Q1) Answer: A C D E B
A Your colleague has clearly demonstrated that he is not taking his professional duties seriously and this issue needs to be addressed for the benefit of his future career and, more importantly, patient safety. Discussion with a senior colleague is the correct decision in order to determine the appropriate course of action. The situation may be more complex than it appears; for example, your FY1 colleague may have underlying health concerns.
C Although you have confronted your colleague, you haven’t addressed any underlying concerns about his professionalism.
B This is a probity issue and arguably could take priority over C. However, if it is a single instance, it is perhaps better addressed locally.
D is clearly not professional.
E is blackmail.
Q2) Answer: C E D B A
The medical or dental professional undertaking an investigation or providing treatment is responsible for ensuring that valid patient consent has been obtained. If this is not practicable the task can be delegated, provided that the person appointed is suitably trained and qualified, knows sufficient detail about the intervention, understands the risks and follows the principles set out in the relevant guidance.
In this situation it is unlikely that a foundation doctor will have adequate skills and knowledge, but that doesn’t mean that they can’t learn, so taking the opportunity to do so seems appropriate. Ultimately the consultant is responsible, so if the registrar leaves no option for the foundation doctor to be involved, discussing it with the consultant seems reasonable.
Q3) Answer: E D C A B
To ensure patient safety is your priority:
A handing over to the FY1 verbally might be a reasonable option (depending on other factors in the department) but it would be essential to document your handover.
B the patient needs to be assessed/treated as soon as possible and the registrar may be in theatre for hours.
C clearly documenting your handover is important. It is, however, unlikely that the FY1 is the best placed to manage this difficult situation.
D the patient is in your department and remains the responsibility of your team and the issue is not an orthopaedic problem. It would be appropriate if handing over to do so to the most senior colleague.
E this patient needs to be seen urgently and assessed by the medical team. You are aware of this situation while working, and ensuring that the patient is in safe appropriate hands before leaving to go home is the appropriate course of action in line with GMC guidance.
Q4) Answer: E B C D A
E Offers a potential solution to the problem, allowing fair sharing of the workload and clear delineation of each individual's responsibility towards patient care.
B Makes your colleagues aware of the issue and highlights that a potential patient safety concern may arise if they do not respond to the situation, however it does not provide a clear solution.
C Allows patient safety concerns to be brought to the attention of a senior, however it might raise concerns about your ability to perform as part of a team.
D May provide definitive evidence of your concerns, however patient safety issues are not immediately addressed.
A Shouting on the ward is unprofessional.
Q5) Answer: D A B C E
This question is about dealing with challenging colleagues. It would be wrong to involve a patient or their relative in any inter-professional disputes.
E is unprofessional and would not deal with the underlying issue. Similarly, the colleague’s refusal to accept the handover doesn’t justify you passing the responsibility to the nurse.
Options A and D should ensure the patient’s care is not compromised, but may add to your workload and stress levels or to that of another colleague.
You need to respect your needs for adequate rest and leisure time, but ensure the bloods get done.
Q6) Answer: F E A
Contacting occupational health is appropriate since they can enact the appropriate pathway. Most hospital trusts have a clear pathway for managing needle stick injuries. Managing the injury in the first instance would be appropriate. Most policies focus on risk assessment and testing of the patient and healthcare worker. These steps are appropriate, but only with appropriate consent.
It is inappropriate to test without consent or without the patient’s knowledge. Even where there might be a clinical basis for testing the patient, if the test has been triggered by a needle stick injury that should be explained, hence C is inappropriate.
D is inappropriate as a first step as no assessment of risk has been undertaken and it is not clear whether post-exposure prophylaxis is needed.
G Without consent, it is an assault to take blood.
H While an infectious diseases consultant is likely to give sound advice, it is not urgent and therefore not necessary to contact them out of hours.
Q7) Answer: B A E
Remember that communication skills can also relate to how you get your point of view across as a professional.
This is mandatory training – it is appropriate that you persevere with it. However, it is also a problem if important mandatory training is that poor and A,B and E will allow you to assess whether everybody else shared your view and to communicate this back to people who could make the course better.
D might seem sensible and professional, but the issue here is that the training is mandatory and thought sufficiently important for you to be released from ward commitments to attend.
C You’re just bunking off!
F, G, H are examples of an unprofessional approach, which would be open to criticism.
Remember the order does not matter and there is no negative marking; just make sure that you only pick three options.
Q8) Answer: B F G
Recognise the limits of your experience in making important life or death decisions. Make sure the patient, and their autonomy or best interests, remain your primary concern.
A You do not have sufficient evidence to support choosing an option which is not in the patient's medical best interests.
B If the patient, when capacitous, has a clear and specific advanced directive in place then discharging him to the nursing home may be the appropriate decision.
C You cannot default to a best interests decision without assessing capacity. Even when a patient is confused, they may still retain capacity to make a specific decision.
D Offspring may contribute towards an overall decision of what is in their parent's best interest when the parent lacks capacity. There is no proxy for decision-making for an adult who lacks capacity.
E By contrast, simply ignoring their input is equally inappropriate.
F If a patient lacks capacity then your duty as a doctor is to act in their best interests.
G In order to determine both whether the patient lacks capacity and to make an assessment of best interests if this is the case, it is likely to be necessary to involve senior colleagues.
H Admitting the patient without considering the complexities of the decision you are making is not appropriate given the facts of this case.