PPS

Question 1

HUMAN RIGHTS ACT 1998
What is the WHO definition of health?
How does this link to the HRA?

Answer 1

• The state of complete physical, mental + social wellbeing + not merely the absence of disease or infirmity.
• The highest attainable level of health is the fundamental right of every human being.

Question 2

HUMAN RIGHTS ACT 1998
When did the HRA come into force?
What is the importance of it?

Answer 2

• 2000 + is set out in the European Convention on Human Rights.
• (Should) form part of an organisations decision-making process to ensure people’s rights are respected + is part of all policy making.

Question 3

HUMAN RIGHTS ACT 1998
What are the underlying assumptions with the HRA?

Answer 3

• State/organisations have a duty to uphold these rights + they’re universal.
• All basic rights are claim rights i.e. others wanting things.
• The irreducible moral status of individuals demands that people are treated in ways that are compatible with that moral status.

Question 4

HUMAN RIGHTS ACT 1998
What are some issues with the HRA?

Answer 4

• ?Universal or Western concept (FGM, judicial executions).
• Which interests are significant enough to justify it being a human right?
• Can absolute claims conflict? All rights are interdependent + inter-related.

Question 5

HUMAN RIGHTS ACT 1998
What are the 5 articles that are frequently engaged in healthcare?

Answer 5

Art 2 – the right to life.
Art 3 – the right to be free from inhumane + degrading treatment.
Art 8 – the right to respect for privacy + family life.
Art 12 – the right to marry + found a family.
Art 14 – the protection from discrimination (sex, race, sexuality etc).

Question 6

HUMAN RIGHTS ACT 1998
What is meant by absolute rights?
Give some examples

Answer 6

They’re never limited i.e. they hold under ALL circumstances.
- Art 3, Art 4 (prohibition on slavery + enforced labour), Art 7 (protection from retrospective criminal punishments).

Question 7

HUMAN RIGHTS ACT 1998
What is meant by limited/qualified rights?
Give some examples

Answer 7

They are limited under explicit + finite circumstances.
- Art 2 (limited), Art 5 (the right to liberty), Art 8 (qualified).

Question 8

HUMAN RIGHTS ACT 1998
Explain why some rights may be limited/qualified.

Answer 8

• Art 5 – if your freedom affects other’s safety.
• Art 2 – medical Tx a pt requests is not a right. Obligation upon state to take appropriate steps to safeguard life but cannot impose a disproportionate burden on the authorities to provide unlimited resources.

Question 9

HUMAN RIGHTS ACT 1998
What is the exceptionality criteria with the HRA?

Answer 9

Applicable to public bodies like NHS trust where they adopt a general policy for the exercise of ‘administrative discretion’, to allow for exceptions from it in ‘exceptional circumstances + leave those circumstances undefined’.

Question 10

HUMAN RIGHTS ACT 1998
What are some topics in individual rights vs. collective groups?

Answer 10

• Should vaccines or blood/organ donation become compulsory?
• Is screening a form of collectivism?
• Wearing a face mask to prevent spread of disease despite disagreement.

Question 11

RESOURCE ALLOCATION
What is rationing?

Answer 11

Where resource is refused because of lack of affordability rather than clinical ineffectiveness.

Question 12

RESOURCE ALLOCATION
Why have rationing needs increased in terms of resource allocation?

Answer 12

• Shift from acute>chronic complex conditions.
• Increase in choice + availability of more expensive drugs.
• Medicalising what used to be ‘normal’ physiology (childbirth, menstruation).
• Ageing population with increasing demand on services.
• Funding has barely increased.

Question 13

RESOURCE ALLOCATION
What are the 3 ethical theories in context of resource allocation?

Answer 13

• Egalitarianism.
• Maximising/Utilitarianism.
• Libertarian.

Question 14

RESOURCE ALLOCATION
What is the concept of egalitarianism?

Answer 14

• Provide all care that is necessary + required to everyone.

Question 15

RESOURCE ALLOCATION
What are the pros/cons of egalitarianism?

Answer 15

Pros:
- equal for everyone (supports belief people deserve equal rights/opportunities)

Cons:
- economically restricted,
- tension between egalitarian aspirations + finite resources.

Question 16

RESOURCE ALLOCATION
What is the concept of maximising/utilitarianism?

Answer 16

• Healthcare should be distributed to bring about the best possible outcome (criteria that maximises public utility).

Question 17

RESOURCE ALLOCATION
What are the pros/cons of maximising/utilitarianism?

Answer 17

Pros:
- resources allocated to those most likely to receive most benefit.

Cons:
- those with ‘less need’ receive nothing.

Question 18

RESOURCE ALLOCATION
What is the concept of libertarian?

Answer 18

Each individual is responsible for their own health, wellbeing + flourishment i.e. incentives for behaviour change, screening participation paid (all paid with savings made from better health outcomes).

Question 19

RESOURCE ALLOCATION
What are the pros/cons of libertarianism?

Answer 19

Pros:
- onus on pt therefore may be more engaged.

Cons:
- not all diseases are self-inflicted,
- should people be held accountable for their current/future health?

Question 20

RESOURCE ALLOCATION
What is the harm principle in relation to Libertarian theory?
What is the con to this principle?

Answer 20

• People should have autonomy in life so long as it doesn’t affect anyone else, even if others see actions as being wrong
• BUT doesn’t appreciate the impact choices has on others

Question 21

RESOURCE ALLOCATION
What is Johnson’s rule of rescue?

Answer 21

A tension sometimes arises between the injunction to do as much good as possible with scarce resources + the injunction to rescue identifiable individuals in immediate peril, regardless of the cost.

Question 22

RESOURCE ALLOCATION
Give an example of Johnson’s rule of rescue.

Answer 22

It’s a perceived duty to save endangered life through disproportionate efforts regardless of cost + usually seen in vulnerable groups like children.
- E.g. treat rare cancer in child with experimental drug that may be effective.

Question 23

RESOURCE ALLOCATION
What is meant by a sustainable process?

Answer 23

One that meets the needs of the present without compromising the ability of future generations to meet their own needs.

Question 24

RESOURCE ALLOCATION
What are the aspects of sustainability

Answer 24

• Economic factors.
• Social factors.
• Environmental factors.

Question 25

RESOURCE ALLOCATION Explain how the NHS can contribute to unsustainable practice

Answer 25

- NHS emissions come directly from everyday clinical practice. - E.g. inefficient use of resources which can lead to clinical waste (over investigating, overprescribing, over intervention).

Question 26

RESOURCE ALLOCATION How can we respond to the unsustainable practices in the NHS?

Answer 26

- Reduce clinical waste via appropriate prescribing, pt education to improve adherence. - Requires system-level action i.e. changes through legislation. - Encourage active travel (improved air quality + reduced risk of CVD).

Question 27

RESOURCE ALLOCATION What is the ladder of interventions?

Answer 27

- Starts at doing nothing/monitoring. - Next steps are education or enabling choice (can be via changing the default). - Ends with incentives, disincentives + then restricting/eliminating choice.

Question 28

MEDICAL NEGLIGENCE Define negligence

Answer 28

A breach of duty of care which results in damage. - There is failure to take proper care over something.

Question 29

MEDICAL NEGLIGENCE What 4 questions should be asked when negligence is suspected?

Answer 29

- Was there a duty of care? - Was there a breach in that duty? - Did the patient come to any harm? - Did the breach cause the harm?

Question 30

MEDICAL NEGLIGENCE What 2 tests can be used to decide if there was a breach in a duty of care?

Answer 30

- Bolam test = would a group of responsible doctors do the same? - Bolitho test = would it be reasonable of them to do so?

Question 31

MEDICAL NEGLIGENCE What factors influence how much money a patient may get from a successful negligence claim?

Answer 31

- Loss of income. - Cost of extra care. - Pain + suffering.

Question 32

MEDICAL NEGLIGENCE What are 6 broad factors which contribute to negligence?

Answer 32

- System failure. - Human factors. - Judgement failure. - Neglect. - Poor performance. - Misconduct.

Question 33

MEDICAL NEGLIGENCE Explain what is meant by system failure.

Answer 33

- Computer system may shutdown > losing notes. - Pt may be unconscious + unable to communicate so important info lost at critical moment. - Hackers could access computer systems = remove confidential information. – Confidentiality breaking in this way could be negligent.

Question 34

MEDICAL NEGLIGENCE Explain what is meant by human factors?

Answer 34

- Personal factors (having a bad day>mistakes). - Teamwork problems (miscommunication, tensions between staff). - Working environment (lighting, space). - Decision density (leaving one person to make all decisions = pressure so more likely to make a mistake).

Question 35

MEDICAL NEGLIGENCE Explain what is meant by judgement failure?

Answer 35

- Defective decision making, bias. - Analytical or intuitive. - Wrong amount or type of information, wrong decision making strategy.

Question 36

MEDICAL NEGLIGENCE Explain what is meant by neglect.

Answer 36

- Not showing enough care. - Falling below expected standard. - Often chain of minor failures which may/may not lead to harm. - Can be multidisciplinary (communication + assumptions).

Question 37

MEDICAL NEGLIGENCE Explain what is meant by poor performance.

Answer 37

- Repeated minor mistakes or not learning from mistakes. - Usually extends beyond attitude to pt care (timekeeping, reliability, illness).

Question 38

MEDICAL NEGLIGENCE Explain what is meant by misconduct.

Answer 38

- Deliberate harm, covering up errors, improper relationships (staff/pts). - Fraud/theft/abuse i.e. falsely claiming sickness, substance misuse.

Question 39

ERROR Define error?

Answer 39

A preventable event that can cause or lead to an unintended outcome.

Question 40

ERROR What can medical error lead to?

Answer 40

Medical error is a preventable event that can lead to pt harm.

Question 41

ERROR What should you do in the event of a Patient Safety Event?

Answer 41

Notify, inform patient, explain + apologise under the Duty of Candour policy

Question 42

ERROR What are 2 types of medical error?

Answer 42

- ADVERSE EVENT = incident that results in pt harm. - NEAR MISS = event which had potential to cause harm but didn't develop further thereby avoiding harm.

Question 43

ERROR What are some different types of human (individual) errors?

Answer 43

- Omission (required action delayed/not taken). - Commission (wrong action taken). - Sequence (action taken in wrong order). - Fixation (regular act so don't recognise if something goes wrong). - Negligence (actions/omissions do not meet standard of an ordinary, skilled person).

Question 44

ERROR What are 4 broad classifications of errors?

Answer 44

- Intention. - Action. - Outcome. - Context.

Question 45

ERROR What is meant by intention?

Answer 45

- Failure of planned actions to achieve desired outcome.

Question 46

ERROR What are 3 types of intention error?

Answer 46

- SKILL-BASED (action made is not what was intended i.e. performing well-known task>little attention>error if distracted). - RULE-BASED (incorrect application of a rule/incorrect plan or course of action taken i.e. in emergencies). - KNOWLEDGE-BASED (lack of knowledge in a certain situation.

Question 47

ERROR What are the issues with knowledge based errors?

Answer 47

- Automatically make us prone to actions not as planned. - Memory may contain mini-theories rather than facts (liable to confirmation bias). - Limited attentional resources.

Question 48

ERROR What is meant by action?

Answer 48

- Generic factors (omission, intrusion, sequence). - Task-specific factors (wrong blood vessel/organ/side, bad knots in surgery).

Question 49

ERROR What is meant by outcome?

Answer 49

- Near miss. - Death/injury/loss of function. - Successful detection + recovery. - Prolonged intubation/stay in ICU.

Question 50

ERROR What is meant by context?

Answer 50

- Equipment + staffing issues. - Accumulation of stressors. - Interruptions + distractions. - Team/organisation factors. - Nature of procedure.

Question 51

ERROR What are some red flags for errors?

Answer 51

- Anomalies. - Broken communication, missing information or confusion. - Departures from normal practice. - Stress.

Question 52

ERROR What are the 10 types of basic error?

Answer 52

- Sloth. - Fixation + loss of perspective. - Communication breakdown. - Poor team working. - Playing the odds. - Bravado + timidity. - Ignorance. - Mis-triage. - Lack of skill. - System error.

Question 53

ERROR What is sloth?

Answer 53

not bothering to check results accurately, inadequate documentation.

Question 54

ERROR What is fixation + loss of perspective?

Answer 54

early unshakable focus on Dx, inability to see bigger picture.

Question 55

ERROR What is communication breakdown?

Answer 55

unclear instruction of plans, not listening to/considering other's opinions.

Question 56

ERROR What is poor team working?

Answer 56

some out of depth, some under-utilised.

Question 57

ERROR What is playing the odds?

Answer 57

choosing the common + dismissing rare.

Question 58

ERROR What is bravado + timidity?

Answer 58

working beyond competence/without adequate supervision (opposite for timidity).

Question 59

ERROR What is ignorance?

Answer 59

lack of knowledge, not knowing what you don't know.

Question 60

ERROR What is mis-triage?

Answer 60

over/underestimating the seriousness of a situation.

Question 61

ERROR What is lack of skill?

Answer 61

lack of appropriate skills, teaching or practice.

Question 62

ERROR What is a system error?

Answer 62

environmental, technology, equipment or organisation features. Inadequate safeguards build into system.

Question 63

ERROR What behaviour is lacking in each basic error?

Answer 63

- Sloth (conscientiousness). - Fixation + loss of perspective (open mindedness, situation awareness). - Communication breakdown (effective communication). - Poor team working (good teamwork). - Playing the odds (probability assessment). - Bravado + timidity (humility). - Ignorance (self-awareness). - Mis-triage (prioritisation). - Lack of skill (effective technical skills. - System error (good system deisgn).

Question 64

ERROR Give an improvement for... i) sloth. ii) fixation + loss of perspective. iii) communication breakdown. iv) poor team working v) playing the odds.

Answer 64

i) attention to detail, full documentation. ii) recognition of clinical patterns but considering facts that don't fit. iii) being approachable + open, listening, clear explanations. iv) clear team structure, leadership + roles. v) evaluation based on scenario features as well as likelihood.

Question 65

ERROR Give an improvement for... i) bravado + timidity ii) ignorance. iii) mis-triage. iv) lack of skill. v) system error.

Answer 65

i) accurate self-evaluation, open communication of mistakes. ii) aware of own abilities + limitations. iii) appreciation of the relative importance of each situation. iv) being properly trained in your role. v) system designed to be easy to use, complete + with design features that identify potential risk.

Question 66

ERROR Define a never event.

Answer 66

A serious, largely preventable patient safety incident that should not occur if the available preventative measures have been implemented.

Question 67

ERROR Give some examples of never events.

Answer 67

- Medical = wrong route for chemo (i.e. intrathecal vincristine scenario). - Surgical = wrong site or retained object. - Mental health = escape of transfer pt, suicide.

Question 68

ERROR What organisations must the hospital trust report never events to?

Answer 68

- National Reporting and Learning Systems (NRLS). - CQC. - Strategic Executive Information System (StEIS).

Question 69

ERROR What are the consequences of never events?

Answer 69

- Financial penalties. - Reputation loss. - CQC visit. - Fitness to practice meetings.

Question 70

ERROR What are the 2 perspectives on error?

Answer 70

- Person approach = focus on the individual at fault. - System approach = focus on the working conditions/organisations at fault.

Question 71

ERROR What is the concept of the person approach to error?

Answer 71

- Looks at + blames an individual/group of individuals. - States errors are the product of unpredictable mental processes (inattention, distraction, negligence). - Focusses on the unsafe acts of people on the frontline.

Question 72

ERROR What are the cons with the person approach to error?

Answer 72

- Anticipation of blame promotes 'cover up' + need for a detailed analysis to prevent recurrence (retraining, discipline).

Question 73

ERROR What is the concept of the system approach to error?

Answer 73

- Adverse events are the products of many causal factors. - The whole system has some kind of flaw at fault to blame. - Adapt system to prevent recurrence (recognise errors + implement defences). - Errors occur due to interaction between active failures + latent conditions.

Question 74

ERROR How can errors + harm be reduced?

Answer 74

- Simplification + standardisation of clinical processes. - Checklists + aide memories (SBAR). - Team training. - Risk management programmes to remedy latent factors. - Mechanisms to improve uptake of evidence-based Tx patterns.

Question 75

ERROR What tools can be used for risk identification?

Answer 75

- Incident reporting. - Complaints + claims. - Audit, service evaluation + benchmarking. - External accreditation. - Active measurement/compliance.

Question 76

ERROR Name the 2 models for errors.

Answer 76

- Swiss Cheese model. - Three bucket model.

Question 77

ERROR Explain the concept of the Swiss Cheese model

Answer 77

- An organisations defences against error are modelled as a series of barriers, represented as slices of cheese. - The holes in the slices represent weaknesses in individual parts of the system. - The holes are continually varying in size + position across the slices. - System failure occurs when a hole in each slice momentarily aligns.

Question 78

ERROR What is the difference between latent failures and active failures?

Answer 78

- Latent failures = flaws to the system e.g. organisational influences (culture, politics), unsafe supervision (oversight, Mx issues), preconditions for unsafe acts (lack of training, system + tools used). - Active failures = unsafe acts that are mistakes + errors at the frontline – the sharp end of the stick.

Question 79

ERROR What is the concept of the three bucket model?

Answer 79

- Error evolves due to interaction between personal, environmental + physical factors as well as organisation – this tool can help stratify risk.

Question 80

ERROR What do the 3 buckets represent in the 3 bucket model?

Answer 80

Self, context + task.

Question 81

ERROR Three bucket model – what comes under self?

Answer 81

- Level of knowledge (newly qualified, senior support available, unaware of current protocols). - Level of skill (competence + experience). - Level of expertise (confidence, automaticity, expectations/assumptions). - Current capacity to do task (fatigue, stressors, illness, life events).

Question 82

ERROR Three bucket model – what comes under context?

Answer 82

- Equipment (maintenance, availability, usability, power sources). - Physical environment (lighting, surfaces, noise, temperature). - Workspace (working environment, handovers, layout). - Team + support (leadership, trust, briefing + reflection). - Organisation + Mx (communication, safety culture + reporting, workload).

Question 83

ERROR Three bucket model – what comes under task?

Answer 83

- Errors (omission, commission, fixation, sequence). - Task complexity (calculations, double checking). - Novel task (unfamiliar events, rare events, new ways of working).

Question 84

ERROR What are some common issues with accidents/safety in healthcare?

Answer 84

- Wrong Dx>wrong plan. - Medication reconciliation (if forget to reconcile the meds list then pts may end up with duplicates, interactions). - High concentration medication solutions. - Pt identification. - Pt care handovers.

Question 85

ERROR Why is safety compromised so often in healthcare?

Answer 85

- Complex, high risk environment. - Responsibilities are often shared. - Practitioners often take risks unknowingly. - System, pt + practitioner interaction. - Resource intensive.

Question 86

ETHICS Define ethics.

Answer 86

system of moral principles + a branch of philosophy that defines what is good for individuals + society.

Question 87

ETHICS Define morality.

Answer 87

concerned with the distinction between good + evil or right + wrong.

Question 88

ETHICS What are the 4 pillars of medical ethics?

Answer 88

- AUTONOMY (respecting pt's right to make informed decisions about their own medical care). - BENEFICENCE(duty to 'do good' i.e. provide benefits to the pt). - NON-MALEFICENCE (duty to 'do no harm' i.e. not doing bad. - JUSTICE (ensuring all pts treated equally + equitable i.e. fairness in distribution of Tx).

Question 89

ETHICS What is the concept of Utilitarianism?

Answer 89

- An act is evaluated solely in terms of its consequences to maximise good + minimise harm.

Question 90

ETHICS What are the cons of utilitarianism?

Answer 90

treats minorities unfairly to promote majority happiness, how do you define what is good?

Question 91

ETHICS What is the concept or virtue ethics?

Answer 91

- Focuses on the person who is acting – do they express good character? - An act is only virtuous if the person is acting with the genuine intention of doing the right thing – are they integrating reason + emotion.

Question 92

ETHICS What are the cons of concept or virtue ethics?

Answer 92

- virtues are culture-specific + too broad for practical application, - no focus on consequences i.e. compassion may lead to not telling harmful truth = lying.

Question 93

ETHICS What are the 5 focal virtues that are acquired?

Answer 93

- DISCERNMENT (ability to judge well). - CONSCIENTIOUSNESS (being thorough, careful + vigilant). - COMPASSION (showing concern for others). - TRUSTWORTHINESS (ability to be relied on). - INTEGRITY (being honest + having good moral principles).

Question 94

ETHICS What is the concept of deontology?

Answer 94

- Features of the act determines worthiness. - Teaches that acts are right/wrong + people have a duty to act accordingly (treat others how you would like to be treated).

Question 95

ETHICS What are the cons of deontology?

Answer 95

consequences not looked at, duties can conflict.

Question 96

ETHICS What are categorical imperatives?

Answer 96

- Version of deontology. - Categorical imperative is a rule that is true in all circumstances. - Act in a way you would be willing it to become universal law.

Question 97

GMC DUTIES AS A DR What are the 4 domains encompassing duties of a doctor?

Answer 97

1) Knowledge, skills + performance. 2) Safety + quality. 3) Communication, partnership + teamwork. 4) Maintaining trust.

Question 98

GMC DUTIES AS A DR Give some examples of the varying duties of a doctor.

Answer 98

- Provide a good standard of practice i.e. keep professional skills updated (1). - Recognise + work within limits of competence (1). - Take prompt action if think pts safety/dignity/comfort is being compromised (2) - Protect + promote the health of pts + public (2). - Tx patients as individuals + respect their dignity + confidentiality (3). - Work in partnership with pts (3). - Work in collaboration with colleagues to best service pts interests (3). - Be honest, open + act with integrity (4). - Never discriminate unfairly against pts/colleagues (4).

Question 99

GMC DUTIES AS A DR What are the benefits of doctors using social media?

Answer 99

- Facilitating public access to accurate health information. - Improving patient access to services. - Establishing wider + more diverse social + professional networks. - Engaging with the public + colleagues in debates.

Question 100

GMC DUTIES AS A DR What are the risks of doctors using social media?

Answer 100

- Loss of personal privacy. - Potential breaches in confidentiality. - Online behaviour that may be perceived as unprofessional, offensive or inappropriate by others. - Risks of posts being reported by the media or sent to employers.

Question 101

DIVERSITY EDUCATION Define culture.

Answer 101

a socially transmitted pattern of shared meanings by which people communicate, perpetuate + develop their knowledge + attitudes about life.

Question 102

DIVERSITY EDUCATION Define acculturation.

Answer 102

Adapting to a new culture.

Question 103

DIVERSITY EDUCATION Define stereotypes.

Answer 103

generalisations about the 'typical' characteristics of members of a group.

Question 104

DIVERSITY EDUCATION Define ethnocentrism

Answer 104

the tendency to evaluate other groups according to the values + standards of one's own culture group, especially with the conviction that one's own culture group is superior to others.

Question 105

DIVERSITY EDUCATION Define prejudice.

Answer 105

attitudes towards another person based solely on their membership of a group.

Question 106

DIVERSITY EDUCATION Define discrimination.

Answer 106

actual positive or negative action towards the objects of prejudice.

Question 107

DIVERSITY EDUCATION What makes up someone's individual culture?

Answer 107

- May be based on heritage, as well as individual circumstances + person choice – it's a dynamic entitiy.

Question 108

DIVERSITY EDUCATION Explain the iceberg model of culture.

Answer 108

- Parts of culture which are visible from the surface (can be deducted from appearance e.g. you can have idea of their age, nationality, ethnicity, gender). - Parts of culture which you cannot possibly see from the surface (more embedded within the person e.g. socioeconomic status, occupation, health, religion, education, sexual + political orientation).

Question 109

DIVERSITY EDUCATION How can we bridge cultural distance?

Answer 109

- Self-awareness = being aware of your own feelings + reactions. - Respectful curiosity = suspend judgement, don't assume – ask. - Greater the culture distance, more likely it is that any assumptions you make will be wrong.

Question 110

DIVERSITY EDUCATION What are the benefits of diversity training?

Answer 110

Pts – adherence more likely as more satisfied with their care, fewer diagnostic tests + referrals, pt Sx burden is reduced. Drs – fewer complaints, more time efficient.

Question 111

DIVERSITY EDUCATION What are some challenges + solutions concerning diversity in healthcare?

Answer 111

- Language barriers (longer appts, interpreters). - Fasting + needs for medications (speak to religious leader ?exemption). - Health beliefs such as different expectations in Dr/Pt relationship (paternalistic), Jehovah Witnesses' refusing blood (talk to pts + understand their beliefs, education). - Expectations of healthcare system private vs. NHS (education). - Taboos (i.e. sexual health in some cultures).

Question 112

COMM DIFFICULTIES From a SALT perspective, what is meant by... i) speech? ii) language? iii) pragmatics? iv) comprehension? v) expression?

Answer 112

i) converting language into an audible form. ii) can be spoken, writing, gestures. It's to do with words + how we put them together. iii) how language is used (turn taking, eye contact). iv) aka receptive language – understanding language. v) aka expressive language – producing language.

Question 113

COMM DIFFICULTIES What happens in speech impairment?

Answer 113

- Words are unaffected, output is affected

Question 114

COMM DIFFICULTIES How may speech impairment present?

Answer 114

- Dysarthria (imprecise/slurred speech), - Apraxia (speech sounds in the wrong order), - Stammer/stutter (dysfluent speech)

Question 115

COMM DIFFICULTIES What are some causes of speech impairment?

Answer 115

- Stroke, - Cerebral palsy, - Acute brain injury, - MND.

Question 116

COMM DIFFICULTIES What happens in language impairment?

Answer 116

Can relate to written or spoken language + is where ability to understand concepts unaffected just ability to understand the means of the message.

Question 117

COMM DIFFICULTIES How may language impairment present?

Answer 117

- There may be trouble understanding some words, longer phrases or grammar etc. - May present as unreliable yes/no, no language produced, word-finding difficulties.

Question 118

COMM DIFFICULTIES What are some causes of language impairment?

Answer 118

- Stroke, - Dementia (primary progressive aphasia), - Acute brain injury.

Question 119

COMM DIFFICULTIES What happens in a pragmatic impairment?

Answer 119

- May be a feature in many conditions (Autism-spectrum disorders). - May present as atypical body language, difficulties with turn-taking.

Question 120

COMM DIFFICULTIES What happens in voice disorders?

Answer 120

- Acute vs. chronic. - Causes – laryngectomy, common cold, GORD, Parkinson's, environmental pollutants.

Question 121

COMM DIFFICULTIES What are the impact of communication disorders?

Answer 121

- Everyday activities (difficulty with work, shopping, transport). - Social engagement (difficulties ordering food). - Relationships (both parties may get frustrated, may lead to isolation). - Healthcare (more vulnerable to medical errors, may face prejudice).

Question 122

COMM DIFFICULTIES What are some strategies to support communication?

Answer 122

- Simplify language, use visual aids, check the person has understood, don't rush. - E.g. break down into smaller chunks, gestures, recap, speak slowly, one Q at a time, different methods of communication, repeat yourself.

Question 123

TEACHING SKILLS How should a skill be taught?

Answer 123

- Breaking the task down into smaller components. - Utilising an internal commentary. - 'See one, do one, teach one'.

Question 124

TEACHING SKILLS What is Peyton's 4 step procedure for skill training?

Answer 124

- Trainer demonstrates without commentary./ - Trainer demonstrates with commentary. - Learner talks through + trainer does. - Learner talks through + does.

Question 125

TEACHING SKILLS What are some critiques of Peyton's 4 step procedure?

Answer 125

- Insufficient time for learner to practice. - Insufficient feedback. - Lack of clarity + thoroughness.

Question 126

TEACHING SKILLS What is a method used in small group teaching? Give examples.

Answer 126

- Tutor facilitation rather than teaching. - Micro-facilitation by dividing into smaller groups. - E.g. rounds (each student has 1m to talk), circular interviewing (students ask each other questions), buzz groups.

Question 127

TEACHING SKILLS What are the key responsibilities of small group teachers?

Answer 127

- Manage the group, activities + learning. - Facilitate the learning by leading discussions, asking open-ended Qs, guiding process + task, enabling active participation of learners + engagement with ideas.

Question 128

TEACHING SKILLS What fundamental questions should a small group teacher ask themselves?

Answer 128

- Who am I teaching? (Numbers, levels, names). - What am I teaching? (Topic, type of expected learning i.e. knowledge, skill, behaviours). - How will I teach it? - How will I know if the students understand/understood?

Question 129

TEACHING SKILLS What are some question strategies?

Answer 129

- Evidence = how do you know that? Evidence? - Clarification = can you give me an example? Explain this term? - Explanation = why is that the case? - Linking + extending = how does this idea support/challenge what we explored earlier? - Hypothetical = what might happen if? - Cause + effect = how is this response related to that? - Summary + synthesis = what remains unsolved/uncertain?

Question 130

TEACHING SKILLS What is the tripartite model of types of learning?

Answer 130

- Surface. - Strategic. - Deep approach.

Question 131

TEACHING SKILLS What is meant by surface?

Answer 131

- Fear of failure. - Desire to complete a course. - Learning by rote + focus on particular tasks.

Question 132

TEACHING SKILLS What is meant by strategic?

Answer 132

- Desire to be successful. - Leads to a patchy + variable understanding (well organised form of surface learning).

Question 133

TEACHING SKILLS What is meant by deep approach?

Answer 133

- Intrinsic, vocational interest, person understanding. - Making links across materials, search for deeper understanding of the material, look for general principles.

Question 134

TEACHING SKILLS What are 4 different types of learner?

Answer 134

- Theorist = complex situation, can question ideas, offered challenges. - Activist = new experiences, extrovert, likes deep end, leads. - Pragmatist = wants feedback, purpose, may like to copy. - Reflector = watches others, reviews work, analyses, collects data.

Question 135

TEACHING SKILLS What is Kolb's learning cycle?

Answer 135

- Conclusions from experience (theorist). - Experience (activist). - What can I do differently next time? (pragmatist). - Review + reflect on experience (reflector).

Question 136

TEACHING SKILLS What is the relevance of different types of learners?

Answer 136

Individuals should choose activities which best match their learning style + identify least dominant style so that they can strengthen these.

Question 137

TEACHING SKILLS What is meant by intuitive thinking in decision making? What are some biases?

Answer 137

- Ability to understand something instantly without conscious reasoning. Biases: confirmation bias (tendency to favour information that confirms or strengthens their existing beliefs or theories).

Question 138

TEACHING SKILLS What is meant by analytical thinking? What are some cons?

Answer 138

- Lacks skills at estimating odds or values but excels at measuring + calculating them. This is the basis of evidence-based medicine. Cons: slow, resource intensive, cognitively demading.

Question 139

TEACHING SKILLS What is the dual process theory?

Answer 139

- Intuitive thinking with its irresistible combination of heuristics + biases, together with analytical thinking, using evidence-based medicine.

Question 140

LEADERSHIP What are the 5 leadership styles?

Answer 140

- Authoritarian. - Participative. - Delegative (Laissez-faire). - Transactional. - Transformational (inspirational).

Question 141

LEADERSHIP What is the concept of authoritarian leadership?

Answer 141

- Allows one leader to impose expectations + define outcomes.

Question 142

LEADERSHIP What are the pros/cons of authoritarian leadership?

Answer 142

Pros: - consistent results, - time spent on crucial decision reduced. Cons: - v strict, - lack of staff creativity/innovation, - lack of group input.

Question 143

LEADERSHIP What is the concept of participative leadership?

Answer 143

Rooted in democratic theory to involve team members in the decision-making process> feeling included, engaged + motivated to contribute.

Question 144

LEADERSHIP What are the pros/cons of participative leadership?

Answer 144

Pros: - encourages staff creativity, - increases staff motivation. Cons: - decisions may be time-consuming, - poor decisions may be made.

Question 145

LEADERSHIP What is the concept of delegative leadership?

Answer 145

- Focuses on delegating initiative to team members, letting things take their own course without interfering.

Question 146

LEADERSHIP What are the pros/cons of delegative leadership?

Answer 146

Pros: - environment of independence, - experienced staff can offer experience. Cons: - downplays role of leader, - leaders avoid leadership, - staff may abuse.

Question 147

LEADERSHIP What is the concept of transactional leadership?

Answer 147

Leader sets clear goals + uses "transactions" such as rewards, punishments etc to get the job done. Staff know how their compliance is rewarded.

Question 148

LEADERSHIP What are the pros/cons of transactional leadership?

Answer 148

Pros: - staff motivation + productivity increased, - reward system. Cons: - innovation/creativity minimised, - less leaders created, - seen as coercive.

Question 149

LEADERSHIP What is the concept of transformational leadership?

Answer 149

- Leader inspires the followers with a vision + then encourages + empowers them to achieve it. The leader serves as a role model for the vision.

Question 150

LEADERSHIP What are the pros/cons of transformational leadership?

Answer 150

Pros: - high value on corporate vision, - high morale for staff, - not coercive. Cons: - leaders can deceive staff, - may need consistent motivation/feedback.

Question 151

LEADERSHIP What leadership model is best suited for healthcare and why?

Answer 151

- Transformational. - It places the needs of pts, carers + families at the centre of all work + people can intervene when necessary. - I.e. speak up if risk to pt, continually improve system, talk to seniors if lack of skill, knowledge or resources.