Chapter 1: Good Medical Practice & Patient Safety

Section 1: Good Medical Practice

Core Principle: Your relationship with a patient is a partnership built on trust, communication, and competence.

SJT Implications: This section governs the fundamental doctor-patient interaction. Actions that build trust and demonstrate competence are always ranked highly.

Guideline Breakdown & Actionable Advice:

1.1 Good Communication:

• What this means: You must be open, honest, and clear. Listen to the patient. Identify yourself and your role.
• In an SJT - Always Do: Options involving exploring the patient's concerns, listening, explaining things clearly, and checking for understanding.
• In an SJT - Avoid: Options where you dismiss a patient's concerns, use complex jargon, or proceed without explanation.

1.2 Good Standard of Practice:

• What this means: You must assess, examine, investigate, and treat patients properly. Crucially, you must recognise your limits and refer when necessary.
• In an SJT - Always Do: Actions that involve gathering more information (history, examination), seeking senior input, or referring to the appropriate specialist/service.
• In an SJT - Avoid: Acting outside your competence, refusing a reasonable request for a second opinion, or delaying a necessary referral.

Typical SJT Scenarios:

• A patient is anxious and you need to explain a complex procedure.
• A patient requests a treatment you don't believe is clinically indicated.
• You are unsure about a diagnosis and need to decide the next step.

Section 2: Patient Safety

Core Principle: Patient safety is your absolute, non-negotiable priority. This overrides almost everything else, including politeness, hierarchy, and efficiency.

SJT Implications: This is the single most important principle in the SJT. Any option that ensures or restores immediate patient safety is almost always the most appropriate action. Any option that compromises it is always the least appropriate.

Guideline Breakdown & Actionable Advice:

2.1 Promote a Positive Culture of Safety:

• What this means: Safety isn't just about you; it's about the team and the system. This involves maintaining your skills, clear communication, and encouraging everyone to raise concerns.
• In an SJT - Always Do: Reflect on your practice, seek feedback to improve, support colleagues who raise safety concerns.

2.2 When an Unintended Outcome Occurs:

• What this means: If a mistake happens, your first duties are to (1) fix the problem for the patient, (2) be open and honest about it (see Section 4), and (3) learn from it.
• In an SJT - Always Do: Actions that immediately mitigate harm to the patient. Actions that involve reporting the incident (formally or to a senior) so it can be learned from.
• In an SJT - Avoid: Hiding the mistake, blaming someone else, or failing to report the incident.

Typical SJT Scenarios:

• You spot a prescribing error on a drug chart.
• You realise you have made a mistake in a patient's treatment.
• A piece of equipment on the ward appears to be faulty.

Section 3: Identifying and Raising Concerns

Core Principle: You have a professional duty to act if you believe patient safety is being compromised by a colleague or a system. Silence is not an option.

SJT Implications: These are classic SJT scenarios. The test wants to see if you can navigate the difficult social situation of challenging a colleague or the system, prioritising patient safety over personal comfort or loyalty.

Guideline Breakdown & Actionable Advice:

3.1 Raise Concerns:

• What this means: You must speak up. The first step is often to speak to the person directly if it is safe and appropriate to do so. If not, you must escalate.
• In an SJT - Always Do: Escalate your concern to an appropriate senior (your clinical supervisor, a consultant, the nurse in charge). Speaking to the colleague directly (sensitively) is often a good first step, but escalation is mandatory if safety is at risk.
• In an SJT - Avoid: Gossiping with peers, confronting a colleague aggressively, or ignoring the problem hoping it will go away.

Typical SJT Scenarios:

• You suspect a colleague is working under the influence of alcohol.
• You notice a senior doctor is not following hand hygiene protocols.
• A colleague consistently leaves tasks for the next person on shift.

Section 4: Open Disclosure

Core Principle: When an adverse event occurs, you must be honest and transparent with the patient and their family.

SJT Implications: This tests your integrity and compassion. The correct approach is always honesty, even when it's difficult.

Guideline Breakdown & Actionable Advice:

4.1-4.3 Be Professional and Empathetic:

• What this means: Acknowledge what happened. Express regret sincerely. Explain the facts clearly. Reassure them about their ongoing care. Explain what will be done to prevent it from happening again.
• In an SJT - Always Do: Inform the patient about the error. Apologise for what happened. Involve a senior colleague in the conversation.
• In an SJT - Avoid: Covering up the error, being defensive, blaming others, or giving false reassurance.

Typical SJT Scenarios:

• You realise you gave a patient the wrong medication.
• A patient's test results were delayed, leading to a worse outcome.
• A surgical complication has occurred.

Sections 5 & 6: Protection of Vulnerable Persons

Core Principle: You have a legal and ethical duty to protect vulnerable individuals. The welfare of a child is paramount and overrides duties of confidentiality to a parent or carer.

SJT Implications: These scenarios test your ability to prioritise the safety of a vulnerable person above all else, including patient confidentiality and requests from family members.

Guideline Breakdown & Actionable Advice:

5.1-5.2 & 6.1 Comply and Report:

• What this means: If you have reasonable grounds to suspect a child or vulnerable adult is being harmed or is at risk of harm, you must report it to the appropriate authorities (e.g., Tusla, Social Services) without delay.
• In an SJT - Always Do: Report your concerns to the relevant authorities. Discuss the case with your senior/safeguarding lead. Document everything meticulously.
• In an SJT - Avoid: Agreeing to a parent's request to keep suspicions confidential. Delaying a report. Trying to investigate the matter yourself.

Typical SJT Scenarios:

• A child presents with injuries inconsistent with the history given.
• A patient discloses historical abuse but mentions the alleged abuser now has contact with other children.
• An elderly patient appears neglected and their carer is dismissive of your concerns.

Section 7: Reporting of Alleged Historic Abuse

Core Principle: When a patient discloses historic abuse, your primary duty shifts from the patient's past trauma to the current risk that the alleged abuser poses to others, especially children or vulnerable adults.

SJT Implications: This is a specific and challenging variant of the child/vulnerable adult protection scenario. It tests your ability to assess current risk and act decisively, even when the patient does not consent to a report being made. Your reporting obligation can override patient consent in this context.

Guideline Breakdown & Actionable Advice:

7.1 Assess Current Risk:

• What this means: Your first step is to gather information. Does the alleged abuser have access to children now? Are they in a position of trust? You must determine if there is an ongoing threat.
• In an SJT - Always Do: Options that involve exploring the current situation. For example: "Gently ask the patient if the person they mentioned has contact with any children now."

7.2 Report if Anyone is at Risk:

• What this means: If you believe there is a current risk, you must report it to the relevant authorities (Tusla, Social Services, Gardaí). You should seek the patient's consent, but you must report even if they refuse.
• In an SJT - Always Do: Informing the patient of your professional duty to report. Escalating to your clinical supervisor or safeguarding lead to ensure the report is made correctly.
• In an SJT - Avoid: Agreeing to keep the information confidential if there is a current risk. Promising the patient you won't tell anyone. Delaying the report.

Typical SJT Scenarios:

• A patient with depression mentions they were abused by a family member who is now a primary school teacher. The patient begs you not to say anything as it would "destroy the family."
• An elderly patient discloses that their adult child, who is their primary carer, is financially abusing them.

Section 9: Healthcare Resources

Core Principle: You have a dual responsibility: to be an advocate for your individual patient while also being a steward of finite public resources for the wider community.

SJT Implications: These scenarios test your ability to balance competing needs fairly and ethically. You must make decisions that are equitable, evidence-based, and prioritise safety without being wasteful.

Guideline Breakdown & Actionable Advice:

9.1 Use Resources Equitably, Efficiently, and Sustainably:

• What this means: Don't waste resources on treatments or investigations that have no evidence base or clinical indication. You must balance the needs of the patient in front of you with the patients waiting.
• In an SJT - Always Do: Follow local and national guidelines for prescribing and investigations. Prioritise patients based on clinical need, not on who shouts the loudest.
• In an SJT - Avoid: Giving in to patient demands for inappropriate treatments (e.g., antibiotics for a viral infection). Ordering expensive scans "just in case" without clinical justification.

9.2 Prioritise Safe Care and Highlight Concerns:

• What this means: If a lack of resources is directly causing patient harm (e.g., not enough nurses on a ward, broken equipment), you have a duty to raise this concern.
• In an SJT - Always Do: Escalate concerns about resource shortages that impact patient safety to a senior colleague or manager. Fill out an incident form if a lack of resources leads to an adverse event.
• In an SJT - Avoid: Simply accepting unsafe conditions. Complaining to peers without taking formal action.

Typical SJT Scenarios:

• A patient demands an MRI for simple back pain, while the waiting list for urgent scans is months long.
• You are on a ward that is dangerously understaffed, and you are concerned mistakes will be made.
• You have to decide which of two sick patients gets the last available bed in the ICU.

Section 10: Safe Environment and Premises

Core Principle: The physical environment where care is delivered must be safe, clean, accessible, and respect patient privacy.

SJT Implications: This is a systems-based issue. SJTs will test if you recognise your responsibility to act when the environment itself poses a risk to patients or staff.

Guideline Breakdown & Actionable Advice:

10.1-10.3 Ensure Appropriate Standards:

• What this means: Patients have a right to be treated in a safe and clean setting. If you see a problem (e.g., a spillage on the floor, a breach of infection control, a lack of privacy), you have a responsibility to address it or raise the concern.
• In an SJT - Always Do: Take immediate action to rectify a simple hazard (e.g., clean up a spill or ask a cleaner to). Report more significant environmental concerns (e.g., broken equipment, persistent poor hygiene) to the person in charge (nurse manager, your senior).
• In an SJT - Avoid: Walking past a clear hazard. Assuming someone else will deal with it.

Typical SJT Scenarios:

• You notice a colleague is not disposing of sharps correctly.
• The ward is visibly unclean, and you are concerned about infection control.
• A consultation room offers no privacy, and conversations can be easily overheard.

Section 11: Leadership and Management for Doctors

Core Principle: Even as a junior doctor, you are a leader and have a responsibility for the quality and safety of care. This includes improving the systems you work in.

SJT Implications: This tests your proactivity and systems-thinking. The best answers often involve not just fixing an immediate problem, but thinking about how to prevent it from happening again.

Guideline Breakdown & Actionable Advice:

11.1-11.4 Take Responsibility and Improve Systems:

• What this means: Your primary responsibility is always the health and safety of patients. If you see a flawed system (e.g., an unreliable handover process, confusing protocols), you should take appropriate action to highlight it or help improve it.
• In an SJT - Always Do: After dealing with an immediate issue, suggest a way to improve the system (e.g., "Discuss the handover process at the next team meeting"). Take part in clinical audits. Raise concerns about administrative processes that are impeding patient care.
• In an SJT - Avoid: Thinking "that's not my job." Repeatedly fixing the same error without addressing the root cause.

Typical SJT Scenarios:

• You notice that weekend handover is consistently poor, leading to tasks being missed.
• A patient's discharge letter is delayed due to an inefficient administrative process, causing them distress.
• You are asked to complete a task but the hospital protocol is unclear and confusing.

Section 12: Health and Wellbeing of Doctors

Core Principle: You have a duty to look after your own health and wellbeing to ensure you are fit to practise and do not pose a risk to patients.

SJT Implications: These are very common and important SJT scenarios. They test your insight and your ability to prioritise patient safety over your own desire to "push through" illness or stress.

Guideline Breakdown & Actionable Advice:

12.1-12.2 Self-Care and Self-Prescribing:

• What this means: You must look after yourself. Have your own GP (who is not a close friend or family member). You must not prescribe controlled drugs for yourself. You should not treat or prescribe for yourself in general.
• In an SJT - Always Do: Make an appointment with your own GP. Seek support from Occupational Health.
• In an SJT - Avoid: Self-prescribing. Asking a colleague for an informal prescription ("corridor consult").

12.5-12.6 Concerns About Your Health & Fitness to Practise:

• What this means: If you have a condition (physical or mental, including stress or burnout) that could impair your judgement or pose a risk to patients, you must seek professional advice and follow it. If a risk exists, you must inform the Medical Council.
• In an SJT - Always Do: Take time off sick if you are unwell. Speak to your educational supervisor or a senior colleague if you are struggling. Contact Occupational Health.
• In an SJT - Avoid: Coming to work when you are clearly unfit to do so (e.g., with a high fever, severe stress, under the influence of medication that impairs judgement). Hiding a health problem that could affect patient safety.

Typical SJT Scenarios:

• You feel burnt out and are struggling to cope with the workload.
• You have a bad back and a colleague offers you some of their personal strong painkillers.
• You have a fever and feel very unwell, but the ward is short-staffed and you feel guilty about calling in sick.

The Definitive SJT Ranking Framework

Apply this hierarchy to every ranking question. The most appropriate actions are at the top; the least appropriate are at the bottom.