Ethics and Professionalism

Question 1

What is burnout

Answer 1

A multifaceted construct characterised by

• emotional exhaustion
• depersonalisation
• low sense of personal achievement

Question 2

What are the four ethical principles

Answer 2

• justice
  
  • ensure fair & equitable provision of care
• beneficence
  
  • act in a way to do the greatest and most reliable good for the patient
• non-maleficence
  
  • avoid harm; almost always balanced against beneficence in surgery as harm is inherent
• autonomy
  
  • always and foremost, respect the patient’s right to autonomy to choose the treatment option which is right for them

Question 3

10 core competencies of the RACS

Answer 3

• Technical skills
• Medical knowledge
• Management and leadership
• Collaboration and teamwork
• Communication
• Cultural competency
• Professionalism
• Scholar and teacher
• Health advocacy
• Judgement

Question 4

Lead time bias

Answer 4

Length of time between detection of a disease due to screening and its usual symptomatic presentation. Lead time bias occurs if testing increases perceived survival time w/o affecting the course of the disease (ie you just know you have it for longer)

Question 5

Length time bias

Answer 5

Due to the fact that diseases that are slow to progress are more likely to be picked up on screening than present symptomatically

An overestimation of survival duration due to the relative excess of cases detected that are asymptomatically slowly progressing, while rapidly progressive disease presents with symptoms rather than screening - a form of selection bias. Can give the impression taht detecting cancers by screening causes cancers to be less dangerous even if less dangerous cancers are simply more likely to be detected by screening.

Question 6

Delivering bad news

Answer 6

SPIKES

• Set up the room
• assess Perception and understanding
• obtain the Invitation to discuss the new
• provide Knowledge and understanding
• provide Empathy and space for emotions
• Strategy and Summary

Question 7

Discuss informed consent.

Answer 7

Physicians have a legal and ethical responsibility to provide adequate information to the patient so that he or she is able to process the information and make appropriate decisions.

Informed consent protects the patient’s autonomy, enhances rapport, and mitigates complications by establishing a relationship based on open, honest discussion.

Three conditions must be met for valid consent

1. The patient must have capacity
2. The patient must receive adequate information
3. The patient must have given consent freely without coercion.

Question 8

What is audit?

Answer 8

Audit is a dynamic cyclical process (an audit loop) in which standards are defined and data are collected against these standards.

The results are then analysed and if there are any variances, proposals for change are developed to address the needs. Changes are implemented and the quality of care reassessed.

Question 9

What is a “Sentinel Event”?

Answer 9

A sentinel event is any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient’s illness.

Examples include:

• Surgery on the wrong body part
• Retained swab or instrument
• Delayed diagnosis of cauda equina