SJT Paper 2 Flashcards
You are attending to Harry, an 89 year old long-term patient requiring palliative care. It has been recorded in Harry’s medical notes that he will be transferred from the hospital to a nursing home within the next few days and he has agreed to this management plan. Later on during the day, Harry informs you that he has changed his mind and no longer wants to move to the nursing home.
Rank in order the appropriateness of the following actions in response to this situation.
A. Explain to Harry that a nursing home is better suited to his needs
B. Ask Harry why he has changed his mind
C. Explain to Harry that the nurses are too busy to meet his needs in the busy hospital environment
D. Inform your consultant that Harry is unsure about going to a nursing home
E. Ask Harry’s relatives to come in and discuss his options with him
Answer: BDEAC
Rationale: This question is about maintaining the patient as the central focus of care and hence the first thing that should be done is to understand why Harry has changed his mind (B). It would be important to understand his situation and this should be the priority, which may also inform any future action. It would be important for the consultant to be advised that the
patient is unsure as the consultant is in charge of the patient (D) and the discharge may have been agreed between them. There is nothing to say relatives have been involved previously, hence speaking to them is less appropriate than approaching the consultant. It may be appropriate to discuss options with Harry’s relatives (E) but only once Harry has made his wishes clear as to whether he consents to his family being involved in the decision-making process. Simply explaining to Harry that a nursing home is better suited to his needs (A) may be appropriate as a later action if Harry’s wishes as to where he wants to be looked after are not realistic - however, there is nothing in the scenario which suggests this may be the case. Finally, explaining that the hospital nurses are too busy (C) undermines
Harry’s confidence in the nurses caring for him for the remainder of the admission and fails to acknowledge that his wishes have change so it is least appropriate
Mrs Jenson has arthritis and works in the pharmaceutical industry. She appears very well informed about her arthritis medication. She tells you that she can show
you evidence that using double the recommended dose of her current medication will be safe for her and will allow her to return to her job more quickly. She asks
you to prescribe to her double the recommended dose.
Rank in order the appropriateness of the following actions in response to this
situation
A. Advise Mrs Jenson that if she chooses to self administer the double dose she is going against medical advice
B. Tell Mrs Jenson that you cannot prescribe more than the recommended dose without senior consultation
C. Ask your consultant to speak with Mrs Jenson
D. Ask Mrs Jenson to show you the evidence that she cites
E. Seek advice from the ward pharmacist
Answer: BECDA
Rationale: This question tests your ability to respond to an inappropriate request from a patient for an inappropriate dose of a medication. (B) is the
most appropriate answer - whilst senior doctors occasionally provide alternative doses of level, as a foundation doctor it is neither safe nor appropriate to make that decision yourself. (E) provides appropriate
additional input from a more experienced colleague but is likely to just confirm the correct course of action (B) rather than initiating it, making it a less direct route to resolution. (C) provides appropriate input for the patient
but will take time to provide, and is again less direct than (B). (D) may provide interesting information and demonstrates you are responding to Mrs Jenson’s query but won’t change your response. Option (A) addresses none of the issues raised by the condition – acknowledging selfadministration without taking action is an unsafe response.
You and an FY1 doctor, Lorraine, are on your first rotation at the hospital. Since beginning this rotation three weeks ago, you have noticed that Lorraine is always eager to undertake additional ward tasks that are delegated by the consultant. As a result of completing too many tasks, Lorraine is staying several hours after her shift should finish every day. Lorraine often appears to be tired, and you have noticed a decrease in the quality of her work. When you sensitively raise this with Lorraine, she informs you that you must be mistaken and appears to be offended. The quality of her work has not improved since your last conversation and you must decide whether you will discuss the matter with her again.
Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important).
A. The likelihood of effectively improving Lorraine’s quality of work by speaking to her for a second time
B. Maintaining the quality of patient care
C. The timely completion of all ward tasks
D. The way Lorraine reacted when you have raised the issue with her last time
E. The extent that Lorraine understands that her tiredness could be affecting patient safety
Answer: BAECD
Rationale: This is about maintaining the quality of care for patients on your ward (B) and helping Lorraine improve the quality of her work (A). Lorraine may not appreciate that her tiredness could affect patient safety and this should be discussed tactfully so that she is aware of the impact this may have (E). Timely completion of ward tasks is desirable but not at the expense of potential errors (C). The previous conversation should not be a deterrent to addressing the issue again (D).
Your FY1 colleague, Amirah, has been working alongside you during a busy night shift. You have both been on-call for the last seven hours without a break or meal. Amirah has complained about feeling dizzy throughout the shift. Amirah tells you that she needs to go and lie down but suddenly she faints in the middle of the ward. She regains consciousness two minutes later.
Rank the order in which the following tasks should be undertaken (1= Do first; 5= Do last).
A. Discuss with Amirah whether she will be able to undertake her remaining tasks for the day
B. Ask a nurse to help you transfer Amirah onto an available bed
C. Alert your specialty trainee* of the incident
D. Speak to the patients on the ward and reassure them that they will be seen to soon
E. Give Amirah a blanket and a cup of water
Answer: BECDA
Rationale: Just as you would approach an unwell patient, the first step here is to ensure your colleague is stable and that they are in a safe and appropriate place, therefore moving her onto a bed (B) is the first priority. Making her comfortable and addressing any possible causes for her faint (dehydration etc) would be the next logical step (E). Once you have done this, making your senior aware of what has happened should be the next priority (C), as they may wish to speak with Amirah directly to check she is okay and they may need to make alternative arrangements for the rest of the shift (directing flow of tasks, arranging cover). As this event occurred on a ward, it is likely that patients will have witnessed it and may be concerned. Reassuring them about the situation and that they will be seen as soon as possible should happen once the immediate concerns have been addressed (D). Finally, once your colleague has had chance to recover from her faint, it would be appropriate to ask how she is feeling and whether she feels able to continue with work (A).
You are working on a busy ward, completing some administrative tasks for your consultant, Dr Findlay. She has asked you to complete some discharge letters which should have been sent out a week ago. A new patient is admitted to the ward and the senior nurse asks you to assess him, as your colleagues are all busy completing other tasks. When you explain that you are currently completing the discharge letters for Dr Findlay, the nurse suggests that you ask the fourth year medical student on the ward to assess the patient instead.
Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important).
A. The medical student’s confidence to assess the patient independently
B. The medical student’s level of clinical competence to assess the patient effectively
C. The discharge letters should have been completed a week ago
D. The urgency for the patient to be assessed is not yet clear
E. The possible time delay before the senior nurse is able to find another available colleague to assess the patient
Answer: BAECD
Rationale: This question is about prioritisation. The medical student’s competence to assess the patient should first be established (B) as not only would it impact patient safety but the medical student’s initial findings could help you to establish the urgency for a full assessment of the patient. The medical student’s level of confidence is also important although it is secondary to their competence (A). As all your colleagues are busy, there is a risk that the senior nurse may not find another available colleague to assess the patient soon enough (E) thereby risking clinical delay. 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
You are observing your specialty trainee*, Allan, in an operating theatre, working with a large team on a complex procedure. The patient begins to deteriorate unexpectedly and the team is under pressure to resolve the situation quickly. As all members of the team are working, Allan begins to use some extremely bad language while talking to another team member. The team member appears to be shocked by Allan’s remarks but does not respond to it and continues to focus on the procedure. You must decide whether to speak up about Allan’s behaviour immediately.
Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important).
A. Allan’s likely intention to be offensive given that he is under pressure to resolve the situation quickly
B. The team member’s reason for not responding to Allan’s remarks
C. The disruption that your interjection may cause to the procedure
D. All healthcare professionals are entitled to work in a respectful environment at all times
E. The impact on other team members if Allan continues to use similar language during the rest of the procedure
Answer: DECBA
Rationale: This question tests your ability to respond to unprofessional behaviour in a clinical situation. The most important consideration in management of your response here is the right for colleagues to work in a respectful environment), thinking about the impact that Alan’s outburst may have on this environment (D). This is followed by a consideration of how uncomfortable colleagues may become and the impact on their performance for the rest of the procedure (E). The impact of interjecting (C) should then be considered -whilst this behaviour clearly should be challenged, the priority is to complete the complex procedure. This may mean than considering when it is most appropriate to interject (for example during a break or after the procedure is complete) should be considered. The team members rationale for not responding is an issue (B) but is less important than the broader issues of a respectful workplace environment and safe completion of the procedure. Finally, (A) offers a partial justification rather than a consideration so is least likely to influence your management of the situation.
You are browsing your social media page in the evening and notice that your FY1 doctor colleague and good friend, Neal, has written a post. Neal writes that he has had a very long day in theatre today, with a patient who had a big bleed. Although there are no direct patient details in Neal’s post, you are aware that it would be possible to identify the patient from the details regarding her bleed, and the fact that the surgery occurred earlier today. The patient is still currently on the ward. As Neal’s social media page is set for public viewing, individuals who are not direct contacts are able to read Neal’s post.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Contact Neal, advising him to remove the social media post
B. When you next see Neal, suggest that he removes the social media post
C. Tell Neal that posting about a patient on social media is unprofessional
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: ACBDE
Rationale: In this case the post should be removed as a priority (A) and Neal needs to be reminded that this kind of post is unprofessional (C). Waiting to see Neal in person could take time so it is less effective (B). It may be appropriate for Neal to discuss this with his clinical supervisor but involving the on call consultant it is unlikely to be helpful (D). 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.
Your fellow FY1 doctor, Katrina, regularly arrives at work late and, consequently, often misses morning ward rounds. During these ward rounds, the consultant provides direction to the team regarding the tasks to be completed for the day. You and members of the healthcare team make notes and discuss the allocation of the tasks based on the consultant’s direction. Katrina asks you for an update on the allocation of ward tasks when she arrives at work late. This causes significant delays to the completion of the tasks that have been assigned to you.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Ask the consultant to delay the ward round until Katrina arrives
B. Make separate notes for Katrina to refer to when she arrives, regarding the tasks assigned to her
C. Discuss with Katrina methods that may help to improve her punctuality
D. Suggest to Katrina that she should ask another member of the healthcare team to provide her with ward round updates
E. Discuss Katrina’s repeated lateness with a senior colleague
Answer: CEBDA
Rationale: As is often the case, the most appropriate method to address this problem is to discuss your concerns directly with the individual involved (C). If you can offer any advice that may help, then that should be your first approach. It would also be appropriate to escalate your concerns to a senior colleague for their input (E). It is less appropriate to make notes for your colleague, as this fails to address the problem of her punctuality and creates increased workload for yourself (B), however it is preferable to shifting the handover to another member of the team (D). Delaying a ward round to wait for a repeatedly late member of the team is not appropriate as it fails to address the actual problem, and delays the entire team (A).
You have been completing an audit with another FY1 doctor, Zara. You are near the end of your rotation and have only collected half of the data; there are two wards remaining to collect data from. You and Zara have both observed that a general trend has emerged in the data that you have collected so far. One morning, Zara informs you that she has fabricated the rest of the data, based on the trend that had emerged in the existing data, and that she has submitted the report to your joint clinical supervisor*, Dr Hadi. The following week, Dr Hadi informs you that she is very pleased with the audit and wants both you and Zara to attend an international conference to present the findings
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Inform Dr Hadi that the data was fabricated by Zara
B. Tell Dr Hadi that you did not have any input into the audit so Zara should attend the conference alone
C. Tell Dr Hadi that there was a mistake with the data, so you and Zara will need to collect some more before presenting at the conference
D. Attend the conference with Zara, but refuse to present any of the findings
E. Suggest to Zara that she admits to Dr Hadi that she fabricated the data
Answer: EACBD
Rationale: This question tests your probity. (E) addresses the probity issue and is the most appropriate response as it allows the individual responsible to take ownership and responsibility for their behaviour. (A) addresses the probity issue but doesn’t create the opportunity for Zara to admit her mistakes which is the preferred option. If she won’t inform Dr Hadi it is the most appropriate next action. (C) ensures that you aren’t involved in delivering fraudulent data but doesn’t address the key issue. (B) ensures that you aren’t involved but directly permits fraudulent data to be presented, which potentially creates a fitness to practise issue for you and Zara. (D) doesn’t address any of the issues and not taking any action at all clearly implicates you in the delivery of fraudulent data. This is the least appropriate response.
You are working on a surgical ward and are due to assist your consultant in theatre with a gallbladder removal. The consultant has completed seven hours of a shift without eating or drinking anything. During a conversation with him shortly before the surgery, you notice that he appears to be having difficulty concentrating on what you are saying and that his hands are shaking slightly. You are aware that there may be implications for patient safety if the consultant carries out the surgery when he is not able to perform to the best of his ability.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Explain your concerns to the consultant
B. Raise your concerns in the surgical team’s pre-operative discussion
C. Continue with the surgery and discuss the incident with your clinical supervisor* afterwards
D. Bleep* the on-call consultant, explaining the situation and asking for advice on what to do
E. Suggest to the consultant that another doctor carries out the surgery
Answer: ADEBC
Rationale: (A) is the most appropriate response as this involves speaking to the person directly. (D) is also appropriate as this raises an appropriate concern and ensures senior, supportive input. It is also most likely to achieve the desired outcome with the least potential difficulty. (E) addresses patient safety but is less direct in that it doesn’t explain to the consultant why you are concerned. (B) is an even more indirect route but ensures patient safety. (C) does not address the patient safety issue.
In your hospital, if members of staff make more than three errors when labelling blood bottles they are required to attend training to learn how to do this correctly. Your FY1 doctor colleague, Declan, has been required to attend this training three times as he has made repeated labelling errors. Despite this, Declan says to you, “It shouldn’t be my job to label blood bottles anyway, so I don’t pay attention”.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Inform Declan that incorrectly labelling blood bottles could have an adverse impact on patients
B. Offer to label blood bottles for Declan in future
C. Tell Declan’s clinical supervisor* about his comment
D. Advise Declan to speak to his clinical supervisor about his repeated labelling errors
E. Tell Declan that he should be more careful when labelling blood bottles
Answer: ADECB
Rationale: This question addresses professionalism. All doctors have to complete mundane but patient safety critical tasks. In this case pointing out that errors in this task may affect patient safety would be a good start (A). Advising Declan to discuss his concerns with his clinical supervisor allows him to address what might be a genuine issue about resources and phlebotomy in the service (D). Reminding him to be more careful can be tactfully done (E) and failing that you have a responsibility to discuss it with his supervisor as a patient safety issue (C). Offering to label the bottles avoids the issue and reinforces Declan’s behaviour (B).
You are the only doctor on a ward. A patient, who is talking to one of the nurses, starts to raise his voice. He tells the nurse that he is hungry, as he has not eaten for two days due to his surgery being delayed. He is being very loud and beginning to disturb the other patients on the ward. You do not know the history of this patient, other than the fact that his surgery has been delayed. You do not know why it has been delayed.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Suggest to the nurse that she should attempt to calm the patient as he is disturbing other patients
B. Explain to the patient that you are sorry that he is hungry but he cannot eat as he is due to have surgery
C. Explain to the patient that he should calm down as he is disturbing the other patients on the ward
D. Explain to the patient that you are sorry that he has had to wait for two days and you will try and find out when his surgery will be
E. Reassure the patient that he will have his surgery soon and that he will be able to eat in the next few hours
Answer: DB[AC]E
Rationale: This question tests your ability to respond to an agitated patient admitted to hospital. The most appropriate option is (D) as this is the only one that addresses directly the patient’s legitimate concerns. Whilst (B) is similar, it is only a partial response to the issues. It explains why the patient cannot eat but does not address the underlying issue of when he will receive the delayed surgery. (A) and (C) are both legitimate issues to address but they cannot be addressed in isolation. As neither deals with the issue of why the surgery is delayed or when the patient can eat they are unlikely to resolve the situation. (E) is the most inappropriate option as you are promising something that you do not know you can deliver, which is unprofessional. If the surgery is cancelled again this is likely to upset the patient further and lead to a formal complaint which you may be implicated in.
One of your patients, Roisin, who you have been looking after on the Cardiology ward, invites you to attend her birthday party at her home next weekend. You have been on the medical team that has been looking after Roisin for the past two months, and she is due to be discharged tomorrow. You do not have any plans for next weekend; however, you are aware that it is inappropriate to see a patient socially outside of work.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Thank Roisin for the invitation but explain that it would not be appropriate for you to attend
B. Invite other individuals from the medical team that has looked after Roisin to attend the party with you
C. Politely decline Roisin’s invitation, saying that you cannot attend
D. Ask another doctor on the ward to manage Roisin’s care until she is discharged
E. Explain that you are unable to attend, but buy Roisin a small gift
Answer: ACDEB
Rationale: This question explores professional boundaries between a doctor and their patient. The most appropriate action is to maintain an appropriate professional boundary and give Roisin an explanation as to why you cannot attend (A). Declining to attend without an explanation (C) would maintain the required boundary, but without an explanation it may upset Roisin or cause her to repeat the request at a later time. Asking another doctor on the ward to manage Roisin’s care until she is discharged does not adequately address the invitation (D) and may similarly cause her to repeat her request. Explaining you are unable to attend without explanation and buying a gift (E) conveys a mixed message and would most likely be viewed as inappropriate. It is clearly not appropriate to attend the party (B). Inviting other members of the healthcare team compounds the blurring of professional boundaries.
Your specialty trainee, Kimberley, informs you that at the weekend she was issued with a speeding ticket by the police. You were on-call at the weekend and Kimberley was not working. She states that in order to avoid having to pay the speeding fine, she informed the police that she was working on-call and was caught speeding while driving to the hospital to deal with an emergency. Kimberley asks you to corroborate her story and inform the hospital rota coordinator that she was working at the weekend.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Advise Kimberley to tell the police the truth about the situation
B. Inform your clinical supervisor* of Kimberley’s request, without naming her, seeking his advice on how to proceed
C. Inform the police that Kimberley was not working on-call at the weekend
D. Decline Kimberley’s request
E. Explain to Kimberley why her request is inappropriate
Answer: AD[BE]C
Rationale: This question tests your probity and professionalism, and in practice a situation like this one would be viewed very seriously by the GMC. The best option would be to advise your colleague that she should be honest with the police (A) as this addresses the underlying issue of dishonesty. Failing this, it would also be appropriate to simply decline your colleague’s request to lie (D), though this does not directly challenge the problem. Seeking advice from a senior colleague would also be acceptable (B) though an FY1 would be expected to recognise themselves that lying for a colleague is not acceptable. Explaining to Kimberley why her request is inappropriate may be helpful after you have addressed the immediate concerns although does not involve declining the request (E). Lying to the police is simply not appropriate (C)
You are on a ward round with your consultant and the surgical specialty trainee*. Mr Ahmadi is due to have an elective resection of a colonic tumour. Your consultant confirms tomorrow’s theatre list, placing Mr Ahmadi first, as he wants to be present for the case. After your consultant has left for the day you realise that he did not notice Mr Ahmadi is taking warfarin for atrial fibrillation, which will increase the risk of haemorrhage during the procedure. The surgical specialty trainee is still on shift, as is the anaesthetist, who is due to do the theatre list.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Raise the problem at the consultant pre-operative ward round
B. Inform the surgical specialty trainee of the problem
C. Inform theatre that Mr Ahmadi’s case needs to be cancelled
D. Discuss the situation with the anaesthetist who is doing the list with your consultant
E. Contact your consultant on his mobile telephone to inform him of the situation
Answer: BDEAC
Rationale: The most appropriate option here is to discuss the problem with your specialty trainee (B) who will be able to advise you how to proceed. Failing this, discussing the situation with the anaesthetist would also be appropriate (D). 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 (E). Waiting until the preoperative ward round leaves little time to correct the situation and may compromise patient care (A). You do not know yet if the operation needs to be cancelled and it would be inappropriate for you to make this decision (C).
You are completing a ward round in the Acute Admissions Unit* (AAU). During the ward round your consultant repeatedly questions the patient management plans of the specialty trainee, Craig. At the end of the ward round you hear the consultant telling Craig that he is not suitable to work in acute medicine. The consultant is then called away to attend to an emergency. Craig appears to be upset and leaves the ward. You are unable to contact Craig on his hospital bleep. There are unwell patients arriving, on whom you need to seek his advice.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Leave the ward to attempt to locate Craig, and ask that he returns to the ward
B. Report Craig to the medical director* for leaving the AAU
C. Seek advice regarding the new patients from another specialty trainee working on the AAU
D. Telephone the consultant, explaining the situation to her and request that she attends the AAU as soon as possible to assist with the new patients
E. Discuss how best to deal with the new patients with the other FY1 doctors on the AAU
Answer: CDEAB
Rationale: This question looks at maintaining the safety of patients when a senior colleague is unavailable. Given that you know Craig is upset and has left the ward, he may be unable or feel unsafe to work until he is less upset. In this circumstance, seeking another specialty trainee (C) would be a reasonable initial response. If this was not possible to maintain safety, contacting the consultant (D) would be the next step in escalation to maintain safety. Discussing with other FY1 doctors (E) may be helpful but is ultimately not an acceptable substitute for a senior opinion for unwell patients. Leaving the ward (A) compounds this issue of safety by leaving the AAU with one less doctor and a lack of senior support. Finally reporting Craig (B) to the medical director is an inappropriate initial action to take as it doesn’t resolve the patient safety issue and would not be the right level at which such a concern should be raised initially.
Your consultant has asked you to take an urgent blood sample from a 65 year old female patient. Five of the patient’s adult children are visiting her and start complaining to you about the care that their mother is receiving and criticising the hospital. Although the relatives are not aggressive, they are being loud and rude and their behaviour is delaying you in taking the patient’s blood sample.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Ask the relatives to be quiet whilst you take the blood sample
B. Ignore the relative’s comments whilst you take the blood sample
C. Ask a nurse to take the blood sample whilst you talk to the relatives elsewhere
D. Ask the relatives to leave whilst you take the blood sample and offer to speak to them afterwards
E. Wait for the relatives to leave, then take the blood sample
Answer: DCABE
Rationale: This question is testing your ability to prioritise safe patient care in a difficult situation. Your priority at work is the patient safety and ensuring high quality care - (D) ensures that the urgent patient care is delivered timeously. (C) will also deliver patient care but involves other staff and may take more time. (A) delivers safe patient care but doesn’t defuse a stressful situation. Further, it doesn’t maintain patient privacy and puts added pressure on the procedure. (B) is likely to exacerbate the situation further - not communicating with the relatives is likely to add to their anger as they will feel ignored. (E) delays timely and safe patient care as well as not addressing the family, which is why it is the least appropriate answer.
Whilst working in the Medical Assessment Unit, you treated a patient for an asthma attack. The patient made a good recovery and was discharged from hospital last week. Today, you receive a short complimentary message from the patient through social media, thanking you for your care. The patient also sends you a friend request on social media.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Ignore the message and friend request on social media
B. Print an anonymised copy of the complimentary message for your development portfolio
C. Respond through social media, asking how the patient’s asthma has been since discharge
D. Talk to your educational supervisor* to reflect on the situation
E. Decline the friend request, politely explain via social media that any further contact would be inappropriate
Answer: EADBC
Rationale: This question is about understanding the boundaries of patient contact via social media in the context of GMC social media guidance. The most appropriate response is (E) as this would hopefully prevent any further contact from arising. It would also be appropriate to simply ignore the request (A), however this does not provide an explanation for the patient, and they may repeat the request at a later time. If unsure what to do, the next most appropriate choice would be to seek senior advice (D). Whilst it would be nice to place the comment in a portfolio (B), this is less appropriate than the first two options and may require consent. Discussing medical conditions via social media (C) is inappropriate.
This is your first post on a busy surgical rotation, and you are struggling with your workload. You have been assigned a combined clinical and educational supervisor, Mr Jones, for your placement. So far you have emailed Mr Jones twice, with no response, and your initial induction meeting was due two months ago.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Refrain from attempting to make contact with Mr Jones, waiting for him to contact you
B. Report to the Foundation Programme Director the lack of response from Mr Jones
C. Contact Mr Jones’ secretary, in order to find Mr Jones and discuss your induction meeting
D. Ask the Foundation Programme Director to assign you a new educational supervisor
E. Ask the hospital switchboard* to transfer your call to Mr Jones’ mobile telephone number
Answer: CBEDA
Rationale: This scenario is asking you to rank the appropriateness of a series of steps to ensure you receive and are able to evidence your essential supervision meetings as an FY1 doctor. Whilst the question does not specify why Mr. Jones has not been in contact, attempting to reach him through his secretary (C) is the most appropriate initial step. Highlighting your difficulty to the Foundation Programme director is also important (B) - as they may be able to support you in obtaining a response and they need to be aware of the issue. The Foundation Programme Director’s awareness of the problem and the steps you have taken to resolve it will prevent the delayed meeting reflecting badly on you, which could potentially impact on your progression through the foundation programme. Option (E) is an alternate method of contacting your supervisor but is likely to be less appropriate than seeking information through Mr Jones secretary of when he might be available. Similarly, requesting an alternate educational supervisor (D) is not unreasonable but is a final resort if a meeting cannot be arranged with Mr Jones with the support of the Foundation Programme Director. Taking no action here (A) is not an appropriate response as there is a risk that no meeting will occur at all. This would reflect poorly on you and is likely to have an impact on your progression through training
You recently attended a training session, which highlighted the importance of keeping accurate patient records for medical care and legal purposes. Your specialty trainee* with whom you regularly work also emphasises this frequently. While working with a consultant you notice that he is writing patient records but is not recording the time and date on the records at the time of creation. He is subsequently revisiting some of the records and estimating the times and dates before submitting them to the archive.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Explain to the consultant that his record keeping is inadequate
B. Search the archive for those records that the consultant has not fully completed, to show to a senior colleague
C. Speak to the consultant about the recent training session highlighting the importance of completing accurate records
D. Discuss the consultant’s behaviour with your specialty trainee, asking what form of action he would advise
E. Return to the notes to record the correct time that the consultant wrote his notes
Answer: CDABE
Rationale: This question relates to the importance of accurate and timely documentation, and the difficulties posed when you are concerned about conduct of a senior member of the team. Politely addressing the consultant directly is the most appropriate approach as it addresses the problem and involves fewer additional and unnecessary members of the team in the situation (C). You are able to use your recent training session as a starter for the conversation. Option D and A are both reasonable approaches, though telling the consultant that his record keeping is inadequate is blunt and likely to cause offence. Therefore, escalating your concerns to your specialty trainee and asking for advice about how to proceed (D) is more appropriate than a confrontational conversation with your consultant (A). Searching through all relevant records would involve a huge amount a work and time on your part, and is not really required in order to raise your concerns. Passing on your concerns to somebody else in the team is not the best approach as it does not directly address the problem (B), though it is slightly more appropriate than retrospectively adding to your consultant’s notes (E), which constitutes a potential probity issue and does nothing to address and correct the overall problem (which is the consultant’s documentation skills).
You have been called by a general medical ward consultant, Dr Patrick, to help cover the ward, which is extremely busy. The FY2 doctor, Chantelle, gives you a list of three patients on the ward who require blood tests urgently. Their samples need to be processed in the next hour and the results will be used to inform a management plan. While you are taking blood from one patient, a senior nurse, Reuben, informs you that you need to examine another patient immediately as she is a relative of one of the surgical consultants. When you read this patient’s notes, there is no clinical urgency to examine the patient.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Tell Reuben that, at the moment, you must prioritise taking the blood samples
B. Ask Chantelle whether you should continue taking blood samples or examine the patient
C. Tell Reuben that you will examine the patient once you have taken all the blood samples
D. Ask Dr Patrick to examine the patient next, explaining that she is a relative of the surgical consultant
E. Examine the patient, as Reuben requested
Answer: CABDE
Rationale: This question looks at managing the request for preferential treatment for a patient by a team member while you need to complete urgent patient tasks. It is clear that the blood samples have been identified as urgent, they would therefore take priority over the non-urgent task. (C) conveys this and reassures Reuben that it will be dealt with when you are available; it is therefore the most appropriate response. (A) conveys the urgency and need to take blood samples but is less appropriate as it does not address Reuben’s query specifically. Seeking clarification from the FY2 (B) is reasonable if you are unsure what to do - however, in this case the prioritisation of the blood samples has already been made clear. Asking Dr Patrick to examine the patient (D) is less appropriate as it has been established that the ward is busy and that examining the patient is a nonurgent task. Finally, simply examining the patient (E) means that you have moved from completing a specific urgent task to a non-urgent task without informing your colleagues. This may please Reuben and the relative of the surgical consultant but has stopped you from completing an urgent task and could place the safety of the patients requiring the urgent blood samples at risk.
You are working on a surgical ward with a specialty trainee* and two other FY1 colleagues. You get on well with your specialty trainee, but have noticed that he often gives you most of the jobs to do rather than delegating the tasks evenly between you and your FY1 colleagues. As a result, you regularly have to work past the end of your shift to complete all the tasks.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Discuss your concerns with the specialty trainee
B. Continue to complete the jobs to the best of your ability
C. Talk to the specialty trainee if the situation has not improved after a month
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: AEDCB
Rationale: This issue assesses your response to a situation when you feel work is being unfairly delegated which is impacting on your ability to leave your shift on time. (A) is the most appropriate response - it allows discussion of the issue and exploration of possible solutions. (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. (C) fails to address the issue in a timely and appropriate manner. (B) doesn’t address the issue and simply maintains the status quo. Over time this could impact on your health and work/life balance, making it the least appropriate response.
You are attending a social gathering at your fellow FY1 doctor, Susanna’s, home when you notice a patient task handover sheet on the kitchen table, with Susanna’s name on it. The document has specific confidential patient information on it.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Inform Susanna that this is a breach of patient confidentiality
B. Advise Susanna to destroy the handover list
C. Report the incident to your consultant the following day
D. Destroy the handover list
E. Advise Susanna to discuss the breach of patient confidentiality with her educational supervisor*
Answer: ABEDC
Rationale: This question focuses on a professional commitment to maintaining patient confidentiality and the sequence of actions required if a colleague had apparently broken this duty of confidentiality to her patients. Susanna may not be aware she has done so, meaning the most appropriate response is to inform her (A). Advising her to destroy the list is important (B) but to do this without an explanation may mean she repeats this action. 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. Reporting the incident to your consultant (C) is the least appropriate answer as this consultant may have no connection to Susanna, or the information. The responsibility to discuss the breach of confidentiality lies with Susanna and her supervising consultant.
Mrs Davies is a patient on the ward. You are informed by a ward nurse that one of her relatives has commented on your attitude towards Mrs Davies. Apparently, she has claimed that you were dismissive of Mrs Davies’ concerns about her treatment and did not spend enough time listening to her. You do not remember the particular incident and it is the first time that you have received any complaints about your attitude.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Approach Mrs Davies and talk to her about any concerns that she has
B. With Mrs Davies’ permission, arrange to meet her relative to discuss her concerns
C. Inform your clinical supervisor* about the situation
D. Seek advice from your Medical Defence Organisation* about how to respond
E. Thank the nurse and inform her that you will reflect upon your communication with patients in the future
Answer: ABCED
Rationale: It is sensible to confirm and corroborate any reported concerns directly with the patient (A), as there may have been a breakdown in communication or misinterpretation along the way. It may also be appropriate to ask the patient for permission to talk to the relative about her concerns, however this is a less direct way of resolving the issue as your responsibility is with the patient (B). It would then be appropriate to escalate this to your clinical supervisor to access support and advice, but it is again less direct than addressing concerns with the patient and her relative (C). Thanking the nurse and informing them that you will reflect on your communication skills is nice, but does not directly address the issue here (E). Similarly, approaching your defence union will not directly address the issue raised and is a drastic action before you obtain more information about the relative’s concerns. Before contacting your defence union, gather a little more information (A and B), and discuss with your supervisor (C), then, if necessary, approach your union (D).
You and an FY1 colleague, Liam, are working a day shift on a ward together. Your senior consultant, Mr Parry, approaches both of you and asks you to assist with a hip replacement operation. You agree to assist and, near the end of the operation, Mr Parry asks you to suture the wound. This is something that you have not done before and you are unsure whether you are competent enough to do it.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Ask Mr Parry to provide instructions and supervise you as you suture the wound
B. Explain to Mr Parry that you do not feel comfortable suturing the patients’ wound
C. Ask Mr Parry whether he will suture the wound so that you can observe
D. Suture the wound to the best of your ability
E. Ask Liam whether he would feel more comfortable to suture the wound instead
Answer: BACED
Rationale: This question is testing your ability to work within the limits of your capability. Explaining to your consultant that you have not performed this skill before and that you do not feel comfortable proceeding is the most appropriate option (B). It is always possible to learn but the consultant should be aware of your level of competency and you should never work above your level of capability. Asking for assistance is another sensible approach, it implies that you are uncertain though you could be clearer about the fact that you have not performed this procedure before (A). Asking for a demonstration is an appropriate approach, though you will not be able to practice the skill yourself (C). Asking a colleague if he would like to perform the skill instead detracts from your own learning opportunity (E), however it is preferable to attempting a task that you are not competent in and comfortable performing (D), which is unsafe and inappropriate.
You are called to help Simon, your specialty trainee*, review a sick patient. When you arrive, the nurse takes you to one side and she tells you that Simon smells of alcohol. You confirm that this is the case. The review is urgent and Simon is needed as you are unable to conduct the review by yourself.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Suggest to the nurse that she asks Simon whether he has been drinking
B. Explain to Simon that he should not conduct the review if he is under the influence of alcohol
C. Contact the consultant immediately to explain the situation
D. Ask a specialty trainee from another ward to review the patient with you
E. Continue with the review, but explain to Simon afterwards that he smells of alcohol
Answer: BDCAE
Rationale: Your initial action is to safeguard the patient, asking your specialty trainee to refrain from any interaction if under the influence of alcohol (B) is appropriate as Simon is directly working with the patient at this time and it is important to safeguard them. It is possible there is an alternative explanation e.g. ketotic breath or contamination of clothing and this allows Simon to take suitable action himself. You should seek help from another specialty trainee to avoid delaying the patient’s review (D) and inform the consultant (C) after prioritising the patient’s needs. Delegating the difficult conversation to your nursing colleague is not appropriate unless the nurse is very senior and has a good working relationship with Simon (A). You should not continue with the review with Simon as this could put the patient at risk (E).
It is 18:00 and you have just been informed by a nurse that a patient, Jane, who has been treated for a chest infection, is ready to be discharged. Jane was ready to go home earlier that day; however, you are aware that there was a delay caused by a lack of hospital transport. Hospital transport is now available and you inform Jane that she can go home. However, Jane refuses, saying that it is too late for her to go home now and that she would prefer to be discharged in the morning. There are no medical reasons why Jane should stay in hospital overnight, and a nurse has just informed you that she has already allocated Jane’s bed to another patient.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Go through Jane’s patient notes to check that there are no outstanding medical issues
B. Ask Jane if she would like a next of kin to accompany her to be discharged
C. Ask the bed manager if they could arrange for Jane to stay for another night in the hospital
D. Explain to Jane that she must be discharged this evening to free up her bed
E. Ask Jane if there is a reason why she does not want to go home this evening
Answer: EBCAD
Rationale: Your initial action should be check with Jane that there is no good reason to prevent her discharge (E). She is assumed to have capacity, so discussion with the patient is the appropriate first response. After ascertaining Jane’s thoughts, it would be supportive to offer to help her inform her next of kin to accompany her to be discharged (B). It would be reasonable to check if a bed is available overnight with the bed manager (C). She was declared fit for discharge earlier so the medical notes should reflect this (A). Discussions about other patients’ needs are seldom helpful in these circumstances and risk giving the impression that the discharge decision has been taken on resource not clinical need grounds (D).
You are working on-call on the Trauma and Orthopaedics ward. You receive a referral from a GP* for her daughter to be admitted to the ward. The GP explains to you that her daughter has sustained a rotator cuff injury to her shoulder through playing sport. You explain to her that she should take her daughter to see their own GP; however, she insists that you accept the referral.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Seek advice from the on-call consultant about whether to accept the GP’s daughter as a referral
B. Re-emphasise to the GP that it is inappropriate for her to refer her own daughter
C. Suggest that the GP take her daughter to the Emergency Department if she needs to be seen urgently
D. Complete a critical incident form* relating to the GP’s inappropriate request
E. Tell the GP that you will accept her daughter’s referral on this occasion only
Answer: BCAED
Rationale: This question tests your ability to respond to an inappropriate request for treatment of another doctor’s family member as the scenario is suggesting that the mother is trying to circumvent normal procedure for her daughter to be seen as a priority. (B) is the most appropriate course of action as per GMC Guidance. (C) advises of the correct referral route if the patient requires urgent assessment. (A) is helpful if you feel you require support to ensure that the correct patient pathway is followed but the GMC guidance makes a clear case for declining this request and (B) remains the most appropriate option. (E) would be against GMC guidance and is therefore a less appropriate answer. It would result in the patient receiving urgent care but it would reinforce inappropriate behaviour. (D) is the least appropriate as this doesn’t help the patient to receive appropriate emergency care and it does not resolve the situation.
