Networks that select basic physician trainees with a structured panel usually include one situational judgement question, and two scenarios are reported so consistently that they deserve their own preparation. Both test the same things: whether you keep patients safe, whether you stay professional under pressure, and whether you know the channels available to a first year registrar.
The difficult supervisor
You are a first term BPT. Your supervisor is hard to approach, often unavailable, and makes decisions you do not always agree with. How do you manage this professionally?
The trap is to answer as though the supervisor is the problem to be solved. Panels are scoring you, not the supervisor, and they want to see three things.
First, patient safety. If a decision you disagree with puts a patient at risk, you act on that regardless of the relationship: review the patient, document your concern, and escalate to another senior if necessary. Say so plainly, because a candidate who would let an unsafe decision stand to avoid conflict fails this question.
Second, a direct and respectful approach to the supervisor. Ask for a regular meeting. Prepare for it. Raise disagreements as questions about reasoning rather than challenges, and accept that experienced clinicians make decisions you will understand later. Reflect on whether the problem is availability, communication style, or a genuine difference in clinical judgement, because each needs a different response.
Third, the channels. If it does not improve, the supervisor of training and the director of physician education exist for exactly this, and using them is not disloyalty. Describe the conversation you would have and what you would ask for.
Close with your own conduct: you keep working hard, you keep the relationship civil, and you learn what you can from the placement. Panels notice candidates who describe the supervisor's faults at length and their own responsibilities briefly.
The family refusing opioids
You are the registrar for a patient from a non English speaking background with end stage myeloma and severe pain. The family refuse opioids, fearing they will hasten death. How do you approach this?
This tests communication across a cultural and language barrier, respect for the family, and advocacy for the patient. A structure that scores:
- Find out what the patient wants. The patient is the person in pain and, if they have capacity, their view comes first. Use a professional interpreter, not a family member, to ask them privately.
- Explore the family's belief without arguing. Where does the fear come from? Often it is a previous experience, a religious concern, or a misunderstanding about what opioids do. Acknowledge it before you explain.
- Explain plainly: the evidence that appropriate opioid doses relieve pain without shortening life, the alternatives, and what untreated pain does. Offer written information in their language if it exists.
- Bring in help: the palliative care team, a cultural or religious liaison, the social worker. A conversation with a chaplain or an elder from the community changes more minds than a registrar can.
- Find the acceptable option. A lower starting dose with close review, a different drug, or a trial period often resolves it. Document the discussion and the plan.
- Say what you would do if the family still refused and the patient wanted treatment: the patient's wishes prevail, delivered with as much family involvement as they will accept, and the consultant informed.
What the panel scores
In both scenarios, structure, patient safety, respect for the other party, knowledge of the available channels, and persistence. Give the next step when the first does not work, because the follow up is nearly always "and if that did not help?". Answer in about two minutes, in the first person, and say what you would do rather than what should happen.