Colleague Consultation · Intermediate · Communication

Addressing a Colleague's Chronic Lateness and Performance Impact

Practise this PLAB 2 colleague consultation station on Adjustment Disorder. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are a senior registrar in a busy gastroenterology unit. Your colleague Morgan Hutchinson Johnson, a fellow registrar, has been persistently arriving late to ward rounds, clinics, and handovers for the past two months. This is affecting team function and patient care. You need to address this professionally and explore the underlying cause.

Background notes: PMH: Nil of note

What this station tests

  • Exploring underlying causes before criticising: lateness may be a symptom of a bigger problem
  • Patient safety framing: missed handovers are a safety issue, not just an inconvenience
  • Practical problem-solving: rota adjustment, handover timing, cover arrangements
  • Agreed plan with follow-up: specific commitments with a review date
  • Escalation pathway if unresolved: educational supervisor, clinical director

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself and your role. State the purpose of the consultation clearly.
  • 1-3 min — Present Case: Use SBAR structure. Situation, Background, Assessment, Recommendation. Be concise and relevant.
  • 3-5 min — Discussion: Discuss differential diagnosis and management. Listen to colleague's perspective. Share concerns professionally.
  • 5-7 min — Agree Plan: Agree on management plan. Clarify roles and responsibilities. Discuss escalation criteria.
  • 7-8 min — Closing: Summarise agreed actions. Confirm documentation. Arrange follow-up communication.

Consultation approach

The opening

Addressing a colleague's performance issue requires balancing support with accountability. Morgan is 32, a registrar, chronically late and missing handovers, affecting patient care. Open with a private, non-confrontational conversation: 'Morgan, I wanted to check in. I have noticed you have been arriving late recently. Is everything okay?'

Core approach

Explore before criticising. Is there an underlying cause? He may have caring responsibilities, health issues, commuting problems, or be struggling with the workload. His lateness may be a symptom, not the problem. Listen first.

If there is a personal issue: offer support (occupational health, flexible working request, GP referral). If the lateness is affecting patient safety (missed handovers mean clinical information is not passed on): this must be addressed regardless of the cause. 'I understand things are difficult, but missing handover means patients are not getting safe care. We need to find a solution.'

Offer practical solutions. Can the rota be adjusted? Can handover be moved? Can someone cover the first 30 minutes while he addresses the underlying issue? Problem-solving, not blame.

Closing and safety netting

Agree a plan together. 'Let us agree that you will be at handover on time from Monday, and if something prevents that, you will let the team know in advance.' If the issue persists despite support: escalation to the educational supervisor or clinical director is appropriate. Document the conversation and the agreed plan. Follow-up: check in within 2 weeks.

How examiners mark this station

Examiners will assess both Domain 1 (Data Gathering) and Domain 2 (Clinical Management) as primary: clarity and structure of your case presentation, appropriateness of your clinical reasoning, and whether you agree a clear plan. Domain 3 (Interpersonal Skills) assesses professional communication and collaborative approach.

Domain 1 (Supporting)

Scores well: Underlying cause explored. Patient safety impact assessed. Pattern documented.

Costs marks: Not exploring causes. Not assessing safety impact.

Domain 2 (Primary focus)

Scores well: Support offered. Practical solutions proposed. Agreed plan. Escalation pathway known. Documentation.

Costs marks: Punitive without support. No agreed plan. Not documenting.

Domain 3 (Primary focus)

Scores well: Non-confrontational. Supportive first. Firm about patient safety. Problem-solving together.

Costs marks: Confrontational. Accusatory. Not offering support.

Common examiner feedback (and how to fix it)

Did not communicate clinical information effectively

Fix: Use SBAR (Situation, Background, Assessment, Recommendation) every time. State clearly what you need from the colleague at the outset.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Before ending, confirm: What is the plan? Who is doing what? When will you communicate next? Document the agreed plan.

Common mistakes in this station

  1. Being purely punitive without exploring causes: he may have a genuine problem
  2. Ignoring the patient safety dimension: missed handovers are a clinical risk
  3. Not documenting: if escalation is needed later, the initial conversation must be documented

Resitting PLAB 2?

If colleague consultation stations have been challenging, practise the SBAR format until it is automatic. The most common issue is failing to clearly state why you are consulting the colleague and what you need from them. Be direct about your clinical question.

Example opening

Hello, this is Dr [Name], I'm the FY2 on [ward]. Thank you for taking my call. I'd like to discuss a patient I'm looking after and get your advice on management.

Frequently asked questions

How should I approach this adjustment disorder colleague consultation?

Addressing a colleague's performance issue requires balancing support with accountability. Morgan is 32, a registrar, chronically late and missing handovers, affecting patient care. Open with a private, non-confrontational conversation: 'Morgan, I wanted to check in.

Where are marks won and lost in this adjustment disorder station?

Examiners reward: Underlying cause explored. Patient safety impact assessed. Pattern documented. Candidates are penalised for: Not exploring causes. Not assessing safety impact.

Where do candidates most often go wrong in this station?

Being purely punitive without exploring causes: he may have a genuine problem. Another frequent error: Ignoring the patient safety dimension: missed handovers are a clinical risk.

Can I do well in this station without real-world experience of adjustment disorder?

This station rewards process over personal experience. The skill being assessed: Patient safety framing: missed handovers are a safety issue, not just an inconvenience. Work through the consultation approach above, then rehearse it aloud under the 8-minute time pressure so the structure holds up in the exam.

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