Professional dilemmas are the MSRA’s pressure cooker — where convenience, loyalty and institutional targets collide with GMC duties, safety, candour and integrity. This episode teaches the three universal moves that protect patients and your registration: uphold standards, offer a constructive alternative, and escalate with documentation. Using high-stakes scenarios involving unsafe shortcuts, documentation dishonesty, and conflicts of interest, we show you exactly how to act under pressure.

0:00 Why ethical dilemmas define professionalism
00:20 Pressure-cooker conflicts explained
00:58 The foundational rule: integrity > convenience
01:40 What the GMC is actually testing
02:20 Safety vs team loyalty
03:10 The five behaviours that always fail
04:00 The three-move universal framework
05:00 Scenario 1 — Consent vs institutional pressure
06:00 Why shortcuts invalidate consent
07:00 Three safe moves for pressure to “rush consent”
08:00 Script: how to decline + offer alternative
09:20 Scenario 2 — Documentation dishonesty
10:00 Candour, audit trails and legal risk
10:40 Addendum vs altering the original note
11:40 Why retroactive edits destroy trust
12:10 Escalating unsafe pressure
13:00 Scenario 3 — High-value gifts & boundaries
13:50 Conflict of interest explained
14:20 Safe refusal + alternative + documentation
15:20 Why perception matters as much as reality
16:10 Universal tie-break rules
17:10 Three high-yield takeaways
18:10 Final reflection: courage under pressure

• Professional dilemmas test values under pressure, not knowledge.
• Integrity, transparency and escalation ALWAYS outrank convenience, blind loyalty or targets.
• Unsafe shortcuts (e.g., rushing consent) = invalid care + legal risk.
• Never falsify or soften notes — only dated factual addenda maintain governance.
• High-value gifts create real or perceived conflicts of interest — decline, redirect, document.
• Every safe action contains: safety → solution → escalation → documentation.

Three-Move Framework

1. Uphold standards (decline unsafe request)

2. Offer a constructive solution (safe alternative)

3. Escalate if pressure continues

Integrity Triggers — “SID”
S – Safety threatened
I – Integrity challenged
D – Documentation requested dishonestly

Addendum Rule — “DAT”
D – Dated
A – Addendum only
T – Truthful, factual, neutral language

Gifts Boundary Rule — “PAD”
P – Politely decline
A – Alternative (charity/feedback)
D – Document tension/insistence

Ethical dilemmas are not trick questions — they assess whether you protect safety, truth and fairness even when pressured. Apply the three-move framework: decline unsafe shortcuts, propose a compliant alternative, and escalate persistent risk. Document factually, guard your boundaries, and remember: professionalism is proved in the moments when it’s hardest to uphold.

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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