During a discussion, a physician once pointed to the name on his lab jacket and said, "MD?makes decisions!" One of the greatest challenges we face in cultivating leadership competence is being centered and skillful in the midst of difficult and upsetting situations, or during times of crisis. Each of the three vignettes in this case offers an opportunity to practice decision-making in challenging situations. The material helps students focus on decision-making. What guides effective decision-making? The vignettes present situations that can be used to describe common approaches to decision-making and explore problems or challenges with traditional decision-making.