Working Under Time Pressure

SJT Textbook: Working Under Time Pressure

Working Under Time Pressure MSRA

This guide covers the intense challenge of Working Under Time Pressure MSRA scenarios. In the Professional Dilemmas paper, you must prove you can maintain structure when the bleep is relentless, prioritising patient safety over speed.

🎥 Video Lesson (YouTube)

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🎯 THE CORE PRINCIPLE

Working under time pressure is about applying a rapid, repeatable structure that keeps patients safe when your workload is heavy and deadlines are tight. Instead of reacting to every bleep and interruption, you pause briefly, identify the top risks, and make a simple, shared plan.

The SJT tests whether you can protect high-risk steps (such as prescribing, defibrillation and critical consent conversations) by single-tasking them, while using the team for lower-risk or clerical work. High-scoring options show short micro-huddles, named owners, timers, and explicit regroup points rather than frantic multitasking.

Documentation and escalation are part of safe time-pressure management. Good answers record the plan and outstanding tasks, set clear thresholds for escalation, and involve seniors early if safety is threatened. Low-scoring answers simply try to “work faster”, juggle everything alone, or delay asking for help.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Call a 30–60 second micro-huddle to list the top safety risks and agree a Now/Next/Later plan.
2. Assign each task a named owner, a timeframe, and a clear escalation threshold.
3. Protect “focus windows” for high-risk steps (for example, prescribing high-risk drugs, defibrillation, or complex consent) by minimising interruptions.
4. Use closed-loop communication (name → task → timeframe → confirm-back) for all urgent or safety-critical instructions.
5. Timebox lower-risk clusters of work (for example, results chase, callbacks, routine letters) using short sprints and timers.
6. Escalate early to the nurse in charge, registrar or site team if deadlines or workloads threaten patient safety.
7. Document the plan, including priorities, owners, timers, and outstanding tasks, so that others can follow and continue it at handover.

Trap answers favour speed over safety, multitasking over protected focus, and silent struggle over escalation and documentation; high-scoring options use brief planning, structure and help-seeking.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I am prescribing a high-risk medication now; please hold non-urgent bleeps for five minutes and confirm back.”
* “You chase the results for ten minutes and call me by 11:15 with an update; if NEWS2 is six or more, escalate immediately.”
* “I have documented our priorities, owners and review times and escalated the workload risk to the registrar and nurse in charge.”
* “We will review this plan together in fifteen minutes and adjust if we are still overloaded.”

P = Pause-plan (micro-huddle and top three risks)
A = Assign owners and times
C = Clock timers and regroup points
E = Escalate early if safety is threatened
R = Record the plan, actions and outstanding tasks

📋 QUICK FAQ

What if I am interrupted while prescribing or defibrillating?
Stop, deal with the interruption only if genuinely urgent, then re-check the whole process from the start. High-risk steps should be as interruption-free as possible, with clear boundaries and support from the team.

Is there time for a huddle when we are already overloaded?
Yes. A 30–60 second micro-huddle saves time overall by preventing duplicated work, omissions and errors. Brief planning under pressure is a safety intervention, not a luxury.

Who should I escalate to when time pressure becomes unsafe?
Inform the nurse in charge and the registrar or consultant, and if needed the site practitioner or on-call manager. State clearly what the risks are, what has been done already, and what support you need.

How often should I regroup the team?
Set explicit regroup times (for example, 10–30 minutes depending on acuity). At each regroup, update priorities, owners and deadlines based on new results and observations.

What must I document when working under pressure?
Record the priorities, owners, time-critical tasks, escalation made, and any outstanding tasks and review times. This creates a clear trail and supports safe handover.

📚 GMC ANCHOR POINTS

* Duty to make patient safety the first concern, even when under pressure (GMC Good medical practice 2024).
* Working within competence and seeking help when needed, including under high workload (Good medical practice, working within limits).
* Delegating tasks clearly and ensuring colleagues understand instructions, timeframes and escalation (GMC Delegation and referral).
* Keeping clear, accurate and timely records, especially during busy periods and at handover (Good medical practice, records and continuity).
* Raising and acting on concerns where workload or system pressures threaten patient safety (GMC Raising and acting on concerns).

💡 MINI PRACTICE SCENARIO

You are an FY2 on an acute medical ward at 17:45. There are multiple bleeps: one about a patient with NEWS2 7 and new confusion, one about overdue antibiotics, one about discharge letters, and several missed phone calls from relatives. Staff look overwhelmed and you feel rushed.

Best action: Call a 60-second huddle with the nurse in charge, list the top three risks (for example, NEWS2 7, overdue antibiotics), assign owners and times, protect your focus to review the deteriorating patient, set a 15-minute regroup and document the plan and escalation to the registrar.
Why: This creates a brief but structured plan, protects critical steps, uses the team, and escalates risk early, in line with GMC duties on prioritisation, delegation, record-keeping and raising concerns.

🎯 KEY TAKEAWAYS

✓ A short pause to plan saves time and errors.
✓ Single-task high-risk steps; avoid multitasking when prescribing or resuscitating.
✓ Use closed-loop communication with owners, timeframes and confirm-back.
✓ Escalate capacity and safety concerns early, not after harm occurs.
✓ Document the plan, escalations and outstanding tasks so others can continue safely.

🔗 RELATED TOPICS

* → Prioritising Clinical Tasks
* → Time & Resource Management
* → Delegation & Supervision
* → Handover & Documentation
* → Escalation & Raising Concerns

📖 FULL PRACTICE QUESTIONS

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

You are the only medical SHO on an acute ward at 18:00. There are three simultaneous bleeps: (1) a patient with NEWS2 6 and new chest pain, (2) a nurse asking about two overdue discharge letters, and (3) a lab alert for a potassium of 6.0 mmol/L in a different patient. The team appear stressed and say they are “too busy to plan”.

Options:
A. Answer each bleep in the order received and try to juggle all three tasks at once.
B. Call a 60-second huddle with the nurse in charge, list the top three risks, and create a Now/Next/Later plan.
C. Go straight to the chest pain patient for assessment, asking a competent colleague to begin hyperkalaemia treatment according to protocol.
D. Focus on finishing the discharge letters quickly so you can “clear easy jobs” before seeing sick patients.
E. Ask the healthcare assistant to prescribe and administer treatment for hyperkalaemia while you review the chest pain.
F. Ask a colleague to hold non-urgent bleeps for five minutes while you single-task prescribing high-risk medication and then confirm back to you.
G. Decide not to write anything down because documentation slows you down when under pressure.
H. Avoid calling the registrar because “they are already busy enough.”

Example SJT — Rank 5 (best → worst)

You are on-call in the emergency department with significant time pressure. You are currently prescribing insulin for DKA when three things happen at once: the phone rings with a relative asking for an update, a nurse asks you to sign a routine drug chart, and your bleep goes off about a patient with NEWS2 7. You feel under pressure to respond to everyone quickly.

Options:
A. Ask a colleague to hold non-urgent tasks for five minutes while you complete prescribing for DKA without interruption, then immediately review the NEWS2 7 patient and escalate to the senior, documenting the plan.
B. Keep the phone on your shoulder while prescribing, answer the relative, and sign the routine drug chart at the same time to avoid delays.
C. Put the DKA prescription on hold, answer the relative’s call, then decide what to do next.
D. Tell the nurse you are too busy and ask the healthcare assistant to sign the routine drug chart.
E. Ignore the bleep about NEWS2 7 because you are already prescribing for DKA.

Options:
A. Protect prescribing, then review NEWS2 7 and escalate, documenting.
B. Multitask phone call, prescribing and chart signing simultaneously.
C. Break off from prescribing to handle a relative’s call first.
D. Ask an HCA to sign a drug chart in your place.
E. Ignore a bleep about NEWS2 7 while focusing on current task.