Clinical Questions

Question 1

A lazy colleague is always late and keeps leaving you jobs. What do you do in this situation?

Answer 1

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Question 2

One of your consultants comes onto the ward drunk one morning. What do you do?

Answer 2

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Question 3

One of your junior colleagues has been late for 20 minutes every day over the past 4 days. What do you do?

Answer 3

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Question 4

Whilst in the mess, you see a bag of what looks like cocaine drop from your Registrar’s pocket. What do you do?

Answer 4

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Question 5

You wrote a case report for publication, which you gave to one of your consultants for review. After 2 weeks, he gives it back to you with two additional names as authors: his brother’s and his wife’s. What do you do?

Answer 5

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Question 6

Your consultant is managing a patient against the recommendations of the established guidelines. What do you do?

Answer 6

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Question 7

During a ward round, your consultant shouts at you in front of a patient for getting an answer wrong. What do you do?

Answer 7

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Question 8

A female patient, who saw one of your male colleagues last week, mentions in passing conversation that the colleague in question examined their breast. This seems odd to you as there is no mention of such an examination in the notes and you see nothing which would justify such a breast examination. What do you do?

Answer 8

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Question 9

You are on call at night. A patient is brought to you as an emergency. The patient requires a specific procedure that you have never done before. You have only observed a consultant once for this procedure. If the procedure is not carried out soon the patient will suffer serious harm. What do you do?

Answer 9

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Question 10

One of your patients is refusing to adhere to your recommended treatment. As a result, her condition is deteriorating rapidly. What do you do?

Answer 10

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Question 11

You are a Registrar. A young female trainee doctor refuses to deal with a patient who is a known rapist. What do you do?

Answer 11

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Question 12

You find out that one of your consultants is romantically involved with someone who is a current patient of the department. What do you do?

Answer 12

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Question 13

Your consultant has made a mistake as a result of an error of judgement and is asking you to alter the patient’s notes to match his version of events. What do you do?

Answer 13

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Question 14

Your consultant does not seem interested in providing you with appropriate teaching. What do you do?

Answer 14

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Question 15

You see one of your colleagues looking at child pornography on the mess’ computer. What do you do?

Answer 15

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Question 16

Once you have reported the problem to the clinical director about a consultant drinking, what is likely to happen?

Answer 16

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Question 17

What would you do if the drunken consultant asks you not to mention anything to anyone because it was the first time that it happened and he promises it won’t happen again?

Answer 17

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Question 18

If, after reporting the matter to the clinical director, you find that he is not responding appropriately, what would you do?

Answer 18

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Question 19

Do you think it’s safe for you to only have two rotations in F2?

Answer 19

I think it can be safe to have two rotations as an F2.

I can understand it can be a concern for doctors who are applying for AFP, however there are important considerations. It’s important we evaluate our practice in a systematic and robust way, via a set amount of assessments and supervised learning events to ensure we have our competencies completed in time.

Nature of AFP post, no on-calls / can always pick up additional shifts

Spoken to many AFP doctors, have reassured me

Question 20

A 14 year-old girl mention that she is pregnant and enquires about an abortion. What do you do?

Answer 20

1. Seek information: Why does she think she is pregnant? Did she have any symptoms? Was there a positive pregnancy test? When was her last LMP? Was she on contraception? Why would she want to have an abortion and does she know about what an abortion involves?
2. Patient Safety: Who was the partner? What is the age difference? What is the nature of the relationship? Did they use protection? Does anyone else know? Would she consider her parents knowing?
3. Initiative: Assess Gillick Competence (can she understand, retain, weight up, does she have maturity and intelligence) if patient cannot be convinced to speak to her parents. Does she understand the advice, the moral, social and emotional implications? Their physical and mental health are likely to suffer unless they have an abortion and is it in their best interests?
4. Escalate: I will always want to advise my senior consultant or GP supervisor in situations like these for advice on how to proceed. If I am concerned there is a risk of patient safety or vulnerability, I would want to get in contact with a child protection officer as well.
5. Support: Support the child and their family if they are involved.

Question 21

You have a 20-year old patient on the ward. She has told you that she does not get on with her father and that, if he calls, you should not tell him anything about her condition. Later on that day, one of the nurses tells you that the father is on the phone, aggressively demanding some information. What do you do?

Answer 21

A scenario involving patient confidentiality is a common place one which will certainly test a junior doctor.

Take phone from nurse, try to diffuse the situation by listening to father’s concerns and take a mental note of them. Blanket statement: Due to wanting to protect the patient confidentiality of all our patients, we will not be sharing any personal information by telephone to members of the public. Highlight zero tolerance policy against hospital staff for abuse. Hang up.

Want to make patient aware of concerned relative, not as a means to convince her but because she deserves to know. Reassure her that we will maintain utmost confidentiality.

Would want to know initially how the father came to know about the daughter being on the ward. Was he there when it happened? Did A&E disclose it? Investigate

Provide support to patient. Reflect on the situation.

Question 22

What do you think makes a good F1? (and how do you demonstrate those qualities)

Answer 22

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Question 23

In evidence-based medicine, why does a clinician need to take account of his/her own clinical expertise?

Answer 23

External evidence can always help inform a clinician in decision making, but it should never replace it.

Evidence alone may show best practice, but may not directly relevant for said patient and may need to be adapted. The patient may have nuances which are different to the patients in the research study, i.e. co-morbidities.

Question 24

What is evidence based medicine? What are the steps involved?

Answer 24

EBM is a combination of using the best available research evidence with your own clinical expertise and judgement. It is applied to a specific patient case, taking into account their values.

1. A question arises from a patient case
2. The doctor constructs a clinical question
3. Use of the PICO framework for a Medline search
4. Appraise evidence of relevant literature
5. Doctor determines best practice
6. Evaluate the result

Question 25

What is clinical governance? Give an example of a time you have seen this in action.

Answer 25

Clinical governance refers to a quality assurance process which maintains and improves NHS standards of care and holding the NHS accountable to patients. ``` 7 main pillars - discuss what they are C - Clinical effectiveness A - Audits R - Risk management E - Education and training - expand on this ``` P - Public engagement I - Information and IT S - Staff management

Question 26

What is your experience of clinical governance?

Answer 26

Clinical governance refers to a quality assurance process which maintains and improves NHS standards of care and holding the NHS accountable to patients. There are 7 main pillars for Clinical Governance and I think I have tried to demonstrate elements of them. For example, during my telephone consultations with patients in GP, I have had to look at guidelines for hypertension in order to suggest what medications may be the best practice for them. Secondly, I have participated in a research project as a data collector for a group at QEHB investigating prognostic indicators for patients post-gastrectomy / esophagectomy which has led to two observational studies and one abstract being published. This relates to the pillar of Clinical Effective and Research. I have also completed a quality improvement project investigating clinicians adherence to NICE Guidelines for the clinical reassessment after each single unit blood transfusion. I am also in the early stages of contributing to an audit in Ophthalmology at York Hospital, which relates to the pillar of Auditing. When I am tasked with a cannula or venepuncture on placement, I will double checked what bloods are required of the patient, so I can prepare my equipment and minimise any mistakes I make and reduces the need to further bleed a patient. Similarly during my Prescribing Masterclasses I always check my drug calculations before marking the answers, which relates to Risk Management. If I ever make a mistake whilst on placement, I always aim to alert someone at the earliest opportunity to minimise any harm to the patient. On a final point, I understand that medical knowledge is always changing, and it is my duty to keep up to date through self-directed learning. For example, when on wards I commonly ask to observe procedures by juniors or attend theatres and watch more complex operations. This is so I am trying to Educate and train myself.

Question 27

In your trust, who is responsible for clinical governance?

Answer 27

Clinical governance refers to a quality assurance process which maintains and improves NHS standards of care and holding the NHS accountable to patients. There are two levels of responsibility: - Legal aspect: Trust Board has a legal responsibility, and the head of the trust board is the Chief Executive Officer. Every year they publish an Annual Review of Clinical Governance. - Practical responsibility: However saying this, it is difficult for the Trust Board to maintain Clinical Governance by themselves. It is important that these responsibilities are disseminated down to the appropriate levels via the Medical Director, Nursing Director, Clinical Director etc. so every staff member has a responsibility.

Question 28

Is evidence-based medicine applicable to all specialties?

Answer 28

Yes, EBM is applicable to all specialties, however it is to varying degrees. One comparison of specialties might be comparing breast cancer treatments which confer a high level of evidence compared to managing a patient with a psychiatric illness such as borderline personality disorder. 1. Some specialties are very research focused and have a strong research culture. May be because research can be carried out due to a larger number and homogeneity of patients thus greater body of evidence. 2. In some specialties, the impact of social and environmental factors may be so strong that each decision is an individual one and there is less evidence to support this.

Question 29

You have been working 13 hours and are about to leave. You feel very tired after a busy shift. The colleague who is taking over from you is late and you are being called to review a patient in A+E. You can see straight away the matter will take some time to resolve. What do you do?

Answer 29

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Question 30

An adult is brought into A+E. He is unconscious, bleeding profusely and may require a blood transfusion. The accompanying relatives tell you that the patient is a long-standing Jehovah’s Witness. What do you do?

Answer 30

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Question 31

What are you most proud of on your CV and why?

Answer 31

Discuss QE Internship

Question 32

What are some of the outcomes required from Promoting Excellence?

Answer 32

Promoting Excellence refers to setting standards of organisations for medical education and training. There are ten standards, split into five main themes: 1. Learning environment and culture 2. Educational governance and leadership 3. Supporting learners 4. Supporting educators 5. Developing curricula and assessments

Question 33

How will you balance being a researcher and a clinician in the future?

Answer 33

This can be a difficult scenario in my head on a day to day basis, as I have never had to balance being both a researcher and a clinician for extended periods of time. Similarly, with the AFP in the West Midlands it is a dedicated block of focused, protected time for a research block to focus on clinical medicine, compared to the day release format in some deaneries. Saying that however, I expect I will have to cover a lot of groundwork for my research project during the earlier clinical rotations, admin such as meetings with supervisor, applying for ethical approvals, grant applications if needed and so on. But ultimately, if there ever was a opportunity where I had to prioritise one or the other, it would be my patients as they would be my biggest priority. On a day to day level however, speaking to many AFPs have reassured me balancing these responsibilities are possible, and it would also give a good insight into what the ACL or ACF may be like, where the clinical / academic balance evens out more.

Question 34

What domains of Good Medical Practice can you tell us about and how have you shown this?

Answer 34

One domain of GMC’s Good Medical Practice which resonates with me is “Communication, Partnership and Teamwork”. Communication and teamwork is so important as both a clinician and an academic. As a clinician, it's just as important to have good knowledge but also use your communication as a vehicle for your patients to understand your point and collaborate with you in your plans. Similarly as an academic, you'll be working collaboratively with many people in your project and communication is essential to work as a team. My communication has been tested both in and out of medical school. ASDA, mentoring, speaking to patients in GP during telephone appointments. The other half of that is partnership and teamwork. My role as Communications Officer at Surgical Society tests this. In my committee I have to work with students from all years of medical school, each with their own unique skills and strengths and using that to their advantage to contribute to the society in the best way. I think using communication skills helps with this because I can help empower them with their roles but also make them feel comfortable if they need to ask for help, because as a team you have to be adaptable and flexible.