PPD

Question 1

Why does Human error occur

Answer 1

Communication

Judgement error

Omission, lapses, violations

Question 2

What is neglect

Answer 2

Falling below the accepted standard

Stems from repeated minor mistakes and a culture of not caring

Mid-Staffordshire

Question 3

Why does poor performance occur

Answer 3

Attitude problem

Failure to learn from mistakes

Affects patient care

Question 4

What is misconduct

Answer 4

Deliberate harm

Lack of candour

Fraud/theft

Improper relationships

Question 5

What are some examples of lack of candour

Answer 5

Hiding mistakes

Ignoring mistakes

Altering medical records

Question 6

What are some examples of fraud/theft

Answer 6

False expenses claims

Time off -sickness

Question 7

What is medical negligence

Answer 7

Legal entity

Laible not guilty of

Question 8

What are the four domains of neglience?

Answer 8

Was there a duty of care?
-offer advice - accepted duty of care

Was there a breach in duty of care

• Bolam test
• Bolitho test

Did the patient come to harm?

Did the breach cause the harm?

Question 9

What is the bolam test? What is the Bolitho test

Answer 9

Would a group of reasonable doctors do the same?

Would it be reasonable of them to do so?

Question 10

What is intuitive decision making

Answer 10

Ability to understand something instantly without conscious reasoning

Advantages
-fast and frugal: Heuristics

Disadvantage
-prone to biase

Question 11

What are the advantages and disadvantages of analytical decision making

Answer 11

requires infromation, knowledge, processing skill

• hypothesis testing
• exhaustive

advantages
-accurate, reliable

Disadvantage
- slow, demanding

Question 12

What is Peyton’s four step procedure for skills training

Answer 12

Trainers runs though, no commentary

Trainer talks through and trainer does

Learner talks through and trainer does

Learner talks through, learner does

Question 13

What are some leadership theories

Answer 13

Great man theory

Trait theory

Behavioural theory
-how leaders behave towards team

Contingency
-leadership style depends on situation e.g. telling - low competence, deligating - high competence

Transactional
-reward and punishment to motivate behaviorus

Transformationa
-taps into needs and values and inspires with new possibilities, raising level of confidence, conviction

Question 14

Is there a right to medical care

Answer 14

Article 2 - state obliged to take appropriate steps to safeguard life

But cannot impose disproportionate burden on the authorities

Question 15

What is a judicial review

Answer 15

Opportunity for an individual to challenge the exercise of power by a public body

Question 16

What is ethnocentrism

Answer 16

evaluate other groups according to the values of one’s own cultural group

Question 17

What is a stereotype

Answer 17

generalisation about typical characteristics of members of a group

Question 18

What is prejudice

Answer 18

Attitude towards another person based soley on their membership of a group

Question 19

What is discrimination

Answer 19

positive or negative actions towards objects of prejudice

Question 20

What is the most common cause of medical error

Answer 20

Miscommunciation 70%

Question 21

What mechanisms may cause inhumane behavioiur

Answer 21

Bystander effect

Conformity
-unwillingness to speak against a prevailing view

Pressing situational factors overriding value ystems

Question 22

What are some examples of never events

Answer 22

Serious, largely preventable safety incidents that should not occur if the available preventative measures are implemented.

Surgery

• wrong site or implanted
• retained foreign object

Medication

• wrong preparation
• wrong route
• overdose

Mental health
-suicide

General heatlhcare

• entrapment in bed rails
• misplaced NG tube
• Misidentification

Maternity
-Death due to PPH

Question 23

What is the structure of quality improvement

Answer 23

Assessment
Diagnosis
Treatment
Standardise

Question 24

What is the difference between common cause variation and special cause variation

Answer 24

Common cause

• chance cause
• due to multiple factors within the system
• random

Special cause

• assignable cause
• statistically sign
• shows change

Question 25

What is consequentialism

Answer 25

Ethics of an act evaluated in terms of its consequnces

Question 26

What is deontology

Answer 26

Features, not the consequences, of an act determine its morality (duty based)

Question 27

What is virtue ethics

Answer 27

The character of the person committing the act determine its ethicality

Question 28

What are the GMC duties of a doctor

Answer 28

Honesty and integrity

Trustworthiness

Good communication

Up to date knowledge

Good teamworking

Work within capabilites

Never abuse patient trust

Protect and promote health (patients and public)

Treat patients as individuals and with dignity

Make care of patient first concern

Question 29

What is the doctrine of dual effect

Answer 29

doing something morally good has a morally bad side-effect, it’s ethically OK to do it providing the bad side-effect wasn’t intended

Question 30

What are some types of human error

Answer 30

Sloth
-not bothering to check

Loss of perspective
-inability to focus on big picture, overlooking warning signs

Communication breakdown

Poor team working

Playing the odds
-dismissing the rare in favour of the common

Bravado
-working beyond competence

Ignorance
-lack of knowledge

Mistriage

Lack of skill

System error

Question 31

What is a system approach vs a person approach to never event investigation

Answer 31

Personal approach: Holding 1 person responsible for the event
- Systems approach: Identifying there are latent errors in the system and that latent + active causes come together to cause error.