Human factors, teamwork and leadership on labour ward — structured SAQ (15 marks)

(a) First two minutes — leadership, escalation, briefing, scribe (4 marks)

One mark per action, with named reasoning. ^[3][4]

• Take the leadership role explicitly. Walk in, identify yourself as the team leader, allocate three named roles: scribe (to record timing and events), timer (to call out minutes from the response), runner (to fetch equipment and call for help). The first minute is the leader's energy; do not delegate it.
• Declare the situation in one sentence. "Mrs [name] is at 8 cm with a category II CTG and the senior is at the other end of the ward" — situational awareness is built by stating the picture, not by assuming it.
• Send for senior help now, not in five minutes. Use the local escalation policy; the senior registrar should be called while the midwife stays with the patient. The order of the actions is parallel, not serial.
• Start a brief cognitive aid. Bring the local CTG/station action card to the bedside; name the next decision (continue observation, intrauterine resuscitation, expedite birth) and the trigger that changes it.

Reasoning marks are awarded for parallel processing (calling while reading the CTG) and for naming the role of the scribe and timer. ^[4]

(b) Structured handover — iSoBAR (5 marks)

One mark per component in order. The Beament 2018 Western Australian implementation study is the named local source for iSoBAR. ^[1]

• I — Identify yourself and the patient: "I am [name], the on-call obstetric registrar. The patient is Mrs [name], G2P1, 39+4 weeks, MRN [number]."
• S — Situation: "She is at 8 cm in spontaneous labour. The CTG has been category II for the last 10 minutes with recurrent late decelerations."
• O — Observation: "Pulse 96, BP 124/78, temperature 36.8, contractions 4 in 10. The CTG baseline is 155 with reduced variability."
• B — Background: "G2P1, previous SVD at term, no antenatal concerns, GBS positive and on antibiotics, ARM at 5 cm four hours ago."
• A — Agree to a plan: "I am asking you to come to room 6 now and to review the CTG. Please confirm by what time you can be here."
• R — Read-back: "I will read this back: you are coming to room 6 now for category II CTG at 8 cm; you will be here by [time]. Confirm."

(c) Closed-loop communication — three steps with one example (3 marks)

One mark per step clearly named. ^[2]

• Sender delivers the message addressed to the receiver by name: "Anna, please give terbutaline 250 micrograms subcutaneously now for the category II CTG with tachysystole."
• Receiver acknowledges by restating the content: "Terbutaline 250 micrograms subcutaneously now, confirmed."
• Sender confirms that the loop is closed: "Confirmed, terbutaline 250 micrograms subcutaneously now."

Additional marks for stating why the loop matters: every verbal order that is not closed-loop is an order that may not have been received, and the Lingard 2004 OR observational study documented that around 30% of communication events failed and a third of those had visible effects. ^[6]

(d) The consultant-arrives trap and the no-blame alternative (3 marks)

One mark for naming the pitfall, one for the alternative, one for the model answer that demonstrates the alternative. ^[3][5]

• The pitfall. When the senior registrar arrives and takes over without re-allocating roles, the existing team is disempowered. The scribe stops writing, the timer stops, the runner disappears, and the new leader is now coordinating from the back of the room with a poorly understood team. This is the classic "consultant arrives, team scatters" pattern that Reason's Swiss cheese model predicts will compound the cognitive load of the event.
• The no-blame alternative. The arriving leader takes the leadership role, but does so by re-allocating roles: "I am taking the team leader role. Joe, you remain the scribe; Sarah, you remain the timer; Mary, you remain the runner. I will brief on the plan in 30 seconds; questions thereafter."
• The model answer. The consultant who is a good CRM practitioner arrives and makes the room calmer, not louder. They re-allocate the team, summarise the situation aloud, ask for one update from the scribe, and announce the next decision and the next trigger. The model answer the examiner wants is the line: "The senior should rehearse the handover to leadership as the safer alternative to taking over from the front."