Adaptability · Ranking sample

Dr. Hannah Cole, a family medicine resident on a long-term care rotation, is on-call…

Read the scenario, answer it, then compare yourself to the answer key. Every option includes a rationale and a transferable principle.

b07AdaptabilityRankinghardLeader + Collaborator

Rank in order the following actions for Dr. Cole to take in response to this situation (1 = Most desirable; 5 = Least desirable).

Dr. Hannah Cole, a family medicine resident on a long-term care rotation, is on-call overnight covering a 120-bed facility. At 23:00, the central nursing call-bell system unexpectedly shuts down across all wings, leaving residents unable to summon assistance electronically. Moments later, a personal support worker informs Dr. Cole that an 84-year-old resident, Mr. Abebe, is acutely hypotensive with rapidly declining vital signs. Simultaneously, the floor nurse presents Dr. Cole with routine, non-urgent evening medication queries for two stable residents. Dr. Cole's supervising physician has not responded to an urgent page placed fifteen minutes earlier. With limited overnight staff and multiple competing demands, Dr. Cole must determine her immediate course of action.

Ranking scale: 1 is most desirable and 5 is least desirable. Use each rank exactly once. Pick one rank per option.

A. Assess Mr. Abebe immediately while directing the floor nurse to institute hourly manual room checks across units.

B. Contact the facility administrator on-call to report the system failure and preceptor unresponsiveness before seeing Mr. Abebe.

C. Evaluate Mr. Abebe at the bedside while asking the nurse to defer medication queries and repage the supervisor.

D. Review and resolve the two routine medication queries quickly with the nurse before assessing Mr. Abebe.

E. Direct nursing staff to establish facility-wide emergency watch protocols before going to assess Mr. Abebe at bedside.

Use each rank exactly once

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Show answer and rationale

A. Assess Mr. Abebe immediately while directing the floor nurse to institute hourly manual room checks across units.

Key: 1

This is the most desirable response because it simultaneously prioritizes immediate life-threatening instability and provides actionable leadership to mitigate facility-wide vulnerability. Dr. Cole addresses the unstable resident directly without delay while delegating floor staff to manage the call-bell outage. This option demonstrates high adaptability by triaging acute clinical deterioration alongside systemic risk.

Prioritize acute clinical instability while delegating system-level safety measures immediately.

B. Contact the facility administrator on-call to report the system failure and preceptor unresponsiveness before seeing Mr. Abebe.

Key: 4

This response focuses prematurely on administrative escalation and blame mitigation while an unstable resident deteriorates without medical assessment. Although an unresponsive supervisor and infrastructure failure warrant escalation, administrative reporting does not protect the immediate life of Mr. Abebe. To rank higher, Dr. Cole would need to stabilize the patient before pursuing bureaucratic channels.

Defer administrative reporting until immediate life-threatening clinical emergencies are stabilized.

C. Evaluate Mr. Abebe at the bedside while asking the nurse to defer medication queries and repage the supervisor.

Key: 2

This response is desirable as it promptly directs clinical attention to the deteriorating resident while eliminating low-priority cognitive distractions. It is ranked lower than Option A because it leaves the facility-wide call-bell system failure completely unaddressed, exposing other vulnerable residents to unmonitored risk. To rank higher, it would need to incorporate a delegation step for resident safety rounds.

Address deteriorating patients directly while filtering out non-urgent operational tasks.

D. Review and resolve the two routine medication queries quickly with the nurse before assessing Mr. Abebe.

Key: 5

This is the least desirable response as it reflects task fixation on low-stakes routine administrative duties in the face of an acute medical emergency. Completing minor non-urgent chart reviews while a resident's blood pressure is crashing compromises patient safety. It demonstrates poor clinical adaptability and failed prioritization under high-pressure conditions.

Never delay emergent patient assessment to complete routine administrative requests.

E. Direct nursing staff to establish facility-wide emergency watch protocols before going to assess Mr. Abebe at bedside.

Key: 3

This response demonstrates situational awareness of systemic safety risks across 120 residents but misprioritizes sequence by delaying bedside care for an actively crashing patient. While organizing unit safety is important, an acute hypotensive crisis requires immediate direct physician assessment. It ranks above administrative escalation because it still engages with real-time facility safety, but falls below direct bedside triage.

Do not delay active bedside resuscitation to coordinate broader facility logistics.

Exam context: FMProC assesses adaptability alongside three other attributes. This is an unofficial worked example, not a live exam item.

Educational scenario only. Not clinical or professional advice.