Medico-legal frameworks — structured oral station (12 minutes)

Opening prompt — "Tell me what you do now."

Model response — say it in this order: ^[1][6][10]

• "The clinical priority is the patient and the baby. I would attend the labour ward now, review the CTG and the partogram personally, repeat the scalp lactate, and act on the result. A pathological CTG with a scalp lactate of 6.8 mmol/L and a two-hour delay in escalation demands immediate senior decision-making — operative delivery if vaginal birth is not imminent."
• "I would speak to the woman and her partner privately, explain that the baby's monitoring has been concerning, what the lactate result means, what the options are now, and that I am recommending a category-one caesarean unless she can deliver vaginally in the next few contractions."
• "I would document a contemporaneous note: the time I was called, the CTG findings, the lactate, the escalation history, what I told the woman, what she asked, what she agreed to, and the operative plan. I would ask the midwife to witness and sign."
• "I would notify the on-call consultant obstetrician if she is not yet involved, the anaesthetist, the paediatrician, the blood bank, and the theatre coordinator. I would ask the unit manager to commence a brief clinical incident record."^[6][10]

Examiner is listening for: senior assumption of responsibility, the parallel action on the clinical and the medico-legal axis, and an audible acknowledgement that the next twenty minutes will be dissected in three forums.

Probe 1 — "Walk me through the negligence test."

• "The plaintiff must prove four stages on the balance of probabilities: duty of care — established by the doctor-patient relationship; breach of duty — measured against the Bolam responsible-body-of-opinion standard as refined by the Bolitho logical-basis proviso; causation — the plaintiff must show that, but for the breach, the harm would not have occurred on the balance of probabilities; and harm — compensable injury."^[1][3]
• "A failure to escalate an abnormal CTG for two hours is a credible breach of duty; causation will turn on whether earlier delivery would have avoided the neonatal compromise."^[1][3]

Probe 2 — "What about the consent conversation you are about to have?"

• "Consent has three elements: capacity — I would confirm she can understand, retain, weigh and communicate a decision; voluntariness — she is in pain, but I would still ensure she is not coerced by the urgency, the staff, or her partner; adequate information — the patient-centred Montgomery and Rogers standard, no fixed percentage, name the material risks of caesarean (bleeding, infection, anaesthetic, uterine scar, visceral injury, hysterectomy, neonatal respiratory distress, accidental extension) and the alternative (continued labour, instrumental birth if the head descends, expectant management)."^[1][4][8]
• "I would use teach-back, offer an interpreter if applicable, document the conversation in quotation, and sign."^[8]

Probe 3 — "The baby is born with Apgar 1, 4 and 7 and cord pH 6.85. What do you do now?"

• "Immediate resuscitation, therapeutic hypothermia consideration, neonatal intensive care, full documentation. Then I would open disclosure to the family with the neonatologist present, using a clear and empathic script, and I would name a contact for ongoing conversation."^[10]
• "I would escalate to the clinical director and the quality and safety team, preserve the original CTG and observation charts, and review the registrar's escalation behaviour."^[6][10]

Probe 4 — "A coroner's office calls. How do you respond?"

• "I would call my medical defence organisation first. I would not give a coroner's interview without legal advice. I would prepare a chronological statement with the records beside me, distinguishing what I recall from what the record shows, citing the RANZCOG guideline in force at the time, and acknowledging uncertainty where it exists. I would sign under penalty of perjury."^[13]

Probe 5 — "The registrar was tired, unsupervised, and did not escalate. Does AHPRA need to know?"

• "I would distinguish voluntary from mandatory notification. I would discuss the case with my MDO and the clinical director. If I formed a reasonable belief, on reasonable grounds, that the registrar had engaged in a significant departure from accepted professional standards placing the public at risk of harm, I would notify AHPRA under s141 of the National Law. Fatigue alone does not meet the threshold; a sustained pattern of unrecognised and unremediated fatigue in a registrar with appropriate supervision may not. Documentation of the event and of the unit's response is essential."^[5][12]

Probe 6 — "The family ask for an apology. Are you exposed?"

• "An apology is not an admission of liability. It is protected by statute in every Australian jurisdiction and in New Zealand. Open disclosure is the regulator's expectation and the family's right. I would apologise that the baby has been compromised, that we will investigate honestly, and that they will be kept informed. I would not speculate on cause or on fault."^[10][15][16]

Probe 7 — "You are personally devastated. How do you look after yourself?"

• "I would contact the medical defence organisation for member support, the Employee Assistance Program for confidential counselling, my supervisor or mentor, and the clinical director for professional debrief. I would not drink, drive, or attend the next shift without sleep. I would expect the hospital to provide roster adjustment, peer support, and access to a structured critical-incident debrief. Adverse outcomes harm clinicians as well as families."^[6][15]