Rapid-recall takeaways distilled from the FY1 SJT question bank, grouped by specialty. One pearl per high-frequency concept. Use it for last-pass revision alongside questions, not as a replacement for them.
134 pearls · 5 specialties · Generated 6 November 2026
Commitment to Professionalism
64 high-yield facts
Decline personal cash gifts in line with trust policy and GMC Good Medical Practice, but acknowledge the family's gratitude and offer the ward charitable fund as an alternative.
Report controlled drug discrepancies immediately - patient safety and legal compliance require prompt escalation; offer compassion alongside accountability; substance misuse is a treatable condition.
Correct allergy-related errors immediately - apply wristbands; stop contraindicated medications; prescribe safe alternatives; report both near misses; never wait for the original prescriber to correct their error.
Act promptly when missed diagnoses are identified - discuss with seniors; recall the patient urgently; report through governance; never alter original clinical documentation retrospectively.
Delegate to students based on their demonstrated competence - match supervision to task complexity; students cannot prescribe; never compromise patient safety to address staffing shortfalls.
Present M&M cases completely and honestly - contributing factors like time pressure are systemic issues worth examining; just culture separates system failures from individual blame; never omit relevant information.
Supervise within your competence - FY1s can supervise students for procedures they can perform themselves; seek senior help for complex procedures; never allow unsupervised practice by students.
Suspicious mole in a non-patient - signpost to the GP for a 2-week-wait referral (NICE NG12); do not provide informal opinions without a record.
Participate honestly in root cause analysis - engage your defence organisation for support; focus on systemic learning; honest contribution improves patient safety for everyone.
Be truthful in coroner's statements - seek defence organisation support; document what you knew at the time; misleading a coroner is a criminal offence; institutional reputation never justifies dishonesty.
Never stop providing feedback because a learner is resistant - use structured approaches; create safe environments; provide specific examples; escalate to the medical school if improvement does not follow.
Decline high-value personal gifts, redirect them to charity, and document any accepted gift - protect public trust and avoid any appearance of financial influence.
Treat every patient with courtesy and dignity regardless of complaints (GMC GMP 15, 46) - use objective documentation, MDT coordination, and trust complaints pathways, and never label patients pejoratively in the clinical record.
Always disclose errors honestly to patients and seniors - escalate for clinical safety first; duty of candour is a legal requirement regardless of outcome.
Correct prescribing omissions immediately and inform the patient - duty of candour applies even when no harm has resulted; document and report through governance channels.
Be honest about delays that affect patient care - duty of candour applies to your colleagues and the patient; accept accountability while highlighting systemic factors; use incidents for learning.
Engage honestly with families during difficult conversations - duty of candour includes empathy and explanation; never blame other staff; seek senior support but do not use their absence to avoid disclosure.
Act immediately when you discover another doctor's error - stop harmful medications; seek specialist advice; inform the patient; clinical safety overrides waiting for the original prescriber.
Lead duty of candour conversations with honesty and empathy - apologise sincerely; provide written follow-up; never deflect blame; seek personal support after serious incidents.
Needlestick injuries require immediate action regardless of workload - document, report, and seek formal medical assessment; your health matters alongside patient care.
Raise concerns about a colleague's health through appropriate channels - seniority does not exempt anyone from fitness to practise assessment; document objectively; act with compassion alongside accountability.
Never compromise safety for training attendance - recognise fatigue; report unsafe rotas formally; the EWTD and New Deal protect your wellbeing and patient safety.
Look for patterns across individual error reports - identify common factors; escalate to management and governance; individual popularity does not override patient safety concerns.
Never use results from the wrong patient - inform your team immediately; retake the correct sample; report the error; apologise to the wrongly sampled patient.
Cancel wrong-patient requests immediately - correct and expedite the right investigation; inform seniors about delays; unnecessary radiation exposure has long-term consequences; Datix reporting enables learning.
Countersigning means you accept full responsibility - check every prescription you sign; use errors as teaching moments; never blame supervised juniors for mistakes you should have caught.
Support struggling students by encouraging professional help - guide them to welfare services; seek supervisor advice on your responsibilities; complete confidentiality is not appropriate when safety may be affected.
Respond positively when students identify your errors - thank them; use the moment for teaching; model professional humility; punishing those who speak up damages patient safety culture.
Patient care always comes before teaching - inform seniors about conflicts; consider integrating students into clinical work as learning; never compromise patient safety for educational commitments.
Over-attachment from a vulnerable patient - escalate early to senior and psychology, set boundaries compassionately, and reserve team-removal for when structured support fails.
GMC duty to raise patient safety concerns applies to every doctor including FY1s; use formal channels + contemporaneous documentation + supervisor support - never silence, social media, or waiting to rotate.
Patient identifiers stay off consumer messaging - escalate to information governance, propose secure-platform alternatives (GMC Confidentiality 2024; NHS Digital).
Escalate concerns about impaired colleagues immediately - patient safety overrides collegial loyalty; verify clinical decisions made during the affected period; offer support alongside accountability.
Never work with infectious symptoms around vulnerable patients - inform seniors and site management immediately; staffing gaps are a management responsibility; your health directly affects patient safety.
Seek occupational health advice urgently if seroconversion is suspected - restrict exposure-prone procedures; your professional duty includes protecting patients from your own health risks.
Support colleagues with mental health concerns while ensuring patient safety - encourage professional help; involve supervisors when clinical performance is affected; absolute confidentiality is not possible when patients are at risk.
Only supervise procedures you are fully competent to manage complications for - recognise your limits; ensure appropriate senior supervision; procedural delegation requires adequate oversight.
Occupational health restrictions must be followed - inform supervisors when colleagues work beyond their cleared capacity; staffing gaps are a management responsibility; support colleagues in prioritising recovery.
Never relabel blood samples - discard and retake; WBIT is a serious near miss requiring Datix reporting; bedside labelling with positive patient identification prevents this error.
Acknowledge errors honestly when safety systems catch them - the WHO checklist prevented harm but the root cause must be investigated; near misses require the same governance attention as actual harm events.
Never omit clinically relevant information from discharge summaries - documentation must be complete and honest; patient safety in the community depends on accurate information transfer; challenge seniors respectfully when asked to compromise documentation.
Prioritise patient safety within governance frameworks - escalate to consultants for restricted prescriptions; prescribe alternatives within your authority; document reasoning; never delay critical treatment waiting for bureaucratic processes.
Reflect honestly on adverse events - seek supervisor guidance; identify learning needs; portfolio reflections are for development, not blame; honest reflection is a sign of professional maturity.
Never post when emotionally distressed - a patient confidentiality breach (D) is the gravest error, anonymity (E) offers no protection from GMC accountability, and seeking support first (A) is always the safest option.
Inform patients about near-miss errors as good practice - duty of candour promotes transparency; report through Datix for systemic learning; never let senior advice override your professional obligations.
Stop unsafe practices immediately when you identify them - correct the immediate risk; report through Datix; address systemic issues through appropriate channels; insulin errors can be fatal.
Engage with clinical governance meetings constructively - prepare honestly; seek pastoral support; these meetings improve patient care; viewing them as learning opportunities demonstrates professional maturity.
Engage openly with mortality reviews - respond promptly and honestly; reflect and learn; seek support for the emotional impact; contributing to these reviews is a professional obligation that improves care.
Never stay silent about safety concerns - seek support from your supervisor; use formal governance channels; Freedom to Speak Up protections exist; the WHO checklist is mandatory for all procedures.
Valid GMC registration is a non-negotiable legal requirement - report lapsed registration to medical staffing immediately; practising unregistered is a criminal offence; the GMC has hardship provisions for financial difficulty.
Mandatory training lapses are patient safety concerns - inform supervisors; expired life support certification must be renewed before leading arrests; support colleagues in meeting training requirements.
Patient safety comes first - perform the missed observations yourself, then address the behaviour directly with your colleague and escalate to the shift coordinator; falsifying clinical records breaches GMC Good Medical Practice and must never be ignored.
Recognise fatigue as impairment; correct the prescription, escalate, Datix; never continue unsafely and never self-prescribe - raise concerns early (GMP 29; BMA Fatigue Charter).
When prescribing errors cause harm, prioritise stopping the offending drug - inform seniors and the patient honestly; report and learn from the incident; never falsify documentation to conceal your role.
Halt and escalate immediately when chemotherapy errors are identified - never assume regimens are interchangeable; report near misses; systemic verification failures require formal investigation.
Address unprofessional behaviour regardless of seniority - report concerns through appropriate channels; support students who raise concerns; patient dignity is non-negotiable.
When a missed investigation could affect patient safety, act immediately - inform seniors and recall the patient; Datix alone is insufficient when active clinical risk exists.
Seek help early for mental health difficulties - self-referral to Practitioner Health is confidential; inform your supervisor; recognising your limits is professional, not weak.
Patterns of errors signal system failure - escalate formally in writing; individual Datix reports are insufficient for systemic issues; external reporting is a protected option when internal channels fail.
Engage openly with governance processes after incidents; prepare and reflect beforehand; defence organisation advice is fine but never a reason to refuse attendance; deflecting blame demonstrates poor insight (GMC Good Medical Practice 22, 55).
Present audit data honestly even when unflattering; audit drives improvement not perfection; discuss with seniors beforehand; complete the cycle with re-audit; never manipulate data (HQIP; GMC GMP 22, 68).
Telephone supervision is not adequate for invasive procedures; decline work outside competence even under pressure; reschedule to a supervised slot to protect patient safety (GMP 14; Foundation Curriculum).
Paediatric medication error - assess via TOXBASE/senior; disclose to parents under duty of candour (Reg 20); Datix and involve pharmacy; never alter records or deflect (GMP 55-56).
When understaffed - prioritise with NEWS, escalate early to the on-call consultant, and document via Datix/safe staffing reports. Never refuse care, abandon patients or delegate medical decisions outside scope. GMC Good Medical Practice expects raising concerns alongside continuing safe practice.
Coping with Pressure
26 high-yield facts
Moral distress → respectful challenge first (A), then MDT with palliative care (C) and ethics referral (E); avoid both blind compliance (D) and unilateral refusal (B).
In an IT outage, invoke downtime procedures and escalate to the site coordinator immediately - maintaining safe patient flow takes priority over waiting for restoration.
Prioritise clinical tasks, hand over the rest with clear context, and be honest about capacity - never leave silently or rush unsafely.
A possible acute coronary syndrome trumps all - triage by acuity, communicate timeframes, then raise staffing concerns afterwards.
Offer support first and encourage self-escalation, but escalate yourself when an impaired colleague threatens patient safety.
Support the victim, document specifics, and escalate through formal channels - clinical competence never excuses bullying behaviour.
D&V on shift - inform seniors, hand over outstanding jobs and unwell patients, and stay off until 48 hours symptom-free per UKHSA/Trust policy.
Raise concerns early (GMC GMP 2024), set safe boundaries around what you can and cannot do, and escalate unsafe rota/staffing gaps to the Guardian of Safe Working Hours through exception reporting under the 2016 junior doctor contract.
Triage by clinical urgency, escalate early when overwhelmed, and never make yourself uncontactable for emergencies.
In a crisis, do exactly as the operating surgeon directs - supervised assistance is safe; independent action beyond your competence is dangerous.
Adult anaphylaxis - IM adrenaline 500 micrograms first (Resus Council UK 2021), then 2222 call, ABCDE, supine with legs raised and high-flow oxygen; antihistamines and steroids are adjuncts, never substitutes.
Patient safety first - assess and stabilise, then report through the incident system; escalation and support, not personal punishment, are the junior doctor's role.
Patient Focus
22 high-yield facts
Escalate locally first (private conversation, then information governance), with external reporting reserved for persistent or serious breaches - anonymisation needs more than removing a name (GMC social media and confidentiality guidance).
Assess capacity for the specific decision at the patient's best moment - a health-and-welfare LPA only takes effect once the person lacks capacity.
For cost-related non-adherence, signpost the prepayment certificate, check exemptions, and involve social prescribing - never dismiss the financial barrier.
Mental Capacity Act 2005 demands proportionate, least-restrictive interventions documented as best interests; repeated distressing reinsertion of an NG tube triggers a fresh review before any further restraint is applied.
Transition to palliative care - review prior wishes, involve specialist palliative care, prescribe anticipatory medications and avoid futile investigations once active treatment is no longer appropriate (NICE NG31; GMC end-of-life guidance).
Complaints threats must never alter clinical or resource decisions; use professional boundary-setting and document clearly; signpost PALS and the trust complaints process; GMC Good Medical Practice requires equitable treatment regardless of status or behaviour.
Anaphylaxis = stop the trigger, IM adrenaline 500 micrograms 1:1000 into the anterolateral thigh, call for help (2222) - repeat adrenaline every 5 minutes; antihistamines and steroids are no longer routine acute therapy per Resuscitation Council UK 2021.
The carer's needs are part of the patient's discharge plan - validate, signpost to GP, and convene MDT planning under NICE NG150 and the Care Act 2014.
Address health anxiety with explanation and safety-netting - unnecessary imaging often heightens anxiety and exposes patients to incidentalomas and overdiagnosis.
act on every incidental finding - document it, inform the patient, and put a named, trackable follow-up plan in place; pulmonary nodules should be managed according to BTS nodule guidance rather than left to chance.
Effective Communication
12 high-yield facts
SJT interprofessional conflict - listen first, problem-solve collaboratively, then escalate; never simply override or capitulate (GMC GMP; NICE NG157 for early mobilisation).
Use an 'ask-tell-ask' approach to prognosis - explore what the patient already knows, deliver honest information with compassion, and offer consultant/CNS follow-up and family involvement; vague reassurance and complete deflection are the least helpful responses per GMC guidance.
Cardiac arrest leadership - assign roles by name, use closed-loop communication, deliver shocks promptly in VF/pVT, and hand over with SBAR (RCUK ALS 2021).
Social media confidentiality breach - act fast, address privately, ensure removal, then escalate to the Caldicott Guardian and information governance team and submit an incident report (GMC 2024 social media guidance).
Theatre safety - graded assertiveness ("I am concerned…"), use objective evidence, recruit team allies and never close while the count is incorrect (NatSSIPs 2/WHO Surgical Safety Checklist).
Use SBAR, document, and escalate up the hierarchy - never accept dangerous delay for an unstable bleeding patient.
SPIKES runs Setting, Perception, Invitation, Knowledge (warning shot then disclosure), Emotions, Strategy - prepare the patient before delivering the news and follow the patient's lead.
verbal details for three complex cases, and written summaries provide a reference during a busy shift. Option G is correct because informing the ward nursing teams about escalation plans creates safety redundancy.
The Accessible Information Standard requires exploring reasonable adjustments (transparent masks, video, written aids) with the patient rather than compromising infection control; never delegate clinical communication about results to staff unfamiliar with the patient's care.
Bad news = right person, right setting, right support, with minimal avoidable delay (GMC Good Medical Practice; SPIKES).
Working Effectively as Part of a Team
10 high-yield facts
Explore pain, delirium, and unmet needs before sedation - chemical restraint is a last resort under MCA and GMC principles, and ward-system issues such as call-bell response often drive apparent 'behavioural' problems.
First night on-call - see the sickest first, agree escalation thresholds with registrar and nurses early, and communicate the plan clearly.
Take nursing concerns about deterioration seriously - reassess at the bedside, agree explicit escalation criteria (e.g. repeat NEWS2 in 1 hour), involve the registrar or critical care outreach early if disagreement persists, and always document the joint plan.
Support the colleague, challenge disrespect directly, and put practical safeguards around communication - escalate formally if the behaviour continues.
Welcome pharmacist safety interventions - thank them, hold the dose, review the latest renal function and consider therapeutic drug monitoring; gentamicin must be dose-adjusted for renal function per the BNF, and you should never deflect blame or delay action.
In MDT disagreements - share objective bedside observations and the patient's wishes; don't take sides or defer because of grade.
Unexpected supervisory gap - escalate for senior cover, prioritise tasks within your competence, and keep nursing colleagues informed.
Support colleagues individually first after an incident; encourage reflection and PSIRF engagement; joint conversations once emotions have settled; MDO advice only if genuinely needed (NHSE PSIRF 2022).
INR 5-8 no bleed - hold 1-2 doses; INR >8 no bleed - oral vitamin K; any bleeding - IV vitamin K +/- PCC (BNF).
Orient locum colleagues early, share contact numbers and ward layout, and remove practical barriers to safe care - induction investment pays dividends in patient safety.
Raise concerns early, in writing, through internal channels first; escalate externally to the CQC only if internal escalation fails - never via social media.
Never transfuse blood of uncertain integrity - escalate to haematology and NHSBT, report via SHOT/Datix, and consider cell salvage or postponement before using potentially compromised units.
Give IM adrenaline immediately per the Resuscitation Council UK algorithm - never withhold for uncertain allergy history or junior status.
In simultaneous operational and clinical emergencies, clinical priorities take precedence - delegate logistics, give clear clinical input to bed managers about who cannot be safely moved, and protect the safe transfer of patients on IV infusions and oxygen.
Raise timing clashes early and directly with the consultant; contact the competing service; never rush documentation or disappear silently - patient-facing commitments require proactive communication (GMP 35).
in a major incident, accept your assigned role, apply the Triage Sieve systematically, follow the command structure, and prioritise rapid identification of those needing immediate intervention - systematic process adherence under pressure saves the most lives.
Burnout warning signs (numbness, avoidance, alcohol, insomnia) → tell educational supervisor + GP/occupational health + NHS Practitioner Health Programme; never conceal - disclosure (GMC GMP 2024) enables support and safe staffing.
In acute bereavement, compassionate presence, honesty about uncertainty (coroner and post-mortem will investigate), and delegating wider-ward support are the therapeutic interventions - never fabricate explanations, silence grief, or sedate normal bereavement (Sands guidance).
K+ >6.5 mmol/L = emergency - ECG, calcium gluconate, insulin-dextrose, salbutamol; act and escalate concurrently; prioritise by immediacy of threat to life (UK Kidney Association 2023).
In surge/divert events adapt flexibly, use ABCDE triage to identify the sickest, and escalate via OPEL - clinical acuity trumps arrival order (NHSE OPEL Framework).
Escalate early to your educational supervisor when overwhelmed; request protected time formally; opportunistic learning is pragmatic; never fabricate assessments - probity issues threaten your career, not just ARCP (Foundation Programme Reference Guide).
Communicate honestly, decompress actively (exercise/mindfulness/journaling), reflect clinically when ready; avoid alcohol; seek NHS Practitioner Health if symptoms persist.
For your first death certification - review protocol, ask the ward nurse, talk to the family sensitively, and complete the MCCD accurately for the Medical Examiner - it is a legal document, not a formality.
SJT distress scenarios - combine compassion (support the colleague) with patient safety (gather missing information from notes, registrar, nursing staff).
After bad news - stay, listen, be honest about palliative care; never give false hope; involve specialist palliative care early; respect confidentiality (NICE NG142; GMC end-of-life guidance).
In suspected acute stroke, activate the hyperacute stroke pathway and obtain urgent CT immediately - do not let detailed examination, blood pressure management, or antiplatelet decisions delay assessment for thrombolysis or thrombectomy.
A QTc above 500 ms in a patient on QT-prolonging drugs is a medical emergency - escalate to both teams and a senior, check and correct potassium and magnesium urgently, and never add a further QT-prolonging agent such as amiodarone.
New post-operative confusion is delirium until proven otherwise - assess for the precipitant (sepsis, opioids, urinary retention, hypoxia, metabolic derangement) before considering any sedation, which can worsen the picture (NICE CG103).
Environmental constraints never justify withholding or depersonalising end-of-life information - maximise privacy with simple measures and let the patient guide the timing, setting, and who is present (GMC end of life care guidance; NICE NG31).
Treat suspected norovirus clinically and act fast - close the ward, cohort patients, and exclude symptomatic staff until 48 hours symptom-free rather than waiting for laboratory confirmation (UKHSA norovirus outbreak guidance).
Standard precautions apply to all patients regardless of known infection status - a hepatitis C diagnosis does not warrant extra precautions or justify declining to care for the patient (epic3 guidelines; Equality Act 2010).
Suspected smear-positive or cavitating pulmonary TB needs immediate airborne isolation and specialist involvement - never wait for microbiological confirmation, especially with immunocompromised patients nearby (NICE NG33).
Every team member can reduce surgical site infections - audit and correct antibiotic prophylaxis timing, maintain aseptic non-touch technique, and embed checklist prompts (NICE NG125).
In an older patient with new confusion after a fall, separate acute delirium from possible underlying dementia, inform the perioperative team, and plan formal cognitive assessment after recovery rather than diagnosing dementia or starting cognitive enhancers acutely (NICE CG103 and CG124).
GCS <=8 = airway at risk; start ABCDE, call ICU/anaesthetics early, run fluids and fix DKA per JBDS - duty of care crosses departmental boundaries.
In suspected elder abuse - document meticulously, interview the patient alone, and escalate to your consultant and the ward safeguarding lead before involving social services; never confront the alleged perpetrator directly or accept their account uncritically.
Imaging in pregnancy - quote the actual foetal dose against the 100 mGy threshold (RCR/RCOG), involve the radiologist, balance imaging risk against the danger of missed pathology, and document informed consent (GMC 2020).
Drug-name abbreviations are a recognised never-event precursor - write generic drug names in full, submit a clinical incident report and follow the trust banned-abbreviation list (GMC Duty of candour; NPSA/MHRA).