2023 UKFPO SJT Practice Paper Flashcards
- You have been working in the Acute Admissions Unit* (AAU) for the past four months and a patient has been admitted for severe abdominal pain. This is the third time that the patient has been admitted for the same condition and you have conducted all of her previous assessments. You go to assess the patient and when she sees you, she says, “No, I do not want you as my doctor again. You can’t find out what is wrong with me. Please go and get me an experienced doctor.”
Rate the appropriateness of the following responses to say in this situation. Assume they are all said in a polite way. (1= Very appropriate; 4= Inappropriate).
A. “Please be assured that I will try my best to find out the cause of your pain.”
B. “I’m here to help you, please don’t speak to me in that way.”
C. “Let me see if a senior doctor is available to assess you instead.”
D. “I’m sorry you feel that way, but it is not my fault you are still experiencing pain.”
E. “I can see if a senior doctor is available, however, you might end up having to wait a while to be seen.”
A) “Please be assured that I will try my best to find out the cause of your pain.” Correct Key: 1 - Very appropriate
Rationale: This response is very appropriate because as a doctor you have a responsibility to work with your patient to address their concerns (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain). Therefore, prioritising trying to find the cause of the patient’s pain is the appropriate thing to aim to do.
B) “I’m here to help you, please don’t speak to me in that way.” Correct Key: 3 - Somewhat inappropriate
Rationale: This response is somewhat inappropriate because whilst communication is integral to establishing a good working relationship with your patient (GMC good medical practice’s Communication, Partnership and Teamwork domain) and it is important to establish boundaries to be able to develop and/or maintain a respectful dialogue between both parties, this response may be interpreted by the patient as confrontational and unprofessional.
C) “Let me see if a senior doctor is available to assess you instead.” Correct Key: 2 - Somewhat appropriate
Rationale: This response is somewhat appropriate because it is your responsibility as a doctor to respond to the patient’s concern (GMC good medical practice’s Communication, Partnership and Teamwork domain), in this case, their concern is not wanting to be treated by you. The four pillars of medical ethics include autonomy, which is the patient’s right to make decisions about their health: This response respects the patient’s right to choose who treats them. According to the NHS Patient’s Charter, a patient also has the right to seek a second opinion on their medical condition. Therefore, this response is acknowledging the patient’s right to have another doctor assess their condition instead of you (GMC good medical practice’s Knowledge, Skills and Performance domain), however you haven’t reassured the patient that she will be assessed by another doctor as requested.
D) “I’m sorry you feel that way, but it is not my fault you are still experiencing pain.”
Correct Key: 4 - Inappropriate
Rationale: This response is an inappropriate response as you have a duty as a doctor to treat patients with respect and dignity (GMC good medical practice’s Communication, Partnership and Teamwork domain). Although the patient has refused treatment from you, it is important that you maintain your professional values and be respectful in your response back to the patient (GMC good medical practice’s Maintaining Trust domain) to maintain the patient’s trust in you as a professional and their faith in the profession.
E) “I can see if a senior doctor is available, however, you might end up having to wait a while to be seen.”
Correct Key: 2 - Somewhat appropriate
Rationale: This response is somewhat appropriate because one of your responsibilities as a doctor is to ensure the provision of sufficient information about treatment options so that patients can make an informed choice about their medical care, including the consequences of refusing treatment (GMC good medical practice’s Knowledge, Skills and Performance domain and the Communication, Partnership and Teamwork domain).
- Part A You have volunteered to be a facilitator on a clinical exam for medical students. A fourth-year medical student, Sarah, approaches you while you are walking out of work. Sarah knows that you are one of the facilitators for the clinical exam and asks you what type of scenarios will be covered in the clinical exam. You have worked with Sarah closely over the last few months.
Rate the appropriateness of the following actions in response to this situation. (1= Very appropriate; 4= Inappropriate).
A. Provide Sarah with some publicly available information about medical school examination
B. Explain to Sarah that it would be unfair on other candidates if only she knew the scenarios before the clinical exam
C. Reassure Sarah that she should not need to know the scenarios before the clinical exam in order to do well
A) Provide Sarah with some publicly available information about medical school examinations Correct Key: 1 - Very appropriate
Rationale: This is a very appropriate action because it is part of a doctor’s responsibility to develop themselves and to support others to develop (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain). Therefore, it is appropriate to provide Sarah with some guidance without giving her unfair advantage over other students and compromising your professional values such as, honesty, integrity and probity (GMC good medical practice’s Maintaining Trust domain).
B) Explain to Sarah that it would be unfair on other candidates if only she knew the scenarios before the clinical exam
Correct Key: 1 - Very appropriate
Rationale: This is a very appropriate action because as a doctor, it is important to maintain positive personal and professional values such as honesty, integrity and probity. Sharing the scenarios with Sarah would amount to you being dishonest and complicit in Sarah cheating in a clinical exam (GMC good medical practice’s Maintaining Trust domain). Apart from being morally wrong, giving Sarah an unfair advantage over her peers by cheating has other implications relating to clinical competence and patient safety as a result of Sarah not learning, revising, consolidating her knowledge and skills to be truly proficient (GMC good medical practice’s Knowledge, Skills and Performance domain).
C) Reassure Sarah that she should not need to know the scenarios before the clinical exam in order to do well
Correct Key: 2 (somewhat appropriate)
Rationale: This action is somewhat appropriate as Sarah’s request may be a result of fear or anxiety relating to her clinical exams. Reassuring Sarah about her potential and ability may be sufficient to enable her to reflect on her actions in requesting access to the scenarios beforehand. However, this action does not address the underlying issues and concerns about honesty, integrity and probity that her actions raise (GMC good medical practice’s Maintaining Trust domain).
- Part A (for reference): You have volunteered to be a facilitator on a clinical exam for medical students. A fourth-year medical student, Sarah, approaches you while you are walking out of work. Sarah knows that you are one of the facilitators for the clinical exam and asks you what type of scenarios will be covered in the clinical exam. You have worked with Sarah closely over the last few months.
Part B: The following day, you see an FY1 colleague, James, talking with Sarah over lunch. James is also a facilitator for the clinical exam. You can hear that James is providing Sarah with specific information about the types of scenarios which will be covered on the clinical exam. As James leaves the room, you walk over to Sarah and when she sees you, looks very guilty.
Rate the appropriateness of the following actions in response to this situation. (1= Very appropriate; 4= Inappropriate).
A. Ask Sarah why she has chosen to also ask James for information
B. Tell Sarah that you will need to inform her educational supervisor* about the situation
C. Encourage Sarah to declare to the medical school that she has been told information about the clinical exam
D. Explore with Sarah why she feels she needs to know the information
A) Ask Sarah why she has chosen to also ask James for information Correct Key: 1 - very appropriate
Rationale: This action is very appropriate as it is important to question and challenge colleagues’ behaviour and professionalism when appropriate. Being privy to Sarah’s desire to know the clinical scenarios in advance of the exam from your interaction with her the day before, it is your responsibility to ascertain if she has made the same request to your colleague. If she has, this is questionable conduct which needs to be addressed (GMC good medical practice’s Maintaining Trust domain).
B) Tell Sarah that you will need to inform her educational supervisor* about the situation Correct Key: 2 - Somewhat appropriate
Rationale: This is a somewhat appropriate action as it is part of your responsibility to raise concern about conduct and performance where indicated (GMC good medical practice’s Safety and Quality domain, Maintaining Trust domain). Informing Sarah of your intention to do so though, is optional.
C) Encourage Sarah to declare to the medical school that she has been told information about the clinical exam
Correct Key: 1 - Very appropriate
Rationale: This is a very appropriate action to take as it is important that Sarah takes responsibility for her actions, including when she makes a mistake or error of judgement. Encouraging Sarah to disclose this to the medical school is essential in terms of her demonstrating positive professional values as required, such as honesty, integrity and probity (GMC good medical practice’s Maintaining Trust domain).
D) Explore with Sarah why she feels she needs to know the information
Correct Key: 1 - Very appropriate
Rationale: This is a very appropriate action to take because supporting others to develop is part of your responsibility as a doctor (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain). Supporting Sarah to explore the reasons behind her action may be useful in helping her develop positive coping strategies and assessment management strategies to help her cope with clinical exams/assessments in the future, as well as other pressures she may come across as part of her ongoing development.
- You are working in the Emergency Department, and a 19 year old patient presents alone, after being elbowed in the eye while playing football. When you inform the patient that she has broken her eye socket and may need to have surgery, she becomes very upset. She tells you that she does not want to have surgery and that she wants to go home.
Rate the appropriateness of the following responses to say in this situation. Assume they are all said in a polite way. (1= Very appropriate; 4= Inappropriate).
A. “It is up to you whether or not you go home.”
B. “Is there is a particular reason why you do not want to have surgery?”
C. “Do you have any family members or friends who can come to support you?”
A) “It is up to you whether or not you go home.” Correct Key: 4 - Inappropriate
Rationale: This is an inappropriate response because as a doctor, you most prioritise patient safety (General Medical Council [GMC] good medical practice’s Safety and Quality domain) as it is in the best interest of the patient (Four Pillars of Medical Ethics – Beneficence and Non-maleficence). It is also important that you address the patient’s concern(s) which is making her upset (GMC good medical practice’s Communication, Partnership and Teamwork domain) and this response fails to do so.
B) “Is there is a particular reason why you do not want to have surgery?” Correct Key: 1 - Very appropriate
Rationale: This response is very appropriate because as a doctor it is your responsibility to listen to your patient and to address their concerns (GMC good medical practice’s Communication, Partnership and Teamwork domain). Establishing the reason(s) for this patient getting upset may be the key to establishing a positive working relationship, enabling her to engage with treatment which is in her best interest (Four Pillars of Medical Ethics – Beneficence and Non-maleficence).
C) “Do you have any family members or friends who can come to support you?”
Correct Key: 1 - Very appropriate
Rationale: This is a very appropriate response because as a doctor, your duty of care to your patient includes responding to your patient’s concerns as well as supporting your patients to care for themselves (GMC good medical practice’s Communication, Partnership and Teamwork domain). Therefore, finding out what support the patient needs and has will enable you to be able to do so in a meaningful way that is also in the best interest of the patient (Four Pillars of Medical Ethics – Beneficence and Non-maleficence).
- Part A You are working on a paediatric ward and a nurse, who works in a different department, approaches you to asks about his 6 year old niece who is a patient on your ward. He asks what is wrong with her and what treatment she is receiving. You are aware that the nurse is not the patient’s legal guardian. You have a good relationship with the nurse and you can see that he is clearly anxious about his niece.
Rate the appropriateness of the following responses to say in this situation. Assume they are all said in a polite way. (1= Very appropriate; 4= Inappropriate).
A. “You know that this is confidential information that I cannot discuss with you.”
B. “You will need to speak with your niece’s parents directly about this.”
C. “Try not to worry. I’m sure everything is going to be fine.”
D. “It is inappropriate for you to ask this of me so please do not ask me again.”
A) “You know that this is confidential information that I cannot discuss with you.” Correct Key: 2 - Somewhat appropriate
Rationale: This response is somewhat appropriate because although the nurse is your colleague and your patient’s relative, they do not have parental responsibility for your patient and therefore have no legal right to be informed about your patient’s private health information. It is important that you respect your patient’s right to confidentiality (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain) and that you treat the patient’s information that has been entrusted to you with respect (GMC good medical practice’s Communication, Partnership and Teamwork domain and Maintaining Trust domain). However, the nurse is clearly anxious about his niece and he may interpret your response as being unsympathetic.
B) “You will need to speak with your niece’s parents directly about this.” Correct Key: 1 - Very appropriate
Rationale: This response is very appropriate as it respects your patient’s right to confidentiality (GMC good medical practice’s Communication, Partnership and Teamwork domain) by referring your colleague to his relatives who have parental rights over your patient. This means that you are not breaching the patient’s confidentiality by disclosing their private information to a colleague.
C) “Try not to worry. I’m sure everything is going to be fine.” Correct Key: 4 - Inappropriate
Rationale: This response is inappropriate because although you are not disclosing specific details of your patient’s condition or status to your colleague, you are breaching your patient’s right to confidentiality by alluding/indirectly referring to their current medical status in your response (GMC good medical practice’s Communication, Partnership and Teamwork domain). The response is also providing assurances that cannot be guaranteed, which may prove to be problematic in the future if the patient’s condition deteriorates and everything is not as predicted.
D) “It is inappropriate for you to ask this of me so please do not ask me again.”
Correct Key: 3 - Somewhat inappropriate
Rationale: This response is somewhat inappropriate because although your colleague should not be asking you to disclose confidential information, it is important that you recognise the motive behind his request is his concern for his niece and respond in a compassionate manner while preserving your patient’s confidentiality (GMC good medical practice’s Communication, Partnership and Teamwork domain).
- Part A (for reference): You are working on a paediatric ward and a nurse, who works in a different department, approaches you to asks about his 6 year old niece who is a patient on your ward. He asks what is wrong with her and what treatment she is receiving. You are aware that the nurse is not the patient’s legal guardian. You have a good relationship with the nurse and you can see that he is clearly anxious about his niece.
Part B: The following day, you arrive on the paediatric ward and notice the nurse reading a set of patient notes. When he sees you approaching, he looks guilty and immediately puts the notes back and walks away. You do not know which set of notes he was reading but suspect that he may have been reading his niece’s notes.
Rate the appropriateness of the following actions in response to this situation. (1= Very appropriate; 4= Inappropriate).
A. Ask the nurse in charge for advice about how to respond
B. Tell the patient’s parents that you suspect the nurse was reading their daughter’s notes
C. Ask the nurse why he was reading a set of patient notes for a ward he does not work on
A) Ask the nurse in charge for advice about how to respond Correct Key: 1 - Very appropriate
Rationale: This is a very appropriate action to take because it is your responsibility to preserve the dignity and confidentiality of your patient as well as to raise concern when you witness inappropriate conduct (GMC good medical practice’s Communication, Partnership and Teamwork domain). However, as you are not certain about what notes your colleague may have been reading, it is important to bring what you have witnessed to the attention of the nurse in charge for advice about how to respond to the situation.
B) Tell the patient’s parents that you suspect the nurse was reading their daughter’s notes Correct Key: 3 - Somewhat inappropriate
Rationale: This is a somewhat inappropriate action to take because although it is your responsibility to preserve the dignity and confidentiality of your patient as well as to raise concern when you suspect or witness inappropriate conduct (GMC good medical practice’s Communication, Partnership and Teamwork domain), there are mechanisms to raise concern appropriately within the Trust and it is important that you follow those processes.
C) Ask the nurse why he was reading a set of patient notes for a ward he does not work on Correct Key: 1 - Very appropriate
Rationale: This is a very appropriate action to take because it is your responsibility to preserve the dignity and confidentiality of your patient as well as to raise concern when you witness inappropriate conduct (GMC good medical practice’s Communication, Partnership and Teamwork domain), including challenging your colleague directly regarding his behaviour on the ward.
- You have had a particularly busy and challenging day on the ward and are feeling overwhelmed and finding it hard to concentrate. You ask your clinical supervisor*, Cathy, if you can leave two hours early because of how you feel and she says, “you need to toughen up, there are not enough staff on the ward anyway so you can’t leave.”
Rate the importance of the following considerations in the management of this situation. (1= Very important; 4= Not at all important).
A. The impact on the rest of the ward staff if you leave work now
B. The risk to patient safety if you complete your shift feeling like you do
C. The amount of time you have left until the end of your shift
A) The impact on the rest of the ward staff if you leave work now Correct Key: 1 - Very important
Rationale: This is a very important because managing the workload is a collaborative effort and it would be inappropriate, irresponsible and negligent to leave the ward short without adequate staff (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain) to maintain safe care (GMC good medical practice’s Safety and Quality domain).
B) The risk to patient safety if you complete your shift feeling like you do Correct Key: 1 - very important
Rationale: This is very important because you must prioritise patient safety and ensure that you work within your own limits (GMC good medical practice’s Knowledge, Skills and Performance domain), including when you are feeling overwhelmed and unable to concentrate (GMC good medical practice’s Safety and Quality domain). In this case, it may be more appropriate to speak to your supervisor for advice about how to best manage the workload and how you are feeling, including the possibility of prioritising the workload with support, taking a break to recuperate, working collaboratively with the rest of the team to ensure that patient care is appropriately covered.
C) The amount of time you have left until the end of your shift Correct Key: 3 - Of minor importance
Rationale: This is of minor importance because patient care and patient safety most be prioritised (GMC good medical practice’s Knowledge, Skills and Performance domain and the Safety and Quality domain) at all times, regardless of how much time you have left until the end of the shift.
- You are working on a paediatric ward and you have prescribed a drug for a patient after being advised to do so by the consultant. The nurse looking after the patient has informed you that she will not give the drug to the patient as she has checked your calculation and believes that it is the wrong dose. You were confident that your calculations were correct. The drug was due to be given half an hour ago, and the patient’s parents are concerned that it is delayed. You know that the timing of the dose is not critical.
Rate the appropriateness of the following actions in response to this situation. (1= Very appropriate; 4= Inappropriate).
A. Reassure the parents that the delay in giving the drug will not cause harm to their child
B. Tell the parents that the delay is because the nurse thinks that your drug calculations are incorrect
C. Ask the consultant to confirm with yourself and the nurse what dose to give to the patient
D. Avoid having a conversation with the parents until after you have sorted out the issue with the drug dose
A) Reassure the parents that the delay in giving the drug will not cause harm to their child Correct Key: 1 - Very appropriate
Rationale: This action is very appropriate as it is important to ensure that you address and respond to a patient and/or their family’s concerns (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain) by reassuring them that the timing of the medication is not critical.
B) Tell the parents that the delay is because the nurse thinks that your drug calculations are incorrect
Correct Key: 4 - Inappropriate
Rationale: This action is inappropriate and unprofessional as this is attempting to blame the nurse for the delay when in essence, the nurse has rightly raised concern about a potential drug error, which is a significant safety issue (GMC good medical practice’s Patient Safety and Quality domain). This response may also result in lack of trust and reputation damage (GMC good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain) which would be detrimental to establishing an effective working relationship.
C) Ask the consultant to confirm with yourself and the nurse what dose to give to the patient
Correct Key: 2 - Somewhat appropriate
Rationale: This action is somewhat appropriate because it is your responsibility as a doctor to seek advice from a senior colleague when appropriate (GMC good medical practice’s Knowledge, Skills and Performance domain and the Communication, Partnership and Teamwork domain) to ensure that the care that is being delivered is safe and effective (GMC good medical practice’s Patient Safety and Quality domain). It could be argued that the need to involve the nurse in the discussion with the consultant is unnecessary.
D) Avoid having a conversation with the parents until after you have sorted out the issue with the drug dose
Correct Key: 4 - Inappropriate
Rationale: This action is very inappropriate as it is important to ensure that you address and respond to a patient and/or their family’s concerns (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain) in a prompt and timely fashion as to not cause any distress to the patient or their family (Four Pillars of Medical Ethics – Beneficence and Non-Maleficence).
- While you are working on a ward, your consultant walks past you and asks you to order an urgent chest x-ray* for a patient. You attempt to ask him why, but he rushes off to treat another critically ill patient. The patient approaches you and asks for an update. When you tell the patient that you are about to order another chest x-ray, she tells you that she had a chest x-ray yesterday and asks why she needs another one.
Rate the appropriateness of the following responses to say in this situation. Assume they are all said in a polite way. (1= Very appropriate; 4= Inappropriate).
A. “The consultant asked for the chest x-ray but I’m not sure why.”
B. “I’m not sure why you need one if you had one yesterday; I’ll cancel the chest x-ray.”
C. “I’ll check that the consultant realises that you had a chest x-ray yesterday.”
A) “The consultant asked for the chest x-ray but I’m not sure why.” Correct Key: 3 - Somewhat inappropriate
Rationale: This response is somewhat inappropriate because although it is an honest response, it does not instil much confidence in your ability as a doctor that you have not found out the reasons for the chest x-ray request before addressing the patient (General Medical Council [GMC] good medical practice’s Patient Safety and Quality domain and the Knowledge, Skills and Performance domain). It would be more appropriate to reassure the patient by addressing her concerns when you have all the facts you need to do so effectively (GMC good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain).
B) “I’m not sure why you need one if you had one yesterday; I’ll cancel the chest x-ray.” Correct Key: 4 - Inappropriate
Rationale: This is an inappropriate response because it is irresponsible and clinically negligent to make a clinical decision without having all the facts to cancel the chest x-ray (GMC good medical practice’s Patient Safety and Quality domain and the Knowledge, Skills and Performance domain). This action is also unethical because it is not in the best interest of the patient as there may be significant health implications from this action (Four Pillars of Medical Ethics – Beneficence and Non-Maleficence).
C) “I’ll check that the consultant realises that you had a chest x-ray yesterday.” Correct Key: 1 - Very appropriate
Rationale: This is a very appropriate response as it is your responsibility as a doctor to ensure that you and the rest of the team have the most up to date and/or relevant information about a patient in order to make decisions about treatment options and to provide the best quality of care (GMC good medical practice’s Patient Safety and Quality domain and the Knowledge, Skills and Performance domain). This action is also in the best interest of the patient as it ensures that the patient is not unnecessarily over exposed to radiation by having another chest x-ray, particularly if it is not required (Four Pillars of Medical Ethics – Beneficence and Non-Maleficence).
- A patient, Helen, was admitted to your ward overnight with abdominal pain and had an ultrasound this morning, which shows that she is pregnant. Her partner visits the ward and sees this written in her notes. You are outside Helen’s room when you overhear her partner saying that he cannot be the baby’s father. You are unsure whether to intervene in case the situation escalates, but his voice gets louder and he beings to shout at Helen.
Rate the importance of the following considerations in the management of this situation. (1= Very important; 4= Not at all important).
A. That Helen and her partner are having a private conversation
B. That Helen’s patient confidentiality is at risk of being compromised
C. That Helen’s partner may become physically aggressive
D. That it is not your job to intervene between patients and their families
A) That Helen and her partner are having a private conversation Correct Key: 3 - Of minor importance
Rationale: This consideration is of minor importance because although the conversation is private, it is taking place on the ward and has been overheard. What is more important is prioritising the safety and wellbeing of your patient (General Medical Council [GMC] good medical practice’s Patient Safety and Quality domain).
B) That Helen’s patient confidentiality is at risk of being compromised Correct Key: 2 - Important
Rationale: This consideration is important because it is your responsibility as Helen’s doctor to preserve the dignity of your patient and to ensure that their confidential information is kept safe (GMC good medical practice’s Communication, Partnership and Teamwork domain). However, the main priority is the safety and wellbeing of your patient.
C) That Helen’s partner may become physically aggressive Correct Key: 1 - Very important
Rationale: This consideration is very important because the safety and wellbeing of your patient is a priority (GMC good medical practice’s Patient Safety and Quality domain) and ensuring that she is safe while she is vulnerable is essential to maintain her wellbeing as well as that of her baby (Four Pillars of Medical Ethics – Beneficence and Non-Maleficence).
D) That it is not your job to intervene between patients and their families
Correct Key: 3 - Of minor importance
Rationale: This consideration is of minor importance because as a patient under your care, it is your responsibility to prioritise their care and needs (GMC good medical practice’s Patient Safety and Quality domain and the Communication, Partnership and Teamwork domain).
- You have been working at a hospital for the past 3 months. Your consultant, Dr Wong, recently changed the structure of the FY1 rota, which now includes working more consecutive night shifts. Since the rota has changed, you have noticed that you and your colleagues are more tired and team morale appears low. Today, whilst you are on the ward, Dr Wong asks you “How is everyone finding the new rota?”
Rate the appropriateness of the following responses to say in this situation. Assume they are all said in a polite way. (1= Very appropriate; 4= Inappropriate).
A. “Was it necessary to change the rota?”
B. “It might be a good idea to discuss the new rota at a meeting with the whole team.”
C. “I think it’s OK, but you should speak to the rest of the team to see what they think.”
A) “Was it necessary to change the rota?” Correct Key: 4 - Inappropriate
Rationale: This response is inappropriate because it is most probably not the best way to open up a meaningful dialogue with your senior colleague about an issue that is having such a negative and significant impact on the team (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain). It would be more appropriate to express concern(s) in a more diplomatic manner in order to encourage your consultant to explore the issue in more detail with you and the rest of the team.
B) “It might be a good idea to discuss the new rota at a meeting with the whole team.” Correct Key: 1 - Very appropriate
Rationale: This response is very appropriate so that concerns can be raised and discussed with the rest of the team (GMC good medical practice’s Communication, Partnership and Teamwork domain). Research indicates that fatigue/tiredness are linked with a higher risk of errors in clinical practice, therefore having the opportunity to express this concern as a group would be important in terms of minimising potential risk to patients (GMC good medical practice’s Patient Safety and Quality domain and the Communication, Partnership and Teamwork domain). It is also your collective responsibility as doctors to flag up any systemic issues that may negatively impact on patients and staff (GMC good medical practice’s Patient Safety and Quality domain and the Communication, Partnership and Teamwork domain).
C) “I think it’s OK, but you should speak to the rest of the team to see what they think.”
Correct Key: 3 - Somewhat inappropriate
Rationale: This response is somewhat inappropriate as it does not reflect your observations or your concerns about the impact of the change in rota on the team. It is important that as a doctor you raise concerns about risk, unsafe practice, or conduct (GMC good medical practice’s Communication, Partnership and Teamwork domain). It is also important that you are honest and act with integrity when providing feedback (GMC good medical practice’s Maintaining Trust domain).
- Part A: You are working on a general medical ward. Over the past week, you have noticed that your FY2 colleague, Eliza, has been more withdrawn than normal. She has also been more easily irritated, which is unlike her typically friendly manner. Earlier today, you noticed that Eliza was very abrupt with one of the student nurses, who looked upset in response. As you enter the staff room to have your lunch, you overhear some of the other nurses complaining about how rude Eliza has been recently. The nurses see you and continue talking.
Rate the appropriateness of the following actions in response to this situation. (1= Very appropriate; 4= Inappropriate).
A. Ignore the nurses, leaving the staff room to eat your lunch elsewhere
B. Find your FY2 colleague to tell her what you heard the nurses saying about her
C. Speak to your FY2 colleague to find out if there is a reason for the recent change in her behaviour
D. Advise your FY2 colleague that you have observed a change in behaviour that is having a negative impact at work
A) Ignore the nurses, leaving the staff room to eat your lunch elsewhere Correct Key: 3 - Somewhat inappropriate
Rationale: This action is somewhat inappropriate because as a doctor, you must treat colleagues fairly and with respect (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain). Ignoring the nurses and leaving the staff room to eat elsewhere does not reflect a positive work ethic or teamwork and may be detrimental to your working relationship with other members of the team.
B) Find your FY2 colleague to tell her what you heard the nurses saying about her Correct Key: 4 - Inappropriate
Rationale: This action is inappropriate because it is unprofessional and not in the best interest of fostering positive working relationships between the different member of staff (GMC good medical practice’s Communication, Partnership and Teamwork domain). This approach may also impact negatively on your FY2 colleague’s confidence, further isolating her from the rest of the team and worsening the already strained working relationships.
C) Speak to your FY2 colleague to find out if there is a reason for the recent change in her behaviour
Correct Key: 1 - Very appropriate
Rationale: This action is very appropriate because it is your responsibility as a doctor and as a colleague to raise concern about your colleague’s change in behaviour. It is also important to do this in a confidential and supportive manner in order to ascertain how to best support your colleague though the challenges she may be facing (GMC good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain).
D) Advise your FY2 colleague that you have observed a change in behaviour that is having a negative impact at work
Correct Key: 2 - Somewhat appropriate
Rationale: This action is somewhat appropriate because it is your responsibility as a doctor and as a colleague to raise concern about your colleague’s change in behaviour. Although it is the FY2 colleague’s responsibility as a doctor to be aware of the impact of her behaviour/change in behaviour on others (GMC good medical practice’s Communication, Partnership and Teamwork domain), it is important that you support colleagues who may have problems with their performance or health and that you are honest when giving feedback to your colleague about your observations (GMC good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain), so that she is made aware of her change in behaviour and its potential impact on others.
- Part A (for reference): You are working on a general medical ward. Over the past week, you have noticed that your FY2 colleague, Eliza, has been more withdrawn than normal. She has also been more easily irritated, which is unlike her typically friendly manner. Earlier today, you noticed that Eliza was very abrupt with one of the student nurses, who looked upset in response. As you enter the staff room to have your lunch, you overhear some of the other nurses complaining about how rude Eliza has been recently. The nurses see you and continue talking.
Part B: This afternoon you are sat with your FY2 colleague, Eliza, on the ward. She becomes frustrated by making a mistake on some paperwork and disturbs you from writing your own notes. She apologises and explains that she is feeling very stressed at the moment, as she is worrying about an upcoming exam. She tells you that she that has been finding it difficult to concentrate at work and apologises if her recent mood has affected you in any way.
Rate the appropriateness of the following actions in response to this situation. (1= Very appropriate; 4= Inappropriate).
A. Reassure your FY2 colleague that she will feel less stressed when the exam is over
B. Ask your FY2 colleague if she has considered speaking to her educational supervisor* about how she is feeling
C. Suggest taking on some of your FY2 colleague’s workload to allow her more time to study
D. Inform your FY2 colleague that some of the nurses have noticed a change in her behaviour
A) Reassure your FY2 colleague that she will feel less stressed when the exam is over Correct Key: 2 - Somewhat appropriate
Rationale: This action is somewhat appropriate because although is it is important that you support colleagues who may have problems with their performance or health, reassuring her is beneficial to her in terms of making her feel better. However, this action does not address the impact that her behaviour is having on others and it is also important that you are honest when giving feedback to your colleague about your observations/concerns (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain).
B) Ask your FY2 colleague if she has considered speaking to her educational supervisor* about how she is feeling Correct Key: 1 - Very appropriate
Rationale: This action is very appropriate as it is important that you support colleagues who may have problems with their performance or health and suggesting that Eliza discusses how she is feeling is an appropriate suggestion in terms of getting Eliza the support she needs to resolve the challenges that she is facing (GMC good medical practice’s Communication, Partnership and Teamwork domain).
C) Suggest taking on some of your FY2 colleague’s workload to allow her more time to study
Correct Key: 4 - Inappropriate
Rationale: This action is inappropriate because it is out of your scope of practice to take on your colleague’s workload, raising potential risk to patient safety (GMC good medical practice’s Knowledge, Skills and Performance domain and the Patient Safety and Quality domain). The monitoring and supervision of Eliza’s caseload and performance is the responsibility of her clinical/educational supervisor and not you as her peer.
D) Inform your FY2 colleague that some of the nurses have noticed a change in her behaviour
Correct Key: 2 - Somewhat appropriate
Rationale: This action is somewhat appropriate because it is your responsibility to raise concern about your colleague’s behaviour and be honest about its impact on the rest of the team (GMC good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain). However, it is also important to consider the potential impact of disclosing this information to Eliza who is already stressed about her workload and upcoming exams.
- You are on a medical team that is well staffed, so your consultant has asked you to help out another understaffed medical team for an afternoon. You have completed the jobs for your patients and would be happy to help another team if needed. However, the ward nurse in charge is very unhappy about losing a team member for the afternoon and asks you to stay on the ward but does not give you a reason.
Rate the importance of the following considerations in the management of this situation. (1= Very important; 4= Not at all important).
A. That the ward nurse in charge must have a reason for wanting you stay
B. That the consultant probably knows the requirements of both wards the best
C. That you might have an easier afternoon if you stay on your current ward
D. That your relationship with the ward nurse in charge might be negatively affected if you go to the other ward
A) That the ward nurse in charge must have a reason for wanting you stay Correct Key: 2 - Important
Rationale: This is an important consideration because the ward nurse in charge may have a different but equally relevant perspective about clinical priorities which needs to be taken into consideration when reviewing staffing (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain). However you have completed all of the jobs for your patients and are able to support the understaffed ward, as requested by your consultant.
B) That the consultant probably knows the requirements of both wards the best Correct key: 1 - Very important
Rationale: This is a very important consideration because your consultant is responsible for providing clinical supervision, support and monitoring of your allocated caseload. Therefore, the consultant probably has a better overview of your capabilities as well as the requirements of both wards (GMC good medical practice’s Communication, Partnership and Teamwork domain) and is best placed to make the decision about where you would be best placed in terms of contribution to the wider multi-disciplinary team.
C) That you might have an easier afternoon if you stay on your current ward Correct Key: 4 - Not at all important
Rationale: This consideration is not at all important because as a doctor, it is your duty to work collaboratively with others to ensure that safe and effective care is delivered to all patients (GMC good medical practice’s Communication, Partnership and Teamwork domain).
D) That your relationship with the ward nurse in charge might be negatively affected if you go to the other ward
Correct Key: 3 - Of minor importance
Rationale: This consideration is of minor importance as patient care and safety must be prioritised above all other factors in the clinical setting (GMC good medical practice’s Patient Safety and Quality domain), including your relationship with the ward’s nurse in charge.
- A patient on the Acute Admissions Unit* (AAU) was admitted to hospital with pancreatitis two weeks ago. The patient was on holiday near the hospital when he was admitted and has therefore asked to be transferred to a hospital closer to his home, which is a three hour drive away. The consultant explains that it is not safe for the patient to travel for at least another week. On your way to the ward, you walk past the patient’s daughter. You notice that she is upset, so you ask her if she is OK. She tells you, “I can’t keep travelling three hours every day to visit my father, I’m too exhausted, but he hasn’t got anyone else. I wish he could be transferred sooner.”
Rate the appropriateness of the following responses to say in this situation. Assume they are all said in a polite way. (1= Very appropriate; 4= Inappropriate).
A. “Don’t worry, your father will be transferred next week.”
B. “Your father’s health is the most important thing to consider in deciding when he can be transferred.”
C. “It is not necessary for you to visit every day, I am sure he would be OK.”
D. “Could you speak with your father on the phone, rather than visiting so often?”
A) “Don’t worry, your father will be transferred next week.” Correct Key: 4 - Inappropriate
Rationale: This response is inappropriate because although it seems to be providing reassurance, the information is potentially incorrect or inaccurate because there is no guarantee that the patient would be medically stable enough to be transferred in a week’s time (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain). The other potential issue is that you are discussing a patient’s confidential clinical information in a public space with his daughter without ascertaining whether the patient is happy for you to do so. Therefore, potentially breaching the patient’s right to confidentiality.
B) “Your father’s health is the most important thing to consider in deciding when he can be transferred.” Correct Key: 1 - Very appropriate
Rationale: This response is very appropriate because it prioritises the patent’s safety and wellbeing as well as his needs over other considerations (GMC good medical practice’s Knowledge, Skills and Performance domain, the Patient Safety and Quality domain and the Communication, Partnership and Teamwork domain).
C) “It is not necessary for you to visit every day, I am sure he would be OK.”
Correct Key: 3 - Somewhat inappropriate
Rationale: This response is somewhat inappropriate because although it comes across as being reassuring, it fails to consider the patient’s specific needs or the needs of his family (GMC good medical practice’s Communication, Partnership and Teamwork domain). It is also based on an assumption that the patient will be okay without necessarily having all the facts required to make such an assertion and without being able to predict the impact on the patient and their family (GMC good medical practice’s Knowledge, Skills and Performance domain and the Patient Safety and Quality domain).
D) “Could you speak with your father on the phone, rather than visiting so often?”
Correct Key: 2 - Somewhat appropriate
Rationale:
This response is somewhat appropriate because it is supporting the patient and his family with information, however the daughter needs to make an informed decision about his ongoing healthcare needs and how to support him (GMC good medical practice’s Communication, Partnership and Teamwork domain).
- You are being shadowed by a medical student, Jeremy, whilst consulting an elderly patient, Mrs McDermott. You are explaining to her that she will be prescribed several medications, when Jeremy interrupts to say that he thinks there is an alternative drug, which would be more appropriate for Mrs McDermott than the one you have suggested. He says that he has read about this in an article online. Mrs McDermott looks confused.
Rate the appropriateness of the following actions in response to this situation. (1= Very appropriate; 4= Inappropriate).
A. Apologise to Mrs McDermott for causing confusion following Jeremy’s comment
B. Ignore Jeremy’s comment and continue the conversation with Mrs McDermott
C. After the consultation, explain to Jeremy that it was an inappropriate time to bring up the article that he has read online
D. Ask Jeremy to explain to the patient why he believes that the alternative drug he has suggested is more effective
A) Apologise to Mrs McDermott for causing confusion following Jeremy’s comment Correct Key: 1 - Very appropriate
Rationale: This action is very appropriate as it is important to be honest, acknowledge when things go wrong in clinical practice and to apologise in the best interest of maintaining trust in you as a doctor and in the profession (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain).
B) Ignore Jeremy’s comment and continue the conversation with Mrs McDermott Correct Key: 4 - Inappropriate
Rationale: This action would be inappropriate as it fails to address the confusion that Jeremy’s interruption has caused which may negatively impact on your ability to establish a meaningful working relationship with Mrs McDermott (GMC good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain).
C) After the consultation, explain to Jeremy that it was an inappropriate time to bring up the article that he has read online
Correct Key: 1 - Very appropriate
Rationale: This action is very appropriate because it is your responsibility as a doctor to support students and other colleagues in practice to develop their clinical and professional skills. Providing Jeremy with honest feedback on the impact of his interruption on the patient should encourage him to be more aware of the impact of his actions on others in the future (GMC good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain).
D) Ask Jeremy to explain to the patient why he believes that the alternative drug he has suggested is more effective
Correct Key: 4 - Inappropriate
Rationale: This action is inappropriate as you may be asking Jeremey to carry out a task that is outside his scope of practice as a student (GMC good medical practice’s Knowledge, Skills and Performance domain), potentially exposing the patient to risk (GMC good medical practice’s Patient Safety and Quality) caused by the confusion from the contrasting information from an unverified source being presented to her. This interaction may have a detrimental effect on the patient’s trust in you as her doctor as well as the wider profession/team, resulting in reduced ability to engage or establish a successful working relationship with the clinical team (GMC good medical practice’s Maintaining Trust domain).
- Part A: You are covering a ward out of hours. An FY2 doctor, Raphael tells you that he will be back shortly. As the ward becomes busier, you note that Raphael has not returned from his break. You find Raphael asleep in the break room. You are very busy and becoming overwhelmed on the ward, so you decide to wake Raphael. Raphael tells you to leave him alone as he needs the rest.
Rate the appropriateness of the following actions in response to this situation. (1= Very appropriate; 4= Inappropriate). A. Explain to Raphael that you feel overwhelmed, under pressure and need his support
B. Explain to Raphael that his behaviour is inappropriate
C. Leave Raphael to sleep and carry on alone throughout the shift
D. Ask other colleagues on the ward for their support
E. Inform a more senior colleague that you are not receiving the support that you need from your FY2
F. Decide to work late to finish the tasks
A) Explain to Raphael that you feel overwhelmed, under pressure and need his support Correct key: 1 - Very appropriate Rationale: This is a very appropriate action. It is clear and explicit that you need help on the ward, as you cannot manage the workload alone, whilst remaining polite and professional. It does not cast judgement on why Raphael is sleeping, but simply asks for his help now that he is awake. B) Explain to Raphael that his behaviour is inappropriate Correct key: 2 - Somewhat appropriate Rationale: This action is somewhat appropriate. Although staff members are entitled to take breaks and rest, which may even include a small nap, this must not over run to when they are meant to be performing clinical duties. However, the response is not entirely appropriate as although Raphael’s behaviour is inappropriate, it does not explain to him what your immediate concerns are with the busy ward and that his help is needed now. C) Leave Raphael to sleep and carry on alone throughout the shift Correct key: 4 - Inappropriate Rationale: This is an inappropriate action. Regardless of Raphael’s reasons for taking a nap, when his allotted break time has finished, Raphael should be ready to continue his clinical duties. If he is unwell or has genuine reasons, then the situation can be escalated, so that he can be sent home and appropriate cover can be found. However, by leaving him to sleep, the situation is not being dealt with, and it also means that the clinical work is becoming overwhelming for one FY1 doctor. Additionally, patient safety may be at risk due to not enough staff and support available. D) Ask other colleagues on the ward for their support Correct key: 2 - Somewhat appropriate Rationale: This action is somewhat appropriate. It is recognising your own limitations and that you are becoming overwhelmed and require support on the ward. Asking for help is a positive step and ensures patient safety. However, the colleagues on the ward may have other duties and asking for their help is taking them away from their own work and it hasn’t dealt with the main problem at this time, which is Raphael sleeping and not able to perform his own duties.
E) Inform a more senior colleague that you are not receiving the support that you need from your FY2 Correct key: 1 - Very appropriate Rationale: This is a very appropriate action. Escalating the situation appropriately has two benefits: it means that additional support can be found for you in order to carry out the jobs properly, and patient safety isn’t compromised. It also means that a senior colleague can deal sensitively with Raphael, as there may be more complex issues involved that may explain the reasons why he is so tired and unable to complete his shift, which can be dealt with by his senior. F) Decide to work late to finish the tasks
Correct key: 4 - Inappropriate Rationale: This is an inappropriate action. Despite the good intentions behind working late to get the jobs completed, it is inappropriate because, as an individual, you cannot simply take on an entire colleague’s workload. You will be tired after a long shift, and in these circumstances mistakes can happen. Rest periods are essential, so you need to finish your shift when allocated and get the appropriate rest needed, so that you are ready for your next shift. Safe working times and rotas have been designed with this in mind. Working late to finish tasks also sets a precedent for other doctors to do the same. Any leftover jobs can be safely handed over to the on-call team or postponed until the following day. Finally, by working late to finish the tasks, not only might it be unsafe, but it is not dealing with the problem that you have been unsupported by a team member, Raphael, who is asleep, and these needs escalating appropriately.
- Part A (for reference) You are covering a ward out of hours. An FY2 doctor, Raphael tells you that he will be back shortly. As the ward becomes busier, you note that Raphael has not returned from his break. You find Raphael asleep in the break room. You are very busy and becoming overwhelmed on the ward, so you decide to wake Raphael. Raphael tells you to leave him alone as he needs the rest.
Part B: Raphael remains asleep for the remainder of the shift. As you are leaving, Raphael wakes up and tells you that, before that shift, he had not slept in 4 days. He commends you for managing well without him. Later on, you find out that your colleague, Shannon, has also had a previous similar experience with Raphael.
Rate the appropriateness of the following actions in response to this situation. (1= Very appropriate; 4= Inappropriate). A. Ask Raphael why he is struggling to sleep during his time off B. Tell Raphael that he is putting patients at risk by coming to work over-tired C. Encourage Raphael to seek support from his General Practitioner (GP)* D. Advise Raphael that you think it is inappropriate to sleep whilst on shift
A) Ask Raphael why he is struggling to sleep during his time off Correct key: 1 - Very appropriate Rationale: This is a compassionate approach, understanding that there are likely to be reasons why Raphael has been sleeping on his shifts. As an individual, you may not be able to fix the reasons on your own, and you will still need to escalate the situation, but by showing an empathetic and compassionate response to a fellow colleague, you are more likely to get a positive response from Raphael, and foster trust and positive working relationship in future. B) Tell Raphael that he is putting patients at risk by coming to work over-tired
Correct key: 1 - Very appropriate Rationale: This is a very appropriate action. Whatever the reasons are for Raphael being so tired that he needs to sleep through his shift, in doing so, he is risking patient safety. If he has genuine reasons, these need to be escalated and dealt with appropriately and he may require a period of sick or compassionate leave before he is safe to work again. C) Encourage Raphael to seek support from his General Practitioner (GP)*
Correct key: 1 - Very appropriate Rationale: This is a kind and compassionate approach, taking into consideration that there may be genuine reasons why Raphael is sleeping during a shift and these reasons need addressing, as he is currently not safe to be at work. Encouraging Raphael to seek support from his GP is a compassionate and empathetic approach by directing him to get some help, rather than cast judgments on his behaviour. D) Advise Raphael that you think it is inappropriate to sleep whilst on shift
Correct key: 2 - Somewhat appropriate Rationale: Although it is inappropriate for Raphael to sleep whilst on shift (not in his allocated break time), advising him that you think his behaviour in inappropriate is somewhat unhelpful, as it might be interpreted as inflammatory by Jeremy and cause a breakdown in trust. This action does not offer any practical solutions, such as speaking with a senior colleague or healthcare professional, nor does it highlight to Raphael the additional stress that it has put you under, which has meant that jobs on the ward are not completed and thus patient safety may be compromised.
- Whilst working on a surgery rotation, your consultant asks you to prescribe a high dose of warfarin for a patient to go home with. However, the pharmacist informs you that the hospital protocol advises to use a smaller dose of warfarin to begin with, to reduce the risk of serious haemorrhage. You have only recently started working with your consultant, but your FY1 colleagues have told you that she often gets angry when her decisions are challenged.
Choose the THREE most appropriate actions to take in this situation. * Option A: Ask the pharmacist to supply the high dose of warfarin, as per the prescription * Option B: Inform your consultant that the warfarin prescription is against the hospital protocol * Option C: Ask your consultant if she wants you to change the prescription to a smaller dose * Option D: Ask the patient whether he is willing to accept the risks associated with the higher dose * Option E: Change the dose of warfarin to follow the hospital protocol without speaking to the consultant * Option F: Ask the pharmacist to contact your consultant to discuss the dosage directly with her * Option G: Ask a different senior colleague for advice on how to proceed with the prescription * Option H: Ask your consultant to explain why she asked you to prescribe a high dose of warfarin
Correct Key: CFH
Rationale: The General Medical Council (GMC) standards of practice require all medics to prioritise safety. In practice, this is done by adhering to evidence practice and following guidelines and protocols, therefore, Option C: Ask your consultant if she wants you to change to a smaller dose as per the Trust protocol would be an appropriate action to take in this situation.
In view of the consultant’s reputation for reacting angrily when challenged, it may help matters to get the pharmacist as the expert on medication to challenge her decision based on the Trust protocol, therefore, Option F: Ask the pharmacist to contact your consultant to discuss the dosage directly with her would be another appropriate action to take. According to the GMC, Communication is a key requirement of good medical practice: The other course of action is to discuss the matter with the consultant to understand as a trainee, the rationale for her decision and the atypical prescription. This may serve to be a useful/meaningful learning opportunity as a trainee, therefore, Option H: Ask your consultant to explain why she asked you to prescribe a high dose of warfarin would be another appropriate action to take in this situation.
- You are working in the Emergency Department. A female patient approaches you as she is leaving and tells you that she thought you were very rude during the consultation that you had with her earlier. The patient is angry because she noticed that you were looking at your phone during the consultation, however, you were looking at her observations on your hospital phone.
Choose the THREE most appropriate actions to take in this situation. * Option A: Reassure the patient that you were paying attention during her consultation * Option B: Apologise to the patient for appearing rude during her consultation * Option C: Explain to the patient that you were looking at her observations on your hospital phone * Option D: Tell the patient that you were using your hospital phone so that she could receive the best possible care * Option E: Advise the patient that in future you will tell patients why you are checking your phone during consultations * Option F: Explain to the patient that doctors frequently have to check information on their hospital phones * Option G: Show the patient her observations that you were looking at on your hospital phone * Option H: Ask the patient if she would like to raise the use of hospital phones with one of your senior colleagues
Correct Key: BCE
Rationale: The General Medical Council’s (GMC’s) standards of practice includes communication and partnership working as being integral components of good medical practice. Specifically, working in partnership with patients by being able to listen to and respond to their concerns and preferences (GMC good medical practice’s Communication, Partnership and Teamwork domain). Therefore, Option B: Apologise to the patient for appearing rude during her consultation, would be an appropriate action to take in this situation. An explanation of what was happening would be appropriate in terms of reassuring the patient about what was happening during their care, therefore, Option C: Explain to the patient that you were looking at her observations on your hospital phone would be another appropriate action to take. In the best interest of the working relationship with the patient, it is appropriate to respond to feedback in terms of informing future practice through lessons learnt from the feedback, therefore another appropriate action in this situation would be Option E: Advise the patient that in future you will tell patients why you are checking your phone during consultations. This course of action may also serve to reassure and rebuild trust between the patient and clinician.
- You are an FY1 doctor working in the general surgical department of a small hospital. The registrar/specialty trainee* contacts you and asks you to inform a patient, Mr Jones, that his operation will be cancelled due to an emergency case. The registrar/specialty trainee tells you he is in theatre and cannot speak to Mr Jones himself. Mr Jones is on the ward, accompanied by his relatives. When you inform him of the situation, Mr Jones looks upset and his relatives gets very angry. They are unhappy with the situation because Mr Jones’ operation has already been cancelled twice. The relatives begin shouting about the poor care delivered by your hospital and demand an explanation.
Choose the THREE most appropriate responses to say in this situation. Assume they are all said in a polite way. * Option A: “I’m sorry but there is an emergency case that takes priority.” * Option B: “I can see you are upset. I know this must be disappointing.” * Option C: “I agree, this is not the best outcome.” * Option D: “Is there anything else I can do to help?” * Option E: “The registrar/specialty trainee has made the decision; I can not do anything about it I’m afraid.” * Option F: “You can wait to discuss this further with the registrar/specialty trainee if you would prefer?” * Option G: “I understand your frustration but getting angry will not help.” * Option H: “There is no need to shout at me, I can not change anything.”
Correct Key: BDF
Rationale: The General Medical Council’s (GMC) standards of practice include the ability to listen to and respond to patients concerns and preferences (GMC good medical practice’s Communication, Partnership and Teamwork domain). Therefore, an appropriate response to say in this situation would be Option B: “I can see you are upset. I know this must be disappointing.” as it acknowledges the effect of the cancellation of the operation on the patient and Mr Jones’s family, validating their collective experience of the care Mr Jones had received so far. Another appropriate response would be, Option D: “Is there anything else I can do to help whilst you wait for your operation to be rearranged?”, as it acknowledges the reality of the operation being cancelled as being unavoidable while reassuring the patient and his family that the operation is to be rescheduled and you are available to provide support (GMC good medical practice’s Communication, Partnership and Teamwork domain). In some cases, as the messenger, the only way to resolve the situation is to defer to the primary source of the information, particularly, if they are a more senior colleague and the primary decision maker, therefore, another appropriate response in this situation is, Option F: “You can wait to discuss this further with the registrar/specialty trainee if you would prefer?”, which offers Mr Jones and his family, the option of speaking with the more senior colleague/decision maker if further explanation/clarification is required (GMC good medical practice’s Communication, Partnership and Teamwork domain).
- You are in the office with your FY2 colleague who is collecting feedback, via email, from his colleagues to use for his learning portfolio. He sends a request to another staff member who is also his girlfriend, who you have previously worked with. He tells you that this is an easy way to make sure that he gets good feedback.
Choose the THREE most appropriate actions to take in this situation. * Option A: Suggest to your FY2 colleague that he requests feedback from someone else instead of his girlfriend * Option B: Contact his girlfriend, recommending that she does not complete the feedback form * Option C: Ask your FY2 colleague if he thinks his girlfriend will respond to his request for feedback * Option D: Report this incident to your FY2 colleague’s educational supervisor * Option E: Inform your FY2 colleague that his behaviour is unprofessional * Option F: Explain the benefits of receiving constructive feedback to your colleague * Option G: Arrange to discuss the situation with your educational supervisor * Option H: Offer to provide feedback to your FY2 colleague yourself
Correct Key: AFG
Rationale: The General Medical Council (GMC) states that being honest, open and acting with integrity in practice are essential characteristics of good medical practice (GMC good medical practice’s Communication, Partnership and Teamwork and Maintaining Trust domains). Therefore, Option A: Suggest to your FY2 colleague that he requests feedback from someone else instead of his girlfriend, would be an appropriate action to take in this situation as this action may encourage your FY2 colleague to remember the importance of demonstrating those values in his actions. As a trainee and a clinician, feedback is a valuable and compulsory part of both personal and professional development, as feedback identifies areas of strength and areas of deficit, requiring further support or development. Therefore, Option F: Explain the benefits of receiving constructive feedback to your colleague, would be another appropriate action to take in this situation (GMC good medical practice’s Communication, Partnership and Teamwork domain). Raising concern about poor practice is also a professional responsibility and, in this case, it is your responsibility and duty to bring your FY2 colleague’s behaviour to the attention of a more senior colleague (GMC good medical practice’s Safety and Quality domain). Therefore, another appropriate course of action to take in this situation would be, Option G: Arrange to discuss the situation with your educational supervisor.
- You are working on an orthopaedic ward. Your fellow FY1 colleague does not like going to the operating theatre and has been avoiding it. As a result, you have spent more time assisting in theatre, and have missed some bedside teaching sessions arranged by the registrar/specialty trainee*. The registrar/specialty trainee has noticed and has made a remark about the time you are away from the ward. You are now meeting with your FY1 colleague to discuss your allocation
Choose the THREE most appropriate responses to say in this situation. Assume they are all said in a polite way.
* Option A: “The registrar is not happy that I have missed some bedside teaching sessions.”
* Option B: “I’ve missed all the bedside teaching because I’m often in theatre.”
* Option C: “I would like us to split the work more evenly in future so that we both can meet all of our learning objectives.”
* Option D: “Is there anything I can do to help, to make you feel better about going to theatre?”
* Option E: “I think you should talk to your supervisor about why you have been avoiding theatre.” * Option F: “You choosing to spend more time on the ward is having an impact on both of us.” * Option G: “I understand you do not like going to theatre, but it is an important part of the job.” * Option H: “The registrar will be disappointed if he notices that I’ve only been in theatre because you did not want to go.”
Correct Answer Key: CDF
Rationale: Option C is an appropriate response as it lets you clearly say that there should be an equal distribution of work going forward. This would work irrespective of any personal equations you may share with your colleague and remains very professional. Option D would be another appropriate response as it offers help and seeks to clarify any issues the colleague may be having. Option F would also be an appropriate response to say as it states what the problem is and would be a good way to check if your colleague has any insight into the issues they may inadvertently be causing.
Options A and B do not offer sufficient clarity to your colleague that he may be causing an issue and make it seem more like a personal problem. Options E, G and H would appear to be more confrontational and make your colleague defensive rather than help solve the issue.
- Part A You are conducting a ward round with your FY2 colleague, Dr Lee. While reviewing one of your patients, Patricia, you see that her chart indicates that she has refused medication for the past week. It is not critical for her short-term health, however, her symptoms are unlikely to improve if she does not take her medication. Dr Lee says, “You don’t seem to care about getting better, you may as well go home” and leaves the room. Patricia looks upset by Dr Lee’s comment.
Choose the THREE most appropriate responses to say in this situation. Assume they are all said in a polite way. * Option A: “Is there a reason why have you been refusing to take your medication?” * Option B: “I really think that you should listen to the advice that Dr Lee is giving you.” * Option C: “Do you not want to get any better?” * Option D: “Do not worry, there are no short term impacts of you not taking your medication.” * Option E: “Are there any questions that you would like to ask me about your medication?” * Option F: “I’m sorry, Dr Lee should not have spoken to you like that.” * Option G: “Do not get upset, if you want to talk to me, I am here to help.” * Option H: “It is really important that you take your medication if you want to get better.”
Correct Key: AEF
Rationale: As part of good medical practice, the General Medical Council (GMC) highlight the importance of working in partnership with patients, including, listening to and responding to their concerns and preferences (GMC good medical practice’s Communication, Partnership and Teamwork domain). Therefore, Option A: “Is there a reason why have you been refusing to take your medication?”, would be an appropriate response to say in this situation as it may enable you to understand the rationale for Patricia’s choice in declining her medication. In most cases of non-compliance with treatment, research has shown that fear or health related anxiety may be a significant contributory factor to patients not following medical advice or instruction. Addressing what those concerns may be a significant step towards allaying those fears/anxieties and perhaps facilitating cooperation and compliance with care. Therefore, Option E: “Are there any questions that you would like to ask me about your medication?”, would be another appropriate response to say in this situation. Good medical practice also requires being honest, open and acting with integrity as per the duty of candour. Therefore, Option F: “I’m sorry, Dr Lee should not have spoken to you like that.”, acknowledges that something has gone wrong in the course of Patricia’s care and apologises for it. This in turn serves to maintain the patient’s trust in you and the profession (GMC good medical practice’s Maintaining Trust domain).
- Part A (for reference): You are conducting a ward round with an FY2 Doctor, Dr Lee. While reviewing one of your patients, Patricia, you see that Patricia’s chart indicates she has refused medication for the past week. It is not critical for her short-term health, however, her symptoms are unlikely to improve if she does not take her medication. Dr Lee states, “what a waste of space it is you being here Patricia. You may as well go home if you do not want to get better” and leaves the room. Patricia looks upset by Dr Lee’s comment. Part B: Dr Lee approaches you after you have spoken with Patricia and expresses his regret for the way he spoke to Patricia. He explains that he is under pressure from the consultant to discharge patients as quickly as possible. He tells you that he feels that this has had a negative impact on his relationships with many of his patients. You have not yet finished the ward round with Dr Lee.
Choose the THREE most appropriate actions to take in this situation. * Option A: Suggest to Dr Lee that he takes a break before finishing the ward round * Option B: Speak to your clinical supervisor* about Dr Lee’s behaviour towards Patricia * Option C: Ask your colleagues on the ward to monitor Dr Lee’s behaviour with patients * Option D: Explain to Dr Lee that you understand that he is under a lot of pressure * Option E: Suggest that Dr Lee speak to the consultant about his concerns * Option F: Advise Dr Lee apologises to Patricia for the way he spoke to her * Option G: Suggest to Dr Lee that he stops trying to discharge patients early and focuses on maintaining positive relationships * Option H: Ask Dr Lee if there is anything that you can do to support him
Correct Key: EFH Rationale: According to the General Medical Council (GMC), a key aspect of good medical practice is ensuring that doctors work within their limitations and are prompt in raising concerns about practice (GMC good medical practice’s Safety and Quality domain). Therefore, Option E: Suggest that Dr Lee speak to the consultant about his concerns, is an appropriate action to take in this situation.
In the interest of his working relationship with his patients, an important step for Dr Lee to take would be to acknowledge and apologise for his actions, which may serve to re-establish Patricia’s trust in him and enable them to have a positive and effective patient-doctor partnership (GMC good medical practice’s Communication, Partnership and Teamwork and Maintaining Trust domains). Therefore, Option F: Advise Dr Lee to apologise to Patricia for the way he spoke to her, would be another appropriate action to take in this situation. The GMC emphasises the role of teamwork as an important aspect of good medical practice (GMC good medical practice’s Communication, Partnership and Teamwork domain). An integral part of teamwork is supporting each other and working together to achieve a common aim/goal. Therefore, Option H: Ask Dr Lee if there is anything that you can do to support him, would be another appropriate action to take in this situation. This action may serve to reassure Dr Lee that he is not alone and has the support of his colleague(s).
- You are clerking* in a three year old patient with cystic fibrosis* who attends frequently with pulmonary* complications. You discover that her parents smoke cigarettes heavily at home and you mention to them that this may be a contributing factor to their daughter’s deterioration. Later that day, the parents tell you they intend to make an official complaint about you because they feel like you were blaming them for their daughter’s deterioration.
Choose the THREE most appropriate responses to say in this situation. Assume they are all said in a polite way. * Option A: “I am sorry that I offended you with my comment, but making a complaint will not help your daughter.” * Option B: “Have you considered the benefits of stopping smoking?” * Option C: “I did not mean to offend you with my comment earlier.” * Option D: “I understand this situation with your daughter must be difficult for your family.” * Option E: “Do you have any other suggestions about what is causing your daughter to have frequent pulmonary complications?” * Option F: “Please give me the opportunity to explain the facts about smoking and pulmonary complications.” * Option G: “Was there something specific that I said that upset you?” * Option H: “My intentions are to inform you of how you can help your daughter.”
Correct Key: CDF
Rationale:
A key component of the General Medical Council (GMC) good medical practice’s Communication, Partnership and Teamwork domain includes treating patients politely and considerately. In its Working in Partnership with Patient’s domain, the GMC also highlights the importance of listening to and responding to patients’ concerns and preferences. In view of these two domains, an appropriate response to say in this situation is, Option C: “I did not mean to offend you with my comment earlier”, which addresses both requirements. Acknowledging the parents’ perspective is essential to fostering a positive working relationship or partnership, therefore, Option D: “I understand this situation with your daughter must be difficult for your family”, would be another appropriate response to say in this situation as this is polite, while demonstrating consideration and compassion. The GMC good medical practice’s Working in Partnership with Patient’s domain also outlines the importance of providing patients with information that they want or need in a way they can understand. Therefore, Option F: “Please give me the opportunity to explain the facts about smoking and pulmonary complications”, would be another appropriate response to say in this situation.
- You are about to start a night shift on a medical ward. During handover, Hussein, the FY1 doctor who has been working the day shift, tells you that he has nothing to hand over. When you are on the ward later that evening, a senior nurse informs you that she bleeped* Hussein several times during the day and spoke to him over the telephone about an 88 year old patient with severe chest pain. You review and treat the patient accordingly. When you discuss this incident with Hussein the next day, he states that he was never informed about this patient, and that the nurse is lying.
Choose the THREE most appropriate actions to take in this situation.
* Option A: Inform Hussein’s clinical supervisor* of the allegations that he has made about * the senior nurse * Option B: Explain the situation to your clinical supervisor, seeking advice on how to * proceed * Option C: Advise Hussein of the severity of his allegations, ensuring that he is aware of * what he is saying * Option D: Inform the senior nurse that Hussein told you that she was lying about the patient * with chest pain * Option E: Speak to the senior nurse involved, obtaining further details about the incident * Option F: Explore with the other nurses whether they overheard the telephone call between * Hussein and the senior nurse * Option G: Suggest to Hussein that he talks to the senior nurse about the incident * Option H: Fill in a critical incident form*, documenting the incident
Correct Key: BCG
Rationale: This question tests your professionalism in the context where two colleagues (the senior nurse and Hussein) have each made allegations about each other professionalism. It is appropriate to emphasise the severity of the allegations when talking to Hussein (option C), and seek early senior advice (option B) on how to proceed in this situation. (Option G) may be uncomfortable for Hussein to consider given the allegations, however, suggesting a face-to-face discussion with the nurse may help resolve this situation particularly if a simple misunderstanding (e.g. a malfunctioning pager) has led each party to make allegations about the other.
It is not your place as the FY1 to initiate an investigation (options E, F and H) into the incidents which have occurred and similarly not your place to raise allegations on Hussain’s behalf (option A). Accusing the senior nurse of lying (option D) is likely to be counterproductive, unprofessional and embroil you in the conflict.
- Part A While working in a busy surgical ward, your FY1 colleague, Abigail, approaches you in the staff room during your break. She tells you that she is feeling very stressed because of the current workload. Abigail explains that she feels that the stress is negatively affecting her mental health.
Choose the THREE most appropriate actions to take in this situation.
* Option A: Ask Abigail if she wants to arrange to talk more about how she feels outside of work
* Option B: Suggest to Abigail that she takes some time off work until she feels less stressed
* Option C: Ask Abigail if she has thought about seeing her GP*
* Option D: Inform Abigail that it is normal to feel stressed when working on a busy ward
* Option E: Suggest to Abigail that she should ask to reduce her workload if it is affecting her mental health
* Option F: Advise Abigail to speak to her educational supervisor* about how she is feeling
* Option G: Suggest to Abigail that she monitors how she is feeling over the next couple of weeks
* Option H: Ask Abigail if there is anything you can do to help her to feel less stressed
Correct Key: CFH
Rationale: As a colleague it is your professional responsibility to provide peer support for a colleague as well as promptly flag up any concerns that may impact on patient care and safety (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork and Safety and Quality domains). Therefore, Option C: Ask Abigail if she has thought about seeing her GP, would be an appropriate action to take in this situation as it is the best way to ensure that Abigail has access to the healthcare she needs for her mental health.
All doctors have a duty to ensure that they are fit to practice, including taking responsibility for their own health as well as others’. It is important to flag up any issues that may impact on their ability to deliver safe and effective healthcare to patients. Therefore, another appropriate action to take in this situation would be, Option F: Advise Abigail to speak to her educational supervisor about how she is feeling, as this will ensure that Abigail is able to access the appropriate support she needs with managing the current workload allocated to her.
Peer support is an important aspect of teamwork and as part of a Multi-Disciplinary Team (MDT), doctors are expected to support each other and other colleagues (GMC good medical practice’s Safety and Quality and the Communication, Partnership and Teamwork domains). Therefore, another appropriate action to take in this situation is Option H: Ask Abigail if there is anything you can do to help her to feel less stressed as this offers much needed support to Abigail and ensures that she knows she is not alone.
- Part A (for reference): While working in a busy surgical ward, your FY1 colleague, Abigail, approaches you in the staff room during your break. She tells you that she is feeling very stressed because of the current workload. Abigail explains that she feels that the stress is negatively affecting her mental health.
Part B: The next day, you and Abigail have twenty patients on your list. You divide your list into ten patients each to manage the jobs. Two hours before you are both due to finish, Abigail is visibly upset and tells you she cannot carry on as she feels so stressed. She gives you her list and bleep* and tells you that she is going to leave the hospital now. You have not finished the jobs for your patients, and you know that she has outstanding jobs on her list to complete.
Choose the THREE most appropriate actions to take in this situation.
* Option A: Ask Abigail if she can help you to prioritise the most important jobs
* Option B: Tell Abigail that you need her to finish her jobs before she can leave
* Option C: Advise Abigail that you have your own jobs to finish and cannot complete her jobs if she leaves
* Option D: Ask Abigail if she is sure that she cannot carry on working
* Option E: Suggest to Abigail that she takes a ten minute break and then sees if she can continue working
* Option F: Inform Abigail that she will need to tell other ward staff if she intends to leave now
* Option G: Ask Abigail how she intends to make sure that her jobs are completed if she leaves now
* Option H: Ask Abigail if she would feel better if she swapped some jobs with you
Correct Key: AEH
Rationale: The General Medical Council (GMC) prioritises patient safety as core to good medical practice and part of that outlines the doctor’s responsibility to ensure that their allocated workload is covered appropriately, including prioritisation of need (GMC good medical practice’s Safety and Quality and the Communication, Partnership and Teamwork domains). Therefore, an appropriate action to take in this situation is, Option A: Ask Abigail if she can help you to prioritise the most important jobs.
The clinical environment can often be challenging and stressful, particularly when a clinician is stressed, fatigued or unwell. Research shows that having appropriate support, including peer support around a person during periods when they are experiencing challenging times or crisis is beneficial and increases the chances of a positive outcome: Part of the responsibilities for a doctor includes peer support, including practical advice and assistance with clinical tasks, particularly when patient and/or staff safety may be at risk (GMC good medical practice’s Communication, Partnership and Teamwork and Safety and Quality domains). Therefore, another appropriate action is, Option E: Suggest to Abigail that she takes a ten minute break and then sees if she can continue working, as this may provide Abigail with the much needed temporary pause to have a break, recuperate/regroup and have the opportunity to think about the best course of action for herself.
Problem solving collaboratively is an integral part of clinical practice and in this situation, Option H: Ask Abigail if she would feel better if she swapped some jobs with you, would be another appropriate action in this situation as it offers both you and Abigail the opportunity to work together to manage the workload safely and in a manner that would be both supportive and beneficial for Abigail and the patients.
- You have just started a night shift on the Medical ward. You are bleeped* by a nurse to attend to an 82 year old patient, Mrs Ratnaike, who is complaining of pain. Mrs Ratnaike is crying and tells you that your FY1 doctor colleague, Haroon, was very rough when he inserted a cannula, just before he hurried away. Mrs Ratnaike says that Haroon mentioned that he was late for a social engagement, and she thinks that he was rushing to leave.
Choose the THREE most appropriate actions to take in this situation.
* Option A: Telephone Haroon, explaining that he made Mrs Ratnaike cry
* Option B: Apologise to Mrs Ratnaike for Haroon’s behaviour
* Option C: Advise Mrs Ratnaike of the hospital’s complaints procedure
* Option D: Explore with your FY1 doctor colleagues whether they have ever witnessed
* similar behaviour from Haroon
* Option E: Ensure that Mrs Ratnaike is comfortable
* Option F: Inform your consultant of the incident
* Option G: The next time he is at work, inform Haroon that he made Mrs Ratnaike cry
* Option H: Reassure Mrs Ratnaike that Haroon would not rush a medical procedure
Correct Key: BEG
Rationale: In this situation, you have heard about the patient’s complaint, but have not heard your colleague’s side of the story. It would be sensible to apologise to the patient, as you are dealing directly with the patient (option B) and to check that she is now comfortable (option E). Following this it would be appropriate to inform your colleague of the event the next time you see him (option G) so that he may reflect on the event. Advising the patient of the hospital’s complaint procedure would also be an acceptable option (C) and could well constitute the next step, however the patient has not said that she wishes to make a complaint, therefore options B, E, and G comprise the most appropriate course of action.
There is no need to call your colleague after he has left the hospital (option A), as there is no urgency for him to know about and resolve the issue if he has already left the hospital. As this is currently a one-off event, gathering more information from your colleagues (option D) or informing your consultant of the incident (option F) are not yet required. You do not know whether Haroon rushed the medical procedure, so it would be unwise to advise her of this at this stage (option H).
