document this discussion.

I began a task and now feel out of my depth. Stop or continue?
Stop as safely as possible, call for immediate help, hand over clearly, and document what has happened. Use the event to plan supervised training and reflection.

Do I have to write down my reflection?
You should keep an objective record of learning needs and planned actions (e.g. supervised lists, simulation), avoiding identifiable patient details. This supports accountability and development.

Can I delegate the task to another junior instead?
Only if they are clearly competent and available, and it is safe to do so. You still need appropriate senior involvement and clear handover to avoid unsafe abdication of responsibility.

What if my senior discourages escalation or reflection?
Follow GMC guidance: prioritise patient safety, seek another senior or route if needed, and document concerns and actions taken.

Reflection and supervision are central to self awareness and insight GMC guidance.

📚 GMC ANCHOR POINTS

• Work within your competence and seek supervision when needed (GMC Good Medical Practice 2024, paras 6–8).
• Maintain and develop knowledge and skills through CPD (Good Medical Practice 2024, paras 9–13).
• Take prompt action if patient safety is at risk, including escalation and raising concerns (Raising and acting on concerns; Good Medical Practice 2024, paras 17–21).
• Be open and honest with patients and colleagues, including about your own limitations (Good Medical Practice 2024, candour and communication sections).
• Delegate and refer safely, ensuring the person is competent and that responsibilities are clear (Delegation and referral guidance).
• Engage in reflective practice to improve care, while respecting confidentiality (Reflective practice guidance).

Patient safety takes priority over pride under self awareness and insight GMC standards.

💡 MINI PRACTICE SCENARIO

A breathless, hypotensive patient on your ward is suspected to have a large pneumothorax. The registrar is scrubbed in theatre and unavailable for 30 minutes. You have only practised chest drain insertion on a manikin and have never done one on a live patient.

Best action: Call a competent clinician to attend urgently while you begin ABCDE assessment, provide oxygen and analgesia, monitor closely, and prepare the patient and equipment.
Why: This combines immediate stabilisation with early escalation to someone competent, acknowledges your limits, and prioritises patient safety over pride or delay.

🎯 KEY TAKEAWAYS

✓ Self-awareness and insight start with honest appraisal of your competence.
✓ Early escalation and supervision protect patients and score highly in the SJT.
✓ Stabilisation (ABCDE) and monitoring must not wait for the senior to arrive.
✓ Misrepresenting your experience or “having a go” unsupervised is unsafe and low scoring.
✓ Documentation and reflection turn incidents into learning and system improvement.
✓ Delegation must be safe, supervised, and clearly handed over.
✓ Patient safety always outweighs embarrassment, hierarchy, or convenience.

🔗 RELATED TOPICS

* → Delegation and Supervision
* → Maintaining Competence and CPD
* → Managing Fatigue and Impairment
* → Raising and Acting on Concerns
* → Duty of Candour and Honesty
* → Patient Safety and Escalation

📖 FULL PRACTICE QUESTIONS

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

A deteriorating patient on your ward is thought to have a large pneumothorax and needs an urgent chest drain. You have only practised the procedure on a manikin and have never inserted a chest drain in a live patient. The on-call registrar is scrubbed in theatre and cannot attend for at least 30 minutes. The patient is tachypnoeic, hypotensive, and in pain.

Options:
A. Call a competent clinician (such as another registrar, consultant, or ICU outreach) to attend urgently.
B. Begin ABCDE monitoring, give appropriate oxygen and analgesia, and prepare the kit and consent while help is en route.
C. Escalate to the duty consultant or site team if immediate cover is not available from the first senior contacted.
D. Proceed yourself now and watch an online video guide if needed to avoid delay.
E. Ask another F1 who has “seen one” to do the drain while you assist.
F. Wait for 30 minutes until the original registrar can attend, without further action.
G. Document your assessment, escalation attempts, and agreed safety thresholds (for example, call ICU if saturations fall or blood pressure worsens).
H. Transfer the patient immediately to another ward without informing any seniors.

Example SJT — Rank 5 (best → worst)

You are the only junior doctor covering a medical ward late in the evening. Three issues arise at once:

1. A patient develops new central chest pain and looks clammy.
2. Another patient needs an IV cannula for time-critical IV antibiotics.
3. A family is in the relatives’ room, upset and wanting an update on delayed scan results.

You are uncertain about the full chest pain protocol for this hospital and are aware that no senior is yet aware of the new chest pain.

Options:
A. Attend the chest pain patient immediately, call the medical registrar, start basic assessments (observations, ECG, oxygen and analgesia per protocol), and ask nursing staff to site an IV cannula for the other patient.
B. Update the family first to keep them reassured, then review the chest pain once you have finished the conversation.
C. Attempt to manage the chest pain yourself without senior input, to avoid “bothering” the registrar.
D. Ask a colleague from another ward to “cover everything” while you stay in the office finishing documentation.
E. Site the IV cannula first because it is quick, then see the chest pain patient.