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Opis ebooka The Ultimate FPAS SJT Guide - Rohan Agarwal

“Sometimes knowing the answer isn’t enough. You need to know how and why it is correct...”Published by the UK’s leading university admissions company, the Ultimate FPAS SJT Guide contains 300 Practice Questions with Fully Worked Explanations. Written for 2018 Entry, it’s full of score boosting strategies and Expert Advice.The worked explanations give you a valuable insight into how to approach difficult questions and the most efficient methods for getting the correct answer 100% of the time.This is a Must Buy for anyone preparing for the FPAS SJT.

Opinie o ebooku The Ultimate FPAS SJT Guide - Rohan Agarwal

Fragment ebooka The Ultimate FPAS SJT Guide - Rohan Agarwal

THE ULTIMATE FPAS SJT GUIDE

300 Questions

Shivun Khosla and Rohan Agarwal

RAR MEDICAL SERVICES

TABLE OF CONTENTS

About the Authors

The Basics

General Advice

The Basics

Medical Ethics

Medical Law

Question Answering Strategy

Important Principles

QUESTIONS

Practice Questions

Answers

Worked Answers

Final Advice

Your Free Book

Afterword

The Ultimate

FPAS SJT Guide

Copyright © 2017 UniAdmissions. All rights reserved.

ISBN 978-0-9935711-3-8

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information retrieval system without the prior written permission of the publisher. This publication may not be used in conjunction with or to support any commercial undertaking without the prior written permission of the publisher.

Published by RAR Medical Services Limited

www.uniadmissions.co.uk

info@uniadmissions.co.uk

Tel: 0208 068 0438

This book is neither created nor endorsed by any medical schools, nor by any other body. The authors and publisher claim no affiliation with any medical school or university. The information offered in this book is purely advisory and any advice given should be taken within this context. As such, the publishers and authors accept no liability whatsoever for the outcome of any applicant’s university applications or for any other loss. Although every precaution has been taken in the preparation of this book, the publisher and author assume no responsibility for errors or omissions of any kind. Neither is any liability assumed for damages resulting from the use of information contained herein. This does not affect your statutory rights.

The Ultimate

FPAS SJT Guide

Dr. Shivun Khosla

Dr. Rohan Agarwal

ABOUT THE AUTHORS

SHIVUN GRADUATED FROM GONVILLE AND Caius College, Cambridge with first-class honours in Biological and Biomedical Sciences before completing his clinical training in the East Anglia region, centred at Cambridge University Hospitals Trust. After spending his foundation year in Kent, Shivun is now a trainee at Guy’s and St. Thomas’ NHS Foundation Trust.

Shivun has a passion for medical education having lectured and tutored throughout his time in Cambridge to medical, veterinary, and biological science students on undergraduate and post-graduate courses. He has also implemented foundation training courses in the South Thames Foundation School, with his work being acknowledged and rewarded by Kings College London and the deanery.

Shivun achieved a total of 91.1 in his FPAS application and scored 49.1 on the SJT.

Rohan is the Director of Operations at UniAdmissions and is responsible for its technical and commercial arms. He graduated from Gonville and Caius College, Cambridge and is a fully qualified doctor. Over the last five years, he has tutored hundreds of successful Oxbridge and Medical applicants. He has also authored ten books on admissions tests and interviews.

Rohan has taught physiology to undergraduates and interviewed medical school applicants for Cambridge. He has published research on bone physiology and writes education articles for the Independent and Huffington Post. In his spare time, Rohan enjoys playing the piano and table tennis.

THE BASICS

What is FPAS?

The Foundation Programme Application System (FPAS) is an online, national standardised system within the United Kingdom (UK), and is designed for final year medical students to apply to foundation training posts. It is run by the UK Foundation Programme Office (UKFPO).

What does the FPAS consist of?

FPAS consists of 10 online sections that need to be filled in so that UKFPO can ensure you have the necessary competencies to practice medicine in the UK after confirmation of passing your final examinations.

The 10 sections include:

Personal Details

Eligibility to practice

Fitness to Practice

References

Competences

Supplementary Evidence and Education Achievements

Supporting Evidence (AFP only)

Preferences for Deanery

Equality

Declarations

The information entered above is used to help generate a total score for your application out of a maximum of 100 points.

Why is the SJT used?

Situational Judgement Testing is a form of psychometric analysis used to assess potential employees’ responses to scenarios that are frequently encountered in the workplace. It allows employers to assess aptitude for competent decision making and tests key attitudes and behaviours of potential candidates.

SJTs have been used in applications for General Practice Specialty Training for a number of years, and their success has been transitioned into the FPAS system and also the UK Clinical Aptitude Test for students applying through UCAS for A100 Medicine.

When do I sit SJT?

The SJT has two datesfor the 2016-2017 cycle – 2nd December 2016 and 9th January 2017.

Your medical school will decide which date you are scheduled to take the exam.

Can I avoid the SJT?

Unfortunately not! Even those who wish to apply for the Academic Foundation Programme are required to take and “pass” the SJT to fulfil the requirements set out by the UKFPO.

How is the SJT Scored?

The SJT is composed of 70 questions in a 2 hour and 20 minute exam. 10 of these questions are “plant questions.” This means that they are not counted towards your final score. The total mark possible is 50.00 but virtually all students score between 20.01 and 50.00. It is worth looking at the most recent score distributions for the SJT as scores tend to cluster between 37 and 42.

Two-thirds of the questions are ranking questions where you receive a stem then five choices to rank in order of most appropriate to least appropriate. These are scored out of a maximum of 20 with the minimum possible mark being 8. For each answer (A-E) that is given the correct ranking (1-5), you receive 4 points. If the ranking you give is one off either way, then you receive 3 points.

For example, if you rank answer A as 2 but the examiners have it as 3, then you would receive 3 marks. If your answer is 2 ranking spots off, you receive 2 marks, if it is 3 ranking spots off, then you get 1 point. If it is 4 spots off, you receive no points. Therefore, if you make one mistake, another answer will be wrong also – thus you lose points in pairs giving an even score. For these ranking questions, you should aim for an average of 16 per question.

One-third of the questions are extended matching type questions where you will be given a choice of eight answers after a stem and will be asked to select the three best answers. Each correct answer is worth 4 marks, giving a maximum of 12 for these questions. These questions are where the majority of marks are lost as getting one option wrong loses you one-third of the available marks.

When do I get my results?

The results for the SJT are not available until March 2017 and come out on the same day as the results of your application. UKFPO do not comment on individual cases nor do they provide feedback or answer rationales.

For more information on FPAS and the SJT, we recommend reviewing the official UKFPO website.

GENERAL ADVICE

Start Early

It is much easier to prepare if you practice little and often. Start your preparation well in advance; ideally by late October to early November for the first sitting or late November for the second sitting. This way, you will have plenty of time to comfortably complete as many questions as you can, and won’t have to panic just before the test, which is a much less effective and more stressful way to learn. In general, an early start will give you the opportunity to identify the complex issues and work at your own pace.

It is best to revise in a group for this type of exam. You will frequently come across questions that you do not agree with the rationales for, and therefore, getting the input of friends who have done the same question may allow you to identify different perspectives. Remember, this is what the examiners do to ultimately set the “optimal” rankings and choices, so you should do it too.

Start with the Practice Paper

Our team would recommend starting your revision with the practice paper. As this is the only official resource, doing it first gives you two advantages when coming to your revision. The first is that you get a realistic impression of the difficulty of the questions they are likely to ask and the time pressures. The second is that you can take that realism into your revision. Our editorial team know some resources are overly simple with their questions and do not reflect what you may experience as a junior doctor or in the exam.

All of our questions are based on anecdotal experiences of people from foundation to registrar level. They have been screened by an independent editorial team formed of medical students to core trainees, all of whom are experienced in medical education

Teamwork

It is best to revise in a group for this type of exam. You will frequently come across questions that you do not agree with the rationales for, and therefore, getting the input of friends who have done the same question may allow you to identify different perspectives. Remember, this is what the examiners do to ultimately set the “optimal” rankings and choices, so you should do it too.

We would suggest creating a small revision group of four or five people and utilising the same resources so that everyone covers the same questions. Then you can sit down and discuss them together and go over rationales you felt were contentious.

THE BASICS

THE SITUATIONAL JUDGEMENT TEST IS a psychological aptitude test; it is an assessment method used to evaluate your ability for solving problems in work-related situations. SJTs are widely used in medicine as one of the criteria when deciding on applicants; it is used for the Foundation Programme and GP applications.

The aim of the SJT is to assess your ability to understand situations that you could encounter as a junior doctor and how you would deal with them. It is a method to test some of the qualities required in a healthcare professional (e.g. integrity and ability to work in a team).

The series of scenarios include possible actions and considerations. You will be asked to assess the “appropriateness” of options in relation to the scenario.

You should subdivide the options into:

A very appropriate thing to do

– This is an ideal action.

Appropriate, but not ideal

– This option can be done but is not necessarily the best thing to be done.

Inappropriate, but not awful

– This should not be done, but if it does occur, the consequences are not terrible.

A very inappropriate thing to do

– This should not be done in any circumstances, as it will make the situation worse.

When given a situational judgement question, there is a basic framework that can help you to work through it:

Identify the basic dilemma (in the example, it is the clash between social commitments and the need for an effective patient handover)

Identify your potential courses of action (where you are given options, do pick one of the options given, but also suggest an alternative action which would be better if you think there is one)

What qualities can be shown by each action

What the potential disadvantages are of these actions

Think about how the perspectives of colleagues/patients may differ from your own

Balance these to pick an action which you can justify with a sound argument

EXAMPLE:

You are an FY1 on liaison psychiatry. You notice that one of the GP trainees is drinking vodka on the job with some of the patients.

Rank the actions below in the order of most appropriate to least appropriate:

Do nothing because they are more senior so you should not interfere

Notify your educational supervisor

Notify your clinical supervisor

Talk to the colleague directly

Contact the GMC

Stem Theme – Colleague is found drinking alcohol at work.

Examples of principles tested – Patient safety, your relationship with teammates, confidentiality of colleagues, professionalism, your duty of care to patients.

A – Good – preserves relationship with teammate; Bad – risk to patient safety, unprofessional

B – Good – action to protect patients; Bad – educational supervisor not directly involved with patient care, risk of breakdown in relationship with that GP, breach of GP’s confidentiality

And so on...

MEDICAL ETHICS

THERE ARE NORMALLY MULTIPLE MEDICAL ethics questions every year so it’s well worth spending your time revising them. These principles can be applied to all cases regardless of what social/ethnic background the healthcare professional or patient is from. The principles are:

Beneficence: The wellbeing of the patient should be the doctor’s first priority. In medicine, this means that one must act in the patient’s best interests to ensure the best outcome is achieved for them, i.e. ‘Do Good’.

Non-Maleficence: This is the principle of avoiding harm to the patient (i.e. Do no harm). There can be a danger that in a willingness to treat, doctors can sometimes cause more harm to the patient than good. This can especially be the case with major interventions, such as chemotherapy or surgery. Where a course of action has both potential harms and potential benefits, non-maleficence must be balanced against beneficence.

Autonomy: The patient has the right to determine their own healthcare. This, therefore, requires the doctor to be a good communicator so that the patient is sufficiently informed to make their own decisions. ‘Informed consent’ is thus a vital precursor to any treatment. A doctor must respect a patient’s refusal for treatment even if they think it is not the correct choice. Note that patients cannot demand treatment – only refuse it, e.g. an alcoholic patient can refuse rehabilitation but cannot demand a liver transplant.

There are many situations where the application of autonomy can be quite complex, for example:

Treating Children

: Consent is required from the parents, although the autonomy of the child is taken into account increasingly as they get older. Children younger than 18 years old can consent to treatment if they are ‘Gillick Competent’ but they cannot refuse it.

Treating adults

without the capacity

to make important decisions. The first challenge with this is in assessing whether or not a patient has the capacity to make the decisions. Just because a patient has a mental illness does not necessarily mean that they lack the capacity to make decisions about their healthcare. Where patients do lack capacity, the power to make decisions is transferred to the next of kin (or Legal Power of Attorney, if one has been set up).

Justice: This principle deals with the fair distribution and allocation of healthcare resources for the population.

Consent: This is an extension of Autonomy- patients must agree to a procedure or intervention. For consent to be valid, it must be voluntary informed consent. This means that the patient must have sufficient mental capacity to make the decision and must be presented with all the relevant information (benefits, side effects, and the likely complications) in a way they can understand.

Confidentiality: Patients expect that the information they reveal to doctors will be kept private- this is a key component in maintaining the trust between patients and doctors. You must ensure that patient details are kept confidential. Confidentiality can be broken if you suspect that a patient is a risk to themselves or to others, e.g. Terrorism, suicides, certain infectious diseases.

MEDICAL LAW

UNDERSTANDING THE PRINCIPLES OF MEDICAL law is essential when answering the questions on the SJT. Here is a brief overview of some key legal cases and principles that you should familiarise yourself with:

MENTAL HEALTH ACT

This act basically governs how healthcare professionals interact with people who have mental disorders and their rights to force treatment. The original act was passed in 1983, but there was a significant amendment in 2007. The most significant components for health professionals are the definition of holding powers which allow doctors to detain and treat a patient with a mental illness against their will. Most notably, these are sections 5(2) and 5(4) which define doctors’ and nurses’ duties respectively. Other orders to be aware of are section 135 (magistrate order) and section 136 (police order). You should hopefully have covered these during your psychiatry rotations.

MENTAL CAPACITY ACT

The primary purpose of the 2005 act is to govern the decision-making process on behalf of adults who lack the capacity to make decisions for themselves. There are several principles to be aware of:

A person must be assumed to have the capacity unless proven otherwise.

A person is not to be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success.

A person is not to be treated as unable to make a decision merely because they make an unwise decision.

An act must be in their best interest.

The act must be the least restrictive with regards to the individual’s freedom.

DATA PROTECTION ACT

This act gives the GMC power to control how data is collected, recorded, and used. Personal data under the act is defined as identifiable information. It’s important that data is:

1) Processed fairly and lawfully
2) Gathered for specific purposes.
3) Adequate, relevant, accurate, and kept up to date

This governs how doctors collect patient information and who they can share this information with. Practical examples are doctors being allowed to break confidentiality for acts of suspected terrorism and road traffic accidents.

GILLICK COMPETENCE

Children under the age of 18 can consent to treatment if they are able to understand, weigh up, and decide they want the treatment. However, they cannot refuse treatment until they are 18 years old. For children under 18 with no parent/guardian and aren’t Gillick competent, you are able to act ‘in their best interest’.

BOLAM TEST

The Bolam test is a legal rule that assesses the appropriate standard of reasonable care in negligence cases involving a skilled professional. The Bolam test states “If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent“. In order for someone to be shown as negligent, it must be established that:

1) There was a duty of care
2) The duty of care was breached
3) The breach directly led to the patient being harmed.

QUESTION ANSWERING STRATEGY

TREAT EVERY OPTION INDEPENDENTLY

THE OPTIONS MAY SEEM SIMILAR, but don’t let the different options confuse you. Read each option as if it is a question of its own. It is important to know that responses should NOT be judged as though they are the ONLY thing you are to do. An answer should not be judged as inappropriate because it’s incomplete, but only if there is some actual inappropriate action taking place.

For example, if a scenario says “a patient on the ward complains she is in pain”, the response “ask the patient what is causing the problem” would be very appropriate, even though any good response would also include informing the nurses and other doctors about what you had been told.

There might be multiple correct responses for each scenario, so don’t feel you have to answer each stem differently. If you are unsure of the answer, mark the question and move on. Avoid spending more than 90 seconds on any question, otherwise, you will fall behind and risk not finishing.

READ “TOMORROW’S DOCTORS” AND “GOOD MEDICAL PRACTICE”

These are publications produced by the General Medical Council (GMC) which can be found on their website. The GMC regulates the medical profession to ensure that standards remain high. These publications can be found on their website, and it outlines the expectations of the next generation of doctors – the generation of doctors you are aspiring to join. Reading through this will get you into a professional way of thinking and will help you to judge these questions accurately.

STEP INTO CHARACTER

When doing this section, imagine you are in the scenarios being presented to you. Imagine yourself as the caring and conscientious junior doctor that you soon will be. What would you do? What do you think would be the right thing to do?

HIERARCHY

The patient is of primary importance. All decisions that affect patient care should be made to benefit the patient. Of secondary importance are your work colleagues. So, if there is no risk to patients, you should help out your colleagues and avoid doing anything that would undermine them or harm their reputation – but if doing so would bring detriment to any patient, then the patient’s priorities come to the top.

Finally, of lowest importance is yourself. You should avoid working outside hours and strive to further your education, but not at the expense of more important or urgent priorities. Remember the key principles of professional conduct and you cannot go far wrong. Of first and foremost importance is patient safety. Make sure you make all judgements with this hierarchy in mind.

BE REALISTIC

The SJT is not a knowledge-based test and the students that perform best in it tend to be ones who have substantial clinical experience. It requires you to be pragmatic when making decisions. For example, in the scenario: “An elderly gentleman from Brazil is admitted to your ward. You can’t verbally communicate as you don’t speak Portuguese”.

In this scenario, many might consider it prudent to arrange an interpreter. However, this can be a laborious and long-winded process (especially out of standard hours). The better option, if possible, is to locate a member of staff that can speak Portuguese to interpret for you.

IMPORTANT PRINCIPLES

AS MENTIONED PREVIOUSLY, THERE ARE several core principles that you should attempt to apply to the questions which will aid you in ranking the answers. Most of these relate to non-technical skills, i.e. beyond knowledge based systems/theory.

ADOPT A PATIENT-CENTRED APPROACH TO CARE

This involves being able to treat patients as an individual and respecting their decisions. You should also respect a patient’s right to confidentiality, unless there is a significant risk to the general public (see “Good Medical Practice”). The final core tenet is maintaining patient safety. This is usually the most important one to apply during the SJT.

WORKING WELL IN A TEAM

Teamwork is an essential part of any job. You must be a trustworthy and reliable team member and also communicate effectively within the team, between teams, and to other specialists. You should always support your colleagues, senior or junior, should they require it. It is important to avoid conflict and be able to de-escalate situations without jeopardising professional relationships where possible.

UNDERSTANDING THE LIMITS OF YOUR COMPETENCE

This becomes more important as you progress through your training as only you will be able to assess your own competence with regards to the management of patients and in procedural skills. You should have an appreciation of what needs to be escalated, when to escalate it, and to whom.

COMMITMENT TO PROFESSIONALISM

You should always act with honesty and integrity as this is expected of anyone entering the profession. This includes apologising for your mistakes and trying to ensure other people apologise for theirs.

TAKING RESPONSIBILITY FOR YOUR LEARNING

Medicine is a career where you are continuously learning. You are the sole person responsible for it and you will need to prioritise your jobs to ensure you attend scheduled teaching and courses. You should be able to critically reflect upon your experiences.

QUESTIONS

PRACTICE QUESTIONS

QUESTION 1:

YOU ARE ON CALL OVER the weekend and have been attending to a sick patient on one of the wards. When you arrive at the acute admissions ward the nurse in charge starts shouting angrily at you for being irresponsible. She says that you are late and should have come sooner as there are many urgent jobs to do.

Rank the actions below in order of most appropriate to least appropriate:

Tell the nurse that they should have bleeped you if they really needed you

Refuse to do any jobs until the nurse apologises

Tell the nurse to lodge a complaint

Threaten to lodge a complaint against the nurse unless they calm down

Explore why the nurse is so angry, explain where you have been and that you didn’t realise that there were urgent jobs to do.

QUESTION 2:

You are the FY1 on the ward round where your other FY1 colleague is running late. When she eventually turns up she says she is feeling unwell with stomach cramps and has been vomiting all morning causing her to be late. She asks you to leave the ward round to give her some IV fluids and some paracetamol from the treatment room to help her feel better so she can come help you with.

Choose the THREE most appropriate actions to take in this situation:

Tell her to go home if she is feeling unwell

Report her to your consultant for coming in when she is an infection risk

Give her some of your own paracetamol

Tell her she needs to sort herself out quickly as the ward is very busy and you need her help

Give her some IV fluids to help her recover quickly as you have a lot of patients and will need her help

Explain that you are in the middle of the ward round and she should ask someone else for help

Offer to cover for the day while she recovers

QUESTION 3:

You are the FY1 on call and have been bleeped to see a patient on a ward. Whilst there a nurse approaches you about a different patient and asks you to write up their venous thromboembolism prophylaxis after a surgery as she asked the ward FY1 to sign the prescription, but they had said they were too busy and refused to sign the prescription.

Choose the THREE most appropriate actions to take in this situation:

Speak to the doctor who refused to sign the medication

Complain to the nurse in charge about the nurse in question because she is undermining the decisions of the ward doctors

Go and see the patient in question

Refuse to sign the prescription and tell the nurse that there will be a good reason why the doctor she had previously ask refused

Speak to your consultant about your FY1 colleague as they are neglecting patient care

Advise the nurse to speak directly to the doctor in question in the future

Advise the nurse to speak to your consultant about the doctor in question

QUESTION 4:

You are the FY1 on a surgical firm and you notice that your FY2 often takes home the patient list in order to be able to memorise the patients for the consultant ward round, which means they do not have to come in so early as you to prepare.

Rank the actions below in order of most appropriate to least appropriate:

Start taking your own list home so you can memorise the patients too

Ask the nurse in charge of the surgical ward for more confidential waste bins

Pointedly ask if he knows where the confidential waste bins are located

Inform your colleague that he should not be taking the list home

Explain to your consultant what he is doing

QUESTION 5:

As the surgical FY1, your consultant has advised you that one of their private patients is coming in to your ward and has asked you to clerk them in and send their pre-operative bloods on your normal NHS shift. You already have a lot of patients to see and worry that this will take up too much of your valuable time.

Rank the actions below in order of most appropriate to least appropriate:

Explain to the consultant that you don’t have time. However, it’s fine if they reimburse you to stay later after your shift to clerk their private patient.

Explain the situation to one of your other consultants to ask for advice

Ignore your consultants message and reply later saying you were too busy with your own patients

Ask to speak to your consultant about the increased workload

Do the clerking and bloods as quickly as possible

QUESTION 6:

You are the anaesthetic FY1 on call in your first few weeks when you are the first to arrive at a cardiac arrest where nurses are performing compressions. The medical registrar arrives and asks you to put in a chest drain as it is believed the patient has a pneumothorax, while they make the notes and timings. You have only done this once, supervised before.

Rank the actions below in order of most appropriate to least appropriate:

Do the chest drain yourself

Ask one of the nurses to bleep the FY2 to come help

Ask the medical registrar for guidance on performing the drain

Tell the registrar you can do the notes while they do the drain

Refuse to do the drain

QUESTION 7:

You have been on day shifts for the past two weeks and have consistently been leaving late because your colleague working the night shift has been arriving increasingly late. You have a friend’s birthday party to go to and you are about to finish your shift but your colleague has not arrived for you to handover the jobs.

Rank the actions below in order of most appropriate to least appropriate:

Leave a written handover in the doctors office and tell the nurses to alert your colleague to these when they arrive

Call personnel to see if your colleague has called in sick

Wait for your colleague to arrive

Hand over to another doctor who is just starting their night shift and ask them to relay to your colleague when they arrive

Call your colleague to ask where they are

QUESTION 8:

You are the FY1 working in a sexual health clinic. You have seen the patient and they are requesting a contraceptive underarm implant. You run this by the consultant, who agrees to put in the implant. Just before starting the procedure, your consultant gets bleeped away and says that you should just do it yourself and they will be back after they have answered the bleep. You have only seen the procedure done once and have read about it in textbooks. The patient is asking you to hurry if possible as she needs to leave and does not know when she will have time to come back as she is very busy.

Choose the THREE most appropriate actions to take in this situation:

Quickly check the procedure steps online then do the implant

Keep the patient in the room ready in the hope that the consultant will return soon

Do not insert the implant but offer the patient alternative contraception to use until she can return to the clinic

Call you consultant and ask how long they will be

Explain to the patient that you can do the implant now or she can wait for the consultant to return

Ask one of your registrars to supervise you during the procedure

Do not do the procedure, the patient will have to wait

Perform the procedure and ask the patient to come back at the next available opportunity to have it checked

QUESTION 9:

You are the surgical FY1 and are assisting in a Caesarean section. During the procedure your senior accidentally pricks you with a needle. There is no one else available to help assist in the operation but it is nearing the end and your consultant says they are able to finish the case alone.

Rank the actions below in order of most appropriate to least appropriate:

Send a sample of the patient’s blood you have saved for an HIV test

Carry on with the operation and complete an incident form after

Report to occupational health immediately

Bleep your colleague to come and take over assisting in the operation

Remove your gloves and run the affected area under a tap

QUESTION 10:

During gynaecology pre-assessment clinic you find one of your patients to have a urinary tract infection. You prescribe antibiotics and send the urine for microbiology culture. The patient tells you that it often takes a few weeks to get a GP appointment, as their practice is very busy. Several days later, the urine culture returns and shows that the infection is resistant to the antibiotic you prescribed.

Rank the actions below in order of most appropriate to least appropriate:

Call the patient and ask them to make an appointment with their GP

Send the patient’s GP a letter explaining the situation

Tell the patient to present to their local A&E and explain the situation

Tell the patient to come and see you on the ward for a hospital pharmacy prescription

Cancel the patient’s gynaecology surgery as they have a current infection

QUESTION 11:

You are the FY1 on call at night and are called to see a patient receiving IV antibiotics and fluids for a post-surgical infection. His cannula has fallen out and you’re unable to cannulate him despite two attempts in his forearm. The patient is adamant that he does not want a cannula in his hands.

Rank the actions below in order of most appropriate to least appropriate:

Record the unsuccessful attempts and write in their notes for their day team to review in the morning

Call your FY2 for help

Bleep the anaesthetist on call to help establish IV access

Change the patient’s antibiotics to an oral prescription

Explain you have no option but to attempt a cannula in the patient’s hand

QUESTION 12:

You are the FY1 on a medical firm. The consultant asks some medical students to write a case study on a patient. You offer to let them see a case report that you’ve written in the past. The students submit their reports to the consultant who asks you to have a look at them. You notice that one of the students has copied your case report almost entirely and has clearly not seen the patient at all.

Choose the THREE most appropriate actions to take in this situation:

Inform the medical school what the student has done

Do nothing as the student may not have had time to see any patients

Ask your consultant what they think about copying others’ work

Ask the student to rewrite his case report

Read the GMC guidelines for plagiarism

Ask the student about what you believe to have happened

Explain what has happened to the consultant

Explain to the students about the importance of professionalism as a doctor

QUESTION 13:

You are working in A&E. One day in the treatment room you observe a healthcare assistant put some medications in his pocket. You worry that he may be taking them home for himself.

Rank the actions below in order of most appropriate to least appropriate:

Inform your consultant of what you have seen

Ask the healthcare assistant what he is doing with the medicines

Inform the personnel department that you think the healthcare assistant is stealing

Privately tell the healthcare assistant to put the medicines back and to go home

Ignore the situation as he may be taking the medicines for some patients

QUESTION 14:

You are looking after a patient on the ward who presented with long term bloody diarrhoea and weight loss. You strongly suspect bowel cancer. One day, he calls you over and asks you directly “Do I have Cancer Doctor?”

Rank the actions below in order of most appropriate to least appropriate:

Tell your patient you are still awaiting test results but will ask your consultant to come and see him when the results are available

Reassure him that there is nothing to worry about you are just running a few routine tests

Arrange to have a discussion with your patient and leave your bleep outside

Explain that it is likely that he has cancer

Explain that you are still waiting for test results but will let him know about them as soon as possible

QUESTION 15:

One of your colleagues comes to you one day out of work saying that she is feeling increasingly stressed and has been drinking alcohol to help her relax. She asks you not to mention this to anyone. She reassures you that she would never drink at work but is finding it increasingly difficult to cope and feels very tired at work.

Rank the actions below in order of most appropriate to least appropriate:

Counsel them as a friend and do not tell anyone

Tell your ward nurses that you think your colleague is stressed and to go easy on them with work if they can

Report your colleague to your hospital personnel department for inappropriate behaviour

Advise your colleague to speak to their clinical advisor about the stresses at work

Tell your consultant that you are worried about your colleague’s drinking

QUESTION 16:

You are the urology FY1 and work with an Asian registrar. A patient needs to be catheterised so your registrar goes away to collect the kit. Meanwhile, the patient tells you that he doesn’t want the registrar to touch him and wants you to do the procedure instead.

Rank the actions below in order of most appropriate to least appropriate:

Do the catheter yourself

Tell your registrar the patient does not want him to do the catheter

Tell the patient he cannot pick his doctor

Explore the patient’s concerns

Refuse to treat the patient

QUESTION 17:

You are working in A&E when you see a young woman with bruises all over her arms who claims to have fallen over. Upon further questioning she admits that her partner is occasionally physically abusive to her but asks you to not tell anyone, as she is worried he will find out.

Choose the THREE most appropriate actions to take in this situation:

Inform her partner you know what he is doing and arrange for him to come to A&E to see you

Speak to your senior about what you have discovered

Offer the patient details of domestic abuse support groups and numbers to call in the hope she changes her mind

Contact the patient’s GP to follow her up in a few weeks

Inform the police

Do nothing and respect her confidentiality as she is an adult with capacity

Call the partner and ask him to book an appointment with his GP

Contact the safeguarding team at your hospital for advice

QUESTION 18:

You are one of the doctors working in A&E. A child is admitted following a serious road traffic accident and needs to be given blood urgently. The boy’s parents explain that they are Jehovah’s Witnesses and they do not want him to receive a blood transfusion under any circumstances as it is against their religious belief.

Choose the THREE most appropriate actions to take in this situation:

Respect the parents’ wishes and try and help the boy without blood products

Call the hospital chaplain in an attempt to persuade the parents

Overrule the parent’s wishes as this is an emergency situation

Contact one of your seniors for advice

Explain to the parents the seriousness of their son’s condition and why he needs the transfusion

Tell the parents they are being irresponsible and their son will die without the transfusion

Ask the parents about what their son would want for himself

Hold the transfusion until the boy is conscious and able to consent for himself

QUESTION 19:

You are one of the doctors at the mess party. Your registrar colleagues asks you whether your FY1 friend is single as he finds her attractive and would like to ask her on a date.

Rank the actions below in order of most appropriate to least appropriate:

Explain that you do not know but suggest your registrar speaks to your FY1 friend himself

Say that you find this behaviour inappropriate and walk away

Tell your registrar your FY1 friend is single and give him her phone number

Tell your consultant what has happened

Inform your FY1 friend what the registrar has said to you

QUESTION 20:

You are the psychiatry FY1 and seeing patients in substance misuse clinic. You see a gentleman who is awaiting detox for alcohol misuse. While chatting you ascertain that he works as a lorry driver and says that he has been fine with this for many years despite his drinking. He doesn’t think it impacts on his ability to drive.

Choose the THREE most appropriate actions to take in this situation:

Inform the DVLA

Explain to him that he must not carry on driving while drinking as it could be very dangerous

Do nothing as he is likely to be undertaking detox soon

Call his wife and explain the situation

Confront him and say it is irresponsible to be driving while drinking and that if he doesn’t provide evidence that he has stopped driving you will call the police

Call the police straightaway

QUESTION 21:

You are the FY1 in A&E. A female patient with capacity presents with vaginal bleeding. She needs an urgent speculum examination. She refuses to allow you to examine her and demands to see a more senior female doctor. You look around but none of them are available.

Rank the actions below in order of most appropriate to least appropriate:

Take their history and respect their request but explain that if their condition becomes critical you will need to proceed with the examination

Wait for a more senior female doctor to become available

Insist that the examination is urgent and you will have to proceed as there are no other doctors available

Explain the urgent need for the examination and explain that there is no doctors matching their desired description available, but respect their request if they decline and wait for another doctor

Offer a female chaperone from the healthcare team as a compromise

QUESTION 22:

You are the FY2 working on a ward. One of the patient’s relatives approaches you looking distressed. They are worried about how the nurses are caring for their relative and are considering making a formal complaint. They ask for your advice.

Rank the actions below in order of most appropriate to least appropriate:

Tell her you will check with the team about what has been going on but a formal complaint won’t make any difference

Explore her concerns and attempt to alleviate any misunderstandings

Suggest she speaks to the patient family liaison department in the hospital for advice

Inform your consultant and the nurses working on the ward about her concerns

Tell her you also have concerns about the nurses and encourage her to make a complaint

QUESTION 23:

You are bleeped to the private ward in your hospital. When you arrive, the nurses explain that one of the patients was receiving an urgent infusion of post-operative fluids but their cannula has stopped working. When she called the consultant responsible for the patient they asked her to bleep the FY1 On call.

Rank the actions below in order of most appropriate to least appropriate:

Offer to help but explain that in the future they should have their own staff available to cannulate private patients

Contact the ward manager to ask about the staff they have available to help in these situations as you are very busy working on shift for the NHS

Help with the cannula but leave a note to explain that you will invoice for this work

Assess the patient and the situation quickly and order in your jobs list according to its priority

Refuse to cannulate the patient as you are already overworked with your NHS patients

QUESTION 24:

You are in your final rotation of your FY1 year. You’re working with another FY1 colleague and notice that they are unable to do ABGs which they should be able to do by now.

Rank the actions below in order of most appropriate to least appropriate:

Advise them to ask a senior for guidance with the issue

Email their clinical advisor to explain the problem

Offer to help them practise ABGs in the clinical skills laboratory

Avoid the problem until they ask you for help

Raise the issue in front of a patient during a ward round so they are forced to admit the problem

QUESTION 25:

You are working as the FY1 in the sexual health clinic. Your patient has been cheating on his long-term girlfriend by having unprotected sex with another man. He is worried he has a sexually transmitted disease. On examination it is apparent that he has genital warts.

Choose the THREE most appropriate actions to take in this situation:

Tell him you must contact his girlfriend to explain her chances of having the disease

Advise him to have an HIV test

Advise him to inform his regular partner

Give advice about safe sexual practices

Test him for HIV as he is in a high risk group

Inform the patient’s GP so they can follow up to ensure they have been adequately treated

Offer relationship counselling as he is clearly unhappy in his current relationship

Tell him you will have to contact the man he had sex with so he can get checked

QUESTION 26:

You are the paediatrics FY1. A 10-year-old boy is admitted with abdominal pain. Whilst taking the history, the interaction between the father and son appears completely normal. However, when his father steps out of the room to take a telephone call, the boy tells you that his father sometimes hits him when he is angry.

Rank the actions below in order of most appropriate to least appropriate:

Do a full physical examination in the presence of the father explaining that you are looking for signs of abuse

Ask the father about what the boy has said, allowing him to offer an explanation for the boys’ accusations

Make a clear documentation of what the boy say and ask him more about the incidents described

Call the police to report the child abuse

Assume that the boy is referring to reasonable discipline as he appears to be well cared for

QUESTION 27:

You are a medical FY1. One of the patients on your ward has a DNACPR (Do not attempt cardio-pulmonary resuscitation) order in place due to terminal bowel cancer. On overhearing the patient with their relatives one day it becomes apparent that they are unaware this order is in place.

Rank the actions below in order of most appropriate to least appropriate:

Apologise to the patient and the family for their previous team being neglectful and not explaining the order properly

Explain that that the DNACPR is in place because cardiopulmonary resuscitation is unlikely to be successful to the patient and their relatives

Wait until you have an opportunity to discuss the order with the patient alone

Consider the DNACPR invalid until you have discussed it with the patient

Inform the seniors in the team of the situation

QUESTION 28:

You are on a surgical attachment with another FY1 doctor. You notice that he frequently takes surgical equipment home which he claims is to practice his surgical skills.

Rank the actions below in order of most appropriate to least appropriate:

Tell him he should return all of the equipment as soon as possible

Do nothing as it will compromise patient care if your colleague doesn’t practise his surgical skills

Inform the clinical supervisor about what you have seen

Tell him you will have to report him to your consultant if you see him take any more equipment

Inform the theatre manager about what you have seen

QUESTION 29:

You are the FY1 on general surgery. During the ward round, the consultant and registrar are called away to attend to an emergency patient. They explain that the next patient just needs to be consented for a left hemicolectomy ready to be next on today’s surgical list.

Rank the actions below in order of most appropriate to least appropriate:

Ask another registrar who has undertaken the operation previously to consent the patient

Complete all of your other urgent jobs then consent the patient

Explain to the registrar that you do not have enough experience to consent the patient for this operation

Consent the patient to the best of your ability.

Ask the registrar for instructions on how to consent the patient and then do so

QUESTION 30:

You have been on a long day shift when a nurse approaches you to write the prescription for a patient you do not know. You are feeling extremely tired and hungry and finding it increasingly difficult to concentrate. You were planning to go for a break to eat something to help you feel more alert towards the end of your shift.

Choose the THREE most appropriate actions to take in this situation: