Prioritisation under pressure is one of the highest-yield SJT skills — and one of the toughest parts of real clinical work. When your task list explodes, staffing collapses, and a deteriorating patient appears, your score (and your patient’s safety) depends on one thing: using a structured, GMC-aligned prioritisation framework every single time.

This episode walks through the full PAUDE method — Prioritise → Allocate time → Urgent escalate → Delegate safely → Enter notes & handover — using real-world scenarios, red flags, traps, model phrases and practical escalation language.

0:00 The overwhelmed doctor at 6 p.m.
00:36 Why GMC and training programmes care about prioritisation
01:20 The three non-negotiable behaviours (prioritise, escalate, continuity)
02:20 Understanding preventable harm & exam scoring logic
03:00 Clinical-first triage vs arrival order
04:00 Early escalation & recognising limits
04:50 Reliable continuity: handover + documentation
05:30 Introducing PAUDE
06:10 P – Prioritise by acuity
07:00 A – Allocate time using visible lists
07:40 U – Urgent escalate (capacity and competence)
08:40 D – Delegate safely with SBR
09:50 E – Enter notes + handover properly
11:00 How to triage when “everything feels urgent”
12:00 Objective instability always wins (NEWS2 7 example)
13:20 Four red flags demanding immediate escalation
14:40 Biggest SJT traps (hero complex, arrival order, unsafe delegation)
15:40 Safe escalation language & model phrases
16:40 Delegation pitfalls and competence checks
17:40 Leaving tasks at end of shift — when it is safe
19:00 Final summary: PAUDE in action

• Acuity beats arrival order — always.
• Escalate early when capacity or competence is exceeded.
• Delegate only to colleagues with proven competence using SBR.
• Objective instability (e.g., NEWS2 7) > subjective history in first triage.
• Four red flags: unseen deterioration, time-critical delays, unsafe tasks, system failures.
• Documentation and handover protect patients and your registration.

PAUDE
P – Prioritise by clinical acuity
A – Allocate time visibly
U – Urgent escalate early
D – Delegate safely (SBR)
E – Enter notes + handover

SBR (Delegation Upgrade)
Situation
Background
Assessment
Recommendation (with explicit timings)

Red Flag Quartet

1. Unseen deterioration

2. Delays to time-critical meds/tests

3. Task beyond competence

4. System/resource failure

When overwhelmed, pause and apply PAUDE.
Prioritise by risk, escalate early, delegate safely, and create an auditable plan. This is the behaviour GMC expects, MSRA examiners reward, and real patients rely on. Master it now, and every “impossible” shift becomes structured and safe.

Links:
• passthemsra.com – Complete MSRA revision, notes, mocks, flashcards
• freemsra.com – Free podcasts, threads and rapid-learning guides
• msra.io – Smart MSRA Qbank with analytics

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