SJT Themes & Notes

Question 1

Themes from GMC GMP - Knowledge, skills

Answer 1

Make care of patient first concern

Provide good standard of practice and care
Keep professional knowledge and skills up to date
Recognised and work within limits of competence

Question 2

Themes from GMC GMP - Safety and Quality

Answer 2

Take prompt action if you think patient safety, dignity or comfort is being compromised

Protect and promote health of patients and public

Question 3

Themes from GMC GMP - Communication and teamwork

Answer 3

Treat patients as individuals and respect their dignity
Treat patients politely and considerately
Respect patients’ right to confidentiality

Work in partnership with patients
Listen to, and respond to, their concerns and preferences
Give patients information they want or need in a way they can understand
Respect patients’ right to reach decisions with you about their treatment and
care
Support patients in caring for themselves to improve and maintain their health

Question 4

Themes from GMC GMP - Maintaining Trust

Answer 4

Be honest and open and act with integrity

Never discriminate unfairly against patients/colleagues

Never abuse patients’ trust in you or the publics’ trust in profession

Question 5

Notes - Domain 1 Knowledge, Skills and Performance

Answer 5

Develop and maintain professional performance
 Be competent in all aspects of work
 Keep professional knowledge and skills up to date
 Regularly take part in activities to maintain and develop competence
 Be familiar with guidelines and developments
 Keep up to date, with law, guidance
 Take steps to monitor and improve the quality of your work
 You should:
 Be willing to find and take part in support opportunities offered by your
employer (mentoring)

Apply knowledge and experience
 Recognise and work within limits of competence
 Assess patient’s condition, provide advice, investigations or treatment and refer
if needed
 Prescribe drugs or treatment, only when adequate knowledge of patient’s
health
 Provide effective treatments based on best available evidence
 Take all steps to alleviate pain and distress when cure not possible
 Respect patient’s right to seek second opinion
 Avoid providing medical care to yourself or anyone with a close relationship
with
 Have consent before examination or investigation

o Record your work clearly, accurately and legibly

Document clear, accurate and legible records, at same time as events or ASAP
Clinical records should include:
o Relevant findings
o Decisions made and actions agreed
o Information given to patient
o Drugs prescribed or investigation/treatment
o Who is making record

Question 6

Notes Domain 2 - Safety and Quality

Answer 6

Contribute to and comply with systems to protect patients
 Take part in reviews and audits of work, take steps to address any problems
and carrying out further training
 Regularly reflect on standards
 Report adverse incidents that put or have potential to put safety of patient, or
another at risk
 Report suspected ADRs

Take prompt actions if patient safety, dignity or comfort compromised:
 If not receiving basic care, you must immediately tell someone who is in
position to act straight away
 If patient at risk because of inadequate premises, equipment or resources you
should put matter right if possible, raise concern and record steps
 If colleagues not fit to practice, ask advice from colleagues, report and record
steps taken

Question 7

Notes Domain 3 - Communication, Partnership and Teamwork

Answer 7

Communicate effectively
 Listen to patients, take account of views and respond honestly
 Give patient information they want or need to know in way they can understand

Teaching, training
 Staff managed have appropriate supervision

Patients
 Be polite and considerate, treat with respect and dignity
 Explain your conscientious objection to procedures, tell them of rights to see another
doctor and make sure enough information available to exercise that right. If not practical
to see another doctor, make sure arrangements are made for suitably qualified
colleague to take over your role

Question 8

Notes Domain 4 - Maintaining Trust

Answer 8

Not use professional position to pursue a sexual or improper emotional relationship with patient
or someone close to them

Not express personal beliefs to patients which may exploit or distress patient

Must be open and honest with patients if things go wrong, if patient under your care has suffered
harm or distress, you should:
 Put matter right (if possible)
 Offer an apology
 Explain fully and promptly what has happened and likely short-term and long-term
effects

Do not deny treatment to patients because their medical condition may put you at risk, if it does,
take all available steps to minimise the risk before providing treatments or making other suitable
alternative arrangements

Respond promptly, fully and honestly to complaints and apologise when appropriate

End professional relationship with patient only when the breakdown of trust between you and
patient means you cannot provide good care

Honest and trustworthy when writing reports and signing forms/documents:
 Take reasonable steps to check information is correct
 Not deliberately leave out relevant information

Question 9

When must you tell the GMC regarding issues?

Answer 9

Must tell GMC without delay if anywhere in world:
 Accepted caution from police or criticised by official inquiry
 Charged with or found guilty of criminal offence
 Another professional body has made a finding against your registration as a result of
fitness to practice procedure

Question 10

What is the rulings on financial dealing?

Answer 10

Be honest in dealings with patients, employers

Not allow interests you have to affect the way you treat, refer patients

If faced with conflict of interest, be open about conflict, declaring interest formally and
exclude yourself in decision making

Not ask for or accept – from patients, colleagues or other – any gift, inducement that
may affect or be seen to affect the way you treat patietns

Question 11

When can confidentiality be broken?

Answer 11

Patient consent

Disclosure is overall benefit to a patient who lacks the capacity to consent
 Assume patient has consent – assess capacity to particular decision at time it needs to
be met (understand, retain, weight up and communicate)
 Make patient first concern, respect dignity, encourage patient to be involved
 If temporary – could you wait until they regain capacity, any previously expressed
preferences, views of legal guardians

Required by law
 Ordered by judge

Justified in public interests
 Protect individuals or society from risks of serious harm/death, crime/communicable
diseases
 Try to seek consent, should tell patient about intention to disclose personal information

Question 12

Key points when breaking confidentiality?

Answer 12

When disclosing information:
o Anonymise information if practical
o Get patients explicit consent
o Keep disclosure to minimum
- If patient cannot be informed of personal information disclosed:
o Inform when regains capacity

Question 13

Key points when sharing information with close ones?

Answer 13

Establish what patient wants – document patient’s wishes

If patient has capacity and refuses permission:
 May be appropriate to reconsider
 Abide by patients’ wishes unless disclosure justified by public interests

If lacks capacity:
 Assume patient wants closest to be kept informed

If close family wants to discuss concerns about patient’s health without involving patient, do not
refuse to listen on grounds of confidentiality however you might need to tell patient about
information received and do not disclose personal information

Question 14

Key points for disclosing to protect adults without capacity?

Answer 14

Disclose if required by law, or you believe patient is experiencing or at risk of neglect,
physical/sexual/emotional abuse or other kind of serious harm

Question 15

What are the rights of adults with capacity?

Answer 15

Rights of adults with capacity to make their own decisions:
o Ask consent before disclosing
o If patient refuses – explore reasons and may be appropriate to encourage patient to consent and
warm of risks of not consenting
o If patient refuses – abide by wishes, even if it leaves them at risk of death or serious harm

Question 16

What are the factors with disclosing information to protect others?

Answer 16

Legal requirements
 Notification of infectious diseases and prevention of terrorism

In public interest
 Crimes, patient not fit to drive, communicable disease, not fit for work

 Consider:
 Potential harm to patient arising from disclosure
 Potential harm to trust in doctors
 Potential harm to others
 Potential benefits to individual or society
 Nature of information to be disclosed
 Whether harms can be avoided or benefits gained without breaching patient’s
privacy

Question 17

Key points with consent to sharing information and when people does not want to know results?

Answer 17

Sharing information and treatment options, consider:
o Needs, wishes and priorities
o Level of knowledge
o Nature of condition
o Complexity of treatment
o Nature and level of risk associated with investigation or treatment

If patient does not want to know detail about condition/treatment:
o Find out why they don’t
o Respect their wishes

Question 18

When is a person assumed to have capacity?

Answer 18

Presume capacity in all adults > 16 years old

Children < 16 may have capacity if mature enough and able to demonstrate capacity

Assessment capacity
o Understand, retain, weigh up and communicate
o If unsure, ask nursing staff or other involved in patients care, or those close to patient

Making decisions about treatment if lack capacity:
o Care of your patient your first concern
o Treat patients with respect
o Encourage patients to be involved
o Consider:
 Whether capacity is temporary or permanent
 Least restrictive option
 Evidence of previously expressed preferences (advanced statements or decision)
 View of legal authority to make decision
 Best interests

Question 19

When to report critical incidents?

Answer 19

Unexpected or avoidable death

Serious harm to patients, staff, visitors (outcome requires life-saving interventions, major
interventions, permanent harm or shorten life-expectancy or prolonged pain)

Allegations of abuse

Never event

Question 20

Common types of never events?

Answer 20

 Wrong surgical site
 Wrong implant
 Retained foreign object post-operation
 Wrongly prepared high-risk injectable medication
 Maladministration of potassium-containing sodium
 Wrong route of chemotherapy
 Wrong route of oral/enteral treatment
 IV administration of epidural medication
 Maladministration of insulin
 Overdose of midazolam during sedation
 Opioid overdose in naïve patient
 Inappropriate administration of daily oral methotrexate
 Suicide using non-collapsible rails
 Escape of transferred prisoner
 Falls from windows
 Entrapment in bedrails
 Transfusion of ABO-incompatible blood
 Transplant of ABO incompatible organs
 Misplaced naso-gastric tube
 Wrong gas administrated
 Air embolism
 Misidentified patients
 Scalding patient
 Maternal death due to PPH after elective C-section

Question 21

Order of action when raising concerns?

Answer 21

Raise concerns promptly
o With senior (SHO, registrar, consultant)

Question 22

Key points from gifts/donations

Answer 22

• Not encourage gifts
• May accept gifts from patients if:
  o Does not affect, way you treat patient
  o Not used your influence to pressurise or persuade patients or their relative to offer gifts
• Refuse gifts that may be seen as an abuse of trust

Question 23

Ending a relationship with a patient - before and when you decide?

Answer 23

Before you end professional relationship:
o Warn patient you are considering ending relationship
o Do what you can to restore relationship
o Explore alternatives to ending
o Discuss situation with experienced colleague

If you decide to end professional relationship:
o Patient is told
o Record decision
o Ensure continuing care for patient

Question 24

Maintaining professional boundaries with patient - key points on current and former patients?

Answer 24

Patients are not a potential sexual partner

Current patients
o Not pursue sexual or improper emotional relationship with current patient
o If patient pursues this, treat them politely and try to re-establish professional boundary, if broken
down then end relationship
o Not pursue someone close to patient
o Not end professional relationship to pursue personal relationship with them

Former patients
o Consider:
 Length of time since professional relationship
 Nature of previous relationship
 Whether patient was vulnerable
 Whether you will be caring for family members

Question 25

Key point on sexual behaviour

Answer 25

Sexual Behaviour and duty to report colleagues

Never make sexual advance towards patients

Question 26

Key points on DVLA advice and concerns?

Answer 26

Driver legally responsible for telling DVLA – remind them of this

If patient is unfit to drive but continues:
o Tell them you may be obliged to disclose this to DVLA if continue to drive
o Inform DVLA – tell patient in writing and spoken word

Question 27

Key points in confidentiality - gunshot and wounds?

Answer 27

Police informed whenever person presents with gunshot wound (even accidental) and wound from knife
attack with knife, blade

Police not informed:
o If knife/blade injury appears to be an accident or self-harm

Question 28

Key points on openness when apologising to patient?

Answer 28

When to apologise to patient:
o If something has gone wrong, and after doing what you can to put matters right

Speak as soon as possible when you realise something has gone wrong

If a near miss, discuss with patient

Question 29

Points on conscientious objection

Answer 29

o Explain you have an objection
o Explain patient right to see another doctor
o Ensure patient has access to relevant healthcare professional

Question 30

Points on relationship with patients online?

Answer 30

o Decline friend request
o Not responding online
o Tell someone at practice
o Don’t necessarily have to terminate doctor-patient relationship

Question 31

Clinical Incident Form- what to report?

Answer 31

Any adverse incident what the potential to produce unwanted effects, or any incident
which has a learning point

Any incident which causes loss, injury or near miss to patient/staff or others

Examples
 Clinical – medication, poor transfers of care, infection issues, medical device
failure, delay in treatment, unexpected outcomes, pressure sores
 Environmental – accidents, violence/aggression
 Professional – records, breaches in confidentiality, standards
 Service – loss of service, loss of data

Question 32

Process of incident reporting - steps to take?

Answer 32

 Incident occurs
 Take immediate actions to prevent harm
 Inform person in charge
 Take further immediate action
 Complete incident form
 Incident review, inclusion in system

Question 33

Key Points on Illness in Job?

Answer 33

Follow hospital policies
 D&V – sick leave until 48 hours after symptoms resolved

Inform one of your team

Inform medical staffing

Question 34

Key Points on Child Protection

Answer 34

If you have concerns that a child or young person is being abused or neglected, inform Child
Protection services

Can remain anonymous but your details can be useful and never disclosed to suspected

Question 35

When to use Yellow Card Reporting System?

Answer 35

 ADRs to medications, vaccines, blood factors, herbal/homeopathic medications
 Medical devices
 Defective medicines

Question 36

Key points of Foundation Doctors - members of support?

Answer 36

Clinical supervisors (consultant looking after you) – responsible for clinical issues

Educational supervisor – personal issues, follow through FY1 year

FY1 cannot do FP10 prescriptions

FY not allowed to discharge
o Unless senior review and part of plan
o If patient requesting discharge
 Assess capacity
 Discuss risks and benefits
 Advise GP and follow up blood tests

Question 37

Key Themes to communication and conflicts

Answer 37

• Avoid arguments
• Address problem directly
• Solve the problem yourself if possible
• Patient safety is first and foremostK

Question 38

Key Themes to Gifts

Answer 38

o Honest, don’t let it affect management or treatment or patient interaction
o If significant amount, must accept and register as organisation

Question 39

Key Point to Consent to procedures

Answer 39

Must know procedure, benefits + risks in depth OR be able to do procedure

Question 40

Key Themes to Errors

Answer 40

Ensure patient safety
 If no harm done – stop harm
 If adverse effect – minimise harm
 If near miss – address and inform patient, inform direct superior

Apologise to patient

Avoid excuses

Question 41

Key Themes - Best Interests

Answer 41

Always assume capacity in > 16

Must prove no capacity – best interests’ decision
 If life-threatening – act in BI, least restrictive option to save life

Question 42

Key Themes to Handover

Answer 42

o Should be in person
o Failing that, to another doctor involved in direct care (SHO)
o Avoid members not involved
o If not, leave entry in patient notes

Question 43

Key Themes to leaving late

Answer 43

o If finite time and not regular – stay and help
o If not specific time and regularly late – not appropriate to stay

Question 44

Key points to escalation

Answer 44

o Up your escalation ladder (your team)
o If personal – clinical and educational supervisor
o External – only if tried escalating up your team

Question 45

What is Gillick Competence?

Answer 45

A child under the age of 16 can consent to treatment/investigations if they have sufficient understanding and intelligence to fully understand what is involved in proposed treatment (including purpose, nature, effects, risks and chance of success and other options)

If a child passes Gillick Test - considered Gillick competent to consent

Only valid if given voluntarily and not under undue influence or pressure

Decision specific

If a child does not pass Gillick test then consent of a person with parental responsibility (sometimes court) is needed to proceed with treatment

Question 46

What are the Fraser Guidelines? What do they relate to? What criteria?

Answer 46

Relate to contraception and sexual health in under 16’s without parental consent

Advice can be given as long as:
- Sufficient maturity and intelligence. to understand the nature and implications of proposed treatment
- Cannot be persuaded to tell her parents or allow doctor to tell them
- Very likely to begin or continue having sexual intercourse with or without contraceptive treatment
- Physical or mental health is likely to suffer unless they receive the advice or treatment
- Advice or treatment is in the young person’s best interests

Should still encourage young person to inform parents and get permission

If the conditions are not all met, however, or there is reason to believe that the child is under pressure to give consent or is being exploited, there would be grounds to break confidentiality