Section B Flashcards
- You are an FY1 doctor working in the Emergency Department. A 48 year old patient presents with an ankle injury. He is intoxicated, loud and demands immediate medical treatment. There are four patients waiting ahead of him. He is upsetting the other patients and at one point, threatens another patient with physical violence.
You answered scoring 0 of a possible 12 marks.
A. Ask one of the nurses to try and calm the patient down
B. Call security for assistance
C. Tell the patient that his behaviour is inappropriate and will not be tolerated
D. Arrange for the patient to be moved to a side room away from the other patients
E. Arrange for the patient to be treated as soon as possible
F. Tell the patient he will not be treated if he continues to behave in this manner
G. Ensure the other patients are not distressed by the situation
H. Ask the other patients if they would mind if this patient was treated before them
Answer: BCG
Rationale: This question asks you to make decisions in a stressful situation that ensure safety and are communicated effectively. Violence against patients and healthcare professionals is not acceptable. Staff and patients should be protected and hospital security can offer assistance (B). Other staff should not be asked to confront the patient (A) as this may place them at risk, but they can support other patients and minimise their distress (G). The patient should be informed that his behaviour will not be tolerated (C). This should not constitute a threat to his right to treatment (F), but his behaviour should not lead to preferential treatment which may compromise care provided to other patients (D, E, H).
- At lunch an FY1 colleague bursts into tears. She says she feels she is not coping with the job. She thinks that her consultant is too demanding and the nurses are annoyed because she is not keeping up with the workload.
You answered scoring 0 of a possible 12 marks.
A. Talk to her about the circumstances of her distress
B. Suggest she discusses the issues with her specialty trainee*
C. Advise her to take a few days’ annual leave to rest
D. Encourage her to get help from her GP*
E. Offer to go with her to talk to her consultant
F. Inform her educational supervisor* that she appears to be struggling
G. Ask other members of the team to be supportive as she is having difficulties coping
H. Offer to assist with some of her workload
Answer: ABE
Rationale: The situation is only described in brief and is likely to be very complicated. It assesses how you work with colleagues and your communication skills. Spending time talking with a colleague can offer much clearer insight as well as often being therapeutic in its own right (A). Similarly, advising talking to a more senior member of the team (B) is likely to bring more support as well as being able to bring a different interpretation of how the FY1 is managing. If, as it seems, the FY1 is experiencing a crisis of confidence, then it cannot simply be left without any agreed way forward, and the person will usually value a colleague’s support in talking to her consultant (E). Taking a few days’ annual leave might bring temporary relief, but will probably not have tackled the problem and returning to work is likely to bring heightened anxiety about coping (C). Getting help from a GP might be appropriate, but will not be immediately accessible and there need to be more immediate actions (D). Asking other members to be supportive removes the responsibility from her (G). Similarly, assisting with her workload is likely to increase the feeling of not coping (H).
- You are on a busy colorectal team and regularly need to work late to complete all of your tasks. Your FY1 colleague, Jenny, works on the breast team and usually finishes all her jobs by lunchtime. You have 20 new patients this morning and a long list of jobs, including checking blood results. You will need to work late in order to complete all of these tasks. You notice that Jenny is checking her personal e-mails on the ward computer. Your specialty trainee* is busy in theatre.
You answered scoring 0 of a possible 12 marks.
A. Ask Jenny if she would mind helping you today
B. Inform your specialty trainee in theatre that you are extremely busy and need some help
C. Stay at work until you have completed all of your tasks
D. Talk to your consultant about the unequal workload between you and Jenny
E. Raise the issue of unequal workloads at the next departmental meeting
F. Explain to Jenny that it is not appropriate to check personal e-mails at work
G. Ask a medical student to assist you by requesting x-rays and scans
H. Hand over the remaining jobs to the on-call team at the end of your shift
Answer: ABD
Rationale: This question looks at your team working, communication and planning skills. The first priority is to ensure delivery of care to the patients you have been allocated. Workloads vary and there will be occasions when colleagues should help each other out (A). In addition it is also important that your team is aware of how busy you are and also has an opportunity to assist you if any member is able (B). Long term, however, there seems to be a mismatch in workloads between posts and this needs to be dealt with both in terms of avoiding excessive workloads for some, but also in providing sufficient clinical experience for others (D). It is best to gather more information, however, before raising this in a formal way (E). It should not be necessary for anyone to work for longer than their required hours because of what is essentially an organisational problem, not a medical emergency (C). It is not appropriate to hand over non-emergency jobs to the on-call team, especially if colleagues could have helped during the day (H). Although checking personal emails on a ward computer is not appropriate, it is unnecessarily confrontational to bring this up especially as Jenny may value the chance to gain experience by helping out (F). Students are on the ward to learn and this can legitimately include them being involved in aspects of care. They are not there to prop up a service, however, and should not be given routine tasks that don’t match their educational needs (G).
- A confused patient has intra-abdominal infection and acute renal failure after a procedure. Instructions to the nursing staff are clearly written in the notes regarding what action to take in response to a change in the patient’s urine output. On the morning ward round, you find these instructions were not followed by the night nursing team and the patient has deteriorated as a consequence. The patient has now received treatment but follow up actions are required.
You answered scoring 0 of a possible 12 marks.
A. Inform the nurse in charge of the ward of the incident
B. Explain to the patient that there was an error with the management of her condition
C. Inform a senior member of the medical team of the incident
D. Speak to the nurses involved next time you see them about your concerns with their management of the patient
E. Find out whether the nurses were aware of the instructions regarding changes to the patient’s urine output
F. Offer to write a protocol formalising team communication
G. Record your account of the night’s events in the patient’s notes
H. Ask the nurses to increase the frequency of observations on the patient
Answer: ACE
Rationale: This question assesses your ability to work well in a team and communicate effectively. Senior nursing and medical staff need to be aware of the incident so that the incident can be logged, investigated and any action taken (A, C). Instructions had been formulated so it needs clarification as to whether these were communicated (E) but the incident itself would not require a change in these instructions (H). Whilst you should record the events in the patient’s notes (G), this is not an immediate priority. Options (F) and (D) are presupposing the outcome of any discussions so maybe incorrect actions. Option (B) is not immediately necessary and the patient would probably not be able to retain or understand the information as they are confused.
- You are walking through your ward when you notice that a patient has two tablets in his hands that he is about to consume. The medication was prescribed to him earlier this morning and his case notes clearly state ‘take one tablet twice daily’. The patient in question does not speak English.
You answered scoring 0 of a possible 12 marks.
A. Arrange for a translator to ask the patient if he knows how he is supposed to take the medication
B. Prevent him from taking both tablets now
C. Speak to the doctor who prescribed the medication about the incident
D. Illustrate on a piece of paper how and when to take the medication
E. Seek advice on drug dosing from the pharmacist
F. Inform the nurse in charge about the incident
G. Find out if his relatives speak good English and can translate the prescription to the patient
H. Ask the nurse who dispensed the medication to explain why he has more tablets than prescribed
Answer: ABH
Rationale: This question looks at communication with patients and your ability to make sensitive decisions. Every patient should be offered a translator wherever possible. It is morally and ethically imperative that patients understand the medical information that is given to them (A). Preventing the patient from taking both tablets now prioritises patient safety. It would be negligent to allow him to take both tablets if you knew this was not what was prescribed (B). By conducting preliminary investigations into the incident and feeding back to the staff involved, you are increasing awareness which may serve to minimise the risk of this happening again (H). Speaking with the doctor who prescribed the medication should be done, however this is not a priority action at this time, particularly as it would appear from the scenario that the prescribing doctor has done nothing wrong (apart from maybe not employing a translator to explain the medication dosing to the patient) (C).Whilst trying to illustrate instructions around taking the pills demonstrates an attempt to communicate with the patient, drawings could be open to misinterpretation and would not be considered medico-legally robust behaviour (D). Involving the pharmacist (E) may be appropriate; however this is not a priority and is not addressing the crux of the issue. Whilst the incident will require reporting, the immediate issues of patient safety, patient explanation and gathering the relevant information to accurately describe the circumstances surrounding the incident are more pressing and required BEFORE speaking to the senior nurse (F). Involving the relatives clearly breaches issues of patient confidentiality (G).
- You are working on a surgical ward and have been asked by the consultant to do a number of tasks: blood from four patients; chase up results from the ward patients and also from patients in yesterday’s clinic; and to sort out infusion prescriptions for two patients due in this morning. You are approximately half way through these tasks and you are sure that you have a sufficient time during the morning to complete the rest. The consultant bleeps you to ask you why the tasks have not been completed yet. You have heard from your FY1 colleagues that this consultant has a reputation for giving Foundation doctors lots of tasks to complete within a short period of time.
You answered scoring 0 of a possible 12 marks.
A. Explain to your consultant that it is unrealistic to expect all of the tasks to be completed by now
B. Tell the consultant that the tasks will be completed as soon as possible
C. Explain to the consultant what tasks you have done, and how long they have taken
D. Ask your FY1 colleagues for assistance with completing the tasks
E. Inform the Foundation Programme Director that the consultant is giving junior doctors unrealistic timeframes to complete tasks
F. Ask the consultant whether he would be able to help you complete some of the tasks
G. After the tasks have been completed, seek advice from your educational supervisor* about how to approach situations such as these
H. Try to speed up completion of tasks by deferring some of the paperwork until later
Answer: BCG
Rationale: This question is about your professionalism and your communication skills. It is important to communicate with your consultant, making it clear what you have done and to reassure them that you are completing tasks efficiently and will complete them as soon as you are able (B, C). This discussion should be done in a professional way, avoiding confrontation at this point (A). There may, however, be learning points for the future in terms of the prioritisation and completion of multiple tasks and this is always worth discussing with a supervisor (G). Although this consultant has ‘a reputation’, this may or may not be accurate and it is too early to escalate this (E), although this may become necessary later. There is no clinical urgency, so for now, it is not appropriate to ask for help from colleagues simply to appease a consultant (D). It is also important to ensure each task is completed properly (H). Presuming that this consultant does pressurise junior staff excessively and asking them to complete some of the tasks is likely to escalate the situation unnecessarily (F).
- You have just started your shift. You have not met one of the patients, Mrs Gordon but you know from the handover that she is being treated for a fractured knee and is recovering well. Her husband has noticed that she has lots of bruising around her knee. He angrily approaches you claiming her doctor is not doing her job properly as the bruising is getting worse.
You answered scoring 0 of a possible 12 marks.
A. Ask a senior colleague to speak to Mr Gordon
B. Ask the nurse who has been caring for Mrs Gordon to speak with him
C. Ask Mr Gordon to lower his voice as he is disrupting the other patients
D. Tell Mr Gordon the other doctor has now finished her shift so you are now taking over responsibility for Mrs Gordon
E. Try to answer any questions Mr Gordon has
F. Reassure Mr Gordon that the bruising will be the result of the fractured knee
G. Set up an appointment for Mr Gordon to meet with the consultant
H. Re-examine Mrs Gordon’s knee
Answer: DEH
Rationale: This question examines your professionalism, communication and empathy. The priorities in this scenario are clearly excluding any new medical pathology (H) and being open, honest and attentive to Mr Gordon’s concerns. Angry patients are often just scared, upset and afraid. Mr Gordon needs to know that you are not his wife’s regular doctor (D). He is therefore much more likely to be understanding if you cannot fully answer all his questions. You should try to answer as many of his questions as you feel able to (E). Asking a senior colleague to speak to him (A) would be the next most appropriate action, however it would be reasonable for you to at least try to speak to him first. Similarly, it may be that in addition to you speaking to him, an appointment with the consultant may be appropriate, but the scenario indicates that he needs a doctor to speak to him immediately. Asking the nursing staff to speak to him (B) is inappropriate. He is clearly concerned about his wife’s medical care (rather than nursing care) so a doctor should speak to him. Not allowing him to speak to a doctor is likely to infuriate him further. As an FY1 you are not going to be able to reassure him that the bruising is simply due to the fracture as there may well be something else going on (F). The patient is likely to need senior review and possibly further investigation before anyone can say for certain that it is purely as a result of the fracture. Asking Mr Gordon to lower his voice (C) is likely to infuriate him further and is therefore going to be detrimental to the situation.
- You have worked on a ward with another FY1 colleague, Ben, for the last three weeks. You have noticed that Ben seems to avoid writing prescriptions and filling in drug charts. The nurses appear to be getting frustrated with Ben because of this. When you speak to Ben about it, he tells you that he is dyslexic but has not told anyone as he is embarrassed.
You answered scoring 0 of a possible 12 marks.
A. Make the nursing staff aware of the situation
B. Check all the drug charts and prescriptions Ben has recently written
C. Explain to Ben the potential safety risks to patients if he continues to ignore the issue
D. Discuss the situation with a senior colleague
E. Recommend to Ben that he raises this with his educational supervisor*
F. Offer to help Ben with his prescriptions and drug charts
G. Discuss the situation with your team and ask them to help you monitor Ben’s drug charts and prescriptions
H. Speak to Occupational Health* (OH) about the best course of action to take
Answer: CDE
Rationale: This question asks you to make professional and patient-focused decisions. This is indeed a potential safety issue, although it should have been picked up before applying to the Foundation Programme. Ben really should discuss this with a senior colleague himself and you have a duty to the patients, and to him, to do so yourself, to ensure the issue is raised (C, D, E). Offering to check the charts and support Ben, whilst noble, is not the way forward since this should be undertaken by someone more senior, and doesn’t deal with the problem (B, F). Raising the problem more widely is not your responsibility and needs to be undertaken sensitively once more senior doctors are involved (A, G, H).
- You have been prescribed codeine for persistent back pain which has become worse in the last few weeks. You have noticed that during shifts you are becoming increasingly tired, finding it difficult to concentrate and your performance, as a result, has been less effective.
You answered scoring 0 of a possible 12 marks.
A. Ask a colleague to assist with your workload until you finish your codeine prescription
B. Make an effort to increase the number of breaks during your next shift
C. Stop taking the codeine immediately
D. Make an appointment to see your GP*
E. Seek advice from a specialist consultant about your back pain
F. Arrange to speak with your specialty trainee* before your next shift and make them aware of your situation
G. Seek advice from your clinical supervisor* regarding further support
H. Consider taking some annual leave
Answer: DFG
Rationale: This question looks at how you demonstrate commitment to professionalism and self-awareness. The essential problem is that as an FY1 doctor the level of your clinical performance is dropping. This constitutes a risk to the patients you are caring for and will impose a greater workload on your colleagues. In this circumstance you should inform and seek the advice of the senior clinician responsible for your work (G) and alert your colleagues (F). This matter is most likely to be related to your prescribed medicine and you should therefore consult with your GP (D) rather than any other specialist (E). It is not your place to re-allocate workload (A). Increasing the number of breaks is unlikely to improve the situation that is likely to be due to an adverse effect of a drug (B). You should not make any unilateral decisions about your medical treatment (C) and should seek the advice of others (D). You should not be seeking to use your annual leave (H) to compensate for a medical problem.
- You are working in the Emergency Department (ED). Mrs Gersbach, a 65 year old female patient, is admitted with chest pain. This is her fifth attendance with chest pain in the last two weeks. She has been extensively investigated over this time, and a cardiologist has documented that all investigations have been normal and that her pain is not cardiac in origin. Today, nothing on examination or any of the investigations suggest that her pain is a symptom of cardiac disease. There are no other worrying signs or symptoms.
You answered scoring 0 of a possible 12 marks.
A. Admit Mrs Gersbach to the AAU), or Acute Assessment Unit (AAU), or Medical Assessment Unit (MAU) is a short-stay ward that may be located within the emergency department, although a separate department. The AAU acts as a gateway between a patient's general practitioner and the emergency department, and the wards of the hospital. “>Acute Admissions Unit * (AAU) for further investigations
B. Write to Mrs Gersbachs GP*, asking her to dissuade Mrs Gersbach from attending the ED
C. Explain to Mrs Gersbach that there appears to be nothing wrong with her
D. Reassure Mrs Gersbach that her pain is definitely not a symptom of cardiac disease
E. Ask a senior colleague to speak with Mrs Gersbach
F. Ask Mrs Gersbach if there is anything that she is worried about that might be causing her pain
G. Arrange an outpatient exercise tolerance* for Mrs Gersbach
H. Tell Mrs Gersbach that her attendance at the hospital is not the best use of the ED’s doctors’ and nurses’ time
Answer: DEF
Rationale: It is always appropriate to reassure patients (D) who are concerned. It is also appropriate for a senior colleague to speak with Mrs Gersbach (E) in order to provide additional reassurance, and to ensure that there are no new causes for concern in her diagnosis. Eliciting the true cause of repeated attendance (F) will help to direct further management correctly. Since Mrs Gersbach has already been extensively investigated by a cardiologist, options (A) and (G) would not be appropriate. Options (B) and (H) are unnecessarily confrontational, whereas option (C), far from being reassuring, will give the patient the impression that her concerns are not being taken seriously.
- An FY1 colleague, Lewis, arrives late into work on a frequent basis. You think you may have smelt alcohol on his breath previously, but were not sure. This morning Lewis smells strongly of alcohol and is unsteady when walking.
You answered scoring 0 of a possible 12 marks.
A. Ask Lewis if he has been drinking alcohol
B. Tell Lewis that he should go home immediately if he is unfit to work
C. Inform the consultant in charge of the ward that Lewis smells of alcohol and is unsteady when walking
D. Seek advice from a senior colleague about how to manage the situation
E. Explore with Lewis if there are any reasons behind his behaviour
F. Tell Lewis that if this happens again, you will have to tell the consultant
G. Tell Lewis to get a cup of coffee
H. Inform the General Medical Council (GMC). It is the principal regulatory body and aims to protect the wellbeing of all patients by ensuring proper standards in medical practice.”>GMC* of your concerns about Lewis
Answer: ABD
Rationale: The suspicion that your colleague has been drinking alcohol is strong, and this should be confirmed first-hand (A). Your first concern should be for the patients under his care, so it is essential that he does not remain at work if his judgement and ability are impaired (B). It is also appropriate to ask for senior help and advice in this situation (D). Informing the consultant in charge of the ward is unnecessary (C) unless your colleague insists on remaining at work. Exploring the underlying issues at the time (E) will be fruitless, and is best done in a more appropriate environment by a trained counsellor. Option (F) is unduly confrontational. Option (G) plays down the gravity of the situation, whereas option (H) is unnecessary, as this step is best undertaken at the end of a recognised pathway by a senior colleague.
- You are in the canteen and are joined by an FY1 colleague, Amadi, who is not on shift. Amadi tells you that his girlfriend was involved in a serious road accident last week and is now in the Intensive Care Unit* (ICU). He tells you that he is very stressed and has barely slept in the last week. He thinks that he is going to have difficulty coping with his weekend shift. He has refused to take compassionate leave as he does not want to leave the ward understaffed.
You answered scoring 0 of a possible 12 marks.
A. Advise Amadi to see his GP*
B. Suggest to Amadi that sleeping tablets may help
C. Advise Amadi to contact the Trust’s counselling service
D. Advise Amadi to seek time off work from his consultant
E. Discuss your concerns with Amadi’s educational supervisor*
F. Advise Amadi to discuss this with his educational supervisor
G. Offer to go somewhere more private to discuss Amadi’s concerns
H. Contact the ICU to find out about Amadi’s girlfriend’s health situation
Answer: DFG
Rationale: There are two aspects here: the first is the duty of care and compassion towards a colleague in a time of difficulty; the second is a duty of care towards patients in recognising a colleague who is unlikely to be able to fulfil their duties adequately and safely. Option (D) is clearly appropriate in that the situation will impact directly on consultant’s firm and the safety of the patients, and the consultant is most likely to be able to organise cover for the doctor. Option (F) is appropriate because the educational supervisor is most involved with pastoral care of the trainees. Taking Amadi somewhere private to discuss further will help get a full and confidential disclosure of the problems (G). However, a direct action is likely to be required such as D or F. There is insufficient evidence of a clear and present danger to patients to warrant informing a senior without the colleague’s consent – this eliminates option (E). Options (A), (B) and (C) are not inappropriate but do not address the issue of the imminent weekend on-call. (H) is clearly inappropriate as you are not looking after Amadi’s girlfriend so confidentiality of the patient would be breached.
- You are treating Mrs Taylor for a urinary infection. You receive the antibiotic sensitivity results. You inform your consultant that the E coli causing Mrs Taylor’s urinary infection is sensitive to amoxicillin. As a result, this antibiotic is then started. You realise later that day that you have misread the result and that the E coli is actually resistant to amoxicillin and is sensitive only to ciprofloxacin. Mrs Taylor had no adverse reaction to the antibiotic.
You answered scoring 0 of a possible 12 marks.
A. Inform your consultant of the correct result
B. Record the incident as a learning point in your learning portfolio*
C. Contact microbiology for advice
D. Tell Mrs Taylor that you have prescribed the incorrect antibiotic
E. Reassess Mrs Taylor’s vital signs
F. Change the antibiotic to ciprofloxacin
G. Repeat the urine specimen culture
H. Ask your specialty trainee* for advice
Answer: ADF
Rationale: This question asks you to make decisions that demonstrate your professionalism. Your consultant might want to know that a change to the management is required, and the patient needs to know that an error (albeit minor) has occurred (A, D). Changing the antibiotic is required to treat the patient (F). Repeating the urine (G) and contacting microbiology (C) will add nothing and, in the absence of an adverse reaction reassessing the patient’s vital signs is unlikely to be of benefit (E). Recording the incident as a learning point is a good idea but is of lower priority (B). If your consultant is available that is the first port of call. Your registrar/specialty trainee would be a reasonable alternative (H).
- You review a patient on the surgical ward who has had an appendicectomy done earlier on the day. You write a prescription for strong painkillers. The staff nurse challenges your decision and refuses to give the medication to the patient.
You answered scoring 0 of a possible 12 marks.
A. Instruct the nurse to give the medication to the patient
B. Discuss with the nurse why she disagrees with the prescription
C. Ask a senior colleague for advice
D. Complete a clinical incident form
E. Cancel the prescription on the nurse’s advice
F. Arrange to speak to the nurse later to discuss your working relationship
G. Write in the medical notes that the nurse has declined to give the medication
H. Review the case again
Answer: BCH
Rationale: Ensuring patient safety is key to this scenario. It is important to discuss the nurse’s decision with her as there may be something that you have missed when first reviewing the patient (B). Therefore it would also be important to review the patient again (H). Also relating to this is the importance of respecting the views of colleagues and maintaining working relationships, even if there is disagreement. As there has been a disagreement regarding patient care, it is important to seek advice from a senior colleague (C).
- You have been approached by an FY1 colleague, James, who has been on shifts with another FY1 doctor, Mark, for the last two weeks. James tells you that Mark has become increasingly careless in monitoring and documenting patient records. On three occasions, James tells you that he has found Mark asleep in the common room whilst on duty. You know Mark very well and have never witnessed such behaviour when you have worked with him previously.
You answered scoring 0 of a possible 12 marks.
A. Tell James that you have never witnessed such behaviour from Mark
B. Suggest to James that he speaks to Mark directly about his concerns
C. Advise James to document his concerns
D. Inform a senior colleague about what James has told you
E. Tell James you will speak to Mark about his behaviour
F. Ask other members of the team whether they have witnessed this behaviour in Mark
G. Advise James to speak to a senior colleague about his concerns
H. Ask James whether he has any evidence that patient safety is being compromised
Answer: BGH
Rationale: This scenario presents a number of conflicts between professional and personal concerns. James should speak directly to Mark about his concerns (B). James has a professional duty to share his concerns with a senior colleague (G), and must do so immediately if he has evidence of patient safety concerns (H). It will be important to keep a professional oversight and not to judge the observations of James (A, C), or act as a third party between James and Mark (D, E, F).
- It is the end of your shift and on your way out of the ward you remind one of the nurses that Mr Baker, who has been admitted to the hospital with chest pains, needs his blood taken within the hour for cardiac markers. The nurse tells you that the ward has now got very busy so Mr Baker will have to wait. She is very abrupt in her response to you.
You answered scoring 0 of a possible 12 marks.
A. Ask the nurse for further details about the other urgent tasks that need to be completed on the ward
B. Ask the FY1 taking over your shift to take Mr Baker’s blood
C. Discuss with the nurse in charge the procedure for taking essential bloods at busy times
D. Insist that the nurse tries to find the time to take Mr Baker’s bloods
E. Take Mr Baker’s blood yourself
F. Suggest to the nurse that she considers how she speaks to other members of the team in future
G. The next day, speak to the nurse privately about the way she spoke to you
H. Speak to the nurse in charge about the way the nurse spoke to you
Answer: BCG
Rationale: This question looks at your communication skills. The first priority is that the patient is looked after, so asking a colleague on duty to do this is appropriate (B). Having said this, the underlying cause needs to be addressed after some information gathering (C), which can then be transmitted to the nurse sensitively at a later time (G). It should not be necessary for anyone to work for longer than their required hours because of what is essentially an organisational problem, not a medical emergency (E). Asking the nurse to take on additional tasks (D) or for more information about the detailed tasks (A) would be inappropriate input to someone else’s job, and options (A), (E) and (F) are counterproductive in time terms. Options (D), (F) and (H) would be confrontational and unwise in the heat of the moment.
- You are working on a busy medical ward and you have one hour left of your shift. During that time you have to complete paperwork, which will take approximately 45 minutes, and see three patients who may take 15 minutes each. A healthcare assistant asks you to speak to a relative of a patient on the ward, who has called the ward asking to speak to someone.
You answered scoring 0 of a possible 12 marks.
A. Ask a nurse on the ward to assist you with seeing the patients
B. Ask the healthcare assistant if he or she can ask a nurse who knows the patient to speak with the relative
C. Stay late at work to ensure that you complete all of the tasks
D. Finish the most important clinical tasks and hand over any uncompleted tasks to the next shift
E. Ask an FY1 colleague to assist you with completing your tasks
F. Inform a senior doctor that you will be unable to complete all of your tasks during your shift
G. Agree to speak to the patient’s relative on the telephone
H. Ask the patient’s relative to call back later to speak to a doctor
Answer: BDE
Rationale: The issue here is the recognition of priorities. There is a clear distinction between clinical and operational priorities. Paperwork is part of the latter. Reviewing patients is the priority before handing over. Option (B) is appropriate as it appropriately deflects this new additional demand on your time. Option (D) is clearly appropriate as the clinical tasks should take priority and be finished first. Option (E) is appropriate because two people working in parallel would likely complete all of the tasks in time for handover. Option (A) is an inappropriate imposition on the nursing staff and would likely be refused in any case. Option (C) is inappropriate as a significant proportion of tasks are operational in nature and handing these over would facilitate not overstaying. Option (F) is irrelevant. Seniors do not need to be made aware of incomplete non-urgent tasks; they simply need to be handed over to the contemporary person taking over. It is customary for nursing staff to provide telephone updates to patients. Options (G) and (H) are therefore inappropriate.
- You are reading some medical magazines in the hospital canteen, whilst on a break. In one magazine, you come across an advertisement for private specialist services bearing the picture and name of Simon, a fellow FY1. You are aware that providing such services is not allowed for FY1 doctors as full registration has not been granted by the GMC* and they can only work in an approved programme and setting. You are aware that Simon is experiencing severe financial difficulties.
You answered scoring 0 of a possible 12 marks.
A. Suggest to Simon that he tells his educational supervisor* about the advertisement
B. Suggest to Simon that he stops providing this service immediately
C. Inform the Foundation Programme Director about Simon’s advertisement
D. Discuss with Simon alternative ways for him to make money
E. Ask fellow FY1s for their opinion on Simon’s actions
F. Ask Simon whether he is aware that providing specialist services is not allowed as an FY1 doctor
G. Ask Simon whether anyone is aware that he is advertising these services
H. Inform Simon that it is unacceptable to place such advertisements
Answer: ABF
Rationale: This question looks at dealing with a colleague in difficulty. It is not your role as a fellow junior doctor to deal with this problem on your own and it is important that Simon seeks help and advice from a senior colleague (A). It is important to let Simon know that it would be best to stop providing this service immediately (B) but also to make sure that Simon realises that this practice is not allowed and that his actions are therefore inappropriate (F). You should not escalate this to the Foundation Programme Director as a first point of contact as there is a clear policy that should be followed (C). It is not your role to act as Simon’s senior (H). In the same way it is not appropriate to involve Simon’s peers (E), try to solve Simon’s financial problems yourself (D) or seek to cover up the incident (G).
- During a ward round, your consultant loses his temper and shouts at the other FY1 doctor on your team for not having ordered blood tests for a patient. This incident is overheard by the patient concerned, the nursing staff and the rest of the medical team.
You answered scoring 0 of a possible 12 marks.
A. Once away from the bedside suggest to the consultant that the situation felt uncomfortable and you were worried that the patient had been upset
B. Tell the consultant later in private that you think that his behaviour was inappropriate
C. Advise your FY1 colleague that he should speak to the consultant about the incident
D. Discuss with the nursing staff whether this is usual behaviour for the consultant
E. Advise your FY1 colleague to speak to his educational supervisor*
F. Apologise to the patient after the ward round
G. Ask a more senior colleague on the team for advice
H. Ask your FY1 colleague if he needs any help with his workload
Answer: AEG
Rationale: This question deals with communication issues. Patient care is the most important thing and as such you do have a duty to initiate further discussion and this is best done in a non-confrontational manner (A). It is important that the FY1 involved with the issue is provided with someone to discuss the incident with, to facilitate reflection (E) and you may need advice from a senior doctor in the team to help with this difficult situation (G). It is not appropriate for you to have a private conversation with the consultant (B), expect the FY1 to deal with the problem directly with the consultant without a third party (C), to discuss your consultant’s behaviour with the nurses (D) or apologise on behalf of the consultant (F). Whilst you may wish to see if your FY1 colleague is managing his workload, it is not a priority in answering this question (H).
