1
Q
- A junior colleague on your team always takes his copy of the
patient list home as there is no confi dential waste bin on the ward.
He says this also helps him prepare for the following day as he can memorize
details in time for the consultant ward round.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Tell him this is unfair as he is ‘getting ahead’ and making you look
disorganized by knowing patient details before the ward round.
B Ask Matron or a Senior Sister about obtaining a confi dential waste bin.
C Let your colleague know that he should not be taking a patient list
home each day.
D Speak to the consultant about your colleague’s behaviour.
E Take your own list home so that you can be as familiar with the
patients as your colleague.
A
- C, B, D, A, E
Confi dentiality is important for maintaining patient dignity and trust in
the medical profession. The security of a patient list cannot be guaranteed
at home and most Trusts will have policies preventing staff from
removing details in this form. The best answer is to raise the issue informally
with your colleague (C): this deals with the issue immediately and
gives them an opportunity to refl ect on their behaviour. Asking for a confi
dential waste bin (B) also deals with the problem but less immediately
and does not guarantee that it will be used by this colleague. Speaking to
your consultant (D) also addresses the problem indirectly but it is less
ideal than (B) because it risks jeopardizing your working relationship, and
may represent premature escalation. (A) is the fi rst incorrect answer
as this would appear childish, unnecessarily competitive, and misses the
real concern about breaching patient confi dentiality. The worst answer is
(E) as duplicating your colleague’s error only doubles the risk of a patient
list being lost.
2
Q
- A patient on your ward is HIV positive. He is from a minority
community which he feels might react negatively if they knew of
his diagnosis. As a result, he is very anxious that no one (including his
close family) should be told.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Eliminate all mention of HIV from his notes.
B Amend your patient list so this detail is missing or obscured (e.g. ‘retroviral
illness’).
C Ensure the safety of other doctors and phlebotomists by writing
‘HIV+’ on blood requests.
D Tell the patient that he should talk to his family as you cannot guarantee
complete confi dentiality.
E Continue as you would for any other patient under your care.
A
- E, B, D, C, A
This is a diffi cult question. (E) is probably the best answer as you should
already be doing everything in your power to maintain patient confi dentiality,
particularly information that is very sensitive. (B) is almost as good
an answer as you are acting positively to respect your patient’s request.
It is not as good as (E) only because you should already have been doing
everything possible to ensure information is secure. (D) is the fi rst wrong
answer for two reasons. First, you would not usually tell a patient they
must talk to their family about a sensitive diagnosis outside the unique
circumstance of there being a sexual partner at risk of infection. Second,
although you cannot guarantee they will never become aware of his diagnosis,
you should be able to confi dently state that everything you do
will protect his confi dentiality. (C) is wrong as it breaches your patient’s
confi dentiality unnecessarily. Some Trusts will have a system of indicating
high-risk patients (e.g. coloured stickers) so phlebotomy staff can
take additional precautions. However, there is an argument that maximal
precautions should always be undertaken for invasive procedures and
therefore this information would be unnecessary to share. In this case,
writing ‘HIV+’ is incorrect as high-risk patients can be identifi ed without
disclosing their precise diagnosis. The worst answer is (A) because
obscuring the diagnosis from his notes will mislead others and potentially
place the patient at risk.
3
Q
- You are sitting in the pub opposite your hospital after work.
A group of doctors and nurses from another department is
talking loudly and joking about patients on their ward. These patients
could easily be identifi ed from the conversations you are overhearing.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Speak to the person who is speaking loudest so he is aware that his
behaviour is inappropriate.
B Call hospital security and ask them to intervene.
C Challenge the whole group so that they are aware that their behaviour
is inappropriate.
D Contact a manager in their department the following day to alert
them to this breach.
E Ignore the situation, as they should know better and you do not want
to cause a scene.
A
- A, C, D, E, B
This group is exposing patient confi dentiality to signifi cant risk. The best
answers are (A) and (C) as they address the problem contemporaneously
and stand the best chance of protecting patient confi dentiality. It is
diffi cult to diff erentiate between the two but you are likely to have more
success speaking to an individual (A) than approaching the whole group
(C). (D) would also address the problem but is less ideal because it does
not stop the problem at the time it was occurring. However, you might
not feel confi dent reprimanding colleagues on your own out of hours in a
social environment and, in which case, you should raise the issue formally
with the Trust (D). (E) is the fi rst wrong answer as you have a professional
duty to protect patients and challenge inappropriate behaviour.
Some people might argue that (B) is at least an attempt to address the
situation; however hospital security would likely be surprised by such a
call and have no jurisdiction away from the hospital site.
4
Q
- As you arrive on the ward one morning, you hear a nurse in a
side room shouting at a patient. The tone and language used are
unpleasant. You know that the patient is elderly and has severe dementia.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Knock on the door and ask to speak with the nurse.
B Discuss the issue with a senior nurse (e.g. Matron) in the fi rst instance
as soon as they arrive.
C Make preliminary enquiries from other staff working that night to ask
if they have noticed inappropriate behaviour.
D Use body language to show your disapproval but do nothing formally
as patient safety is not at risk.
E Contact the Care Quality Commission anonymously to avoid raising
the issue with employees of your Trust.
A
- A, B, C, E, D
You have a duty to take appropriate action following any concerns about
patient care, dignity, or safety. The question raises the issue of verbal
abuse by a member of staff against a vulnerable patient. (A) is the best
answer because it addresses the issue immediately and separates the
(potentially abusive) staff member from the patient. (B) is the fi rst incorrect
answer even though a senior nurse is exactly the right person to
speak to. This is because waiting for such a person introduces delay and
does not ensure the immediate safety of this patient. (C) is also wrong
because it introduces delay but, this time, you are speaking to the wrong
people, and risk prejudicing a disciplinary (or even criminal) investigation
at a later time. However, (C) does imply that you are planning to
take further action, even if it is not your role to investigate at this stage.
(E) is not as good an answer as there is nothing in the question that
justifi es raising concerns externally when internal procedures are likely
to be more expedient. (D) is obviously the worst answer as the GMC
imposes a duty on doctors to raise concerns about patient dignity being
compromised. You are not at liberty to ignore this event.
5
Q
- You begin induction at your new Trust and are asked to sign a
number of agreements. One of these is an agreement never to
raise concerns with bodies outside of your employing organization. This
is a condition of taking up your post.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Sign the form and begin work as instructed.
B Throw the form away and hope that no one notices that it was not
returned.
C Explain that you cannot sign as this prohibits you raising concerns
appropriately about patient welfare.
D Sign the form but resolve to raise concerns about patient safety in
whatever way is necessary to ensure their resolution.
E Contact your medical defence organization or the GMC for advice if
in doubt.
A
- C, E, B, D, A
The GMC is clear that doctors must not sign contracts that fetter their
ability to raise concerns. The simplest approach would be to politely
explain that you are unable to sign such a document (C) as this might
resolve the issue and could even prompt the Trust to avoid asking doctors
to do this in future. An alternative but more complicated approach
would be to contact the GMC or medical defence organization for advice
(E). The fi rst incorrect answer is (B) as this ignores your new employer’s
improper attitude to whistleblowing and has a fl avour of dishonesty as
you are deliberately not returning the form in the hope that no-one will
notice. (D) is worse than (B) in that it is essentially the same but this
time you have deliberately agreed to something with which you have no
intention of fulfi lling. The worst answer is (A) as this is contrary to your
professional obligation to raise concerns.
6
Q
- You are on call and asked to prescribe amoxicillin for a patient
complaining of pain on urination. The nurse has tested his urine
which shows leucocytes and nitrites characteristic of a urinary tract infection.
Amoxicillin is the suggested treatment according to local protocol.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Thank the nurse for being proactive and prescribe amoxicillin.
B Prescribe trimethoprim as this is the antibiotic of choice according to
your recollections from medical school.
C Review the patient yourself and then prescribe if necessary.
D Reprimand the nurse for testing the urine without instruction.
E Explain that you will only prescribe antibiotics if the patient becomes
confused or haemodynamically compromised.
A
- C, A, B, D, E
Although the diagnosis might be clear, you are responsible for the appropriateness
of prescriptions. The best answer is therefore (C) as the patientwill receive the correct treatment and you can ensure (for example) that
they are not grossly unwell and have no allergies etc. (A) is the second best
answer as the patient receives the correct treatment and you are working
positively with your nursing colleague. You will commonly see this scenario
played out on the wards; however, the responsible doctor should really
assess their patient before prescribing. (B) is less ideal because, although
it may be an appropriate treatment, antibiotic policies will refl ect local
resistance patterns and should be followed unless there are good clinical
reasons to depart from protocol. (D) is the fi rst obviously wrong answer
as you are unlikely to provoke a positive reaction, have not treated the
patient, and there is no reason why a nurse should not proactively identify
clinical problems. (E) is the worst answer as it exposes the patient to significant
harm by waiting for them to become compromised by their infection.
7
Q
- You feel understaff ed and undersupported when on call. Together
with an FY2 doctor, you are responsible for all new medical
admissions and the welfare of around 300 ward patients. Attempts to
raise your concern with managers, your Educational Supervisor, and the
Clinical Director have been unsuccessful.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Contact the Medical Director and, if necessary, the Trust Chairman.
B Document each stage of your complaint carefully.
C Contact a documentary programme and off er to carry a hidden camera
to capture specifi c problems.
D Write an article for your local newspaper raising concerns about the
care of Mrs Baggins in side room 4.
E Carry on and do your best whenever you are on call.
A
- A, B, E, D, C
(A) is the correct answer as it is the most appropriate way of escalating
concerns when other appropriate people have been unable to help.
(B) is vital as it may protect you later and provides a valuable record;
however, it does not in itself address the issue at hand. The other three
answers are incorrect. Although carrying on and ignoring the problem is
wrong (E), your part is at least neutral and others may highlight concerns
instead. This makes (E) slightly better than (C) and (D) as these answers
require you to actively breach patient confi dentiality without any attempt
to raise concerns internally fi rst. (C) is the worst option only because a
video record feels like a greater breach of privacy and there is an element
of dishonesty in concealing a camera at work.
8
Q
- Your consultant knows that you are interested in his specialty and
suggests that you attend a one-day course in another city the following
week. You recognize that this would be a good opportunity for
professional development. Unfortunately you have no remaining annual
leave days and are not entitled to study leave. The rota administrator says
that you cannot have time off to attend.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Ask your SHO if she will look after the ward in your absence and go
if she agrees.
B Speak to your Educational Supervisor and, with their support, ask the
service manager for special permission.
C Accept that you cannot attend the course.
D Add up the number of days that you worked late the week before and
attend the course as you are owed enough hours in lieu.
E Attend the course as you already have your consultant’s permission.
A
- B, C, A, D, E
The two possible correct answers are (B) and (C). (B) is slightly better
as you are proactively trying to attend a useful educational event while
following your department’s rules. (A) is the fi rst incorrect answer as
informal arrangements of this kind can breach departmental procedures
and problems could arise, for example if that team member is deployed
elsewhere because of staff shortages or is unwell on the day in question.
However, you have at least made an eff ort to ensure your patients are
looked after and that your clinical team (SHO and consultant) agree to
your absence. (D) and (E) are both wrong as you are not entitled to
attend and have made no eff ort to arrange clinical cover. However, (E) is
worse because, on top of everything else, it means taking time away
when you are being paid to be at work.
9
Q
- An elderly patient’s daughter tells you that she is concerned about
the ward care of her mother. She is thinking about writing a formal
complaint, and asks you if she is over-reacting and how best to complain.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Tell her that you will look into things but that a formal complaint will
not help.
B Suggest that she drops into the Patient Advice and Liaison Service
(PALS) to see what they can off er.
C Explore her concerns and try to clear up any misunderstandings.
D Let your consultant and/or the Ward Sister know that the daughter is
dissatisfi ed and that a formal complaint might follow.
E Tell the daughter that the ward nurses are particularly bad and that
she should complain.
A
- C, D, B, A, E
The best answer is clearly to do what you can to clarify misunderstandings
(C) as this will help you understand the concerns and might facilitate
a speedy resolution. (D) is the next best answer as making colleagues
aware might help resolve issues and will keep them informed. (B) is also
appropriate as PALS can off er advice independently of the clinical team
and help this relative take her complaint further. However, she might not
visit PALS after your conversation and (B) is not as good as (D) becausethe Ward Sister might be able to allay concerns or solve problems more
expediently. (A) is the fi rst wrong answer because you should never
discourage others from exercising their right to complain about poor care.
However, (E) is wrong for two reasons as it is unprofessional to complain
about colleagues to third parties and, as in (A), you are attempting to
infl uence the relative’s decision about whether to complain.
10
Q
- You are reviewing the drug chart of Tim, a young male patient
with a previous anaphylactic reaction to penicillin. Your
registrar has prescribed Tazocin which you know contains a penicillin
antibiotic. The patient has not yet received his fi rst dose.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Strike out the prescription and let the nurse know that it should not
be administered.
B Complete a clinical incident form.
C Speak with the registrar to alert him/her to this error.
D Ensure that the allergy is recorded clearly on the drug chart and in the
patient’s notes.
E Amend the prescription, but do not cause a fuss as no harm was done.
A
- A, E, D, C, B
Your fi rst priority is Tim’s safety. (A) is therefore the best answer because
it ensures the drug is not administered. (E) is partially correct because it
ensures the patient is safe, but it does not follow through to understand
the cause of the error or to ensure it doesn’t happen again. (D) is correct
and should happen although in itself is insuffi cient to ensure the
drug is not administered. The last two answers (C) and (B) address the
cause of the mistaken prescription but fail to correct the immediate risk
of an avoidable anaphylactic reaction. Raising the issue directly with
the registrar (C) is better as it ensures immediate feedback (while they
remember the case) and you can be satisfi ed yourself that feedback has
been delivered. (B) would complete your clinical governance obligation
to ensure errors are reported centrally to permit root cause analysis and
identifi cation of structural problems. However, as an isolated intervention,
it is less important than the others.
11
Q
- You are concerned that patients on your ward are rarely seen
by a senior doctor. They are reviewed weekly by a registrar
but almost never by consultants, who seem to be working at a private
hospital most of the time. You are uncertain whether to raise the
issue or how you would do this as both your Clinical and Educational
Supervisors are consultants within this department. You are deciding
whom to contact for advice.
Choose the THREE most appropriate actions to take in this situation
A The consultant who seems most absent from the department and is
known to have the biggest private practice.
B Your partner.
C Your medical defence organization.
D A friend from school whose judgement you trust and is now a solicitor.
E An employer liaison offi cer at the General Medical Council.
F A consultant in another department who is known for his fi erce opposition
to private practice.
G An SHO who spends his weekends at the private hospital assisting in
theatre.
H A senior non-clinical colleague (e.g. a manager).
A
- C, E, H
This is a diffi cult question that implies a long-standing, cultural issue
within your department, which you have interpreted as resulting in a
lack of senior staff available to patients. It is diffi cult to know under the
circumstances who best to contact, although, in such cases of uncertainty,
the GMC suggests getting advice from a senior member of staff
(H), a GMC employer liaison adviser (E), a medical defence organization
(C), or Public Concern at Work, which is a charity providing confi dential
advice in such cases. The absent consultant (A), moonlighting SHO
(G), and the consultant opposed to private practice (F) seem unlikely
sources of impartial advice. Your partner (B) and friend from school
(D) are not recommended as they might not understand the issues and/
or are not bound by professional duty (e.g. to keep your concerns in
confi dence).
12
Q
- A medical student approaches you for advice. He is very concerned
that your consultant has asked students to perform
rectal examinations on patients under general anaesthesia without consent.
You doubt that this is possible and suspect consent must have been
obtained beforehand.
Choose the THREE most appropriate actions to take in this situation
A Warn the student not to say anything as he will upset the consultant
and/or make him angry.
B Explain that the consultant is very professional and that consent might
have been obtained beforehand.
C Explain that consent was probably obtained beforehand and that the
student should do as instructed in theatre.
D Advise the student to ask the consultant if there is doubt about the
consent process.
E Warn the student not to say anything as he needs the consultant’s
support to pass the rotation.
F Tell the student that specifi c consent for him is not required for some
procedures (e.g. rectal cancer resection).
G Advise the student to mention this on the anonymous feedback after
the rotation ends.
H Suggest that the student speaks to an appropriate person at his medical
school if in doubt.
A
- B, D, H
All doctors should encourage a culture in which concerns can be raised
openly. This is particularly important for medical students who must
learn early on not to ignore concerns. However, you should seek to
clarify any misunderstandings and mention that consent might have been
obtained without the student being present (B). Ultimately, the student
should raise this issue with the consultant (D) to ensure they are not
complicit in examining patients inappropriately. If they have concerns,
their medical school will have its own ‘raising concerns’ policy (H).You should not advise the student to keep quiet about their concerns.
Specifi c consent for examination by medical students cannot be implied
by consent to any particular operation (F). Raising the concern anonymously
(G) may be unhelpful, as misunderstandings cannot be clarifi ed
and neither can further details be gathered for the concern to be acted
upon. The student may wish to contact his medical school (H) before
escalating concerns up the Trust hierarchy.
13
Q
- You are the surgical FY1 doctor and hear that an unconscious
patient in the A&E resuscitation area has a ruptured abdominal
aortic aneurysm (AAA). Your SHO tells you to feel the patient’s abdomen
as this is a rare opportunity to feel the expansile mass you read about in
textbooks. You have never felt a ruptured AAA before.
Choose the THREE most appropriate actions to take in this situation
A Decline to examine the patient as you do not have consent.
B Make a note to read about abdominal aortic aneurysms as this is not
something you have encountered properly before.
C Find your medical students so that they can examine the patient
as well.
D Examine the patient as this is a valuable learning opportunity.
E Introduce yourself to the most senior doctor present and ask if you
can examine the patient.
F Tell your SHO that you are busy on the ward and will go later if you
have time.
G Call the patient’s next of kin at home to ask if you can examine her
father.
H Tell your SHO that you will only examine the patient if he completes
a work-based assessment for your e-portfolio.
A
- B, D, E
As a doctor, you have a responsibility to maintain your clinical skills and
learn from patients. It is important to make allowance for this despite
routine clinical commitments (F). Educational opportunities should be recognized
for their intrinsic value and not simply to gain work-based assessments
(H). This case clearly raises an issue of consent that is impossible to
obtain under the circumstances. However, you are unlikely to feel a ruptured
abdominal aortic aneurysm in a well patient and a brief abdominal
examination may be appropriate (D) (A). As a doctor, you are in a diff erent
position from medical students who cannot directly infl uence a patient’s
care (C). If you were to examine the patient, it might be appropriate to
ask the senior clinician responsible for their care (E). However, calling the
patient’s relatives at a time when they are probably distraught is likely to be
unhelpful (G). You should certainly identify this gap in your experience and
read about aneurysms whether or not you examine the patient (B).
14
Q
- You are a medical FY1 doctor seeing a new patient in A&E.
This could be an opportunity to ask your senior to complete a
work-based assessment for your e-portfolio. The assessment requires a
senior doctor to observe you examining a patient and then complete an
electronic form. You ask the medical registrar who says she is too busy
to help. Your SHO overhears and off ers to complete the assessment
without seeing you examine the patient.
Choose the THREE most appropriate actions to take in this situation
A Thank the registrar and ask if you could present the case to her later
for your own experience.
B Tell the registrar that you need senior feedback if you are to develop
as a doctor.
C Thank the SHO and forward him an electronic form to complete.
D Ask the SHO if he will complete two work-based assessments at the
same time.
E Ask the SHO to watch you examine the patient and then complete an
assessment.
F Examine the patient as formally as possible, even though you are not
being assessed.
G Examine the patient a few hours later when someone might be available
to assess you.
H Tell your Educational Supervisor how diffi cult it is to get senior colleagues
to complete formal assessments.
A
- A, E, F
Work-based assessments are only one means of developing your clinical
skills as a doctor. You may wish to examine every patient formally as if you
were being observed and assessed (F). You might also gain by presenting
and/or discussing the case (A). In this instance, the ‘helpful’ SHO might
agree to watch you examine the patient before completing the assessment
(E). Delaying the patient’s assessment or care for your benefi t is
unacceptable (G).
Nevertheless, it is important to recognize that senior doctors have
other commitments and cannot always be available to teach. Reminding
the medical registrar of their teaching responsibilities is unlikely to nurture
a joyous teacher–student relationship (B). Although assessments
can be diffi cult to obtain, each trainee is responsible for achieving a
minimum number (H). You should resist off ers from other doctors to
complete work-based assessments if the criteria for these have not been
satisfi ed (C) (D). These off ers jeopardize the probity of senior doctors
and may deprive you of opportunities for genuine feedback.
15
Q
- You are an FY1 doctor required to attend mandatory teaching
on Tuesday afternoon. This is also the time that your consultant
holds his only ward round of the week. Your registrar is unimpressed
that you want to ‘slip off ’ when you are needed to update the consultant
on each patient’s progress. He suggests that you sign the attendance
register then return to the ward round.
Choose the THREE most appropriate actions to take in this situation
A Explain that teaching is mandatory and you are required to attend.
B Sign the attendance register so that your progression through FY1 is
not obstructed, and then attend the ward round.
C Agree that your presence on the ward round is necessary and that
you will miss teaching.
D Speak with your consultant and explain that your commitments are
confl icting.
E Off er to update your registrar about each patient so that he can facilitate
the ward round in your place.
F Explain that teaching is mandatory and then go to the doctors’ mess
for a long break.
G Attend the ward round but read up on the teaching you missed
afterwards.
H Send a text message asking an FY1 colleague to sign you in to teaching.
A
- A, D, E
It is your responsibility to satisfy all mandatory requirements of the
Foundation Programme. However, foundation doctors are a key part of
the clinical team and your absence could impact negatively on patient care.
Therefore you should take steps to minimize the impact of your absence.You should attend mandatory commitments (A) unless this compromises
patient safety. However, to resolve a potential confl ict in future,
you should seek advice from your consultant (D). It should be possible
for another member of your team (e.g. the SHO or registrar) to lead
the ward round (E) in your absence and you can update this person
to facilitate continuity of patient care. Only extraordinary circumstances
should cause you to miss teaching (C) (F). If you have to miss a mandatory
training session (e.g. because of a clinical emergency) you should
ensure that you catch up in other ways, such as private study (G). Signing
the attendance register dishonestly (B) or asking someone else to do so
(H) raises signifi cant probity issues.
16
Q
- Your consultant has two third-year medical students and asks
you to teach them for a day. You are a new FY1 doctor who
is not yet confi dent with the role and feel that you are too busy to look
after students.
Choose the THREE most appropriate actions to take in this situation
A Tell your consultant that you are far too busy to look after students.
B Wait until your consultant has left, and then sign the students’ attendance
forms and send them away.
C Wait until your consultant has left and then tell the students that you
are too busy.
D Give your bleep to a colleague and deliver a 60-minute tutorial on a
topic of your choice.
E Explore the students’ career aspirations and ask what jobs they are
applying for.
F Give the students clear tasks that match their learning objectives and
help you if possible.
G Ask the students to spend the morning completing discharge summaries
which you will check and sign afterwards.
H Ask the students questions about topics with which you are particularly
comfortable.
A
- A, F, H
Doctors have a duty to promote the education and development of
junior colleagues. (A) is correct as it ensures you will be able to fulfi l your
ward obligations and that the students are not under-sold with regards
the teaching they receive. (F) is ideal because it helps both you and the
students achieve your goals for the day. (H) is helpful as it will stimulate
the students to think while ensuring you are in a position to correct any
gaps in their knowledge.
Signing students’ attendance forms before sending them away
(B) deprives them of teaching and casts doubt on your own probity.
(C) is incorrect because it implies dishonesty and prevents the students
from being taught. A formal tutorial might be useful, but under these
circumstances might confl ict with ward commitments (D). Similarly,
frivolous conversation (E) will not benefi t the students nor ensure you
complete your work on the ward. You should not exploit students by
asking them to spend signifi cant amounts of time on routine tasks with
limited educational value (G).
17
Q
- You are coming to the end of FY1 and are being shadowed by
the fi nal-year medical student intended to replace you. You are
very concerned about his attitude towards other healthcare professionals
and have received negative feedback from the nursing staff . After fi ve
weeks, he asks you to complete a feedback form for his medical school.
Choose the THREE most appropriate actions to take in this situation
A Tell the student throughout the placement that he should adjust his
attitude.
B Wait until the end of the placement and then meet somewhere privately
to discuss your concerns.
C Tell the student about your concerns but mark all performance
domains as ‘satisfactory’.
D Let your Clinical Supervisor know that the incoming FY1 doctor has a
bad attitude.
E Indicate your concerns on the feedback form with specifi c examples.
F Give the student an opportunity to discuss your feedback.
G Write to the medical school dean suggesting that formal action be
considered.
H Wish the nursing staff ‘good luck’ working with the incoming FY1
doctor.
A
- A, E, F
You must be open and honest while delivering feedback in a constructive
and professional manner. Raising your concerns throughout the placement
(A) (B) will allow the student to explain his behaviour (F) and adjust
his attitude. It would be dishonest to mark the student as ‘satisfactory’
in a domain if you actually believe otherwise (C). Instead, you should
raise your concerns using specifi c examples (E) as when giving any negative
feedback. However, concerns should only be raised with the Clinical
Supervisor (D) or medical school (G) if their gravity warrants such interventions.
Inciting the nursing staff to prejudge the incoming FY1 doctor
(H) would be unhelpful and make it harder for him to change before
starting the post.
18
Q
- Your Trust has introduced mandatory online prescribing training
for specifi c drugs (e.g. insulin, warfarin, and antibiotics).
You are confi dent working with these drugs and will probably have to
complete the training in your own time as your ward commitments are
excessive.
Choose the THREE most appropriate actions to take in this situation
A Decline to complete the online modules because there is no time during
your working day.
B Complete the online modules quickly, but pick random answers so
that you don’t have to read the text.
C Ask your Clinical Supervisor or an appropriate manager for protected
time in which to complete the modules.
D Complete the modules in your own time without complaint.
E Refuse to complete the modules but satisfy yourself that you can prescribe
safely.
F Provide feedback after completing the modules as to whether or not
you found them helpful.
G Ask your partner, who is a doctor, to complete the modules for you
at home while you are on call.
H Contact the British Medical Association to ask whether you can be
forced to complete the modules.
A
- C, D, F
Doctors must continue to develop knowledge throughout their careers
and ensure that they are up to date. You should either ask for time during
the day to complete the modules (C) or recognize their general benefi tand do so at home (D). Refusing to comply with reasonable requests
from your Trust (A) (E) (H) may cause employment diffi culties.
Asking someone else to complete the modules (G) or doing so without
reading their content (B) deprives them of their educational purpose.
The former is also dishonest. Whether or not you found the
modules helpful, you should consider providing feedback (F) so that they
can be developed and improved for others.
19
Q
- A group of fi ve medical students is attached to your fi rm. You
have been spending a lot of time with one of the students and
feel that a mutual attraction is developing.
Choose the THREE most appropriate actions to take in this situation
A Try to avoid the student for the rest of the rotation.
B Meet with the student socially so that any romance can develop away
from the workplace.
C Try to ensure that your attention is equally distributed between all
students on the fi rm.
D Avoid any romance developing while the student is attached to
your fi rm.
E Tell the student that you are attracted to them but that you should
remain professional.
F Ask one of the others whether this particular student is attracted
to you.
G Try to avoid unprofessional feelings developing in future.
H Continue with any developing relationship, as you are not directly
responsible for supervising medical students.
A
- C, D, G
You should avoid compromising your professional relationship with colleagues,
including medical students (H). As a doctor on the team, you are
responsible for their supervision, learning, and continued assessment.
Attention should not be distributed unfairly (C) and romantic relationships
should be discouraged (D), ideally at the earliest possible stage (G).
It would be unhelpful and unfair to avoid one particular student (A) and
unprofessional to meet socially with ulterior motives (B). Although honesty
is usually commendable, a frank discussion should be avoided (E) as
it risks escalating the situation and surprising the student, particularly
if you have misinterpreted their feelings. Similarly, asking questions of
other students should be avoided (F).
20
Q
- You have been looking after Sid, a 90-year-old with end-stage
heart failure, for a number of months. His condition is worsening.
You visit one day and he hands you an envelope containing £500.
Although you protest, he insists, saying that it is a ‘thank you’ and that he
‘doesn’t need it any more’.
Choose the THREE most appropriate actions to take in this situation
A Tell Sid that the gift is too much and that you will only accept £50.
B Thank Sid for the gift but explain that you are unable to accept.
C Accept the gift and then ask an appropriate person within the Trust
whether this is allowed.
D Ask Sid to sign a statement so you are not accused of theft later on.
E Accept the gift but give it to Sid’s daughter, who is his next of kin, at
her next visit.
F Ask him to think carefully about his decision.
G Suggest that he donates the money to your favourite charity instead.
H Ask an appropriate person in the Trust for advice.
A
- B, F, H
There is no absolute rule preventing doctors from accepting gifts.
However, the GMC does prohibit doctors from inviting or pressuring
patients to make gifts, either to themselves or to anyone else. For this
reason, you should not suggest that Sid donates money to a specifi c charity
(G) or that he off ers you a diff erent amount (A).
Many Trusts will have policies on gifts (e.g. a maximum value) with
which you should be familiar before accepting (H), and not afterwards
(C). Although rules will vary, explaining that you are unable to accept the
gift (B) is certainly an acceptable response. At the very least, you should
not accept a high-value gift immediately without being convinced that it
is more than a spontaneous gesture (F).
Transferring money from the patient to his daughter (E) when this was
not his intention would be inappropriate. Asking Sid to sign a statement
(D) would overly formalize the situation and not protect you against the
accusation of having coerced the gift. If you feel that this is necessary
given the gift’s high value, this is an indicator that the gift is inappropriate.
21
Q
- As the obstetrics and gynaecology FY1 doctor, you are called
to see a 30-year-old woman who is four hours postpartum and
is actively bleeding. The patient is a Jehovah’s Witness and she tells you
she will not accept any blood products. Despite your attempts at fl uid
resuscitation, the patient continues to bleed. She remains hypotensive,
with an Hb of 5.5, although still alert and orientated.
Choose the THREE most appropriate actions to take in this situation
A Transfuse her immediately with red blood cells.
B The woman’s decision can be overruled when a child’s life is at risk.
C Commence a frank discussion with the patient, highlighting the risks
and benefi ts of the blood transfusion including the possibility of death
if she refuses.
D Continue to give intravenous fl uids if the patient consents, but do not
transfuse any blood products.
E Wait until the patient becomes unconscious before attempting to
transfuse blood products.
F Seek the advice of the consultant haematologist as soon as possible.
G Call the Hospital Liaison Committee for Jehovah’s Witnesses.
H Speak to your consultant to initiate the process of overruling the
patient’s decision with a court order.
A
- C, D, F
In this dilemma, you must balance the principles of autonomy and
non-malefi cence. Good Medical Practice reminds us that ‘doctors must
not discriminate against patients by allowing personal views to adversely
aff ect the professional relationship with patients or the treatment they
provide’ (A). The patient has severe postpartum haemorrhage (PPH) and
a transfusion is indicated, but it cannot be given without consent. There
is no risk to the life of the child (B). It is essential to confi rm the patient’swishes and clarify with certainty any decision to refuse blood products
(C) before ruling out a transfusion (D), and it should not be assumed that
her wishes would be consistent with ‘typical’ Jehovah’s Witness practice.
It would be unethical to transfuse the patient without frank discussion
while she remains conscious (E). In complex cases involving Jehovah’s
Witnesses it is absolutely essential to involve senior colleagues, and a haematologist
should also be involved early on (F). If the patient agrees to
their involvement, a Jehovah’s Witness Hospital Liaison Committee can
serve as a useful source of support for patients (G). There is no suggestion
that the patient currently lacks the capacity to make a decision (H).
22
Q
- You are examining a ten-month-old infant in A&E who has been
brought in by his parents after an episode of bloody diarrhoea.
On examination you fi nd that he has signifi cant scarring secondary to his
circumcision. The parents say that the circumcision was performed by an
experienced religious leader in accordance with their beliefs.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A The scarring does not require treatment on this admission, as it has
nothing to do with the presenting complaint.
B Document the fi ndings and discuss the management options with
your consultant.
C The examination fi nding constitutes evidence of genital mutilation,
and Child Protection Services should be informed immediately.
D Refer the patient to a paediatric surgeon for further assessment.
E Refer the parents to parenting classes for failing to act in accordance
with their child’s best interests.
A
- B, D, A, E, C
The correct answer is to perform a detailed physical examination, and
discuss this diffi cult situation with your senior (B). A less appropriate
response would be to make the referral to the paediatric surgeon yourself
without your senior’s involvement (D). However, this would be better
than ignoring your examination fi ndings completely (A).
The assessment of a child’s best interests must include the cultural/
religious values of the child and/or parents. (E) is therefore an inappropriate
referral, regardless of your own personal beliefs about religious
circumcision, while (C) represents an even more serious accusation with
greater implications for the parents. However, female genital circumcision
(or mutilation) is a criminal off ence and should be dealt with as such.
23
Q
- You receive your fi rst paycheck as a qualifi ed doctor at the end
of a very busy month’s work on an understaff ed medical ward.
You are pleasantly surprised to fi nd that you have received substantial
payment for locum shifts, despite having never been asked to work outside
your contracted hours. You calculate that the additional hours you
have had to work on the medical ward approximate to the additional
payment you have received in error.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Overall, you are receiving the correct amount of payment and are not
under any obligation to correct an error made by payroll.
B Write a cheque amounting to 95% of the total additional income
that you have been paid for a charity of your choice, retaining a small
amount as compensation for your eff orts.
C Keep a work diary of the number of hours that you are working.
D Involve your Educational Supervisor, as you should not be working
outside your contracted hours.
E Alert payroll to the error so that any additional payment can be
docked from your salary.
A
- E, D, C, B, A
GMC guidance reminds us that probity is at the heart of medical professionalism.
In this instance, it is important to address the issues of erroneous
payment for locum shifts and working additional unpaid hours
separately. The immediate priority should be to return any excess payment
to your employer (E) before seeking to rectify your own excessive
working hours, which may benefi t from the input of your Educational
Supervisor (D). (C) is not as good an answer as completing a work diary
in itself does not resolve the problem (although it may be necessary at
some stage). The two wrong answers are (A) and (B), and there is little
additional virtue to be found for donating your ill-gotten gains to charity.
Even if it became evident that you had worked a similar number of hours
unpaid, failure to raise the issue would cast serious doubt on your professional
judgement. It could also lead to disciplinary or even legal action.
24
Q
- You are preparing your specialty training application for general
surgery. You had few opportunities to gain experience in
theatre as a foundation doctor. However, you have spoken to many people
about surgical careers and watched video recordings of operations.
You have booked a Basic Surgical Skills course and read the manual, but
have yet to attend it. You are considering what statements you can legitimately
make on your application.
Choose the THREE most appropriate actions to take in this situation
A I have enjoyed participating in various operations during my time as a
foundation doctor.
B I have enjoyed developing my surgical knowledge through experience
as a foundation doctor.
C While I have made every eff ort to learn about a career in surgery,
my Foundation Programme rotations have not allowed time to attend
theatre.
D I have managed to gain indirect experience of theatre through watching
videos of operations in my spare time.
E I have developed an enthusiasm for the working environment of the
operating room through extensive surgical experience.
F I look forward to developing my surgical experience during this surgical
specialty training programme.
G I am fully profi cient in the Basic Surgical Skills course curriculum.
H My inexperience in the operating room is compensated by a superior
command of general medicine.
A
- B, D, F
This scenario tests honesty about experiences and qualifi cations when
applying for posts. The GMC requires that relevant information must
not be deliberately omitted. While it is possible to mislead the reader
with sentences that imply particular experiences (e.g. theatre exposure
(A) (E) and courses attended (G)), it would be more honest to
describe actual experiences on the ward (B) and alternative means of
learning about operations (D), and to share your enthusiasm for future
training (F). Arguments about too few opportunities (C) or unjustifi edclaims of superior clinical competence (H) are unlikely to impress a
selection panel.
25
25. You are completing an orthopaedics audit during one of
your FY1 rotations. The consultant surgeon has asked you to
review the complication rates for total knee replacements performed
at this hospital and compare them with the average across the Trust.
Your analysis shows slightly worse postoperative outcomes at this
hospital, and the average appears to be signifi cantly skewed by the high
complication rates of your consultant.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Report the consultant surgeon to the Care Quality Commission, as
this is an issue of patient safety.
B Ask all the orthopaedic consultants for advice about the data at the
following week’s departmental meeting.
C Speak with your consultant orthopaedic surgeon privately about the
fi ndings.
D Omit your consultant’s data, and submit a report without further
discussion.
E Obtain further data on preoperative parameters for the cases.
25. C, E, B, A, D
Integrity is an essential foundation for any clinical or scientifi c study, including
audit, which rests on the honesty and openness of the investigators.
Conclusions must not be reached hastily from fi ndings which may be misinterpreted.
In this scenario the best answer would be to discuss your concerns
as soon as they arise with the consultant in question (C). She might
be able to give a simple explanation (e.g. atypical case mix) and point you
in the right direction for further data collection. This also addresses any
potential issue early in case there is a short-term change that the consultant
would like to implement. Although (E) raises your concerns from the
audit and is very likely to show that there is no problem, it does introduce
an unnecessary delay and is therefore worse than (C). (B) carries the same
delay and is an inappropriate forum in which to raise this issue, but still
off ers the opportunity to address the underlying problems. However, raising
the issue internally with the consultants in your department should be
favoured in the fi rst instance over contacting an external body (A); there
is nothing in the question that would suggest this is necessary. The worst
answer is (D), as you are potentially complicit in a cover-up.
26
26. After leaving your evening shift as the on-call medical FY1 doctor,
you walk through the town and come across a group of medical
students who have been attached to your ward. They are behaving quite
out of character, obviously under the infl uence of alcohol, and are shouting
profanities at passers-by. The students are eventually confronted by a
passing police offi cer before being asked to move on.
Choose the THREE most appropriate actions to take in this situation
A No further action is necessary, as medical students are not regulated
by the same code of practice as doctors.
B Chase the students down the street and demand that they answer for
their actions.
C Inform your Educational Supervisor about what has occurred in the
morning.
D Email details of what you observed to the medical school dean.
E Approach the police offi cer and enquire as to whether further action
is needed.
F Confront the medical students about their behaviour the following day.
G Reserve your comments until the end of their medical placement
when you are asked to give formal written feedback.
H Withhold any details of the incident from other junior colleagues.
26. D, F, H
The GMC sets out professional standards which guide undergraduate
medical students (A). Behaviour outside the clinical environment can
impact on a student’s fi tness to practise and should always justify public
trust in the medical profession. The students should be asked to explain
their actions (A). It is unlikely to be resolved at the time of the incident
(B) and is not the responsibility of your own supervisors (C). Instead, the
students should be confronted soon after the incident (F) (G) and their
supervisors informed of this breach of professional duty (D). Informing
your colleagues is unlikely to improve the situation (H). The police will
deal with the students in their own way—your responsibilities as a member
of the medical profession are diff erent (E).
27
27. During a two-week vacation in Singapore, you became
embroiled in an altercation at a bar and were subsequently
given a caution by police. You return to work feeling rather upset and
ashamed but determined to put the whole incident behind you.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Try to put the issue behind you.
B Wait until you have settled into your new rotation before raising the issue.
C Inform your Medical Defence Union and seek legal advice.
D Contact the GMC immediately to report the caution.
E Ask your consultant for advice as to how you should proceed.
27. D, E, C, B, A
According to Good Medical Practice , doctors must inform the GMC without
delay if they have ‘accepted a caution, been charged or found guilty
of a criminal off ence, anywhere in the world’. This includes motoring
off ences unless these are resolved by a fi xed penalty notice. For this
reason (D) is the best answer. Asking your consultant for advice at the
earliest opportunity should help signpost you to the correct procedure
and is at least an attempt to transparency (E). Seeking independent
advice is always helpful, but does not go any distance towards discharging
your responsibility as a professional to declare your caution abroad
(C). (A) and (B) are clearly wrong as it is contrary to guidelines to delay
informing the GMC. (A) is worse only because it implies indefi nite dishonesty
rather than inappropriate delay (B).
28
28. You arrive at work before the consultant ward round and
attempt to print the patient list. You are hindered by slow
equipment and a broken printer. The ward round is unable to begin until
you have a current patient list and your consultant is frustrated as he
needs to begin an all-day endoscopy list.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Express your frustration with the IT equipment and demand that the
consultant requests replacements.
B Send the patient list to your personal email address and print it on the
neighbouring ward.
C Ask a medical student to print the list while you begin the ward round.
D Ask the nurses on each of the wards whether there are any new
patients who are under the care of your consultant.
E Advise the team to reconvene in 15 minutes while you contact the IT
helpdesk and attempt to print the list.
28. C, E, D, A, B
Punctuality is an essential attribute for facilitating expeditious patient care.
In this instance, a delay in printing the patient list has limited the time available
to review each patient. None of the options is ideal and the question
requires you to balance the practicalities of running an effi cient ward
round with the diffi culties you are currently facing. In this instance, the
best answer is to ask the medical student (if they are willing) to catch you
up with the list once it is printed (C). This would allow the round to begin
without delaying your consultant’s list. (E) ensures that the list is available
but at the cost of a delayed endoscopy list and/or rushing the end of the
ward round. (D) is less suitable as it risks missing patients on the ward
round who might then be deprived of the opportunity to be assessed by
a senior doctor. The two wrong answers are (A) and (B). (A) is unhelpful
and is unlikely to endear you to your consultant, though it is otherwise
a fairly neutral action. (B) by contrast is the worst answer as it is never
appropriate to use personal email addresses to send patient information.
29
29. You observe an FY1 colleague shouting at a staff nurse in front
of a patient. Afterwards, the nurse approaches you to discuss
the FY1 doctor’s behaviour. He explains that the FY1 has had several
‘angry outbursts’ since joining the ward two months ago and he is unsure
how to deal with them.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Advise the nurse to talk to his line manager as it is not your responsibility
to get involved in nursing-related matters.
B Bleep the FY1 and ask him to return to the ward and apologize to the
nurse and patient.
C Apologize on behalf of the FY1, and ask the nurse not to pursue the
matter any further at this time as you will speak to the other doctor.
D Inform the FY1 colleague’s Clinical Supervisor about the episode and
what the staff nurse has told you.
E Send an email to your FY1 colleague detailing what the staff nurse has
told you, to provide a written record of your conversation.
29. D, B, A, E, C
It is very tempting when answering these questions to latch on to a
single algorithm for answering similar situations. For example, most
scenarios are best answered by directly approaching the person about
whom you are concerned fi rst. This might even be the correct answer
here depending on your existing relationship with the FY1 doctor.
However, in this case, the issue that has arisen is between a nurse and
another doctor, and you are only involved as a by-stander. It might
then be more appropriate to report the concerning behaviour you
have witnessed to an appropriate senior colleague and allow them
to manage the situation from this point forth. For this reason (D) is
the best answer. The next best option is to contact the FY1 doctor
directly, and mediate between the two parties (B). Although this might
resolve the current issue (B) it is not as good as (D) because only
their Educational Supervisor will have an overall view of whether this
represents a pattern of concerning behaviour. (A) is half-correct as
the nurse probably should contact his line manager, but it sounds dismissive,
unsupportive, and ignores the fact that you are a witness to
‘bullying’ behaviour at work. (E) does not really achieve anything as it
is an impersonal means of communication and does not take the issue
any further. Although elements of (C) appear correct, it is the worst
answer only because you should never discourage a colleague from
expressing their concerns.
30
30. During the return fl ight from your holiday abroad, an announcement
is made requesting medical assistance for one of the passengers.
You graduated from medical school three weeks ago and have
yet to start your fi rst job as an FY1 doctor; you feel particularly apprehensive
about attending to a possible in-fl ight emergency on your own.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Do nothing since you are not legally bound to provide medical
assistance as you have not yet signed a contract with your employer.
B Inform the cabin crew that you are a recently qualifi ed doctor, and
begin your medical assessment immediately.
C Approach the unwell passenger and determine if you will be able to
off er any help before informing the cabin crew of your presence.
D Wait for ten minutes to see if anyone else on board can assist before
volunteering to assess the passenger.
E Review the passenger, but ask the cabin crew to make an announcement
for more senior medical assistance as you are only recently
qualifi ed and very inexperienced.
30. B, E, C, D, A
It might be tempting to choose (E) as a way of recognizing your own
limitations and seeking help early; however the in-fl ight emergency
might be something you are able to manage. A further call before
even a cursory assessment of the patient would be excessive. You
will often encounter this in the hospital, when you are asked to attend
an emergency, and it is usually more appropriate to assess a patientyourself (even if briefl y) before seeking further help, as there are
often simple things you can do fi rst, and assessing the patient helps
guide the type of help that you ask for. For this reason (B) is narrowly
a better answer than (E). (C) is inappropriate as it implies a cursory
examination, and that you might not formally assess the patient in an
eff ort to remain unidentifi able. However, it at least supposes that you
are off ering your assistance. (D) and (A) are incorrect answers as the
GMC requires that ‘in an emergency, wherever it arises, you must
off er assistance, taking account of your own safety, competence, and
the availability of other options for care’. (D) risks delaying review or
treatment of a patient in extremis, whereas (A) supposes not off ering
your assistance at all. Although you should always work within your
limits, inexperience is a poor reason for failing to act appropriately
in an emergency.
31
31. A group of medical students ask if you can help them prepare
for their forthcoming end-of-module examination on the respiratory
system. You agree to teach them at the end of the week, provided
that they stay and assist you with some ward jobs that evening,
which they agree to do. You are reminded about your teaching commitment
the day before the students’ examination, but unfortunately you
have forgotten to prepare a relevant lesson plan.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Inform the students that they should have reminded you earlier in the
week, and now you are unable to teach them.
B Defer the teaching until they want to prepare for their next
end-of-module examination.
C Attempt to teach the students, even if your knowledge is insuffi cient,
but fi nish the teaching early if it does not prove helpful.
D Teach the students about haematology, with which you are more
comfortable.
E Adopt a style of teaching that only utilizes questioning the students,
and refl ect every question asked back towards the group.
31. C, E, D, B, A
Doctors must be willing to teach and train students and other doctors as
part of their responsibility for the care of patients now and in the future.
This necessity requires the appropriate skills and attitudes of an eff ective
teacher, one of which is eff ective planning.
Whether it was wise to do so, you have promised teaching these students
in preparation for their respiratory exam. You will need to be honest
and upfront that you have not prepared adequately for this (although
this is not an option). For this reason (C) is the best answer, as you are
obliged to attempt to provide some value to the students. (E) represents
an attempt at teaching; even if you are not contributing to their
knowledge you can at least try to identify gaps and help them revise.
(D) is clearly not as good, as this is not what the students have identifi ed
as an imminent learning need. However, some teaching is better than
none, and the students might still be grateful for an opportunity to learn
about a subject with which you are comfortable and confi dent teaching.
(B) is essentially no teaching (for now) which is worse than (E), as above.
The worst answer is blaming the students who kept their part of the
bargain (A).
32
32. You are asked by your consultant in paediatric surgery to clerk
an infant who has been admitted to A&E with bilious vomiting.
This is the fi rst week of your fi rst FY1 rotation and you have had limited
experience in paediatrics beyond your fi ve-week rotation in medical
school two years ago. You are unsure whether you should clerk the
patient, if you should inform the parents of your inexperience, and who
would be responsible if you were to assess the infant.
Choose the THREE most appropriate actions to take in this situation
A Attempt a rudimentary clerking before calling the consultant to
review the patient.
B Refuse to clerk the patient as you do not have suffi cient experience.
C Conduct a thorough assessment of the patient once you are sure that
he is stable.
D Act with the knowledge that the consultant is ultimately responsible
for your assessment, as his trainee.
E Act with the knowledge that you are responsible for your assessment
of the patient.
F Introduce yourself as a doctor, but do not state your seniority for fear
of further worrying the infant’s parents.
G State your position as a junior doctor.
H Admit that this is your fi rst week as a junior doctor but that you will
not be responsible for any treatment decisions yourself.
32. C, E, G
As a foundation doctor, you will experience many practices for the
fi rst time (B), and the safe management of patients should be paramount
(A). You should use an ABCDE approach and ensure that all
patients are stable before completing a more thorough assessment
(C). You are ultimately responsible for your actions when assessing
and treating any patient (E), while the consultant takes responsibility
for your training and supervision (D). In introducing yourself to
a patient or parents, you are clarifying your position within the team
of doctors providing their care (G) (F). Your introduction does not
require a detailed account of your training and experiences as this may
unduly compromise the trust placed in your advice (H). However, it is
important to remain honest and transparent if asked about your grade
or experience by the patient’s family.
33
33. The fi nal-year medical student attached to your ward asks you
if you could write a reference in support of his application for
a university-level history course which starts three months before his
fi nal-year examinations. You are concerned as, despite his enthusiasm,
the student has a poor clinical knowledge base. You are not convinced
by his assurances that he will be able to balance this new commitment
with his medical course.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Write a reference indicating that his knowledge base is poor but that
he might do much better in another academic subject.
B Write a supportive reference, as his clinical knowledge base is not
relevant to his performance on a history course.
C Suggest that he asks your consultant to write a reference to provide a
more seasoned perspective on his ability.
D Tell the student that your position might not qualify you to comment
on his suitability for the course.
E Set the student a mock clinical examination, and off er to write his
reference based on his performance.
33. C, D, E, B, A
References should be written honestly and objectively, particularly with
respect to positions in healthcare which may place patients at risk if individuals
are appointed incorrectly. (C) and (D) are therefore the most
appropriate answers. (C) appears more constructive as it off ers an alternative
to yourself as a referee while implying that there are more experienced
people available to help with this request. Of the three incorrect
responses (E) is best because it makes an attempt to objectively determine
whether the student is coping with their current course of study
to which they should be committed before embarking on a second. The
last two answers are diffi cult to distinguish between. You should probably
express your concerns to the student, but write a generally supportive
reference (B), rather than sabotaging his application with a poor
reference, particularly without giving him some indication that this would
happen if you were to do as he asked (A).
34
34. A male FY1 colleague in paediatrics is clerking a frightened
15-year-old girl who has been brought into A&E by her older
sister who says that she has been the victim of a violent attack. After
establishing a good rapport with the patient, the FY1 arranges for a
physical examination. However, the girl remains adamant that no one
else be present. In the absence of your registrar, your fellow FY1 asks
for your advice.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Advise him not to examine the patient and instead wait for the
registrar.
B Suggest that he performs a physical examination by inspection alone,
with a chaperone present if the girl agrees.
C He should agree to forego the chaperone and complete a thorough
physical and internal examination to rule out any genital injury.
D Tell him to insist on the presence of a female nurse as a chaperone,
and to avoid examining the patient if she insists on no one else being
present.
E Ask the older sister to sign in the medical notes agreeing to act as the
chaperone.
34. D, A, B, E, C
The most important fact here is that you are not told the patient is in
extremis, and therefore there is no clinical urgency to perform an examination.
There are a number of considerations, including the welfare of a
scared and vulnerable patient, your colleague’s diffi culties as an inexperienced
male member of the team, and the complications around examining
a patient who has been the alleged victim of a sexual assault. (D) is
the best answer, as he should examine the patient only if a chaperone
can be available, and his initial examination is likely to be limited (i.e.
no internal examination until senior support is available). If there is any
doubt, or a chaperone is not available, then (A) would be the correct
answer, although less ideal as it makes little progress in the management
of the patient. (B) is less good, and while credit might be given for performing
any examination of the patient with a chaperone, examination
by inspection alone off ers little clinical value. Although it is common
practice to use a female relative as a chaperone, in a particularly sensitive
case this is not appropriate, and it is not common practice to ask a chaperone
to sign in the notes (E). (C) is clearly the worst answer because
an inexperienced male doctor should not perform an intimate examination
on a minor who has suff ered alleged sexual assault, regardless of
whether there is a chaperone!
35
35. Your hospital is at the centre of a news story regarding a leaked
audit which shows a recent rise in mortality following heart
valve replacements. As an FY1 doctor on the cardiothoracic ward, you
feel strongly about the negative portrayal of your senior surgical colleagues’
abilities, believing the results to be due to the use of a new
prosthesis. A news reporter approaches you as you are leaving the ward
and asks if you would like to comment.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Share with the reporter your honest opinions of the competence of
your senior colleagues and the possibility of a fault with the new prosthetic
valves.
B Ask for the contact details of the reporter and agree to an interview
once you have obtained permission from your local Trust.
C Politely decline to comment.
D Discuss in general terms the diffi culty that surgical innovators face
when introducing novel technologies, without going into specifi c
details about your department.
E Explain your frustration with the ignorance demonstrated by the
media and the general public in relation to health matters.
35. C, B, D, E, A
Even as a more junior doctor, it is essential to realize the impact that your
comments can have on your own hospital and more widely across the profession
itself, particularly those made available in the public domain. The best
answers are clearly the two in which you are not providing any meaningful
comment for the reporter at this time, as you are unprepared and inexperienced.
(C) is probably preferable to (B) because the Trust is unlikely to
agree to an FY1 doctor providing an interview on this subject. Although the
next three are incorrect, clearly the better two—(D) and (E)—are the ones
in which general comments are made and you do not refer specifi cally toyour department or your theories about this particular issue (A). (D) is better
than (E) because you are unlikely to come across well complaining about
the ignorance of the general public in the public domain.
36
36. You have volunteered to be the deanery’s FY1 representative.
A recent survey has shown that the greatest frustration of
90% of FY1 doctors is the limited teaching given during a typical week.
However, a senior member of the deanery committee has described his
frustration at your ‘diffi cult predecessor’ who was constantly ‘trying to
change things’, and you are unsure how receptive the committee will be
to your suggestions.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Based on the recent survey fi ndings, request approval for a full review
into the teaching provided for FY1 doctors by each hospital’s postgraduate
medical education offi ce.
B Conduct another questionnaire asking more specifi c questions about
the teaching to the FY1 doctors themselves.
C Avoid the topic during your initial committee meetings, as you are
unlikely to gain the favour of your seniors.
D Predict the response of all of the FY1 doctors to questions on the
failures of teaching based on your own experiences, and take this evidence
to the committee as justifi cation for a detailed review by each
hospital’s education offi ce.
E Resign as the deanery’s FY1 representative.
36. B, A, C, E, D
None of the answers is particularly good. (B) is probably the best answer
because it gives you an opportunity to fi nd out more precisely where
diffi culties with teaching provision have arisen, without requiring additional
resources from the postgraduate medical offi ce. As the FY1 representative,
you carry the (perhaps unenviable) burden of ensuring some
change is made if necessary. Although a full review into teaching may be
excessive this is the only other option you are provided with in which
FY1 doctors’ views are taken into consideration (A). (C) is less good as
an answer because it introduces unnecessary delay, although there might
be strategic reasons for wanting to raise the issue later. (D) and (E) are
both unhelpful; (D) is worse as it appears to mislead the committee by
suggesting that you have consulted widely amongst FY1 doctors.
37
37. You are left a gift of substantial value from the family of a
wealthy patient whom you have recently cared for on the ward.
You are frequently praised for the time and eff ort that you spend with
patients, but this is the fi rst time that you have personally received a gift.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Inform the GMC of the gift.
B Inform the Ward Sister in charge of the gift.
C Seek the advice of your medico-legal defence organization.
D Accept the gift, but share its monetary value with the rest of your
medical team.
E Attempt to obtain the family’s details and return the gift.
37. E, C, B, A, D
The GMC requires that you never encourage patients or their relatives
to off er gifts that will directly or indirectly benefi t you, and you should
make reasonable eff orts to dissuade them from such off ers. For this
reason (E) is the best answer as it perfectly mirrors this advice. The
second best answer is to seek impartial professional advice (e.g. from
a medical defence organization) as you are unlikely to have experience
of receiving high-value gifts (C). This is probably more appropriate
than informing the Ward Sister, but doing so (B) is at least an attempt
to seek advice and may lead you to be directed towards your Trust’s
policy on acceptance of gifts. Accepting the gift with no attempt to dissuade
the relatives should be your last option, particularly given that
it is high value (D). Although there is no role for informing the GMC
about receiving a gift, regardless of its value (A), this is probably a safer
answer than (D).
38
38. An FY1 doctor who works with you on the surgical ward is
asked to complete a death certifi cate and cremation form for a
patient he has been treating. However, he has a conscientious objection
to cremation, based on religious beliefs, and would prefer you to complete
the form even though you have never met the patient.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Agree to complete the cremation form, as your colleague has provided
a valid reason for refusing.
B Advise your colleague to claim that he has not been adequately
trained to complete cremation forms.
C Inform your colleague that he has a duty to put aside any personal
beliefs and complete the cremation form.
D Suggest he takes a few days annual leave which will give the bereavement
offi ce time to fi nd someone else to complete the form.
E Refuse to sign the cremation forms on the grounds that you are not
familiar with the patient.
38. C, E, D, B, A
All qualifi ed doctors have a legal obligation to sign cremation forms,
and cannot refuse on personal or religious objections to cremation
(Cremation Acts 1902 and 1952). (C) is therefore the correct answer.
You should probably advise your colleague that, if they are the only doctor
who can sign the form, they should do so to avoid unnecessary delay
and distress to relatives. (E) is less helpful but still correct as you are not
giving your colleague the full benefi t of your medico-legal knowledge
but have done the right thing in declining to sign a cremation form for
a patient you do not know. (D) would be improper advice, as your colleague
going away for this reason would be unprofessional and risk delay
to funeral arrangements and consequent further distress to family members.
(A) is the worst option as you are not legally entitled to complete
a cremation document as you have not cared for the patient during their last illness. This means that encouraging your colleague to lie (B) falls
between simple unprofessional behaviour (D) and illegality (A).
39
39. You are a foundation doctor with an interest in orthopaedic
surgery. In an eff ort to improve your specialty training application,
you would like to complete an Advanced Trauma Life Support
(ATLS) course. Unfortunately, your Trust gives priority to doctors working
in A&E. One of the A&E doctors has been given a place on this basis
but off ers it to you in exchange for covering one of his night shifts.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Accept the off er as it appears to be a mutually benefi cial agreement.
B Tell the other foundation doctor that you will gratefully accept his
off er but you are not willing to complete the weekend shift.
C Refuse the off er.
D Ask the advice of the ATLS coordinator at your hospital.
E Accept his off er and attend the course, but do not turn up for the
weekend shift.
39. D, C, A, B, E
Although you are keen to attend the course, it would be wrong to
subvert the process for allocating places. If your colleague is unable to
attend the course, he should explain this to the coordinators. Therefore
you should ask whether they would agree to transfer the place to you
from your colleague, which is why (D) is the best answer. The second
best answer is (C), as refusing the off er would allow the place to be
reallocated more equitably. (A), (B), and (E) are all incorrect; of these,
(A) appears to be preferable as everyone is satisfi ed by the arrangement.
(B) is next, as you are willing to take the place on the course
without completing your part of the arrangement. The worst option is
clearly (E) as this risks leaving the A&E department understaff ed as well
as betraying your colleague’s trust.
40
40. As the FY1 doctor in cardiology, you are responsible for looking
after your consultant’s NHS patients. One of the patients
who had been under your care for the last 48 hours is transferred to the
private ward on the other side of the hospital. At the request of your
consultant, the nurses on the private ward have bleeped you on several
occasions to complete various clinical procedures. You feel challenged
by the additional workload and are uncertain whether you will complete
your routine tasks.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Ask the consultant for additional reimbursement in return for providing
more of your time for assisting with his private patients.
B Explain the situation to one of the other cardiology consultants.
C Speak to the patient and ask whether he would mind returning to the
NHS ward.
D Arrange a meeting with the cardiology consultant, via his secretary, to
discuss the additional workload.
E Do not respond to any bleeps from the private ward; if it is genuinely
a consultant’s request he will contact you.
40. D, B, A, C, E
Your NHS employer has allocated a set amount of work per employee
and may not have accounted for additional tasks on the private ward.
Your primary responsibility is for your own patients, and their care must
not be compromised by acquiescence to inappropriate requests, even if
driven by your consultant. The best answer is (D) as you should generally
approach the person most likely to resolve the situation satisfactorily,
who is the consultant in this case. Speaking to another consultant
would be less ideal but may lead to her imparting wise advice for you
to follow (B). (A), (C), and (E) are the wrong answers. (A) is probably
the best of these, although you are unlikely to be entitled to additional
money for work done during additional time, asking your consultant is
unlikely to cause signifi cant harm to anything except your dignity and
career! Attempting to coerce the patient would be much worse (C).
But failing to answer your bleep (even if you think it’s from a ward for
which you are not responsible) could result in harm to patients if you are
uncontactable (E).
SJT
flashcards
Decks in class (15)
# Cards
-
SJT Practice Paper 1 (Official)70
-
SJT Practice Paper 2 (Official)70
-
SJT format15
-
GMC guidance32
-
SJT glossary15
-
SJT paper rationale48
-
SJT - golden rules1
-
SJT At A Glance Practice Paper50
-
Oxford Handbook Practice Test60
-
Commitment to Professionalism40
-
Coping with Pressure40
-
Effective Communication40
-
Patient Focus40
-
Working Effectively As Part of A Team40
-
2023 UKFPO SJT Practice Paper75
