A struggling or impaired colleague is answered with SPIES: seek information, secure patient safety, take the initiative, escalate in proportion to the risk, and support the colleague. The duty underneath the mnemonic is professional, not optional. RCS Good Surgical Practice states that a surgeon must raise concerns at the earliest opportunity when patients or colleagues may be put in jeopardy by a colleague's conduct, performance or health, and Good Medical Practice 2024 frames the same expectation as a culture in which errors and concerns can be talked about safely.

Key takeaways

  • SPIES stands for seek information, patient safety, initiative, escalate and support; it is an interview structure, not a guideline, so say the duties behind it.
  • RCS Good Surgical Practice, section 3.6, states that concerns should be raised at the earliest opportunity when there is reasonable belief that the care and wellbeing of patients or colleagues may be put in jeopardy, including by a colleague's conduct, performance or health.
  • Good Medical Practice 2024, paragraph 48, requires colleagues to be treated with kindness, courtesy and respect; paragraph 52 requires you to help create a culture that is respectful, fair, supportive and compassionate.
  • Good Medical Practice 2024, paragraph 76, requires those with formal leadership roles to create an environment in which people can talk about errors and concerns safely, and to deal with concerns promptly and adequately.
  • Good Medical Practice 2024, paragraph 78, asks every doctor to take care of their own health and wellbeing and to recognise if they may not be fit for work.
  • Patient safety decides the speed: an immediate risk means removing the colleague from clinical work now, through a senior, before any supportive conversation.

What is the principle behind the struggling-colleague scenario?

The principle is that patient safety comes first and the colleague comes a close second: you protect patients from harm and you protect a colleague from being left to fail.

Good Medical Practice 2024 organises its duties into four domains, and the third, colleagues, culture and safety, holds both halves of this scenario. Paragraph 48 requires kindness, courtesy and respect to colleagues.

Paragraph 52 states that you must help to create a culture that is respectful, fair, supportive and compassionate by role-modelling those behaviours. A struggling colleague is the test of whether you mean it.

RCS Good Surgical Practice, section 3.6, turns that culture into an action: raise concerns at the earliest opportunity when patients or colleagues may be in jeopardy for any reason, including a colleague's health.

What does SPIES stand for and how is it used?

SPIES is a five-step interview structure: seek information, patient safety, initiative, escalate, support. It is a mnemonic taught for interviews, so name it as a structure and hang the duties on it.

Seek information

Establish facts before judgement. What was observed, by whom, how often, and is it a change from the colleague's normal? A private, unhurried conversation is the first source, and gossip is not a source at all.

Patient safety

Ask whether any patient is at risk right now. If a colleague is impaired on shift, the immediate step is to make sure their patients are covered, which means telling a senior at once.

Initiative

Do something proportionate yourself: take over a task, suggest a break, check the drug chart they wrote, and make the conversation happen rather than waiting for someone else.

Escalate

Involve the right senior at the right speed: the registrar or consultant on call for an immediate risk, the educational or clinical supervisor for a pattern, and formal routes if local ones fail.

Support

Point the colleague to help, occupational health, their supervisor, their GP, the trust wellbeing service, and follow up. Good Medical Practice 2024, paragraph 78, is a reminder that recognising unfitness for work is itself a duty the colleague owes.

How would a worked scenario run in the station?

A typical CST scenario: your fellow SHO has been late three times this week, seems withdrawn, and you find a prescribing error on a patient they clerked. Tonight you smell alcohol when they arrive for the night shift.

Step one: patient safety tonight

The alcohol changes everything. A possibly intoxicated doctor cannot see patients, so you speak to them privately, say what you have noticed, and tell them you must inform the registrar or consultant on call so cover can be arranged.

Step two: escalate and document

Call the senior on call and state the facts without diagnosis: lateness, withdrawal, the prescribing error you have already corrected, and the smell of alcohol. Record the times and what was said.

Step three: support the colleague

Stay with them if it is safe to, make sure they get home safely, and tell them where help is. The next day the supervisors and occupational health own the process, and your job is to remain a colleague.

Step four: reflect on the earlier signs

The panel will ask whether you should have acted after the lateness and the error. The honest answer is yes: a quiet conversation and a word to the supervisor a week earlier might have prevented tonight.

What is the interviewer listening for?

The CST panel listens for patient safety placed first and fast, facts separated from assumptions, and a colleague treated with the respect Good Medical Practice 2024 requires.

  • An immediate risk handled through a senior tonight, not through a chat next week
  • Observed facts, not a diagnosis of alcoholism, depression or burnout
  • No promise of secrecy: confidentiality is offered within the limits of patient safety
  • Proportionality: a single bad day and a pattern with errors get different responses
  • Named routes: supervisor, occupational health, the trust's raising-concerns policy, and the formal routes if local ones fail
  • Your own limits: you support a colleague, you do not become their doctor or their therapist

What is the trap in this question?

The trap is promising to keep it between you, or the opposite, reporting a colleague to the GMC before anyone local has been told.

Promising secrecy fails because the professional duty to protect patients cannot be signed away by a friend. Say instead that you will share only what is needed with the people who need to know.

Going straight to the regulator fails because Good Medical Practice 2024 expects concerns to be raised in line with workplace policy and, where needed, with advice from a colleague or a defence body first. Local, prompt and proportionate beats distant and dramatic.

What is the escalation route?

Escalate to the registrar or consultant on call for an immediate risk, to the colleague's educational or clinical supervisor for a pattern, and to the clinical director, the freedom to speak up guardian or the trust's raising-concerns policy if the response is inadequate.

Good Medical Practice 2024, paragraph 76, states that doctors with formal leadership roles must make sure concerns raised with them are dealt with promptly and adequately, in line with workplace policy and the GMC's guidance on raising and acting on concerns. That is what you are entitled to expect when you escalate.

The GMC/NMC guidance on the professional duty of candour adds the organisational half: healthcare professionals must be open and honest with their organisation and report adverse incidents that lead to harm, and near misses, so lessons are learnt.

How does the struggling colleague link to the portfolio domain?

The struggling colleague links to the CST portfolio through the teaching and leadership evidence the panel discusses, because how you handled a colleague under pressure is a leadership example with a named outcome.

NHS England's 2025/26 CST portfolio guidance grades teaching experience up to level A for designing and delivering a programme of four or more sessions, and a wellbeing or induction session for new doctors is a common way candidates turn a hard experience into evidence.

It also gives you a truthful reflective story for the question about a time you had a difficult conversation with a colleague.

How this comes up at the CST interview

The struggling colleague is one of the most reliable management-station scenarios at the CST interview, usually escalated by the panel from a tired colleague to an intoxicated one to test whether your speed changes.

Practise SPIES aloud with the duties attached, and practise the moment you tell a friend you must inform a senior. coresurgeryinterview has a scored struggling-colleague scenario among its 299 questions, marked by AI against the same domains: /Question-Bank/Sample-Questions.