SJT Mock 2nd attempt

Question 1

Patient asks if they have cancer and you do not have all the results but it is likely that he does.
Say you will chase up the results and speak to him as soon as possible
Say you will chase up the results and get a senior colleague to discuss it with him

Answer 1

Senior Colleague

Not an F1s responsibility to break bad news

Question 2

Accidentally sent 2 patients home with each others treatment plan as they have similar names:
A. Inform consultant
B. Seek advice from F1
C. Adjust original letters in the patients’ records
D. Trust that follow up care in the community will correct the error and apologise to the patients
E. Contact both patients to explain there was a mix up

Answer 2

EABCD

It would be appropriate to enter information that there had been an error into the case notes and indicate that the specified information did not relate to this patient (C). However, alteration of the case notes with the intention or effect of covering up an error, e.g. removing evidence, would be an extremely inappropriate and unprofessional act. Option (D) does not address the situation or put safe patient care foremost and is an inappropriate act.

Question 3

Not getting many learning opportunities
Offer to assist F1 colleagues on busier wards
Inform the Foundation programme director that the job should be reviewed to include more learning elements

Answer 3

Offer to assist F1 colleagues on busier wards

Question 4

Patient arrives from AAU without correct paperwork near the end of your shift
Ask nurse to request the paperwork ASAP
Handover to night shift F1 to chase up paperwork
Inform reg that the paperwork is missing

Answer 4

Handover > Nurse > Reg

Ensuring a proper handover (with documentation) with the night-shift FY1 is acceptable (D). Asking the nurse in charge to contact the admitting unit achieves a similar result, but is less reliable, and since you have not contacted a specific doctor for a medical task, you will have less certainty that it will be acted on (B). A more senior doctor will be in a position to ‘chase up’ the admitting unit to complete the relevant paperwork and drug chart, but they will also have to other duties that require attention from someone at their level (E)

Question 5

Patient only speaks Urdu
Ask senior for advice on how to proceed
Contact next of kin about symptoms
Continue trying to communicate as best you can

Answer 5

Senior > Next of Kin > Continue

Question 6

Husband rings up asking how his wife is:
Tell him that you would like to discuss her case with a senior colleague before speaking with him
Tell him that he will need to speak to her directly about her condition

Answer 6

Tell him that he will need to speak to her directly about her condition

Question 7

Not confident as you have been asked to do a procedure you have not done or observed before:
Find a senior colleague to supervise you
Find a colleague to do it while you observe

Answer 7

Find a colleague to do it while you observe

• should observe before doing with supervision

Question 8

You overhear your Reg say A CT scan requested by your consultant is inappropriate:
A. Request the CT scan, as asked by your consultant
B. Discuss the case and difference of opinion with the consultant radiologist
C. Discuss with your consultant the reasons for the CT scan
D. Tell your consultant that the specialty trainee has said that the CT scan is not needed and
that the request is inappropriate
E. Suggest to your specialty trainee that if he thinks the scan is not needed he should raise
this with the consultant

Answer 8

CEABD

The consultant retains overall responsibility for the patient and so if it is not possible to discuss the reasons for different viewpoints, it is appropriate to follow the consultant’s advice (A). Discussing the case with the radiologist is likely to be beneficial for patient management and your learning but it would be better to understand the reasons for the difference in opinion by discussing with your own team rather than involving another consultant (B). Option (D) is the least appropriate because it gives the appearance of telling tales and may stir up conflict within the
team

Question 9

Your colleague calls in sick. They have posted pictures of a night out last night:
A. Make other colleagues on the rota aware of the photos from the party
B. Suggest to your FY1 colleague that she remove the photos from the social networking site
C. Seek advice from another FY1 colleague
D. Ask your colleague for an explanation of why she called in sick the day after a party
E. Alert a senior colleague to the photos on the social networking site

Answer 9

DCBEA

Informing a senior colleague would only be the correct action if there was no adequate explanation forthcoming, the doctor did not show genuine remorse and learning or there were on-going concerns regarding patient safety (E)

Question 10

Uneven allocation of tasks between you and an F1 colleague
Complain to the ward consultant about the allocation of tasks
Discuss the situation with another FY1 colleague

Answer 10

Discuss the situation with another FY1 colleague

Getting a second independent opinion in matters like this is always helpful and may seem easier, although an FY1 colleague will not have the benefit of experience of your educational supervisor (E). Involving the ward consultant may be appropriate but by simply complaining you are not trying to resolve the issue and work collaboratively with others

Question 11

Patients wife angrily approaches you asking why they have not been discharged

Ask your specialty trainee* to explain why her husband is not being discharged today
Inform her that you cannot speak with her until she has calmed down
Tell her that you will speak to her when you return to the ward

Answer 11

Reg > Return > When she has calmed down

Question 12

Nurse asks you to prescribe a laxative as your F1 colleague refused to do it:
Ask F1 why they refused
Assess the patient

Answer 12

Ask F1 why they refused

Question 13

Senior nurse doesn’t wash hands. What is more important

She is much more experienced than you
it is the responsibility of infection control to enforce hygiene

Answer 13

She is much more experienced than you (ranked 4th out of 5)

Question 14

Colleague is going to be 30 minutes late. You are meant to have dinner with your partner. What do you do
C. Make a list of patients and outstanding investigations to give to your colleague as soon as she arrives
D. Ask your specialty trainee* if you can leave a list of your patients and their outstanding issues with him to give to your colleague when she arrives and then leave at the end of your shift
E. Leave a message for your partner explaining that you will be 30 minutes late

Answer 14

ECD

Although it is not appropriate for trainees to stay for an extensive period of time after their shift ends, or do this on a regular basis, staying an extra 30 minutes on this occasion is important to ensure an effective handover

Question 15

Nurse consistently rude to you and undermines you in front of patients and staff
Inform consultant
Inform Nurse in charge

Answer 15

Consultant

Informing the nurse in charge (B) is best left to your consultant.

Question 16

Colleague smells of alcohol (pick 3)
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

Answer 16

ABD

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

Question 17

You are busy and a medical student suggests they can attend to a patient while you do a discharge summary. Which is more important:
The discharge letters should have been completed a week ago
The urgency for the patient to be assessed is not yet clear

Answer 17

The discharge letters

The discharge letters do not constitute an urgent clinical priority (C). The urgency of the assessment required will only be determined by an initial assessment (D) which should happen with a minimum of delay.

Question 18

Colleague has social media post about a patient which can be identified.
C. When you next see Neal, suggest that he removes the social media post
D. Inform your on-call consultant of Neal’s social media post
E. Advise Neal to change his social media settings to ‘private’ so that only his contacts are able to read his posts

Answer 18

CDE

Although the advice to change media settings to private (E) is sensible that could be interpreted as condoning the original post which is inappropriate irrespective of settings.

Question 19

Consultant leaves at the end of the shift but doesn’t realise a mistake for the morning list do you:
Speak to the reg on shift
Speak to the anaesthetist on shift
Call the consultant on his mobile

Answer 19

Reg > Anaesthetist > Consultant

Contacting your consultant out of hours while he is at home is less acceptable than discussing the problem with appropriate members of the team who are still at work

Question 20

Reg gives you more tasks than your F1 colleague
C. Discuss your concerns with the specialty trainee
D. Inform your educational supervisor* of the difficulties you are experiencing with your workload
E. Delegate some of your tasks to your FY1 colleagues

Answer 20

CED

(E) will assist your personal wellbeing and it addresses the problem in real time - however it does not stop your speciality trainee delegating so much work to you. (D) is appropriate but may take some time to arrange and may not be required if the issue can be resolved directly with the speciality trainee

Question 21

You see a handover list at your colleagues house:

A. Inform Susanna that this is a breach of patient confidentiality
B. Advise Susanna to destroy the handover list
D. Destroy the handover list
E. Advise Susanna to discuss the breach of patient confidentiality with her educational supervisor*

Answer 21

ABED

Discussion and reflection with her supervisor (C) are important but represent an action that will become more appropriate later once the immediate issue with the handover sheet has been dealt with. Destroying the list (D) may mean that Suzanna is unaware of what has happened to the document which may cause problems when reporting the breach of confidentiality at work.

Question 22

Nurse tells you a patient’s relative has commented that you have a bad attitude:
Thank the nurse and inform her that you will reflect upon your communication with patients in the future
Inform your clinical supervisor* about the situation

Answer 22

Inform your clinical supervisor* about the situation

Thanking the nurse and informing them that you will reflect on your communication skills is nice, but does not directly address the issue here

Question 23

GP refers their own child:
Complete a critical incident form* relating to the GP’s inappropriate request
Tell the GP that you will accept her daughter’s referral on this occasion only

Answer 23

Accept on this occasion only

A critical incident form is the least appropriate as this doesn’t help the patient to receive appropriate emergency care and it does not resolve the situation.

Question 24

Cardiology registrar refuses your referral of patient with ACS:
A. Contact Lynda again, reiterating the urgency for her to assess
Mr Cox immediately
B. Contact the cardiology consultant, asking him to review Mr Cox since Lynda is
too busy
D. Contact a senior colleague from your own team, seeking support in managing the
situation

Answer 24

DAB

The most appropriate option is (D), as this patient is critically unwell and you need support to manage both the clinical scenario and the declined referral. Similarly, involvement of a senior colleague may highlight, for example, any issues with the initial referral which led to it being declined. Calling the cardiology specialty trainee back (A) to restate the position may have the desired outcome of getting her to attend, but is less likely to succeed as it has already been tried.

Question 25

Consultant doesn’t wash his hands:

Offer him hand gel between each patient
Suggest to the hospital’s Infection Control team that they place posters around the hospital reminding people to wash their hands
Report Dr Dixon to the hospital’s Infection Control team
Raise the importance of hand washing at the next team meeting, when Dr Dixon is present

Answer 25

Hand gel > Meeting > Report > Posters

Suggesting posters are placed around hospital is the least direct and effective way to address this problem

Question 26

Patient films your conversation:
Ask them to delete footage
Explain it is inappropriate to record this
Explain it is their choice if they keep the recording or not

Answer 26

Their choice > Inappropriate > Delete

Question 27

Scan request is rejected:
Ask an available doctor for advice about ordering MRI scans
Wait until this afternoon’s ward round to speak to the consultant about the scan
Politely explain to the radiologist that as the scan is urgent, you do not have time to ascertain why it is required

Answer 27

Wait until the afternoon > say you do not have time > ask for generic advice

Waiting will ensure that the correct clinical information is supplied but will delay patient care and dependent on the urgency of the case, could even lead to patient harm. (E) contradicts guidelines on ordering investigations for patients - you have to supply clinical information and a justification for ordering the test. (B) is inappropriate for this situation as it refers to generic advice, not specific to resolving this clinical situation.

Question 28

Family is upset, and the nurse believes this is because the information you gave them was very confusing:
A. Ask the nurse for further feedback as to why she thought that the information that you provided was confusing
B. Speak to the relatives again, to determine whether they understood the information that you provided
C. Ask a senior colleague to accompany you to speak with the relatives
D. Ask the nurse to explore with the relatives what has upset them

Answer 28

BDAC

Asking the nurse to further feedback without exploring issues with the family (A) may be helpful but invites further speculation rather than direct clarification. Asking a senior colleague (C) to accompany you is reasonable but without an understanding of why the family members are upset or confused, there is likely to be little benefit

Question 29

You are in the Acute Admissions Unit* (AAU) and are writing up a patient’s drug chart. The nurse tells you that one of the patients has been waiting 10 minutes for a cannula to be inserted. You know that the patient was seen by your FY1 colleague, Alex, five minutes ago. Alex has now left the AAU but you do not know the reason why. The nurse informs you that Alex did not insert the cannula when he was with the patient. There is no clinical urgency to insert the cannula.

A. Ask the staff if they know why Alex has left the ward
B. Contact Alex and ask him to return to the ward and insert the cannula
C. Ask the nurse to contact Alex to request that he returns to AAU to insert the cannula
D. Tell the nurse you will insert the cannula as soon as you have finished writing up the patient’s drug chart

Answer 29

ADCB

The most appropriate response is to establish why Alex left the ward (A) as this may have been to attend an emergency or obtain equipment for the procedure. Doing the cannula when you are able can ensure the ongoing care of the patient (D), but it does not address why a member of the team (Alex) has left. Contacting Alex is reasonable but it is more important to establish why he left the ward first from the staff as he may be busy with an important task. As you are in the process of dealing with a patient critical action i.e. completing a drug chart, this should take priority so asking the nurse to find where Alex is would be more appropriate (C) than leaving the task to contact him on your own (B).

Question 30

During ward round consultant says to do various invasive procedures. You know the patient earlier asked not to have any.
During the ward round, inform the consultant that the patient told you that he did not want any invasive procedures to be conducted
Talk to the consultant after the ward round about whether the procedures are a necessary option for the patient
During the ward round, ask the patient whether he wants to undergo these procedures

Answer 30

Inform consultant during ward round > ask patient > wait till after

Waiting delays the conversation, patient may be undergoing the procedure before the ward round is complete

Question 31

Relatives demanding to know the details about a rare disease you do not understand:
Explain what you can
Explain due to the rarity of the disease it is best to wait to talk to a senior doctor

Answer 31

Explain due to the rarity of the disease it is best to wait to talk to a senior doctor

Question 32

You are working on your first rotation in surgery. Whilst assessing a 65 year old female patient with jaundice, the consultant surgeon asks you to refer the patient to the Gastroenterology department regarding further treatment. You are unsure why this referral is required.

A. Ask a more experienced colleague to make the referral
B. Conduct research on the Internet into why the referral could be required
C. Contact the gastroenterology consultant to explain that you need to make the referral, and ask what information they need to proceed
D. Ask a more experienced colleague what information the Gastroenterology department will require to make the referral
E. Speak to the consultant surgeon again to gain more information before making the referral

Answer 32

EDBCA

If you are unsure about why a referral has been requested, check with the person requesting it (E). They may have forgotten to explain the details to you, and it furthers your learning and understanding. Failing this, speaking to another senior member of the team for generic information about this type of referral will be helpful (D), however they may also be unsure of the consultant’s reason for requesting this referral. Taking a proactive approach and researching your questions will be appreciated by the team you are referring to (B) and will also further your knowledge. Contacting the gastroenterology consultant without understanding why you are calling is likely to be unproductive and frustrating for yourself and the team you are referring to (C). Asking a colleague to make the referral for you is inappropriate as you are passing work to a colleague and failing to address your own learning needs (A)

Question 33

Patient finds nurse to be rude and inconsiderate:
Speak to nurse involved
Inform nurse in charge
Inform consultant

Answer 33

Nurse involved > Nurse in charge > Consultant

Question 34

What is the focus of this question:
You have noticed that Funmilayo often works for several hours before and after her shift. When you mention this to a nurse, she says that Funmilayo does this in order to complete tasks that are outside of her remit, to support her learning and development. Today, you see Funmilayo in the staff room at lunchtime, looking very tired.

Answer 34

Funmilayo

(options directly addressing her health are higher)

Question 35

Patient cant sleep because nurses are very loud on the phone. Pick 3
B. Ask the patient to tell you more about this situation and her concerns
C. Explain that telephones are only used at night by nurses for urgent issues that cannot wait until the morning
D. Document the patient’s concerns in the nursing notes
E. Inform the nursing staff that the patient is having trouble sleeping because of the noise levels at night
F. Arrange for the patient to be given some ear plugs
G. Ask the ward manager about the feasibility of moving the patient to a different bed

Answer 35

BEG

Documenting the problem in the nursing notes (D) may be important but won’t resolve the situation

Question 36

What do you need to apologise on behalf of a colleague

Answer 36

Prior discussion with that colleague

Question 37

Rate the appropriateness of:
Reassure Sarah that she should not need to know the scenarios before the clinical exam in order to do well

Answer 37

2 - somewhat appropriate

Doesn’t enable her to reflect on asking for answers

Question 38

Rate the appropriateness of:
Explore with Sarah the reasons why she wants to know the clinical scenarios before the exam

Answer 38

1 - Very appropriate

Question 39

Rate the importance of:
The impact on the rest of the ward staff if you leave your shift early

Answer 39

1 - Very important

Question 40

Nurse suggests you have prescribed the wrong dose. Rate the appropriateness of:
Ask the consultant to confirm with yourself and the nurse what dose to give the patient

Answer 40

2 - somewhat appropriate

It could be argued that the need to involve the nurse in the discussion with the consultant is unnnecessary.

Question 41

A patient asks you why she needs another X-ray and you aren’t sure why. Rate the appropriateness of:
The consultant asked for the chest x-ray but Im not sure why

Answer 41

3 - Somewhat inappropriate

Honest, but doesn’t instil the patient with confidence

Question 42

Nurses are criticising your colleague. Rate the appropriateness of:
Find your F2 colleague and tell her what you heard the nurses saying

Answer 42

4 - Inappropriate

Question 43

Your colleague is asleep.
Rate the appropriateness of asking other colleagues on the ward for their support

Answer 43

2 - Somewhat appropriate

Doesn’t deal with the main problem of colleague sleeping. And your other colleagues have their own duties already

Question 44

Your colleague is sleeping and the ward is busy. Rate the appropriateness of:
Inform a more senior colleague that you are not receiving the support that you need from your F2

Answer 44

1 - Very Appropriate

Senior colleague can more sensitively deal with our sleeping colleague, who may have personal reasons for being asleep

Question 45

Patient complains that you’re on your phone during the consultation. Which is better:
Explain to the patient that you were looking at her observations on your hospital phone
Tell the patient that you were using your hospital phone so that she could receive the best possible care

Answer 45

Explain to the patient that you were looking at her observations on your hospital phone

Question 46

Family is complaining as there relative’s surgery has been cancelled due to an emergency procedure. Pick 3
Option A: “I’m sorry but there is an emergency case that takes priority.”
Option B: “I can see you are upset. I know this must be disappointing.”
Option C: “I agree, this is not the best outcome.”
Option D: “Is there anything else I can do to help?”
Option E: “The registrar/specialty trainee has made the decision; I can not do anything about it I’m afraid.”
Option F: “You can wait to discuss this further with the registrar/specialty trainee if you would prefer?”
Option G: “I understand your frustration but getting angry will not help.”
Option H: “There is no need to shout at me, I can not change anything.”

Answer 46

BDF

Question 47

Lara is going for a meal with one of her patients.
* Option A: Ask to speak to Lara in private to reiterate that her behaviour is unprofessional
* Option B: Advise Lara to tell the patient that she cannot go out for dinner with him
* Option C: Suggest to Lara that she speaks to her other colleagues to see what they think
* Option D: Discuss the situation directly with Lara’s clinical supervisor*
* Option E: Ask Lara if she has previously arranged to meet up with patients outside of work

Answer 47

ABDCE

Ask Lara if she has previously arranged to meet up with patients outside of work as this is outside the scope of your interest as a current colleague and therefore not your responsibility to explore further

Question 48

Patient has dementia and is abusive to you. The consultant asks you to examine the patient.

Option A: Request that the consultant attends the examination of the patient with you
* Option B: Ask your FY1 colleague if she is available to help you examine the patient
* Option C: Ask the consultant if there are any strategies that you could use to manage the patient’s abusive behaviour
* Option D: Inform the consultant that you do not want to conduct the examination following your last experience with the patient
* Option E: Explain to the consultant why you found the interaction with the patient last week extremely challenging

Answer 48

ECBAD

The least appropriate response is (D): Inform the consultant that you do not want to conduct the examination following your last experience with the patient as it may be perceived as unprofessional and it demonstrates a lack of compassion, poor understanding and insight into the signs/symptoms of the patient’s chronic condition (dementia) and how other factors such as sepsis/infection may affect or impact on the patient. This response may be perceived as dereliction of duty, i.e., a clinician failing in their duty of care for a vulnerable patient.

Question 49

Samira is ill but wants to come in to attend teaching sessions. Which is more important:

The ability of Samira to meet her educational needs
Whether there are enough staff to see the patients should Samira be off sick

Answer 49

Samiras educational needs

Options D is not an important consideration in determining if Samira can go off sick, as she is putting others at risk by attending the hospital when she is unwell.