Answers and tips

Q1) B A E C D

B is the only correct answer.
A might be acceptable if you have to do more tests anyway.
E might be acceptable if the shift is changing, but the patient should know what has gone wrong. You are required to apologise when something has gone wrong. The tests are required and you need to have informed consent prior to taking the blood.
C is passing responsibility and lacks transparency.
E is similar to C and the order is likely interchangeable.
D potentially puts you and the patient at risk.

This type of question can be the most difficult – how to deal with errors and colleagues.

Q2) B E D A C

The theme of communicating with difficult colleagues is not uncommon; it's not always related to illness, but also to dealing with circumstances where you might work with people who are good at their job but perhaps 'difficult'.

B provides the best answer; you demonstrate your knowledge of the ECG and provide a truthful response, and it indicates that you understand it's your responsibility to obtain the results and ensure that you are correct.
E, although not necessarily incorrect, does not demonstrate the mutual respect you should have for colleagues.
D may be seen as unsupportive of colleagues.
C, A present potential patient safety concerns as results may be incorrectly attributed to the patient. C has the potential to present greater safety concerns.

Q3) B A E D C

This scenario relates to confidentiality.

A 15-year old girl is likely to be Gillick competent and should be assessed for her capacity to provide consent for disclosure.
Option A assumes she has capacity, but this needs to be formally assessed and documented.
E might be appropriate if you are unsure, and it is better than getting it wrong. It can be helpful to seek the father's perspective just in case, however he cannot provide consent if the patient is competent, nor override her competent consent.

Q4) C A E B D

This question examines your knowledge of confidentiality and how to apply it when under pressure.

C is the best answer. You should consider the request and whether the information ought to be provided in the public interest, but decline to disclose if it is not appropriate to do so.
If you are unsure, you should seek the guidance of a senior colleague and therefore A is the next correct answer.
B is not correct as there are circumstances in which information should be disclosed.
E is also incorrect as this simply places the burden on a colleague who is no more able to decide matters than you.
D is incorrect and the least appropriate choice, as you risk breaching patient confidentiality without justification.

Q5) A C B E D

This question requires you to consider how you approach being asked to do something outside your experience. As an FY1 you are unlikely to have the necessary knowledge of the operation to be able to consent the patient adequately.

A is the most correct answer as it allows the person delegating the role to you to understand why this cannot be done safely and for them to find a more suitable person to assist.
C is less appropriate as it is disruptive to another colleague outside your team, who will have their own workload pressures and who will not know the patient.
B is the first wrong answer, but is in part mitigated by an attempt to obtain the knowledge needed.
E is also wrong as it impacts directly on other patients and the efficient running of the department.
D is the worst option, as it is the least safe. You should not consent a patient for a procedure where you do not have adequate knowledge.

Q6) B C A E D

This question simply asks you to prioritise in terms of clinical necessity.

Immediate life-threatening emergencies should be dealt with first, prior to attending a patient who has the potential to rapidly deteriorate. The relief of pain would be the next clinical priority, before attending to an individual who may have a medical cause for worsening of their confusion.

The final priority is to address the administrative task to allow a patient to go home.

Q7) B C D A E

This should be straightforward – the clinical priorities must come first. Our exam tip here is that irrelevant criteria, such as age of patient or disability, are put in to invite you to make the wrong call.

Q8) C D B A E

This situation might generate a medical emergency. Your colleague is in a panic and you should take control and take the immediately necessary steps to ensure the patient is safe.

This incident should be reported in the normal way and the patient advised of what has occurred, but this can wait until after the patient is safely treated.

Q9) B A E C D

Without the consent of a competent 16-year old, it is a breach of confidentiality to disclose information about the patient without her consent. The ideal situation would be to encourage the 16-year old to involve the mother in her care, particularly as she will require physical and psychological support going forward.

B, A, E are clearly similar responses and simply more or less polite.
D is legally and professionally unjustifiable and C is rude.

Q10) B D H

The patient should be at the centre of your concerns and bed pressure should not influence your decisions about treatment. In pragmatic terms, you should make sure that all the relevant paperwork is in place for an appropriate discharge as soon as clinically indicated.

Q11) G H F

This question examines your professionalism and communication skills. The priorities in this scenario are dealing appropriately with a complaint made in a public place and being open and honest with Mr Hawthorn, whilst also being mindful of not escalating his anger or placing yourself at risk.

C – Shouting for security would seem to be an overly defensive reaction to the scenario, although if the incident had occurred in an isolated place and you had felt threatened by possible violence it would have been important to safeguard your own wellbeing.
D – Making eye contact may escalate the problem and confronting Mr Hawthorn may have an inappropriately negative effect.
A – Whilst you are entitled to a break, and being interrupted during a meal is frustrating, it may be unprofessional not to deal with some situations, such as this, as they arise.
B – Inviting Mr Hawthorn to discuss the complaint with you on the ward after lunch does not offer a specific timeframe and might suggest to him that your lunch is more important than his wife.
G – However, considering that his concerns are about the nursing care on the ward and you are the most junior member of the medical staff, it may be more appropriate for him to speak to the nurse in charge.
H – It is important that Mr Hawthorn feels listened to, and contacting a senior colleague demonstrates that you recognise the seriousness of his concerns. It is likely a senior colleague will be appropriate to deal with the breadth of his issues.
E – It is important to be aware of the hospital's complaints protocol and to be able to advise patients how to make an official complaint if they wish to do so.
F – But in many situations a prompt, open and honest explanation, with an apology where appropriate, can resolve misunderstandings and frustrations at an early stage. Whenever you are in a place where you could be overheard, it is important to bear in mind patient confidentiality. Consider whether you may need the patient's consent to discuss the details of their care, and to explain this professionally to their relatives.

Q12) B E H

You are required to cooperate with investigations, including coroners' inquiries and complaints, and must promptly provide a full and honest account to both.
You should also reflect on the case with a senior colleague to identify any learning points arising from the incident.

Therefore B, E and H are the most appropriate answers. You should not ignore a request or delay your response, and should never alter the medical records in the manner outlined.

Q13) B C D

This question is about being able to focus on the needs of patients, despite perceived barriers to doing so.

A – It would be important to consider whether your consultant's actions met the threshold for referral to the GMC. This would be difficult to determine in isolation based on the facts as presented.
B – In the first instance, keeping a verbatim account of his comments, as the basis of a presentation of the issue you wish to raise, would provide valuable support for your concerns.
C – Raising your concerns with a senior is an appropriate course of action.
D – If you can offer specific examples, your concerns will be better highlighted.
E – The venue for discussion is clearly inappropriate; furthermore, it is unlikely that your contemporaries will be better placed than you to advise you how to act.
F – The BMA offers advice on contract and interprofessional issues, but is not an agency to report an individual to.
G – We would refer you to the relevant GMC guidance to help you make a decision regarding the best course of action.
H – The GMC requires you to put patients at the centre of your considerations, and the inappropriate behaviour illustrated requires further investigation.

On your marks for the SJT

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On your marks for the SJT