Time & Resource Management

SJT Textbook: Time & Resource Management

Time and Resource Management MSRA

This guide introduces the critical domain of Time and Resource Management MSRA scenarios. In the Professional Dilemmas paper, you are tested on your ability to juggle competing clinical demands without compromising patient safety or your own wellbeing.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Time and resource management is about delivering safe care when workload exceeds what one person can reasonably do. The SJT tests whether you focus on the sickest and most time-critical problems first, rather than working down a list in arrival order or by convenience.

Good performance means noticing when the system is becoming unsafe, escalating early to seniors and operational leads, and using the wider team appropriately. You must delegate tasks within colleagues’ competence, use structured communication (for example SBAR), and avoid trying to do everything yourself at the cost of patient safety.

Continuity is just as important as speed. High-scoring answers ensure robust documentation and handover so that outstanding tasks, risks, and review plans are clearly owned when you go off duty.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Prioritise clinically using ABC, NEWS2 and time-critical diagnoses (sepsis, chest pain, stroke, new neuro deficit) rather than first-come-first-served.
2. Maintain a visible, updated task list (paper or electronic) that is re-ordered as new information comes in and clearly marks urgent items.
3. Escalate workload and safety concerns early to the registrar, consultant, nurse in charge or site manager when care may become unsafe.
4. Delegate tasks safely using SBAR to colleagues whose competence and role match the job, confirming what is needed and by when.
5. Use structured handover tools (for example, electronic lists and formal handover meetings) so that risks, review times and outstanding jobs are clearly owned.
6. Protect your own limits by recognising when you cannot complete work safely, raising concerns, and using exception or incident reporting where appropriate.
7. Plan for interruptions by building in time to re-triage, re-check obs and revisit high-risk patients rather than rigidly sticking to an old plan.
8. Document key decisions promptly including escalation, prioritisation rationale and any delays, so that others can safely continue care.

High-scoring options use clinical risk to set the order, ask for help early, match tasks to the right person, and always leave a clear, documented plan.

💬 MODEL PHRASES (Use These in SJT Logic)

* “This workload is becoming unsafe; I am escalating to the registrar and nurse in charge so we can redistribute tasks.”
* “Can I hand over these routine jobs to you using SBAR while I focus on the NEWS2 8 patient now?”
* “Before I leave, I will update the handover list to show outstanding tasks, review times and who is responsible.”
* “This task is beyond my competence unsupervised, so I need senior support or an alternative plan.”

P = Prioritise by clinical risk and time sensitivity
A = Allocate time with a visible, updated list
U = Urgently escalate when workload or safety is unsafe
D = Delegate within competence using SBAR
E = Enter notes and hand over clearly before leaving

📋 QUICK FAQ

How do I prioritise when everything looks urgent?
Start with immediate risk to life or limb (airway, breathing, circulation, sepsis, chest pain, stroke, high NEWS2), then time-sensitive treatments (antibiotics, insulin, anticoagulation, imaging), and finally important-but-routine tasks such as discharge paperwork and non-urgent bloods.

When should I escalate workload concerns?
Escalate as soon as patient safety, dignity or basic standards may be compromised by volume of work, staffing or equipment issues. Do not wait until harm has occurred; GMC guidance expects you to raise concerns promptly.

Is it acceptable to leave on time with jobs outstanding?
Yes, provided you hand over clearly and ensure continuity. You are not required to finish every job personally, but you must ensure that outstanding tasks, review times and key risks are clearly handed over and recorded.

What if I am asked to do something beyond my competence?
Explain your limits, request supervision or a more appropriate colleague, and prioritise patient safety. GMC guidance is explicit that you must work within your competence and seek help when needed.

Should I skip documentation to catch up on the list?
No. Brief, focused documentation is essential for continuity and safety. Cutting notes completely is unsafe; instead, write concise entries and use structured tools to save time.

📚 GMC ANCHOR POINTS

* Providing good clinical care and managing resources responsibly (GMC Good medical practice 2024, early sections on clinical care and resource use).
* Raising and acting on concerns where patient safety may be at risk (GMC guidance and Good medical practice paragraphs on safety and speaking up).
* Delegating tasks safely, ensuring that colleagues have the necessary skills, experience and supervision (Good medical practice 2024, delegation and referral).
* Ensuring continuity and clear record-keeping, including accurate, timely documentation and handover (Good medical practice 2024, records and continuity).
* Leadership and management responsibilities for managing workload, supporting colleagues and maintaining safe systems (GMC leadership and management guidance).

💡 MINI PRACTICE SCENARIO

You are the only SHO on the ward at 18:30. Your list includes: a NEWS2 8 patient with rising oxygen requirement waiting for review, an overdue antibiotic dose for a septic patient, three routine discharge letters, and several non-urgent blood requests. The nurse in charge tells you there are no extra staff and is worried about safety.

Best action: Prioritise reviewing the NEWS2 8 patient and ensuring the septic patient receives antibiotics urgently, while immediately escalating workload and staffing concerns to the registrar and site manager and delegating routine tasks using SBAR.
Why: This focuses on the highest clinical risk, raises concerns early, shares the load safely and maintains continuity, in line with GMC duties on patient safety, delegation and raising concerns.

🎯 KEY TAKEAWAYS

✓ Clinical risk and time sensitivity always trump arrival order.
✓ Escalate workload and safety problems early rather than silently coping.
✓ Delegate tasks only within colleagues’ competence and with clear communication.
✓ Keep a visible, updated list so the team understands priorities and outstanding work.
✓ Use structured handover and documentation to protect continuity.
✓ Use incident or exception reporting when system pressures repeatedly threaten safety.

🔗 RELATED TOPICS

* → Escalation & Raising Concerns
* → Delegation & Supervision
* → Handover & Documentation
* → Resource Allocation & Fairness
* → Self-awareness & Insight

📖 FULL PRACTICE QUESTIONS

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

You are a CT1 doctor covering the medical wards on an evening shift. The registrar is in theatre with a sick patient. Your current tasks are: reviewing a NEWS2 7 patient with suspected sepsis, prescribing insulin for a stable patient with high capillary glucose, writing three discharge summaries for patients who can go home tomorrow, consenting a stable patient for a CT scan that can be done overnight, and checking routine bloods for tomorrow’s clinic. The nurse in charge tells you that drug rounds are running late and is worried about the unreviewed septic patient.

Options:
A. Work through the list strictly in the order the jobs arrived so that no one complains about being delayed.
B. Immediately review the NEWS2 7 patient and prescribe antibiotics, then call the registrar to update them and seek advice, documenting the plan.
C. Focus on finishing the three discharge summaries so that tomorrow’s ward round is quicker.
D. Ask a competent colleague to check routine bloods and chase non-urgent results while you deal with the septic patient.
E. Ignore the nurse in charge’s concerns because she is not a doctor.
F. Consent the stable CT patient first because it is quick and will get a job off your list.
G. Update your task list, marking the septic patient and time-critical treatments as top priority, and explain expected timeframes to nursing staff.
H. Skip documentation of your reviews to save time, planning to write notes later when the ward is quiet.

Example SJT — Rank 5 (best → worst)

On a busy evening, you are covering two wards. A patient with chest pain and rising NEWS2 is waiting for review; an elderly patient needs evening insulin; three families are asking for updates; and several routine bloods are due. You feel overwhelmed and are starting to lose track of what has been done.

Options:
A. Review the chest pain patient immediately, call the registrar with an SBAR handover, and ask the nurse in charge to help you identify which routine tasks can be delegated or safely postponed, documenting an agreed plan.
B. Try to complete all tasks yourself without telling anyone you are struggling, staying several hours late and hoping it will be easier tomorrow.
C. Focus on speaking to the families first so that they are less likely to complain, leaving the chest pain review until later.
D. Ask a competent colleague to give the evening insulin and do routine bloods while you assess the chest pain patient and update one family, recording your actions briefly in the notes.
E. Skip documentation for now and rely on your memory to update the notes at the end of the shift.