Why can you not discuss risks and benefits of endoscopy as an FY1?
- what should you do instead?
You are not qualified to perform this procedure; hence you cannot gain consent for it or discuss risks and benefits.
Instead, you should organise for your registrar/ consultant to have this conversation with the patient
Final year medical student has been missing days off placement and today failed to turn up to a teaching session you prepared. Who is it appropriate to talk to?
The student, his peers, your registrar/consultant
- Failing this, it may be necessary to notify the medical school
Child tells you they have not attended school in 5 months. What should you do? (3)
- Verify this is correct with the school
- Look for any signs of abuse/neglect
- Refer to school nurse
- Paediatric OP appt
Your proud mother asks you to look at her friend’s ECG that she had done at the GP practice. What is the most appropriate course of action?
- Explain that the GP is the best person to be looking at this, and explain to your mother that you shouldn’t be treating family and friends
Your consultant asks you to stay late to see her post-operative private patients. You have plans with friends. What should you do? (3)
- Explain politely that you have plans and are unable to stay tonight
- Speak to your educational supervisor if they ask you again
(note: it is sometimes right to help a colleague even when you don’t get paid for these duties)
35 year old woman presents with persistent headaches and you notice that she is covered in bruises on her arms and legs.
What should you do? (3)
- Ask her if there’s anything she’d like to talk to you about
- Inform her that there are places that she can go to talk about anything that has happened
- Review in a couple of weeks
Your FY1 colleague has been coming in later and later and you’ve seen her crying in the mess. She confides in you that her mother has been ill and she has been helping out at home. Her consultant wants her to assist in theatre but she needs to drive home to help her mum.
- What should you do? (3)
- Sit her down and ask her how she is coping and whether she might need some time off (SUPPORT YOUR COLLEAGUES EMOTIONALLY)
- Advise her to speak to her consultant about these issues (APPROPRIATE ESCALATION)
- Offer to help out in theatre (SUPPORT YOUR COLLEAGUES PRACTICALLY)
You have been given your FY1/FY2 rotations and have not received Obs/Gynae. You really want to do OG as a career. What should you do?
- See if your Foundation School has a ‘swap shop’ where FY2 rotations can be swapped with others
- Consider getting some taster sessions in obs and gynae during your FY1/FY2 years
- Get involved in other ways (e.g audit in obs/gynae)
Mother decides she doesn’t want her child to be vaccinated. What should you do? (3)
- Ask her what her concerns are regarding vaccination (PROBE for CONCERNS)
- Inform her on the risks of not getting her child vaccinated (INFORM and EDUCATE)
- Ask your senior colleague for advice (ASK for ADVICE)
8 year old in ED with pain in ankle. Able to weight bear, no bony tenderness or swelling. Mother demands an XR. What do you do? (3)
- Explain that X-rays carry risks
- Explain that an XR isn’t indicated here
- Speak to senior colleague for advice
A patient complains that one of your colleagues has bad body odour. What should you do?
- See if you can notice this yourself before taking any further action
- Speak to your colleague and tactfully explain the situation to them
- Do not gossip with the other doctors about this
A porter at the hospital asks you out on a date. You are nearing the end of your rotation at this hospital.
What should you do?
- Politely decline his request as relationships at work can interfere with patient care (PATIENT SAFETY)
- Wait until you move hospital before accepting his offer if you want to
You feel that your FY1 colleague is not demonstrating the knowledge required of his grade. What is the most appropriate course of action? (2)
- Have a tactful discussion with Julian
- Speak to the registrar for advice
You are called to a patient who has not opened their bowels in three days and is vomiting with abdominal pain and distention. They are unwell. What should you do? (3)
- ABCDE
- Call a senior
- Call the surgical team – note: she likely has SBO and she will likely need IV fluids and an NG tube pre-op
Young woman decides that she wants a TOP and doesn’t want to tell boyfriend. What should you do? (2)
- Ask her what her concerns are about telling boyfriend (PROBE about CONCERNS)
- Encourage her to speak to her boyfriend
- Signpost her to family planning clinic so she can be informed of all available options (INFORM / EDUCATE)
Your FY1 colleague has already taken 2 weeks off on this rotation and wants another week off. You also want to take some time off as you haven’t taken any as yet, but your ward does not permit both FY1s to be on leave at the same time. What should you do?
- Clarify with your PG lead how much time should be taken off. Answer = 9 days per rotation (CLARIFYING your CONCERNS: with SENIOR/LINE MANAGER)
- Discuss with your FY1 colleague in case she is mistaken about how much leave she can take (CLARIFYING your CONCERNS: with PEERS)
- Ensure that any leave you take is booked well in advance to allow for adequate time for staffing and rota changes
You are due to work on Christmas Day but know this will upset your family. You could try to swap shifts with another FY1, organise to pay for a locum to work your shift, call in on Christmas Day morning and ‘refuse to work’ or call in sick on Christmas Eve. Rank from most to least appropriate.
- swap shifts with another FY1,
- organise to pay for a locum to work your shift,
- call in sick on Christmas Eve
- call in on Christmas Day morning and ‘refuse to work’ (refusal to work is not permitted)
An angry mother of a 15-year-old patient of yours presents because she has found a contraceptive pill in her daughter’s bag. She demands to know why you have prescribed this.
a) What do you do? (3)
b) What are the Fraser criteria to prescribe contraception to someone under age 16 (5)
a) - Do not disclose that you have given the daughter the pill (CONFIDENTIALITY)
- Ask the mother what her concerns are about her daughter getting the pill (PROBE about CONCERNS)
- Explain that in a hypothetical situation, if a 15 year old girl understood the risks of using contraception that it would be permitted for her to be prescribed it without the mother being informed of this
b) GILLICK COMPETENCE:
1. They have capacity and understand the risks
2. Will have sex regardless
3. Can’t be persuaded to tell parents
4. Risks to mental/physical health if not prescribed
5. Best interests decision
You realise that you have sent a patient home post-cholecystectomy without the usual prescription of 5 days co-amoxiclav. What should you do? (3)
- Call the GP and politely ask him to prescribe this to the patient when they arrive at the practice
- Call the patient and ask them to go to the GP to pick up their prescription. Apologise for your error (DUTY of CANDOUR)
- Consult your senior colleagues for advice (ASK for ADVICE)
40-year-old man admitted with chest pain. Nurse is trying to take blood from him for his 6h troponin levels but the patient starts shouting abuse at her and demanding that he be allowed to leave the hospital.
What should you do? (3)
- Calmly tell the patient that it is unacceptable to abuse staff (SAFETY of STAFF)
- Explore his concerns about being in hospital/venepuncture (PROBE about CONCERNS)
- Explain the risks of leaving hospital but if patient has capacity inform him that he is allowed to leave whenever he likes (AUTONOMY if CAPACITY)
You are looking after Mr Kucera who has previously been treated for prostate carcinoma. Preliminary investigations are strongly suggestive of a recurrence. As you finish taking blood from a neighbouring patient, Mr Kucera leans across and says “tell me honestly, is my cancer back?”
Rank in order the appropriateness of the following actions in response to this situation.
A. Explain to Mr Kucera that it is likely that his cancer has come back
B. Reassure Mr Kucera that he will be fine
C. Explain to Mr Kucera that you do not have all the test results, but you will speak to him as soon as you do
D. Inform Mr Kucera that you will chase up the results of his tests and ask one of your senior colleagues to discuss them with him
E. Invite Mr Kucera to join you and a senior nurse in a quiet room, get a colleague to hold your ‘bleep’ then explore his fears
DCEAB
