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SJT Prep > SJT Main Question types > Flashcards

SJT Main Question types Flashcards

1
Q

What are the main principles in a prescribing error related question?

A
  1. Contact the person who wanted the prescription - may know reasons why its okay / they need to know why it cant be done
  2. Ask for senior advice - not as important as telling person involved
  3. Ward pharmacists still important to ask original person as they may have specific reasons / need to know why you’ve not done what they requested
  4. Usually avoid changing dose w/out doing before step BUT don’t do nothing / prescribe possibly unsafe medications (eg double dose)
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2
Q

What are the main principles in a discharging patients related question?

A
  1. Try to understand patient’s POV - may be reason that could be fixed(Try to assist their discharge, better to ask bed manager before looking for reasons)
  2. FY1s should never discharge w/out senior supervision
  3. Avoid encouraging self-discharge
  4. Generally don’t keep pts in hosp longer than needed (asking bed managers > looking for excuses in notes) BUT don’t say you need the bed (may stop them from telling you valid reasons they can’t go home)
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3
Q

What are the main principles in a work-life balance related question?

A
  1. Patient safety is always the priority
  2. Own well-being comes next
  3. Right to finish work on time also important
  4. Consultant’s refrences less important
  5. Social life least important
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4
Q

Which types of tasks are more important when prioritising tasks?

A

Clinical > Operational (examining pts > paperwork)

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5
Q

What to do if you can’t update pts in a question?

A

Standard practice for nurses to update relatives in SJT land

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6
Q

What to do if you have too much work and can’t complete it in a shift?

A
  1. Finish most important tasks and handover uncompleted urgent tasks to night team (standard practice)
  2. Can ask FY1 colleague to help ONLY if they are finished with their own tasks
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7
Q

What are the main principles in a working under pressure/ prioritising jobs question?

A
  1. Patient safety is no. 1 priority !!
  2. If you are busy with a pt and asked to review another - can ask for obvs whilst finishing current urgent job
  3. Do not reassure nurses ab patients they are worried about that you havent reviewed personally
  4. Always work within remits of your training
  5. If you’re on break and called to med emergency - Attend the emergency!
  6. Generally do not get senior input until you have done initial assessment - eg if nurse is worried, go see pt then tell your senior
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8
Q

What are the main principles in a teamwork / communication question? (too much work and collaegue has not much on surgical job on regular basis)

A
  1. Speak to colleagues directly
  2. Inform senior that you are busy and may need some help - also important they are aware of workload so they dont add anymore
  3. LONG TERM SOLUTION - talk to consultant about uneven workloads (not reporting collaegue)

Better to raise to consultant before departmental meeting

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9
Q

Principles of teamwork and communication qs?

A
  1. If feeling bullied or undermined do not delay addressing issue
  2. If there is an issue between nurse and patient inform senior nurse
  3. If there is an issue between you and a nurse, inform you consultant
  4. If a colleague has left for a learning opportunity and you aren’t coping with the workload ask them to return
  5. Reporting colleagues is last resport
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10
Q

What to do in handing over jobs question when someone refuses due to workload?

A
  1. Explain that it is their job and remind them if they do it
  2. Find another colleague to handover however it is not their responsibility
  3. Leaving instruction in pt notes may mean it isnt done
  4. Don’t hand the job to nurses as it is not their job
  5. Do not stay on for an extra 4 hours as it can impact pt safety w/ tiredness (maybe w/in 30 mins is acceptable)
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11
Q

Key principles of handing over jobs?

A

Handover to equivalent raks (eg F1s (or higher))

Do not handover to nurses - have their own jobs

Avoid handing over to a doctor not responsible for those patients

Do not stay late at work to carry out routine jobs

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12
Q

What to remember in appropriate actions qs?

A

All the actions are in conjunction with each other - a sequence of events

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13
Q

What to remember in appropriate actions qs?

A

All the actions are in conjunction with each other - a sequence of events

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14
Q

Pt complains that nurse isnt giving her usual medication, what to do?

A
  1. Review notes to see if there is a reason it is being witheld - most likely a doctor’s problem not nurses
  2. Acknowledge their concern and say you will look into why it happened
  3. If there are no issues prescribe the appropriate meds
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15
Q

General principles of handling complaints?

A

Do not blame other colleagues

Can apologise w/out taking blame (cant apologise for colleagues)

Do not feel bullied by pt relatives who are lawyers - treat every pt equally w respect

Do not lie to pt / relatives / anyone

Good to have chaperone when dealing w upset pt / relatives

Do not make confrontational / inflammatory comments

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16
Q

Pt confidentiality - relative who is your friend asks ab results what to do?

A
  1. Say you cant say due to pt confidentiality
  2. Advise to wait til meeting where a senior doc can explain better
  3. Explore their anxiety ab results (may put you in a sit where you may give away info by accident)
  4. Ask if they have permission from the pt to get results - doesnt really matter cause you need expressed consent from pt themselves
  5. Telling them the results - obvs a breach of confidentiality
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17
Q

Principles of confidentiality?

A

Do not share info beyond necessary medical team w/out expressed concern

Do not take home any pt confidential info

Remove and destroy any pt confidential sensitive info in inappropriate places eg stuck to computer screen
>
Inform pt of any confidentiality breaches that concern them

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18
Q

Working within your competencies - asked to do a procedure you dont know

A
  1. Probity - explain to person asking you that you don’t feel confident (if possible away from pt)
  2. Ask the person asking you to provide instruction / supervise you is next (unless core competency eg ABG, bloods etc - ask to supervise)
  3. Ask to observe
  4. Ask another F1 to do - not their job + losing out on your own learnign
  5. Do it the best you can - pt safety at risk
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19
Q

What to do helping struggling colleague?

A

Talk to her about her distress - therapeutic

Suggest they talk w/ senior / educational supervisor

Offer to go w/ them to talk to consultant

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20
Q

What not to do helping struggling colleague?

A

Suggest taking annual leave for ill health

Offer to help w workload - prolongs issue

Do not speak to THEIR educational supervisor (speak to ur own or tell them to)

Dont tell another F1 what to do only their seniors can do this

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21
Q

What to do w/ advising a colleague when youre not involved?

A
  1. Suggest col 1 talks to col 2
  2. Suggest col 1 to talk to senior ab concerns
  3. Ask col 1 if any evidence of pt safety being compromised
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22
Q

Requesting urgent imaging but dont know why so cant do it?

A
  1. Speak directly to person requesting asap
  2. Ask the radiologist to contact the person requesting
  3. Wait until afternoon when you will see that person - delays urgent
  4. Explain its urgent and yo cant explain why
  5. ask any doctor about why it might be needed - not specifc to situ
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23
Q

Handling colleagues bad behaviours?

A
  1. Probity - advise them to tell the truth
  2. Dont get involved in their lies
  3. explain to colleague why its wrong - less useful when they know why
  4. seek advice from seniors - less useful when you know what they will say
  5. dont lie to the police
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24
Q

Handling colleagues bad behaviour qs?

A
  • Not your place as F1 to investigate or help w financial concerns or tell consultant their behaviour was inappropriate or organise cover for others

For drunk colleagues - deal w immediate pt safety –> prioritise speaking w consultant

For v tired / drunk colleagues - EXPLAIN your concerns V suggest someone else do it - pt safety issue = be direct

You can apologise on behalf of organisation for uneccesary distress but not for colleague without discussion

Avoid anything that perpetuates a colleagues bad behaviour eg offering to routinely catch them up when they are repeatedly late for work

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25
Q

What to do when managing your own clinical mistakes?

A

(Correct mistakes that risk pt safety 1st)

  1. Inform patients of the issue 1st!
  2. Inform your seniors / consultant - they are in charge of the patient
  3. Ask for advice - ideally from seniors but peer otherwise also useful
  4. Don’t try to cover up the mistake
  5. Dont do nothing
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26
Q

Teamworking principles - f1 being mean to other colleagues - what are the main things?

A
  1. F1 should not talk to other members of staff like this
  2. F1 should be held accountable
  3. HCA should tell senior about what happened
  4. HCA not taking feedback isnt the issue
  5. It is yours and everyones responsibility to stop bullying
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27
Q

Main considerations in teamworking qs?

A

Don’t snitch on colleagues - if they havent done something they’re meant to eg bloods - do it yourself before telling senior

Don’t move teams due to issues - will make the issue stay for the next person

If a colleague hasnt done a job and you can do it - if theres no CIs do it

It is unethical to take credit for someone else’s work eg audit

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28
Q

What to do in translation questions in SJT land?

A
  1. Find a doctor who speaks the language
  2. NHS telephone translator - as this can take time
  3. Ask a senior what to do?
  4. Ask pt’s NOK for hx
  5. Continuing to try to communicate on your own
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29
Q

Social media and professional boundaries qs - main principles?

A

Decline SM friend / follow requests from pt - send a message to explain why its inappropriate so it doesnt happen again

When communicating in public - maintain confidentiality

Do not go to pt parties - explain why its inappropriate v decline on its own

Do not buy presents

GMC says dont ask or accept gifts from pts etc that can affect how you treat pts (Max £50 gift for organisation v individual)

Don’t pressure pts to donate to charities

Decline requests to treat families and colleagues

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30
Q

Questions relating to hospital prescribing protocols

A

1st advice from senior on your team - know the pt and familiar w protocol

If abx - ask on-call microbio however not good in non-emergent cases and wont know pt

Next best = BNF (non specific to local)

Dont trust nurse as not their job to prescribe however in SJT nurse > national guidance as not related to local guidelines or give doses

DO NOT ask for advice from off duty seniors
DO NOT wait until pre surgery / too late
DO NOT cancel surgeries - F1s shouldnt do this

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31
Q

You’re asked to break bad news w/ incomplete results, wyd?

A

Shouldnt do this, better to have senior handle the convo

32
Q

Colleague undermining standards on the ward - handwashing?

A
  1. Speak directly
  2. Speak to ward nurse may be able to help as they’re in charge of standards on the ward
  3. Specialty trainee might help but won’t help knowing underlying issue
  4. Monitoring prob is an issue as it doesn’t issue problem at hand
  5. Infection control - excessive could damage professional relationship
33
Q

Can you detain patients as an F1?

A

No -F2 or higher so get seniors

34
Q

What to do if you have nothing to do?

A
  1. Ask consultant to get more involved - helps your specific team
  2. Offer to help other f1s in other teams
  3. Ask foundation programme director to help you and see if changes are needed
  4. Ask foundation programme to move units - bit much and isn’t constructive
  5. Taking on extra responsibility outside of professional aspect is something separate
35
Q

Boundaries of professional responsibilities? - missing paperwork

A
  1. If unsure if an issue is a pt safety issue contact the responsible team yourself first !!
  2. Proper handover W night team
  3. Nurse in charge and ask them to do the same thing less reliable however
  4. Senior doctor - good but paper work may be below their paygrade
  5. Sending a message least reliable as they may not receive
36
Q

Addressing pt concerns and providing reassurance?

A
  1. First ask pt about their ICE - you can give specific reassurance
  2. Reassure the pt - however with asking about their concerns you can’t get a full understanding of how they feel
  3. Telling ward manager to make sure pt are provided w info solves long term issue however doesnt deal with issue for specific pt
  4. Asking nurse to reassure - handing off to someone else and they may not be able to do it in a timely manner
  5. Speaking to relatives of pt - doesnt address pt’s concerns
37
Q

What is the ideal way of handing over tasks?

Putting in pt notes and telling a specific docotor

OR

Telling nurse in charge to contact an available doctor

A

Putting in pt notes and telling a specific docotor

38
Q

Discharge but the doctor doing it is delayed and pt wants to leave - wyd?

A
  1. Ask another senior doctor to have a look and discharge
  2. If no seniors onsite present to discharge - contact senior on phone and see if they can give verbal approval and supervise through process and review F2F asap
  3. Communicate w pt about situ however this is not as good as their time pressured situ is affected
  4. Inform them of right to self discharge
  5. F1 discharge w/out supervision is worse than self discharge!!
39
Q

Who can you handover jobs to?

A

Same level as you

OR higher

40
Q

Pt confidentiality w a pt’s relative?

A
  1. Tell them you need pt’s consent
  2. Sharing info they already know can buy some time
  3. Telling them to speak to pt can add to stress as it may make them worried about something wrong
  4. Saying you need to speak to senior avoids the problem and doesnt get consent to discuss
  5. Breaks confidentiality
41
Q

Who to inform if you get given a gift from pt on the ward?

A

Ward sister

42
Q

Pt complaints due to delays

A
  1. ogise to pt + family and listen to concerns
  2. Explain the reasons for the issue - clinical need for other scans to be done first
  3. Explain things change quickly in the hospital and that at the time the info was accurate
  4. Tell them about formal complaint procedure
  5. Not fair to blame radiology as they are responding to clinical needs
43
Q

Colleague has left you with loads of work because theyve randomly left - wyd?

A
  1. Contact them ASAP and ask them to come back as you cant deal w all the work theyve left
  2. Wait until they come back to tell them to tell you in the future when they leave - doesnt deal w immediate sity but helps in long term
  3. Telling a senior - speak to her directly first
  4. Cant just hold her jobs until she comes back, they have to be done based on clinical need
  5. Reporting to her line manager for isolated incident is too much need to find out a bit more and talk to them yourselves
44
Q

Prioritising and delegating tasks - nurse worried about a pt you’ve seen earlier

A
  1. Ask the nurse about recent changes
  2. Ask the nurse to go collect vital signs whilst you wrap up
  3. Go there direct - good but assumes that the other task is more important than your current one
  4. Handing off responsibility to another doctor - less useful and may not mean it is done in a timely manner
  5. False reassurance
45
Q

Pressurised situ where you dont have experience - wyd (critically ill pt)

A
  1. Initial assessment before you get seniors!!!
  2. Contact seniors and ask for advice!!
  3. If there is a team nearby that knows the pt ask them
  4. Ask the consultant to come back and have a look but only after you’ve fully assessed
  5. Crash trolley - V Extreme and only if its an arrest or emergency - could risk other pts that need it
46
Q

Conflict within senior members of team and pt care

A
  1. Discuss w consultant can get different viewpoints in view
  2. Telling the reg to raise the point w the consultant could be confrontational
  3. Consultant has overall responsibility so doing as they say is also likely appropriate
  4. Discuss within your own team before going and asking others
  5. Snitches get stiches and cause beef in the team
47
Q

Mental capacity act concerns:

A
  1. Talk to patient to check understanding
  2. Tell person that initially consented that pt may need clarification
  3. Consultant has ultimate say so tell them there may be an issue
  4. Ask the nurse to contact the person that initially consented - passing the buck
  5. Tell the pt to not consent until they have more info - inappropriate to do this without trying to resolve the issue first
48
Q

Ensuring clearest communication - when you’re trying to leave:

Go to ward and check wag1

OR

Continue calling to try to get a response

A
  1. Go to ward and check wag1 - see if it is because ward is overwhelmed or what
  2. Continue calling to try to get a response - does the same thing but less reliable and doesnt tell you if there is a situ on the ward
49
Q

Pt family distressed and asking you about something you don’t know about

A
  1. Explore concerns
  2. Get person who is responsible to talk to them (consultant)
  3. Senior help
  4. Ask the consultant why - doesnt deal w immediate situ
  5. Lie
50
Q

What should NOT be handed over to on-call team?

A

Shouldnt handover non-emergency jobs to on-call staff which your colleagues can help you with

51
Q

What to do when pt safety issue due to nurses / someone not following instructions

A
  1. Senior medical and nursing staff need to know - so it can be logged and any action taken
  2. Check if the people meant to be following the instructions were aware of them beforehand
  3. Unlikely to benefit from explaining to the pt as they are confused so may not be able to retain the info
  4. Can’t assume the blame of the nurses without ix from seniors / senior nursing staff
52
Q

Who is best placed to talk to distressed pts?

Nurse who knows the pt

OR

You!

A

You! - when pts are distressed they might prefer speaking to doctors to help alleviate any stresses

53
Q

Consultant has had a go at your colleague?

Should you tell them to talk to the consultant directly about the issue (on their own)

OR

Speak to another senior colleague for advice

A
  • In this situ when consultant has had an issue w colleague and shouted at them they are already angry w them - hence may be inappropriate to suggest they talk to consultant w/out 3rd party help
  • Hence talking to a senior colleague for advice on how to approach the matter may be a better solution
54
Q

What to do when a pt remains worried about their condition despite reassurance?

A

When a pt remains worried about their condition despite reassurance might be worth involving a senior to talk to them to further this

55
Q

Why may it be better to advise a pt’s family to talk to the pt directly rather than telling them you will need to speak to a senior before talking to them when they ask qs about the pts condition

A
  • Telling the husband to talk to the pt directly is harsh however still solves the problem at hand
  • Telling them you need to speak with a senior is evasive and doesnt solve the issue
56
Q

Nothing to do - what should you do?

A

Try to make yourself useful before raising the issue to higher ups - this is a slower and more long-term issue

  • Hence 1st see what you can do within your team
    • Then see if you can help other F1s on other teams
57
Q

Raising issues w/ problematic colleagues - what are the important principles?

A
  • It is most important to maintain quality of care !!
  • Then realise whether it’s going to be effective talking to them another time
  • They may not realise effect on pt safety
  • Timely completion important but not if it will lead to errors
  • Previous convo shouldnt deter you
58
Q

What to do when a colleague has health issues ?

A

When a colleague has health issues approach similar to unwell pt:

  • Ensure they’re stable and in a safe space - bed
  • Address possible causes for the issue
  • Tell a senior what’s happened
  • Since its on the ward and pt may have seen - reassure them
  • Once theyve recovered see how theyre doing and if she can continue with work
59
Q

Prioritisation skills - getting med student to help you what are the main considerations?

A
  • Competence - priority
  • Confidence - next most important
  • Time delay for another person to be found to do it is next most important as it could cause patient harm
  • Operational tasks are not of clinical priority at the moment
  • Not knowing how urgent the pt should be assessed could only be known after initial assessment
60
Q

What are the main considerations when responding to unprofessional behaviour in clinical situ?

A
  • All colleagues have a right to work in a respectful environment
  • How uncomfortable colleagues may affect their clinical performance
  • How interjecting may effect the procedure
  • Why the team members didn’t respond is less important than maintaining overall working environment
  • Justifying bad behaviour isnt a good idea and shouldnt influence your decision
61
Q

Dealing w agitated pts:

A
  1. Address pt concerns
  2. Apologise but dont try to solve the issue?
  3. Calm down pt directly or indirectly due to effect on other pts
  4. Make promises you dont know are true
62
Q

What to do if the person in charge of the pt has gone away?

A

More appropriate to approach members of the team that are still on-site before contacting those that are off-site

63
Q

Pt safety when a senior isnt free

A
  • Ask another senior of the same level
  • Try consultant if that isnt possible
  • Asking peers is okay but not better than seniors however leaving the ward is worse as you’re leaving the area with a doctor less and the pt potentially at risk
64
Q

Angry relatives of a pt?

Ask to be quiet

OR

Ignore?

A

Asking them to be quiet for procedure is better than ignoring them as not communicating with them can make the situ worse

65
Q

Boundaries of pt contact via social media - GMC social media guidance?

A
  • Decline and explain why
  • Decline !!!
  • Ask a senior for advice if unsure
66
Q

Accurate timely documentation - someone else on the team senior isnt doing it correctly - wyd?

A
  • Speak to the person directly
  • Ask for senior advice on how to approach
  • Speak to person directly (beefy)
  • Collect evidence of the issue
  • Edit their notes to correct the issue - probity issue? + doesnt address underlying issue hence may perpetuate issue
67
Q

You are doing an urgent task and are being requested to do a non-urgent task whilst the ward is busy - wyd?

A

In this case you want to ask someone else (even the consultant) to do it before doing it yourself as the task youre doing is URGENT hence you shouldnt leave an URGENT task for a non-urgent one

68
Q

Inappropriate request from a doctor for family member - priorities?

A

Always make sure that the pt can still be cared for
- Accepting the request means it can help pt however filling out critical incident report - wont help pt at all

69
Q

Declined referral - too busy: - wyd?

A
  • Asking for senior help appropriate as clinical and referral scenarios need senior help
  • Trying to contact again is appropriate but not before getting immediate senior help
70
Q

wyd if a pt records your convo with them?

A
  1. Discuss w pt why they did that
  2. Ask your clinical supervisor what to do
  3. Tell them its their choice whether or not to keep the video
  4. Beefy replies - thats inappropriate or delete it lad
71
Q

Dealing w a situ where pt communication wasnt effective and what to do now?

A
  • Talk w pt directly to figure out issue and deal with it
  • Ask someone to talk w pt to figure out what went wrong
  • Asking for more details w/out consulting pt - doesnt give you extra pt insight nor helps fix the issue
  • Going to speak to pt w senior is less useful as you dont know yet what went wrong
72
Q

What to do if colleague has left w/out telling anyone?

A

F- irst try to find out where colleague has gone
- Maintain patient care
- If you are in the middle of a pt critical action (eg completing drug chart) ask a nurse to contact them
- Contact them yourselves
- Specialty trainee is excessive

73
Q

Pt care concerns - you get blamed - wyd?

A
  • Deal w initial pt care concerns
  • Make sure the senior knows you arent responsible for the error
  • Try to figure out reason for error
  • Delay pt care
74
Q

Request made in difficult convo - pt family want info that you dont know and you said a senior would:

A
  • Contact senior for the pt to talk to family
  • Tell fam to wait for seniors
  • Tell them everything that you understand and the treatment
  • Explain that you’re an F1 so dont know everything
  • Apologise and leave - doesnt do anything useful
75
Q

Referral issue - you dont know why its being referred:

A

Check on internet to see why referral could be needed - proactive approach
- Calling team youre referring to inorder to get more info - fustrating for both you and that team
- Hand off the referral to someone else that knows

SJT Prep (1 decks)

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