SPIES is the framework specifically designed for the questions that make candidates most nervous: scenarios involving problematic colleagues, professional misconduct, ethical dilemmas, and situations where patient safety and professional relationships collide. These questions appear in virtually every NHS interview at every level, and having a reliable structure to fall back on prevents the common mistake of either being too harsh or too passive in your answer.
The SPIES Structure
S — Seek Information: Never jump to conclusions. Your first step should always be to gather facts and understand the full picture before taking action. Ask yourself: What exactly has happened? Is there an explanation I might not be aware of? Could there be mitigating circumstances (illness, personal crisis, misunderstanding)? Asking questions first demonstrates maturity and avoids making a bad situation worse. Example: “Before taking any action, I would try to understand the full picture. There may be factors I’m not aware of, such as illness or personal difficulties, that could explain the behaviour.”
P — Patient Safety: This is the non-negotiable priority. If there is any immediate risk to patients, that must be addressed first, regardless of how uncomfortable it is. Ask: Is anyone in danger right now? Do I need to act immediately to make the environment safe? If a colleague is intoxicated on shift, for example, patient safety demands they are removed from clinical duties before anything else happens. Example: “My first priority would be to ensure that patient safety is not compromised. If patients are at immediate risk, I would take steps to ensure their safety before addressing the underlying issue.”
I — Initiative: Take appropriate action at your own level before escalating. This usually means having a private, non-judgmental, supportive conversation with the colleague. Approach them in a quiet setting, express your concerns factually and without accusation, and listen to their response. Many situations can be resolved with a compassionate conversation. Example: “I would approach the colleague privately and in a non-confrontational way, expressing my concern and asking if there is anything going on that I can help with.”
E — Escalate: If the issue is serious, unresolved after your initial conversation, or represents a pattern, escalate appropriately. Know the escalation pathway: consultant/clinical supervisor, clinical director, medical director, Freedom to Speak Up Guardian, and in extreme cases, the GMC. Document your concerns. Incident reporting through systems like Datix may also be appropriate. Example: “If the conversation did not resolve the issue, or if the behaviour was serious enough to warrant formal action, I would escalate to my consultant or clinical supervisor and, if appropriate, submit a Datix report.”
S — Support: This final step is what separates a good answer from an excellent one. Consider the colleague’s wellbeing. Are they struggling with burnout, stress, mental health difficulties, substance misuse, or personal problems? Signpost them to occupational health, counselling services, the BMA wellbeing service, or their own GP. This demonstrates empathy, maturity, and alignment with GMC Good Medical Practice’s emphasis on supportive workplace culture. Example: “I would also want to make sure my colleague is okay. I would signpost them to occupational health or other support services, and check in on them subsequently.”
Common SPIES Scenarios in JCF Interviews
- A colleague arriving consistently late for shifts
- You suspect a colleague has been drinking alcohol before a shift
- A colleague is rude to nursing staff or patients
- You witness a senior doctor making a clinical error
- A colleague contradicts you in front of patients
- You overhear nurses discussing a colleague’s drug use
- A colleague seems burnt out and is making more mistakes than usual
- Your consultant makes an inappropriate comment to a patient
- Worked examples: 3 full SPIES model answers included in downloadable resource pack.
- Resource: SPIES Scenario Practice Cards (12 scenarios with model answer outlines).