Competency Questions Flashcards
What evidence will you collect during your FY programme and beyond to demonstrate your ongoing fitness/competence to practice?
As an F1/F2, the types of evidence which is required to ensure completion of training can be split into
- Assessments
e-Portfolios, Core Procedures, TABS, ES / CS End of Year / Placement report - Supervised Learning Events
CBDs, Mini-CEXs, DOPS, “Developing the Clinical Teacher”
LEADERS + LEARNS
At least 1 audit per year
Any evidence which will be in support of applying to CT/ST training beyond F2
Describe a time when your communication skills made a difference to the outcome of patient care
Having good communication is a cornerstone of being a clinician, and an academic.
A few weeks ago, I was on my surgical rotation and for my own learning, I decided to clerk and examine an interesting patient. She was 4 days post-up following a subtotal colectomy and ileostomy, following a complication with her Ulcerative Colitis.
Post-operatively, nurses mentioned the patient was making a very good recovery, there were no peri/post-op complications, however by speaking to the patient directly she began to share her apprehensions and regret towards the operation. She was struggling every day in changing her stoma bag and was having leakages, she felt apprehensive over what foods to eat, and mentally was feeling quite low as she wasn’t allowed visitors during COVID.
I also took it upon myself to visit her every other day for the next week and monitor her progress. Gradually I noticed her confidence increasing, she was getting more adventurous with hospital foods, was mobilising more each day and her pain was subsiding. But in our conversations one day she turned to me one day and said “I’m still struggling to see a future after being discharged”, which surprised me as it was clear she was doing much better but I replied “I understand this, but it’s important to look at how much progress you’ve made in a single week already”. She’d paused a little and thought about this, the days had all merged into one and overlooked all progress she’d made.
She was very grateful for me sharing my observations of her progress and later mentioned at times when she’d felt tearful, she had remembered what I’d said in how she’d already come. I also appreciated how important it was to touch upon a patient’s emotions after surgery, as quite often there are changes to how a patient may view their bodies, they may be going through almost a grief-type adjustment process and sometimes these can be overlooked in clinicians. It also highlighted to me the importance of re-visiting patients, as quite often we only see a single snapshot event of their care.
Give an example of a situation where you showed empathy towards a patient.
Having good communication is a cornerstone of being a clinician, and an academic.
A few weeks ago, I was on my surgical rotation and for my own learning, I decided to clerk and examine an interesting patient. She was 4 days post-up following a subtotal colectomy and ileostomy, following a complication with her Ulcerative Colitis.
Post-operatively, nurses mentioned the patient was making a very good recovery, there were no peri/post-op complications, however by speaking to the patient directly she began to share her apprehensions and regret towards the operation. She was struggling every day in changing her stoma bag and was having leakages, she felt apprehensive over what foods to eat, and mentally was feeling quite low as she wasn’t allowed visitors during COVID.
I also took it upon myself to visit her every other day for the next week and monitor her progress. Gradually I noticed her confidence increasing, she was getting more adventurous with hospital foods, was mobilising more each day and her pain was subsiding. But in our conversations one day she turned to me one day and said “I’m still struggling to see a future after being discharged”, which surprised me as it was clear she was doing much better but I replied “I understand this, but it’s important to look at how much progress you’ve made in a single week already”. She’d paused a little and thought about this, the days had all merged into one and overlooked all progress she’d made.
She was very grateful for me sharing my observations of her progress and later mentioned at times when she’d felt tearful, she had remembered what I’d said in how she’d already come. I also appreciated how important it was to touch upon a patient’s emotions after surgery, as quite often there are changes to how a patient may view their bodies, they may be going through almost a grief-type adjustment process and sometimes these can be overlooked in clinicians. It also highlighted to me the importance of re-visiting patients, as quite often we only see a single snapshot event of their care.
Give an example of a stressful situation you have been involved in
As clinicians, it’s very common we encounter stressful situations so it’s important to recognise when we feel this way and what to do.
I can recall being on a night-shift on my Emergency Medicine rotation. A very young man had come in with a hypoxic brain injury following a suicide attempt. The part I found particularly stressful was the discussion unfolding between the family of the dying patient and the emergency medicine consultant. I can recall having to step outside of the family room to have a cry and feeling low the next few days.
I found speaking about it with my colleague who was also present in resus definitely helped. I remember visiting the patient in ICU after he resuscitated was helpful. He was cleaned up, had family photographs which were placed around him. He shortly died after but that was how I wanted to remember him and it made me feel better. I also shared my reflections with the ICU nurse involved in his care, which helped me come to terms with this tragedy.
I took so many lessons from this patient. It highlighted some of the incredible skills I saw the consultant use when breaking bad news, but more importantly I unexpectedly came face to face with a young dying patient and find within myself some healthy techniques in order to come it.
How do you organise your workload?
As a clinician and as an academic, it’s important to organise your workload in order to be as productive as possible.
I am a medical student which has its own set of responsibilities, I am also involved in many additional roles, ranging from being on a committee and a GOSH ambassador. In my personal life, I am also a daughter to elderly parents and an older sister to three younger siblings.
Making list at the start of the day and using a calendar is very helpful in helping to organise my workload, whether it is medicine or non-medical related. I may prioritise tasks based on their urgency or by how big of a task it is, so I can big + urgent tasks first and get them out of the way, and during breaks I can do smaller tasks. It’s also important to review my to-do list regularly.
As an older sister and first daughter, it’s usually my responsibility to do lots of house admin; whether that’s paying for a bill, helping my dad complete his paperwork for his tax credits or calling up the doctor’s, I have now started to delegate tasks to my younger siblings. This is important because it gives them the opportunity to learn but also lightens my responsibilities to focus on other things.
During my busy schedule, I try to keep my weekends free in order to build up some slack in my working week. This I use for an overspill in case I fall behind and allows me to catch up, or I can similarly use it to relax before the next week.
How do you recognise that you are stressed?
As a clinician, it’s very important to know not only how to deal with stress but to recognise the early tell tale signs within yourself.
Having been a university student for 8 years now (Biochemistry + Medicine), I tend to get stressed during exam season and show this by becoming quite anxious, I might carry a lot of tension in my neck and shoulders and lose my appetite. During my second year of Biochemistry this meant I’d lost a lot of weight but thankfully now this hasn’t happened since.
I find that having regular meals, snacking in between and keeping hydrated helps. Because by not eating this can impact on my stress levels and ability to concentrate. Other techniques I use include talking to friends and family about how I’m feeling which can offload some tension and make me feel better.
It’s very important to have self-care days as a clinician and have good mental health, especially as we are involved in the direct care of patients.
How do you cope with stress?
Discuss resus event + triggers for stress during exams
Give an example of where you failed to communicate properly?
During my GP rotation in final year, I was performing telephone consultations independently and on the triage notes for my next patient, it mentioned she wanted to discuss start contraception.
During my telephone consult, I felt confident counselling the patient of the pros and cons of the combined pill and screened for any contraindications and how / when to take it. I then asked if she had any questions, and would end the call to speak to my supervisor who would prescribe the pill if she was happy.
As soon as I’d hung up, I realised I’d assumed she wanted the combined pill and hadn’t explored any other options she as the coil or implant. I immediately discussed this with my supervisor and I decided it was best I rectify my mistake by calling up, apologising and try to rectify the situation by mentioning what other options were available and if she was interested.
The patient was happy with her initial plan and was still happy with the COCP, but said she might consider other options at a later stage. It was a good point of reflection and highlighted how important it was to keep consultations quite open initially before narrowing things down.
Describe a situation where you had a number of things to be done at the same time. How did you approach the situation and what was the result?
There was a time only a few weeks ago, when I’d felt inundated with several tasks over the course of the week. I’d had to do some medical school admin, uploading evidence of my completed skills, revise for the SJT, read a paper for AFP, some surgical society meetings and some family admin such as booking appointments for my dad.
To-do lists
Allocating tasks to other people
Having the weekend free
Do you work better on your own or as part of a team?
I think as a clinician and academic, it’s important to work as good independently as you do in a team and be fluid between both roles depending on the situation
From personal experience, I have joined the Surgical Society Committee as Communications Officer. I have a good working relationship with my committee, however a large portion of my work involves working independently in creating educational infographics, responding to queries and requests and maintaining the social media pages of our society. I take pride in the ownership of these tasks and it is a defined role so I know what is expected of me.
I have a good working relationship with the President, so if I need to discuss anything with him I feel I can do this. During meetings I will definitely try to bring out the different ideas from each individual which is crucial if we are all working towards the common goal of progressing the society’s profile. There have also been times when other team members may be falling behind due to university commitments and I can step in and assist them, and this is what makes a good team player.
I think having good communication is the crux of this. I have always had very good feedback from other members of the team.
Tell us about a mistake you have made.
During my GP rotation in final year, I was performing telephone consultations independently and on the triage notes for my next patient, it mentioned she wanted to discuss start contraception.
During my telephone consult, I felt confident counselling the patient of the pros and cons of the combined pill and screened for any contraindications and how / when to take it. I then asked if she had any questions, and would end the call to speak to my supervisor who would prescribe the pill if she was happy.
As soon as I’d hung up, I realised I’d assumed she wanted the combined pill and hadn’t explored any other options she as the coil or implant. I immediately discussed this with my supervisor and I decided it was best I rectify my mistake by calling up, apologising and try to rectify the situation by mentioning what other options were available and if she was interested.
The patient was happy with her initial plan and was still happy with the COCP, but said she might consider other options at a later stage. It was a good point of reflection and highlighted how important it was to keep consultations quite open initially before narrowing things down.
What are the advantages and disadvantages of admitting when mistakes are made?
Reflect on COCP scenario
Advantages:
- Allows the opportunity to own up and correct it as early as possible and thus minimise any impact the patient may have experienced
- It is a learning opportunity for yourself not to do it again
- May encourage trust in patient if you own up to a mistake
Disadvantages:
- Supervisor / patient may lose trust in me. However this may be minimised as a medical student who is still learning but may be worsened as a doctor
- It also contributes to a negative blame culture in the NHS which refuses to take ownership of mistakes and learning from it
- Negative consequences -> further complaints, being struck off
What makes you a good team player?
Someone who understands their role in a team and how it fits within the whole picture. For example, in my role as Communications Officer for the Surgical Society, I understand clearly what is expected of me as well as my roles and responsibilities. These include managing the social media platforms, producing educational infographics for our members and also other societies as well. Once I know what I have to do, it makes taking ownership of my duties a lot more easier.
Someone who can communicate effectively in the team. Despite knowing my role, I have a good working relationship with the surgical society president if I had a question, or suggestion on a topic. During meetings, I’m quite passionate about getting everyone’s ideas across so if I notice someone who may be quiet, I would try to encourage they have space and time to make a suggestion.
Similarly, if I notice one of my team members may be struggling or falling behind in a particular task, it’s important as a team player to be flexible and adaptable. I might have a chat with them in private and offer to listen and help by absorbing some of their roles or offering new ways to do what they’re doing.
Give an example of a recent situation where you played an important role in a team.
Recently, I was involved in a Quality Improvement Project looking to improve clinicians’ adherence to NICE Blood Transfusion Guidelines; particularly clinical reassessment after each single-unit blood transfusion.
I was tasked to work with three of my fellow medical student colleagues, who each had their own strengths in making this project very successful. Together we shared the big role of data collection in order to identify which wards were least adherent to guidelines and had the largest potential to improve. We all agreed this was a large task and it was fair to divide this evenly.
I was then tasked with working alongside the Blood Transfusion Coordinator to create an amended pilot protocol and checklist, which acted as a physical prompt to alert staff to record clinical reassessments.
One of my team members was familiar with the F1s at said ward, and so I suggested she arrange a meeting with ward staff to raise awareness of the protocol’s purpose, which she did an excellent job of.
Thanks to our efforts, our data showed improvements in record keeping. As a group we also brainstormed issues which may have identified issues preventing the project from becoming more successful, and myself and colleague noticed one issue of the junior doctor changeover during our project. We acted on this by arranging a follow-up meeting, where this time I had the opportunity to practice speaking to staff.
Thus project highlighted the importance of working collaboratively and having both shared and distinct roles. I am particularly proud of my contribution as we received an “Excellent” grade for our project and was invited to present our findings as an Oral Presentation at the hospital Grand Round. Elements of our presentation were also used to develop an E-learning package.
What do you think makes a good team?
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