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All stations/Station 2/Sub-station 2B

Sub-station 2B — Ethics & Professionalism

A structured ethics / professionalism scenario: capacity, consent, confidentiality, raising concerns, candour and GMC Good Medical Practice — answered with SPIES and the four pillars.

7–8 minutes Same 2 examiners as 2A Station 2
Practise Ethics & Professionalism questions Run a timed mock

What happens in the room

  • Examiners read out a short ethical scenario, then ask 'What would you do?'.
  • Expect 2–3 escalating probes: 'And if the patient refused?', 'What if your consultant disagreed?'.
  • At least one question maps to GMC Good Medical Practice (2024) and Duty of Candour.
  • Often closes with reflection: 'What would you have done differently?'.

What the examiners are scoring

  • Use of a structured ethical framework (SPIES + four pillars).
  • Patient safety always prioritised first.
  • Understanding of capacity (MCA 2005), consent (Montgomery), confidentiality and information sharing.
  • Duty of candour — what it is, when it applies, who to involve.
  • Raising concerns — who, how, escalation ladder, whistleblowing protections.
  • Professionalism — non-judgemental tone, empathy, GMC-aligned conduct.

Framework — SPIES + Four Pillars (Beauchamp & Childress)

  1. 1S — Seek information

    Clarify facts, speak to those involved, review documentation.

  2. 2P — Patient safety

    Immediate steps to keep the patient safe — always the first action.

  3. 3I — Initiative

    Take ownership: speak to the colleague, address the issue directly where appropriate.

  4. 4E — Escalate

    Senior, supervisor, clinical director, medical director, GMC if needed.

  5. 5S — Support

    Support patient, family, colleague; reflect, document, learn.

  6. 6Four pillars

    Autonomy, beneficence, non-maleficence, justice — name them when balancing the dilemma.

High-yield topics

Capacity assessment (MCA 2005) and DoLSConsent — Montgomery, refusal of treatment, advance decisionsConfidentiality — Caldicott, disclosure to DVLA / police / familyDuty of candour — clinical errors and never-eventsRaising concerns about a colleague (clinical, behavioural, health)End-of-life care — DNACPR, ReSPECT, withdrawal of treatmentSocial media, probity, conflicts of interest

Example stems

  • "A consultant colleague smells of alcohol on the ward round. What do you do?"
  • "A Jehovah's Witness with active GI bleed refuses transfusion. How do you proceed?"
  • "A patient with newly diagnosed epilepsy refuses to stop driving. What's your approach?"
  • "You realise the wrong-dose antibiotic you prescribed has caused harm. What now?"

What a Score 5 answer looks like

  • Names a framework (SPIES + four pillars) explicitly and applies it.
  • Patient safety is the first action stated.
  • Demonstrates accurate knowledge of MCA, Montgomery, confidentiality and candour.
  • Calm, non-judgemental tone — supports the colleague as well as protecting the patient.
  • Escalates appropriately and documents — knows who to involve at each stage.

Common pitfalls

  • Reflexively reporting a colleague to the GMC before speaking to them or escalating locally.
  • Forgetting candour — failing to apologise or offer explanation to the patient/family.
  • Confusing capacity with best interests; treating refusal as lack of capacity.
  • Vague 'I'd talk to my consultant' without saying what you'd ask for.
  • Moralising tone — examiners want a professional who supports, not a judge.