This episode teaches one of the highest-yield SJT skills: recognising when you are beyond your competence, pausing early, and escalating safely. You’ll learn how to apply GMC Good Medical Practice, manage cultural pressure, stabilise deteriorating patients, and use memory frameworks to act safely under stress.

0:00 Situational awareness intro
00:28 Why limits matter
01:04 GMC expectations
01:40 Scenario: septic patient + central line request
02:24 The pause rule
03:10 Cultural pressure to “just do it”
03:58 Why delayed escalation causes harm
04:40 Working strictly within competence
05:20 Five-step safety framework
06:08 Stabilising while waiting for help
06:58 ASK mnemonic
07:40 STOP–Review–Plan sequence
08:10 Pattern 1: risky procedures
08:58 Pattern 2: deteriorating patient
09:40 Decoy traps
10:20 Probity & documentation
11:02 Red-flag moments
11:36 Off-site senior escalation
12:14 Final three must-know rules
12:52 Rapid recap summary

• Pause immediately when a task exceeds your skill, capacity, or training.
• Escalate early — phone the senior, crash team, or site manager as needed.
• Stabilise with ABCDE and safe interim measures while help arrives.
• Never attempt high-risk procedures without direct supervision.
• Maintain ownership until a competent clinician agrees takeover.
• Avoid trap behaviours: “have a go”, vague notes, delegating to untrained staff.
• Clear documentation protects patient safety and your probity.

ASK
A – Assess risk
S – Seek supervision
K – Keep notes & keep the patient safe

STOP–OP
S – Stop
T – Talk to senior
O – Options review
P – Plan & proceed safely

Links:
• passthemsra.com – Complete MSRA revision, notes, mocks, flashcards
• freemsra.com – Free podcasts, threads and rapid-learning guides
• msra.io – Smart MSRA Qbank with analytics

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