Human factors, teamwork and leadership on labour ward — structured oral station (12 minutes)

Opening prompt — "A pathological CTG at 02:40 with the team scattered. Talk me through your first move."

Model response — say it in this order: ^[1][9]

• "My first move is situation awareness: I confirm the CTG myself before I act, because Level 1 of Endsley's model is perception — gather the data, do not act on a summary. I then define the task: this woman may need expedited delivery."
• "I communicate using closed-loop orders. I ask the midwife to call the consultant at home and the senior in theatre, and I ask for the call to be read back to me so I know it has landed."
• "I escalate with graded assertion: if the senior cannot come immediately, I state clearly that I have a pathological CTG and I need a decision-maker at the bedside now."^[4][9]

Examiner is listening for: the candidate names the CRM skill they are using, not just doing it. ^[5]

Probe 1 — "What is the difference between a slip and a lapse, and between active and latent failures?"

• "A slip is an action-based error — the right plan executed wrongly, like picking up the wrong syringe. A lapse is a memory-based failure — forgetting to give the next dose of a protocol. Both are skill-based errors." ^[1]
• "Active failures happen at the sharp end — the clinician at the bedside. Latent failures are the conditions the organisation created — staffing levels, equipment availability, fatigue, the layout of the ward. Reason's Swiss cheese model says the disaster only happens when an active failure passes through aligned holes in the latent defences." ^[1][2]
• "The management implication is the one examiners reward: you cannot remove human error, but you can build system defences that catch it — checklists, double checks, forcing functions, and a culture where the junior can speak up." ^[1]

Probe 2 — "The midwife is worried but hesitates to call the consultant. How do you fix that?"

• "This is a culture and graded assertion problem. I teach and model the CUS framework — 'I am Concerned, I am Uncomfortable, this is a Safety issue' — so that any team member has a script to escalate that cannot be ignored." ^[5]
• "Graded assertion has steps: hint, then suggestion, then assert, then the CUS-word. The senior who does not respond to CUS is the one in the next MBRRACE report. The fix is both individual (the junior rehearse the words) and organisational (the unit normalises speaking up)." ^[5][14]

Probe 3 — "How would you hand this patient over at shift change?"

• "I use iSoBAR: Identify the woman, Situation (pathological CTG, decision for category-1 caesarean), Observations (the latest vitals, bloods, CTG summary), Background (parity, risk factors, the obstetric history), Agreed plan (who is doing what, the time-critical steps), Read-back (the receiver repeats the plan so nothing is lost)." ^[9]
• "Closed-loop communication for any drug or action order: I say it, the receiver reads it back, I confirm. The single commonest communication failure Lingard found was information that was transmitted but never received or acted on." ^[8]

Probe 4 — "What is the evidence that team training actually improves outcomes?"

• "The Crofts shoulder dystocia RCT showed sustained skill retention at 6 and 12 months after a single 40-minute drill — training sticks when it is hands-on and multi-professional." ^[11]
• "The THISTLE stepped-wedge trial is the honest counter-example: PROMPT in 12 Scottish units did not significantly improve the primary outcome, because implementation fidelity varied. Training works when it is actually delivered, to the right people, with the right dose. The lesson for the station: training is necessary but not sufficient — local delivery and leadership matter." ^[13]
• "The WHO Surgical Safety Checklist showed mortality falling from 1.5% to 0.8% and complications from 11% to 7% across eight hospitals — a checklist is a human-factors tool, not a paperwork exercise." ^[17]

Probe 5 — "How do you debrief after the event?"

• "Hot debrief within minutes — stop, breathe, what did we just do, what went well, what would we change. It belongs to the team." ^[14]
• "Cold debrief within days — a structured, facilitated review of the timeline, the decisions, and the system factors. It belongs to the unit." ^[14]
• "I name the second victim: the clinician who carried the event needs peer support and follow-up. The MBRRACE themes — recognition, escalation, handover, ethnic disparity — are the curricular spine that the debrief should mine." ^[14]