What is the SPIES framework?

Seek information, Patient safety, Initiative, Escalate, Support — a structure for professionalism dilemmas. It scores when applied thoughtfully to the specifics, not recited as an acronym.

Should I confront the consultant directly?

Sometimes a discreet word works, but challenging your own consultant is genuinely hard — and involving another senior immediately instead is legitimate. What is not acceptable is public confrontation, or letting that difficulty delay removing him from patient contact.

What happens to the patients the consultant already saw that morning?

They need review by another senior — an impaired assessment cannot be trusted. Remembering the already-seen patients (and the clinic and on-call cover) is what separates complete answers from acronym recitals.

The "Consultant Smelling of Alcohol" CST Question

How to answer the impaired senior colleague scenario in the CST interview with SPIES: patient safety over hierarchy, escalation routes, and compassionate support.

Published 10 July 2026

On this page

How the scenario tends to open
The approach that scores
Where candidates lose marks
Rehearse it
Frequently asked questions

The consultant who arrives on the ward round smelling of alcohol is probably the most rehearsed professionalism scenario in surgical training interviews — which raises the bar: examiners have heard the SPIES acronym a thousand times, and what distinguishes answers is how honestly you handle the seniority gap.

How the scenario tends to open

A typical stem: your consultant arrives late to the ward round; you smell alcohol on his breath and his speech is slurred; he has a clinic this afternoon and is on call tonight. The follow-ups escalate: he laughs it off — what now? What about the patients he has already seen? Who covers tonight?

The approach that scores

SPIES fits, but the marks are in how each step bends around the power imbalance. Be sure of your facts first — what exactly you observed, whether others noticed — and avoid a public confrontation on the round. You might manage a discreet private word, but challenging your own consultant is genuinely hard, and going straight to another senior is a legitimate first move, not a failure of nerve.

Then put the principle where the examiner can hear it: patient safety overrides hierarchy. No doctor who may be impaired can carry on seeing patients, operating, running a clinic, or holding the on-call — and it gets dealt with today, not after a quiet word tomorrow.

Escalate promptly — a different consultant, or up to the clinical or medical director per trust policy. This is not something a core trainee should carry alone.
Close the loops the impairment opened: every patient he has already reviewed this morning needs reassessment by another senior, and the clinic and tonight’s on-call need cover.
Bring in the GMC dimension: doctors are expected to act where a colleague’s health could put patients in danger.
Be compassionate: there may be an alcohol problem or a personal crisis behind it — occupational health, his GP, and professional support services are the routes; gossip is not.
Protect yourself sensibly: document factually and contemporaneously, seek advice from your educational supervisor or defence organisation, and check afterwards that action was actually taken.

Where candidates lose marks

The rehearsed-but-hollow answer recites SPIES without ever naming the hard part — that this is your boss. The opposite failure is letting the hierarchy delay action: agreeing to "keep an eye on him" or waiting until after clinic. And answers that end at escalation miss the second half of the station: the already-seen patients, the uncovered on-call, and the human being inside the problem.

Rehearse it

Reading about the "consultant smelling of alcohol" cst question is the easy half. Rehearse this exact scenario out loud, on the clock, with an AI examiner — this scenario is in Reviva’s library, with feedback marked the way the panel marks. Or start with the wider format in the cst management station guide.

Frequently asked questions

What is the SPIES framework?: Seek information, Patient safety, Initiative, Escalate, Support — a structure for professionalism dilemmas. It scores when applied thoughtfully to the specifics, not recited as an acronym.
Should I confront the consultant directly?: Sometimes a discreet word works, but challenging your own consultant is genuinely hard — and involving another senior immediately instead is legitimate. What is not acceptable is public confrontation, or letting that difficulty delay removing him from patient contact.
What happens to the patients the consultant already saw that morning?: They need review by another senior — an impaired assessment cannot be trusted. Remembering the already-seen patients (and the clinic and on-call cover) is what separates complete answers from acronym recitals.

Sources. Grounded in GMC Good Medical Practice duties around colleague impairment and the SPIES approach, as rehearsed in Reviva’s CST management scenario. Educational only — follow your trust’s policies.