"A fellow student turns up to placement smelling of alcohol." "You see a colleague copying answers." "A friend on your course tells you they made a drug error and asks you to keep it quiet."
These are among the most common MMI stations, and they catch candidates out for a predictable reason: the instinct is either to report immediately or to protect a friend, and neither is the answer. Panels want to see that you gather facts before acting, that patient safety outranks loyalty, and that you can raise a concern without abandoning the person you are raising it about.
SPIES is the framework most UK candidates use for these stations.
The SPIES Framework
- S — Seek information — Establish the facts before acting. Speak to the colleague directly and without accusation. What did you actually observe, and what might explain it?
- P — Patient safety — The overriding priority. Is anyone at risk right now? If so, that takes precedence over everything else in this list, including the colleague's feelings and your own discomfort.
- I — Initiative — What can you do yourself, within your competence? Often this is asking the colleague to step away from clinical duties, correcting an error you can correct, or encouraging them to self-report.
- E — Escalate — If the concern is beyond your competence, or the colleague will not act, take it to a supervisor, educational supervisor, or the appropriate senior. Escalating is not betrayal — it is the mechanism the profession provides.
- S — Support — The colleague is still a person, and usually a struggling one. Offer support: occupational health, student services, a conversation. Say this out loud; candidates who omit it sound punitive.
Why Candidates Lose Marks
- Jumping straight to escalation. Reporting without speaking to the colleague first looks reflexive rather than reasoned — unless there is immediate danger, in which case say why you are skipping ahead.
- Promising confidentiality. Never agree to keep something quiet before you know what it is. Say you will treat it seriously and discreetly, not that you will keep it secret.
- Omitting support. The most common gap. An answer that ends at "I would escalate" is incomplete.
- Making it about you. "It would be awkward for me" is not a consideration the panel is interested in.
- Confusing initiative with acting beyond your level. A first-year student does not manage a colleague's health problem. Recognising the limit of your competence is itself a mark.
Worked Example: The Colleague Who Smells Of Alcohol
- Seek information — I would speak to them privately, away from patients and other staff, and describe what I noticed without accusing them. There may be an explanation — a medication, an event the night before, or a problem they have been managing alone.
- Patient safety — Regardless of the explanation, I would not be comfortable with them seeing patients while I had that concern. I would ask them not to continue with clinical duties for now.
- Initiative — I would encourage them to speak to their supervisor themselves. A self-report is better for them and shows insight.
- Escalate — If they refused, or returned to patients, I would tell the supervising clinician the same day. This is not something to sit on.
- Support — I would make clear I was not trying to end their career — the opposite. Alcohol problems among students and doctors are common and treatable, and there are confidential routes to help.
Worked Example: The Colleague Who Made An Error
- Seek information — What happened, when, and has the patient been affected? Has anyone else been told?
- Patient safety — If the patient could still come to harm, that is dealt with first: the clinical team needs to know now, before any conversation about how the error is handled.
- Initiative — I would strongly encourage them to report it through the incident system themselves, and offer to be there when they do.
- Escalate — If they would not, I would report it. Concealing a clinical error is a professionalism issue in its own right.
- Support — Being involved in an error is genuinely distressing. I would remind them the system is designed to learn rather than blame, and that people do come through this.
SPIES And The Four Principles
SPIES tells you what to do. The four principles of medical ethics tell you why — and panels often ask a follow-up that requires the second. Non-maleficence and beneficence sit behind patient safety; justice and autonomy sit behind how you treat the colleague. If you have time, name the principle once rather than listing all four.
When To Use SPIES — And When Not To
- Use it when a station involves a person behaving in a way that worries you: a colleague, a student, occasionally a senior.
- Do not use it for a pure ethical dilemma with no colleague in it — a consent or confidentiality question is better structured around the four principles.
- Do not use it for breaking bad news to a patient, which is SPIKES, not SPIES. The names are one letter apart and candidates do mix them up under pressure.
Related Prep
- Professionalism interview questions — what panels look for in colleague scenarios
- Medical ethics questions — the wider ethical framework
- MMI role play tips — when there is an actor in the room
What To Do Next
- Work through professionalism questions and ethical awareness questions in the free question bank — pick three colleague scenarios and outline SPIES responses
- Practise saying the Support step aloud. It is the step candidates drop when they are nervous, and it is the one that separates a safe answer from a good one
- Run a timed mock with Go Doctor's AI interviewer — colleague scenarios attract hard follow-ups ("What if they begged you not to?"), and those are where structure holds or collapses