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You are attending to Harry, an 89 year old long-term patient requiring palliative care. It has been recorded in Harry’s medical notes that he will be transferred from the hospital to a nursing home within the next few days and he has agreed to this management plan. Later on the day, Harry informs you that he has changed his mind and no longer wants to move to the nursing home.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Explain to Harry that a nursing home is better suited to his needs

B. Ask Harry why he has changed his mind

C. Explain to Harry that the nurses are too busy to meet his needs in the busy hospital environment

D. Inform your consultant that Harry is unsure about going to a nursing home

E. Ask Harry’s relatives to come in and discuss his options with him



B - Patient focus

D - Consultant is in charge of pt and discharge agreed between them

E - Relative can be discussed but no indication they were involved so consultant first

A - This could be done later but not now

C - Not relevant to situation


Mrs Jenson has arthritis and works in the pharmaceutical industry. She appears very well informed about her arthritis medication. She tells you that she can show you evidence that using double the recommended dose of her current medication will be safe for her and will allow her to return to her job more quickly. She asks you to prescribe to her double the recommended dose.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Advise Mrs Jenson that if she chooses to self administer the double dose she is going against medical advice

B. Tell Mrs Jenson that you cannot prescribe more than the recommended dose without senior consultation

C. Ask your consultant to speak with Mrs Jenson

D. Ask Mrs Jenson to show you the evidence that she cites

E. Seek advice from the ward pharmacist



B - F1 don’t make those decisions

E - advice from pharmacist and direct [its your prescription here not consultant as in other qs]

C - less direct route

D - may be interesting but won’t change your response

A - Allowing this is unsafe


You and an FY1 doctor, Lorraine, are on your first rotation at the hospital. Since beginning this rotation three weeks ago, you have noticed that Lorraine is always eager to undertake additional ward tasks that are delegated by the consultant. As a result of completing too many tasks, Lorraine is staying several hours after her shift should finish every day. Lorraine often appears to be tired, and you have noticed a decrease in the quality of her work. When you sensitively raise this with Lorraine, she informs you that you must be mistaken and appears to be offended. The quality of her work has not improved since your last conversation and you must decide whether you will discuss the matter with her again.

Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important).

A. The likelihood of effectively improving Lorraine’s quality of work by speaking to her for a second time

B. Maintaining the quality of patient care

C. The timely completion of all ward tasks

D. The way Lorraine reacted when you have raised the issue with her last time

E. The extent that Lorraine understands that her tiredness could be affecting patient safety



B - Care most important

A - help to improve her quality of work

E - She may not know it is affecting and so should be discussed

C - Completion of tasks is good but SAFTEY is priority

D - previous convo should not be a deterrent to addressing again


Your FY1 colleague, Amirah, has been working alongside you during a busy night shift. You have both been on-call for the last seven hours without a break or meal. Amirah has complained about feeling dizzy throughout the shift. Amirah tells you that she needs to go and lie down but suddenly she faints in the middle of the ward. She regains consciousness two minutes later.

Rank the order in which the following tasks should be undertaken (1= Do first; 5= Do last).

A. Discuss with Amirah whether she will be able to undertake her remaining tasks for the day

B. Ask a nurse to help you transfer Amirah onto an available bed

C. Alert your specialty trainee* of the incident

D. Speak to the patients on the ward and reassure them that they will be seen to soon

E. Give Amirah a blanket and a cup of water



B - get her stable and safe first

E - then address causes for fall eg dehydration

C - after this should inform senior

D - Pts likely seen and should be re assured

A - after they have recovered should find out if she can continue with work


You are working on a busy ward, completing some administrative tasks for your consultant, Dr Findlay. She has asked you to complete some discharge letters which should have been sent out a week ago. A new patient is admitted to the ward and the senior nurse asks you to assess him, as your colleagues are all busy completing other tasks. When you explain that you are currently completing the discharge letters for Dr Findlay, the nurse suggests that you ask the fourth year medical student on the ward to assess the patient instead.

Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important).

A. The medical student’s confidence to assess the patient independently

B. The medical student’s level of clinical competence to assess the patient effectively

C. The discharge letters should have been completed a week ago

D. The urgency for the patient to be assessed is not yet clear

E. The possible time delay before the senior nurse is able to find another available colleague to assess the patient



B - this would impact safety if they don’t know how

A - confidence is secondary to competence

E - Risks clinical delay

C - Not an urgent priority

D - urgency of assessment only determined by initial assessment


You are observing your specialty trainee*, Allan, in an operating theatre, working with a large team on a complex procedure. The patient begins to deteriorate unexpectedly and the team is under pressure to resolve the situation quickly. As all members of the team are working, Allan begins to use some extremely bad language while talking to another team member. The team member appears to be shocked by Allan’s remarks but does not respond to it and continues to focus on the procedure. You must decide whether to speak up about Allan’s behaviour immediately.

Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important).

A. Allan’s likely intention to be offensive given that he is under pressure to resolve the situation quickly

B. The team members’ reason for not responding to Allan’s remarks

C. The disruption that your interjection may cause to the procedure

D. All healthcare professionals are entitled to work in a respectful environment at all times

E. The impact on other team members if Allan continues to use similar language during the rest of the procedure



D - Colleges should work in respectful environments

E - If rest of team are uncomfortable it could impact on procedure

C - Impact of interjecting is important and should be done at a good time - ie. during a break
[wording insinuates you aren’t gonna interject]

B - Reason for not responding less important than broader issues of respectful workplace

A - this is partial justification and so least likely to influence management of situation


You are browsing your social media page in the evening and notice that your FY1 doctor colleague and good friend, Neal, has written a post. Neal writes that he has had a very long day in theatre today, with a patient who had a big bleed. Although there are no direct patient details in Neal’s post, you are aware that it would be possible to identify the patient from the details regarding her bleed, and the fact that the surgery occurred earlier today. The patient is still currently on the ward. As Neal’s social media page is set for public viewing, individuals who are not direct contacts are able to read Neal’s post.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Contact Neal, advising him to remove the social media post

B. When you next see Neal, suggest that he removes the social media post

C. Tell Neal that posting about a patient on social media is unprofessional

D. Inform your on-call consultant of Neal’s social media post

E. Advise Neal to change his social media settings to private so that only his contacts are able to read his posts



A - Needs to be removed - deals with immediate situation

C - Should also tell him this is unprofessional

B - less time efficient

D - on call consultant is not likely to be helpful (clinical supervisor may be)

E - this could be seen as condoning it happening


Your fellow FY1 doctor, Katrina, regularly arrives at work late and, consequently, often misses morning ward rounds. During these ward rounds, the consultant provides direction to the team regarding the tasks to be completed for the day. You and members of the healthcare team make notes and discuss the allocation of the tasks based on the consultant’s direction. Katrina asks you for an update on the allocation of ward tasks when she arrives at work late. This causes significant delays to the completion of the tasks that have been assigned to you.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Ask the consultant to delay the ward round until Katrina arrives

B. Make separate notes for Katrina to refer to when she arrives, regarding the tasks assigned to her

C. Discuss with Katrina methods that may help to improve her punctuality

D. Suggest to Katrina that she should ask another member of the healthcare team to provide her with ward round updates

E. Discuss Katrina’s repeated lateness with a senior colleague



C - directly deal

E - can escalate with seniors

B - this increases your workload and doesn’t deal with the problem but better than shifting onto another member (D)

A - fails to deal and makes whole team late


You have been completing an audit with another FY1 doctor, Zara. You are near the end of your rotation and have only collected half of the data; there are two wards remaining to collect data from. You and Zara have both observed that a general trend has emerged in the data that you have collected so far. One morning, Zara informs you that she has fabricated the rest of the data, based on the trend that had emerged in the existing data, and that she has submitted the report to your joint clinical supervisor*, Dr Hadi. The following week, Dr Hadi informs you that she is very pleased with the audit and wants both you and Zara to attend an international conference to present the findings.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Inform Dr Hadi that the data was fabricated by Zara

B. Tell Dr Hadi that you did not have any input into the audit so Zara should attend the conference alone

C. Tell Dr Hadi that there was a mistake with the data, so you and Zara will need to collect some more before presenting at the conference

D. Attend the conference with Zara, but refuse to present any of the findings

E. Suggest to Zara that she admits to Dr Hadi that she fabricated the data



E - she should explain her self

A - if she wont you should tell him

C - makes sure you arent involved in fraudulent data but doesn’t solve issue

B - Not involved but lets bad data out

D - clearly implicates you in delivery of fraudulent data


You are working on a surgical ward and are due to assist your consultant in theatre with a gallbladder removal. The consultant is currently fasting for religious reasons and he has completed seven hours of a shift without eating or drinking anything. During a conversation with him shortly before the surgery, you notice that he appears to be having difficulty concentrating on what you are saying and that his hands are shaking slightly. You are aware that there may be implications for patient safety if the consultant carries out the surgery when he is not able to perform to the best of his ability.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Explain your concerns to the consultant

B. Raise your concerns in the surgical team’s pre-operative discussion

C. Continue with the surgery and discuss the incident with your clinical supervisor* afterwards

D. Bleep* the on-call consultant, explaining the situation and asking for advice on what to do

E. Suggest to the consultant that another doctor carries out the surgery



A - Directly deals with issue

D - ensures senior supportive input

E - addresses safety but DOESNT EXPLAIN your concerns

B - more indirect but still deals with safety

C - does not address safety


In your hospital, if members of staff make more than three errors when labelling blood bottles they are required to attend training to learn how to do this correctly. Your FY1 doctor colleague, Declan, has been required to attend this training three times as he has made repeated labelling errors. Despite this, Declan says to you, “It shouldn’t be my job to label blood bottles anyway, so I don’t pay attention”.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Inform Declan that incorrectly labelling blood bottles could have an adverse impact on patients

B. Offer to label blood bottles for Declan in future

C. Tell Declan’s clinical supervisor* about his comment

D. Advise Declan to speak to his clinical supervisor about his repeated labelling errors

E. Tell Declan that he should be more careful when labelling blood bottles




D - allows him to address issue

E - should remind him but could be done more tactfuly

C - if not -> can tell his supervisor

B - avoids issue and reinforces behaviour


You are the only doctor on a ward. A patient, who is talking to one of the nurses, starts to raise his voice. He tells the nurse that he is hungry, as he has not eaten for two days due to his surgery being delayed. He is being very loud and beginning to disturb the other patients on the ward. You do not know the history of this patient, other than the fact that his surgery has been delayed. You do not know why it has been delayed.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Suggest to the nurse that she should attempt to calm the patient as he is disturbing other patients

B. Explain to the patient that you are sorry that he is hungry but he cannot eat as he is due to have surgery

C. Explain to the patient that he should calm down as he is disturbing the other patients on the ward

D. Explain to the patient that you are sorry that he has had to wait for two days and you will try and find out when his surgery will be

E. Reassure the patient that he will have his surgery soon and that he will be able to eat in the next few hours



D - DIRECTLY addresses concerns

B - only a partial response to the issues

A -

C -
[Both kinda need to happen but doesnt explain why thats the order] - perhaps because nurse knows the pt so better than you do it

E - obvs stupid


One of your patients, Roisin, who you have been looking after on the Cardiology ward, invites you to attend her birthday party at her home next weekend. You have been on the medical team that has been looking after Roisin for the past two months, and she is due to be discharged tomorrow. You do not have any plans for next weekend; however, you are aware that it is inappropriate to see a patient socially outside of work.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Thank Roisin for the invitation but explain that it would not be appropriate for you to attend

B. Invite other individuals from the medical team that has looked after Roisin to attend the party with you

C. Politely decline Roisin’s invitation, saying that you cannot attend

D. Ask another doctor on the ward to manage Roisin’s care until she is discharged

E. Explain that you are unable to attend, but buy Roisin a small gift



A - good maintain boundaries

C - also good but better to explain

D - doesn’t deal with invitation and may cause her to ask again

E - buying a gift could be seen as inappropriate

B - boundaries have been breached


Your specialty trainee, Kimberley, informs you that at the weekend she was issued with a speeding ticket by the police. You were on-call at the weekend and Kimberley was not working. She states that in order to avoid having to pay the speeding fine, she informed the police that she was working on-call and was caught speeding while driving to the hospital to deal with an emergency. Kimberley asks you to corroborate her story and inform the hospital rota coordinator that she was working at the weekend.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Advise Kimberley to tell the police the truth about the situation

B. Inform your clinical supervisor* of Kimberley’s request, without naming her, seeking his advice on how to proceed

C. Inform the police that Kimberley was not working on-call at the weekend

D. Decline Kimberley’s request

E. Explain to Kimberley why her request is inappropriate


[serious issues - get them to come clean first ]

A - deals with dishonesty and situation

D - does not implicate you but also doesn’t deal with situation

B - advice always good

E - you havent actually said no here

C - Clearly not


You are on a ward round with your consultant and the surgical specialty trainee*. Mr Ahmadi is due to have an elective resection of a colonic tumour. Your consultant confirms tomorrow’s theatre list, placing Mr Ahmadi first, as he wants to be present for the case. After your consultant has left for the day you realise that he did not notice Mr Ahmadi is taking warfarin for atrial fibrillation, which will increase the risk of haemorrhage during the procedure. The surgical specialty trainee is still on shift, as is the anaesthetist, who is due to do the theatre list.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Raise the problem at the consultant pre-operative ward round

B. Inform the surgical specialty trainee of the problem

C. Inform theatre that Mr Ahmadi’s case needs to be cancelled

D. Discuss the situation with the anaesthetist who is doing the list with your consultant

E. Contact your consultant on his mobile telephone to inform him of the situation



B - trainee is doing the case

D - then anaesthetist

E - Don’t need to discuss with consultant out of hours at home so other two better

A - Too much time delay - may compromise care

C - you don’t know if it will be cancelled and so shouldn’t make the decision


You are completing a ward round in the Acute Admissions Unit* (AAU). During the ward round your consultant repeatedly questions the patient management plans of the specialty trainee, Craig. At the end of the ward round you hear the consultant telling Craig that he is not suitable to work in acute medicine. The consultant is then called away to attend to an emergency. Craig appears to be upset and leaves the ward. You are unable to contact Craig on his hospital bleep. There are unwell patients arriving, on whom you need to seek his advice.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Leave the ward to attempt to locate Craig, and ask that he returns to the ward

B. Report Craig to the medical director for leaving the AAU

C. Seek advice regarding the new patients from another specialty trainee working on the AAU

D. Telephone the consultant, explaining the situation to her and request that she attends the AAU as soon as possible to assist with the new patients

E. Discuss how best to deal with the new patients with the other FY1 doctors on the AAU



C - Another trainee would be good to help now

D - if you cant maintain safety - Consultant is good

E - advice good but need senior support for unwell pts

A - leaving ward means even less staff

B - doesn’t resolve safety and raised way too high


Your consultant has asked you to take an urgent blood sample from a 65 year old female patient. Five of the patient’s adult children are visiting her and start complaining to you about the care that their mother is receiving and criticising the hospital. Although the relatives are not aggressive, they are being loud and rude and their behaviour is delaying you in taking the patient’s blood sample.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Ask the relatives to be quiet whilst you take the blood sample

B. Ignore the relatives’ comments whilst you take the blood sample

C. Ask a nurse to take the blood sample whilst you talk to the relatives elsewhere

D. Ask the relatives to leave whilst you take the blood sample and offer to speak to them afterwards

E. Wait for the relatives to leave, then take the blood sample



D - urgent care delivered in good time [Saying you’ll talk after seems to be good here when care is urgent]

C - Also good time but involves more staff

A - delivers safe care but doesn’t diffuse

B - exacerbates situation further

E - delays urgent care and doesnt address relatives


Whilst working in the Medical Assessment Unit, you treated a patient for an asthma attack. The patient made a good recovery and was discharged from hospital last week. Today, you receive a short complimentary message from the patient through social media, thanking you for your care. The patient also sends you a friend request on social media.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Ignore the message and friend request on social media

B. Print an anonymised copy of the complimentary message for your development portfolio

C. Respond through social media, asking how the patient’s asthma has been since discharge

D. Talk to your educational supervisor* to reflect on the situation

E. Decline the friend request, politely explain via social media that any further contact would be inappropriate



E - Deals with issue and isn’t rude

A - this is ok but doesn’t explain and so could happen again

D - if you don’t know what to do ask a senior

B - good to have in portfolio but other things are more important here

C - wrong


This is your first post on a busy surgical rotation, and you are struggling with your workload. You have been assigned a combined clinical and educational supervisor*, Mr Jones, for your placement. So far you have emailed Mr Jones twice, with no response, and your initial induction meeting was due two months ago.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Refrain from attempting to make contact with Mr Jones, waiting for him to contact you

B. Report to the Foundation Programme Director* the lack of response from Mr Jones

C. Contact Mr Jones’ secretary, in order to find Mr Jones and discuss your induction meeting

D. Ask the Foundation Programme Director to assign you a new educational supervisor*

E. Ask the hospital switchboard to transfer your call to Mr Jones’ mobile telephone number



C - Best way to contact is through secretary

B - Director will be good to support you in getting a response and they should be aware

E - less good way of getting in touch

D - final resort if director cant help

A - no good - need to have a tutor and it may never occur if you don’t do something


You recently attended a training session, which highlighted the importance of keeping accurate patient records for medical care and legal purposes. Your specialty trainee* with whom you regularly work also emphasises this frequently. While working with a consultant you notice that he is writing patient records but is not recording the time and date on the records at the time of creation. He is subsequently revisiting some of the records and estimating the times and dates before submitting them to the archive.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Explain to the consultant that his record keeping is inadequate

B. Search the archive for those records that the consultant has not fully completed, to show to a senior colleague

C. Speak to the consultant about the recent training session highlighting the importance of completing accurate records

D. Discuss the consultant’s behaviour with your specialty trainee, asking what form of action he would advise

E. Return to the notes to record the correct time that the consultant wrote his notes



C - Good as direct and involves as few members as possible

D - Good to get advice

A - true but a little blunt and may cause offence

B - lots of time and effort and not needed to raise concerns

E - this could be a probity issue and doesn’t deal with issue (poor note keeping)


You have been called by a general medical ward consultant, Dr Patrick, to help cover the ward, which is extremely busy. The FY2 doctor, Chantelle, gives you a list of three patients on the ward who require blood tests urgently. Their samples need to be processed in the next hour and the results will be used to inform a management plan. While you are taking blood from one patient, a senior nurse, Reuben, informs you that you need to examine another patient immediately as she is a relative of one of the surgical consultants. When you read this patient’s notes, there is no clinical urgency to examine the patient.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Tell Reuben that, at the moment, you must prioritise taking the blood samples

B. Ask Chantelle whether you should continue taking blood samples or examine the patient

C. Tell Reuben that you will examine the patient once you have taken all the blood samples

D. Ask Dr Patrick to examine the patient next, explaining that she is a relative of the surgical consultant

E. Examine the patient, as Reuben requested



C - these bloods are urgent and examining is not - also saying you will do it when you can

A - still prioritises blood but doesn’t address rubens request

B - advice is good but it is clear the bloods are priority here

D - the ward is busy and this is a non urgent task

E - not completing urgent tasks to do less urgent


You are working on a surgical ward with a specialty trainee* and two other FY1 colleagues. You get on well with your specialty trainee, but have noticed that he often gives you most of the jobs to do rather than delegating the tasks evenly between you and your FY1 colleagues. As a result, you regularly have to work past the end of your shift to complete all the tasks.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Discuss your concerns with the specialty trainee

B. Continue to complete the jobs to the best of your ability

C. Talk to the specialty trainee if the situation has not improved after a month

D. Inform your educational supervisor* of the difficulties you are experiencing with your workload

E. Delegate some of your tasks to your FY1 colleagues



A - Deals with issue timely

E - addresses issue of workload but not deal with problem

D - may take some time to deal with

C - Doesn’t address issue timely

B - doesn’t address


You are attending a social gathering at your fellow FY1 doctor, Susanna’s, home when you notice a patient task handover sheet on the kitchen table, with Susanna’s name on it. The document has specific confidential patient information on it.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Inform Susanna that this is a breach of patient confidentiality

B. Advise Susanna to destroy the handover list

C. Report the incident to your consultant the following day

D. Destroy the handover list

E. Advise Susanna to discuss the breach of patient confidentiality with her educational supervisor*



A - she may be unaware so tell her

B - good to destroy but without explaining may happen again

E - good but doesn’t deal with issue now

D - destroying and not telling may mean she doesn’t know what happened to the document

C - your consultant may have no contact with suzanna- it is more for her and her consultant


Mrs Davies is a patient on the ward. You are informed by a ward nurse that one of her relatives has commented on your attitude towards Mrs Davies. Apparently she has claimed that you were dismissive of Mrs Davies’ concerns about her treatment and did not spend enough time listening to her. You do not remember the particular incident and it is the first time that you have received any complaints about your attitude.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Approach Mrs Davies and talk to her about any concerns that she has

B. With Mrs Davies’ permission, arrange to meet her relative to discuss her concerns

C. Inform your clinical supervisor* about the situation

D. Seek advice from your Medical Defence Organisation* about how to respond

E. Thank the nurse and inform her that you will reflect upon your communication with patients in the future



A - good to confirm any reported concerns as could be misinterpretation along way

B - Less direct and responsibility is to pt

C - after this could escalate to supervisor

E - this is nice but doesn’t deal with issue

D - doesn’t address issue and you should have done ABC before


You and an FY1 colleague, Liam, are working a day shift on a ward together. Your senior consultant, Mr Parry, approaches both of you and asks you to assist with a hip replacement operation. You agree to assist and, near the end of the operation, Mr Parry asks you to suture the wound. This is something that you have not done before and you are unsure whether you are competent enough to do it.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Ask Mr Parry to provide instructions and supervise you as you suture the wound

B. Explain to Mr Parry that you do not feel comfortable suturing the patient’s wound

C. Ask Mr Parry whether he will suture the wound so that you can observe

D. Suture the wound to the best of your ability

E. Ask Liam whether he would feel more comfortable to suture the wound instead



B - Always inform if you are not comfortable

A - Asking for assistance is good but should inform first

C - this is good but you wont get to practice BASIC skill

E - This takes away from your learning opportunity

D - never do things you ain’t competent in


You are called to help Simon, your specialty trainee*, review a sick patient. When you arrive, the nurse takes you to one side and she tells you that Simon smells of alcohol. You confirm that this is the case. The review is urgent and Simon is needed as you are unable to conduct the review by yourself.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Suggest to the nurse that she asks Simon whether he has been drinking

B. Explain to Simon that he should not conduct the review if he is under the influence of alcohol

C. Contact the consultant immediately to explain the situation

D. Ask a specialty trainee from another ward to review the patient with you

E. Continue with the review, but explain to Simon afterwards that he smells of alcohol




D - Get assistance to minimise time delay conducting URGENT review

C - inform after prioritising pt needs

A - shouldn’t delegate to nurse unless she is senior and has good working relationship with simon



It is 18:00 and you have just been informed by a nurse that a patient, Jane, who has been treated for a chest infection, is ready to be discharged. Jane was ready to go home earlier that day; however, you are aware that there was a delay caused by a lack of hospital transport. Hospital transport is now available and you inform Jane that she can go home. However, Jane refuses, saying that it is too late for her to go home now and that she would prefer to be discharged in the morning. There are no medical reasons why Jane should stay in hospital overnight, and a nurse has just informed you that she has already allocated Jane’s bed to another patient.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Go through Jane’s patient notes to check that there are no outstanding medical issues

B. Ask Jane if she would like a next of kin to accompany her to be discharged

C. Ask the bed manager if they could arrange for Jane to stay for another night in the hospital

D. Explain to Jane that she must be discharged this evening to free up her bed

E. Ask Jane if there is a reason why she does not want to go home this evening



E - get more info

B - this is good and supportive

C - find out if a bed for the night is possible

A - medical notes should just confirm what you already know

D - this may make jane think discharge is on resource grounds rather than clinical - Don’t need to discuss other pt needs here


You are working on-call on the Trauma and Orthopaedics ward. You receive a referral from a GP* for her daughter to be admitted to the ward. The GP explains to you that her daughter has sustained a rotator cuff injury to her shoulder through playing sport. You explain to her that she should take her daughter to see their own GP, however, she insists that you accept the referral.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Seek advice from the on-call consultant about whether to accept the GP’s daughter as a referral

B. Re-emphasise to the GP that it is inappropriate for her to refer her own daughter

C. Suggest that the GP take her daughter to the Emergency Department if she needs to be seen urgently

D. Complete a critical incident form* relating to the GP’s inappropriate request

E. Tell the GP that you will accept her daughter’s referral on this occasion only



B - GMC gidance

C - advises correct route if urgent

A - good if you require support but should do B

E - against GMC guidance

D - Doesn’t help with emergency care and doesn’t resolve


A 50 year old patient, Mr Cox, is referred by his GP* to the Emergency Department with severe chest pain. You suspect that Mr Cox has acute coronary syndrome. In line with your hospital’s guidelines, you request that the cardiology specialty trainee*, Lynda, attend to assess him. However, she refuses as she is too busy.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Contact Lynda again, reiterating the urgency for her to assess Mr Cox immediately

B. Contact the cardiology consultant, asking him to review Mr Cox since Lynda is too busy

C. Document in Mr Cox’s notes Lynda’s refusal to attend

D. Contact a senior colleague from your own team, seeking support in managing the situation

E. Continue managing Mr Cox yourself, following hospital guidelines for managing acute coronary syndrome



D - pt critically unwell and needs expert review asap

A - good as a second call might make her come

B - ensures safety but doesn’t deal with declined referral

E - without senior support good to do something

C - important but doesn’t resolve issue


You are completing a ward round with your consultant, Dr Dixon. You notice that Dr Dixon is not washing his hands in between examining patients. You are aware that all hospitals have an Infection Control* policy that requires all staff to wash their hands in between examining and treating patients. When you inform Dr Dixon of your observation that he is not washing his hands, he becomes annoyed and tells you that he does not have time to wash his hands in between examining every patient.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Offer Dr Dixon alcohol hand gel in between each patient

B. Suggest to the hospital’s Infection Control team that they place posters around the hospital reminding people to wash their hands

C. Report Dr Dixon to the hospital’s Infection Control team

D. Raise the importance of hand washing at the next team meeting, when Dr Dixon is present

E. Tell Dr Dixon that he is putting patients’ safety at risk by not washing his hands



E - Direct way of approaching problem

A - Can overcome problem in short term

D - less confrontational but LESS DIRECT AND TIMELY

c - will deal but quite confrontational

b- not direct or timely or effective compared to others


A nurse on the ward asks you to speak to a patient, Miss Sharif, who became distressed after she was mistakenly told that she was due to have a biopsy later that afternoon. You look through Miss Sharif’s notes and then talk with her to apologise for the error, reassuring her that she does not need to have a biopsy. When you finish talking to her, Miss Sharif informs you that she has filmed your conversation, without your consent.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Explain to Miss Sharif that it is her choice whether or not to keep the recording

B. Seek advice from your clinical supervisor* about how to manage the situation

C. Inform Miss Sharif that filming your conversation is very inappropriate

D. Discuss with Miss Sharif her reasons for wanting to record the conversation

E. Ask Miss Sharif to delete the footage


-need to deal sensitively

D - can resolve issues

B - likely to have experience

a - it is her choice

c - confrontational

e - more blunt and direct


You are one of eight FY1 doctors working in the Acute Admissions Unit (AAU). All FY1 doctors have been allocated to cover one day of a four-day bank holiday weekend. However, one of your FY1 colleagues, Lydia, feels that this is unfair as she has worked a previous holiday weekend in the same rotation. Lydia sends an email to the hospital’s rota coordinator and states that since it is a public holiday, she does not think that all of the FY1 doctors should be allocated to work. She has copied in all of the FY1 doctors to the correspondence, including yourself, and listed everyone as co-signatories, indicating that everyone is in agreement with her assertions. You have had no discussions with Lydia regarding this matter and were not aware that she was going to send this email. You do not agree with Lydia’s views. You and Lydia are not allocated to work on the same day of the bank holiday weekend.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Explore Lydia’s reasons for including you as a co-signatory without your permission and whether she has permission from the other FY1 doctors to include them in her email

B. Offer to also cover the day that Lydia is allocated to work

C. Inform the rota coordinator that you had not been consulted prior to this email being sent

D. Advise the rota coordinator to produce an alternative rota for the bank holiday weekend, excluding Lydia

E. Ask Lydia to send a further email to the rota coordinator, clarifying that you were not a co-signatory



A - Find out more - may have just been oversight to include you

E - if lydia declines to clarify
C - you can

D - likely to complicate

B - doesn’t solve communication issue


You are working an on-call shift on a Friday evening. You are called to a ward to see the family of a patient who has just died. The patient and relatives are members of a religion that states burials should happen as soon as possible after death. You do not know the patient, although you are aware that your FY1 colleague, Claire, was treating the patient earlier today. As you enter the ward, the patient’s relatives immediately request that you contact Claire as they want her to sign the death certificate.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Telephone Claire to ask that she comes back to the hospital to sign the patient’s death certificate

B. Escalate the relatives’ request to the on-call consultant

C. Tell the relatives that Claire has left the hospital and will not be able to return to sign the death certificate until her next shift on Monday

D. Sign the patient’s death certificate

E. Contact the ward manager to see if there are any other doctors in the hospital who are able to sign the death certificate



E - Quickest solution to issue and allows you ro continue with on call duties

B - gets senior input but he also might not be able to do it

C - may disappoint but might not be other doctors able to

A - unfair on claire

D- you haven’t met - can’t sign


You have just completed a ward round with the consultant and he has asked you to organise an urgent MRI* scan for a patient. The consultant then leaves the ward, but informs you that he will return this afternoon to conduct another ward round. You begin to complete the MRI scan request form, but you are unsure of the reason that the scan is required, even after consulting the patient’s notes. However, you decide to take the form to the Radiology Department, as you know that the scan is urgent. When you arrive, the radiologist tells you that he will not conduct the scan as you are unable to explain to him why the scan is required.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Telephone your consultant immediately, asking him to explain to you why the scan is needed

B. Ask an available doctor for advice about ordering MRI scans

C. Wait until this afternoon’s ward round to speak to the consultant about the scan

D. Ask the radiologist to contact the consultant to determine why the scan is required

E. Politely explain to the radiologist that as the scan is urgent, you do not have time to ascertain why it is required



A - gets correct info and ensures your learning

D - also good

C - gets correct info but TIME DELAY

E - contradicts guidelines - need justification for ordering investigations

B - doesn’t resolve situation


It is almost the end of your shift. You recently spoke with a patient’s family, accompanied by a nurse, Camilla, to provide an update on the patient’s treatment. Camilla now approaches you to say that the relatives were very upset after you had spoken with them. She explains that in her opinion the information that you provided was confusing, which she thinks is the cause of the relatives being upset.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Ask Camilla for further feedback as to why she thought that the information that you provided was confusing

B. Speak to the relatives again, to determine whether they understood the information that you provided

C. Ask a senior colleague to accompany you to speak with the relatives

D. Ask Camilla to explore with the relatives what has upset them

E. On your handover list, indicate that a further discussion is required with the patient’s relatives



B - reduce confusion by speaking directly with family

D - LESS DIRECT but also get more info

A - may be good but more speculation rather than DIRECT clarification

C - whilst you are unsure probs don’t need senior support

E - big time delay


You are in the Acute Admissions Unit* (AAU) and are writing up a patien’s drug chart. The nurse tells you that one of the patients has been waiting 10 minutes for a cannula to be inserted. You know that the patient was seen by your FY1 colleague, Alex, five minutes ago. Alex has now left the AAU but you do not know the reason why. The nurse informs you that Alex did not insert the cannula when he was with the patient. There is no clinical urgency to insert the cannula.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Ask the staff if they know why Alex has left the ward

B. Contact Alex and ask him to return to the ward and insert the cannula

C. Ask the nurse to contact Alex to request that he returns to AAU to insert the cannula

D. Tell the nurse you will insert the cannula as soon as you have finished writing up the patient’s drug chart

E. Contact your specialty trainee* for advice



A - may have been emergency or to get equipment for procedure

D - maintains pt care but doesn’t find out why alex left

C - you are completing a drug chart so nurse can ask alex
B - you could do it but after you finish task

E - this is just a cannula


You are on a ward round with your consultant. One of the patients on the ward, Mr Andersen, is very ill and frail although he still has full capacity and is able to communicate. Your consultant recommends that several invasive procedures are conducted to determine the cause of Mr Andersen’s illness. Mr Andersen told you when he was admitted to the ward that he did not want to have any invasive procedures conducted.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. During the ward round, inform the consultant that Mr Andersen told you that he did not want any invasive procedures to be conducted

B. Talk to the consultant after the ward round about whether the procedures are a necessary option for Mr Andersen

C. Seek advice on what to do from another senior doctor

D. Discuss with Mr Andersen why it is in his best interest to undergo the procedures

E. During the ward round, ask Mr Andersen whether he wants to undergo these procedures


-need to be timely

A - best and least confrontational

E - Also good

B - delays discussion but does deal with it

C - indirect way of dealing with issue

D - would be good if pt doesn’t know which tests they want but here there is a direct request to not


You are on a surgical ward round with an FY1 colleague, a specialty trainee* and a consultant. The specialty trainee looks at the notes and drug chart of a patient who is due to go for colorectal surgery. The specialty trainee notices that a blood test that he had asked your FY1 colleague to do earlier on has not been done. The specialty trainee turns to you and asks why you have not done the blood test.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Apologise that the blood was not taken and offer to take the blood test now

B. Explain to the specialty trainee that he had asked your colleague to take the blood test, not you

C. Ask your FY1 colleague why he has not taken the blood test

D. Tell the specialty trainee that you will take the blood test later

E. Liaise with your FY1 colleague regarding who will take the blood test now



A - best for pt safety

E - less direct

B - this is good as you were not responsible but priority is the blood test

C - clarification as to why

D - delays pt care


You recently started working on the Rheumatology ward where visiting hours are in the afternoon, a time when senior doctors are often not present. The relatives of a patient, Mr Cheung, have come to visit him. He has recently been diagnosed with a rare disease and his relatives ask you to explain his diagnosis and treatment plan. You have been reading about the disease; however, you are not very familiar with it and you do not understand the full details of Mr Cheung’s treatment plan. You explain this to the family, advising them to wait for a senior doctor to speak to them. They insist that you give them further details now, asking why you do not know about the disease or treatment plan if you are looking after Mr Cheung.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Contact the senior doctor treating Mr Cheung, asking her to come and speak to his relatives as soon as possible

B. Explain the details that you understand about Mr Cheung’s disease and treatment plan to his relatives

C. Explain to the family that as an FY1 doctor you are not expected to know the details of all rare diseases

D. Apologise to Mr Cheung’s relatives, excusing yourself

E. Explain to Mr Cheung’s relatives that, due to the rarity of the case, they should wait to speak to a senior doctor


[get senior support for these complex diseases]

A - Better to get some support to avoid causing more worry or confusion

E - Clear statement that specialist knowledge is needed

B - may lead to further questions you can’t answer

C - explains why you cant but doesn’t help fam

D - doesn’t deal with relatives concerns


You are working on your first rotation in surgery. Whilst assessing a 65 year old female patient with jaundice, the consultant surgeon asks you to refer the patient to the Gastroenterology department regarding further treatment. You are unsure why this referral is required.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Ask a more experienced colleague to make the referral

B. Conduct research on the Internet into why the referral could be required

C. Contact the gastroenterology consultant to explain that you need to make the referral, and ask what information they need to proceed

D. Ask a more experienced colleague what information the Gastroenterology department will require to make the referral

E. Speak to the consultant surgeon again to gain more information before making the referral



E - unsure why refer - check with person requesting

d - asking more experienced member of team why

b - researching your questions is good

c - calling without knowing why you are calling is not ideal

a - passing on work and limiting learning needs


You are on-call on a busy late shift and covering the Stroke ward. Mrs Appleton is an inpatient with a dense hemiplegia and dysphasia. Her daughter Sally, who is a nurse in Australia, has rung the ward to enquire about the progress of her mother. You have not been involved in Mrs Appleton’s care as you have just started your shift, but you are aware that she is stable. The nurse in charge of the ward confirms Sally’s identity asks you to speak with her.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Ask Sally to telephone during the daytime when the ward doctors are available

B. Tell Sally that you are unable to provide her with information about her mother’s condition

C. Check the clinical notes before explaining to Sally that her mother is in a stable condition

D. Ask an available doctor, who has been involved in Mrs Appleton’s care, to speak to Sally

E. Ask the nurse in charge to tell Sally that there is no-one available to speak to her at present



C - Should always check notes first

D - also reasonable to get doctor who was involved

A - may not be able to give info on pt you are unfamiliar with or may be
B - uncomfortable giving info with relative unknown to you

E - delegation of task and may undermine sally and ward staff relationship


One of your patients, Miss Greenlee, confides in you that she finds one of the nurses who is caring for her to be rude and inconsiderate. Miss Greenlee tells you that she is a bit frightened of the nurse. You have not heard similar feedback about this nurse before, and find her to be approachable and friendly.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Tell Miss Greenlee that you have always found the nurse to be approachable and friendly

B. Explore these concerns with Miss Greenlee in more detail

C. Explain Miss Greenlee’s concerns to the the nurse involved, seeking her views on the situation

D. Inform the nurse in charge of what Miss Greenlee has told you

E. Discuss the issue with Miss Greenlee’s consultant



B - get more info

C - you find her approachable so will probably be receptive of feedback

d - next best way to make sure action is taken

e - better to raise with nursing team than consultant

A - no acknowledgement of her concerns


You are working on a surgical ward. Your specialty trainee* arrives on the ward looking unkempt and you notice that he smells of alcohol. He is due to operate in one hour, and you believe that his ability to operate may be impaired.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Suggest to the specialty trainee that he looks too tired to operate

B. Ask other team members whether they think the specialty trainee is fit to operate

C. Inform your consultant of the situation

D. Contact the theatre team and ask them to prevent your specialty trainee from operating

E. Suggest to your specialty trainee that he should not operate if he is under the influence of alcohol



C - delicate situation so consultant best to handle as still 1hr til operation so cover could be found

E - this is good but could create confrontation

b - Trainee should be treated with discretion until more facts gathered

d - Better ways to go about this

A - doesn’t address concerns


You are working on the Obstetrics and Gynaecology ward with another FY1 doctor, Funmilayo. You have noticed that Funmilayo often works for several hours before and after her shift. When you mention this to a nurse, she says that Funmilayo does this in order to complete tasks that are outside of her remit, to support her learning and development. Today, you see Funmilayo in the staff room at lunchtime, looking very tired.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

A. Suggest to Funmilayo that she should not work additional hours outside of her shift

B. Tell Funmilayo that you are concerned about how hard she is working

C. Remind Funmilayo that she should not be completing tasks that are outside of her remit, even if it is for her learning and development

D. Suggest to Funmilayo that if she is tired at work, this may have a negative impact on patient safety

E. Inform your specialty trainee* of your observations, seeking advice on how to proceed



B - most DIRECT to raise your concern

E - appropriate but less direct

d - raises safety issue but doesn’t deal with impact on Funmulayo

a - She is aware she working outside shift already

c - not your role to supervise other f1s and delineate their clinical remit


You and an FY2 doctor, Max, are working within a busy emergency department. You are both treating patients separately in adjacent rooms. You have just finished an examination of your patient, Miss Poon, and she is about to leave. Through the wall, you both hear Max making loud derogatory remarks towards his patient. This behaviour is completely uncharacteristic of Max.

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

A. Apologise to Max’s patient

B. Take Max aside and ask him privately about the incident

C. Immediately inform a senior doctor

D. Reassure Miss Poon that Max is usually very professional

E. Apologise to Miss Poon for what she has heard

F. Ask Max’s patient if she would like to make a complaint

G. Inform Max that this behaviour is highly inappropriate

H. Report the incident to Max’s clinical supervisor*


Immediate impact on quality needs an immediate response

B -take him aside and explain
G - and tell him it is wrong
C - and inform a senior

AE - appologies should be made but not priority now
D - not your job to defend
F - or initiate complaints
H - reporting should be done by SENIOR


A very ill patient tells you one morning that she wants to discharge herself from the hospital, because she has not slept for the last three nights. She says that this is because her bed is next to the nurses’ station and the telephone is always either ringing or the staff are talking on it during the night. She tells you that the staff often seem to be chatting on the telephone rather than discussing medical matters. The patient has not been deemed ready for discharge.

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

A. Offer the patient some general advice on how to sleep better at night

B. Ask the patient to tell you more about this situation and her concerns

C. Explain that telephones are only used at night by nurses for urgent issues that cannot wait until the morning

D. Document the patient’s concerns in the nursing notes

E. Inform the nursing staff that the patient is having trouble sleeping because of the noise levels at night

F. Arrange for the patient to be given some ear plugs

G. Ask the ward manager about the feasibility of moving the patient to a different bed on the ward


[Dealing with pt concern]

B - good to listen and find out more

E- good to inform nursing team as they may be unaware

(G) - simple action of moving can be good

(CF) - reasonable but don’t solve problem

(D) - doesnt resolve


One of your patients, Mr Austin, is an 85 year old man who has terminal cancer and is receiving palliative care. The team that is looking after him anticipates that he is likely to die within the next 48 hours. Mr Austin’s daughter, Helen, has just arrived from New Zealand, and asks to speak to you. She demands to know why her father is no longer receiving treatment. You are aware that active treatment has been withdrawn due to the stage of Mr Austin’s cancer, and the team is trying to make him as comfortable as possible.

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

A. Ask Helen if she would like to speak to a more senior member of the team

B. Reassure Helen that her father is comfortable

C. Suggest to Helen that she spends some time with her father

D. Reassure Helen that the team is working hard to make her father as comfortable as possible

E. Advise Helen to make an appointment to speak to her father’s consultant

F. Explain to Helen why her father’s active treatment has been withdrawn

G. Inform Helen that her father does not have very long to live

H. Ask the senior nurse to come and speak to Helen



A - senior as complex case

D- good to remind hellen care is our priority

F - if she declines to wait you may have to explain

(E) - unfamiliar situation for relative and increases burden on her

(b) - this is subjective and maybe not true

(C) - this is a personal decision

(h) out of nurses remit


An 80 year old patient, who has been on the ward for three days for treatment of a urinary tract infection, is now much improved and due to be discharged home. The patient is extremely keen to get home, where she lives alone. The patient has two daughters, the first daughter, who is present at the hospital, is keen for her mother to return home. However, her second daughter telephones the ward and leaves a message with one of the nurses to say that she is very unhappy that her mother is being discharged, as she feels that her mother is not coping at home.

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

A. Continue with the current arrangements for discharge

B. Try and find out more details about the second daughter’s concerns

C. Explain to the patient that the second daughter does not want her to be discharged

D. Contact the second daughter and explain that it is her mother’s right to decide whether she is discharged or not

E. Ask Occupational Therapy* to assess the patient

F. Ask the first daughter if she has any concerns about her mother being able to cope at home

G. Explain to the first daughter that she and her sister need to discuss the issue between them

H. Ask the patient if she feels that she is able to cope at home



B - explore concerns

E - OT made for these assessments

H - if pt has capacity her wishes are key

(A) - risks damaging relationships with fam

(DGC) risks increasing tensions within fam

(F) she already said she is happy


You are working a surgical on-call shift and are due to finish at 20:00. You are preparing to hand over your remaining duties to your FY2 colleague, when you receive a bleep* from the ward at 19:55 asking you to take the history of a very sick patient, Mr Martin, who has just been admitted by his GP* and may need emergency surgery. The FY2 doctor, who you are due to hand over to, is currently in theatre with the surgical specialty trainee*. The consultant is at home.

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

A. Telephone the ward to explain that you cannot take Mr Martin’s history as you are due to finish your shift

B. Make a list of what needs to be done for handover and leave it with reception

C. Attend to Mr Martin and take his history

D. Explain to the nursing staff that the FY2 doctor and specialty trainee are currently in theatre before going home

E. Go to theatre to notify the surgical specialty trainee that Mr Martin may require emergency surgery

F. Hand over your remaining duties to the FY2 doctor

G. Wait with Mr Martin until the specialty trainee and FY2 doctor have finished in theatre

H. Telephone Mr Martin’s GP to find out the urgency of his surgery


[Prioritise pt care]

C - need to attend pt

E - should notify so they can prepare

F - Handing over important tasks is key

(AD) - put pt at risk

(B) - doesn’t address issue and it may be lost or not picked up

(G) wasting time

(H) gp already referred for surgery


Your FY1 doctor colleague, Roshan, has asked to speak to you in confidence. He has received feedback from his clinical supervisor* that his style of communicating with colleagues is unacceptable. You have noticed when working with Roshan that he is usually courteous, although on occasions he can be irritable and patronising with the nursing staff. Roshan is seeking your view on what he should do.

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

A. Inform Roshan that you agree with his clinical supervisor’s comments

B. Advise Roshan to seek feedback from other members of the team regarding his communication skills

C. Offer to conduct some role play with Roshan so that he can practise his communication style

D. Advise Roshan to speak to his clinical supervisor about strategies for improving his communication

E. Advise Roshan to contact the foundation team to discuss the feedback

F. Advise Roshan to inform his clinical supervisor that he does not agree with the feedback

G. Advise Roshan to attend a communication skills workshop

H. Offer Roshan constructive feedback based on your past observations of h



B - more feedback for more holistic view of com skills

D - good way to investigate and think of effetive strategies

H - good for you to give constructive feedback

(C) - role play should be done by trained people under supervision

(G) - should be done when supervisor confirms issue


You are part of the multidisciplinary team* that has been involved with the care of a 90 year old patient, Mrs Turner, who has now been put on a palliative care pathway. You are at her bedside attending to her when her son comes into the room and insists on being able to take his mother home immediately. He tells you that he does not want her to remain on the hospital ward, and instead wants her to die at home surrounded by all of her family. Mrs Turner is awake and appears to be upset by the situation.

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

A. Ask Mrs Turner’s son to try and calm down

B. Suggest to Mrs Turner’s son that he come with you to a quiet room on the ward

C. Ask a senior doctor on the ward to speak to Mrs Turner’s son

D. Call security to defuse the situation

E. Inform Mrs Turner that you will discuss the situation with her son

F. Try to explore with the son the rationale behind his request

G. Discuss with Mrs Turner what her preference is for where she dies

H. Advise Mrs Turner to ask her son to leave the ward until he is calmer



BF - acknowledge sit is distressing and diffuse

G - which allows you to find out her wishes

(E) - shouldnt just ‘inform’ - should be a discussion

(C) senior probs needed but not right now after initial distress diffused

(AH) antagonise


A five year old patient on your ward, Caleb, has been in hospital for three days with a fever. He has not been eating or drinking normally during this time. Caleb’s diagnosis is yet to be confirmed, despite ongoing investigations. You are asked by the nurse in charge to speak with Caleb’s father, Mr Hamilton, about his son’s progress. Mr Hamilton is angry and displaying aggressive behaviour because Caleb has not yet been diagnosed, and he says that Caleb is not getting any better. The specialty trainee* is currently in clinic and your consultant has left the ward for the day.

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

A. Speak to Mr Hamilton, with the nurse in charge present, to try to explore his concerns further

B. Ask the specialty trainee to speak with Mr Hamilton upon his return from clinic

C. Ask your consultant to speak to Mr Hamilton the next time she is on the ward

D. Request that hospital security removes Mr Hamilton from the ward

E. Inform Mr Hamilton that you will not tolerate his aggressive behaviour

F. Suggest that Mr Hamilton documents his concerns in writing

G. Ask the nurse in charge to inform Mr Hamilton that you are still awaiting the results of investigations

H. Acknowledge Mr Hamilton’s frustrations



H - priority is acknowledge

A - chaperone good

B - as no diagnosis yet senior support is good

(C) too much delay
(G) - may make it harder for college later
(EF) - antagonise
(D) overkill now


You have just started an overnight on-call shift. A nurse asks you to speak to a patient, Desmond, who had a number of tests taken after being admitted this morning with acute abdominal pain. The nurse explains that Desmond is agitated, as he has not been given information about his current condition, the results from the tests or for how long he will have to stay in the hospital. You visit Desmond, who explains that he was expecting a parcel to be delivered at his house and is worried he will not be in to collect it. Desmond asks you to tell him everything you know about his condition. You are unfamiliar with his medical history and his test results, as you only started your shift two hours ago.

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

A. Suggest to Desmond that he asks the medical team to answer his questions in the morning

B. Ask Desmond whether he would like you to contact one of his neighbours so that they can collect his parcel

C. Read through Desmond’s patient notes, before answering his questions

D. Ask the nurse in charge to give you a full verbal account of Desmond’s history

E. Document Desmond’s test results in his patient notes

F. Speak to your specialty trainee* about Desmond’s management

G. Listen to Desmond’s concerns

H. Reassure Desmond that he will soon be home from hospital to collect his parcel



C - needed before you can answer qs

F - trainee likely know more

G - always listen to concerns

(a) delay
(B) not to do with med care
(E) not essential now


Mr O’Brien has alcoholic cirrhosis of the liver. He is embarrassed about his condition and does not want his family to know the diagnosis. At least four members of his family visit the ward every day and on each occasion ask you how Mr O’Brien is. On this occasion they approach you and seem upset. They tell you that they believe that Mr O’Brien is dying of cancer and that his case is being mismanaged. They begin to get angry.

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

A. Advise the family that you will have to call security if they do not calm down

B. Ask your specialty trainee* to speak with the family

C. Ask the family why they think Mr O’Brien’s case is being mismanaged

D. Ask the nursing staff to assist you in dealing with the family

E. Explain that you cannot discuss Mr O’Brien’s case without his permission

F. Tell Mr O’Brien that his family thinks he is dying of cancer, asking him to clarify his condition with them

G. Reassure the family that Mr O’Brien will not die of cancer

H. Suggest to the family that they may be better speaking to Mr O’Brien about their concerns



C - find out more about concerns

E - tell about confidentiality

H - both may benefit from conversation

(F) don’t need to tell him that
BD - don’t need senior help or nurses just yet
A - last resort


You are on your way to take a break when you overhear an FY2 colleague, Anita, breaking bad news insensitively to the relatives of one of your patients, who has just been diagnosed with lung cancer. Anita leaves quickly. The relatives are looking extremely distressed.

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

A. Tell the nurses that the patient’s relatives look extremely distressed and may need some support

B. Apologise to the patient’s relatives on behalf of Anita

C. Speak to the Foundation Programme Director* about Anita’s communication skills

D. Contact the hospital chaplain and ask that she comes and supports the patient and their family

E. Approach the relatives and offer them the opportunity for further discussion

F. Suggest to Anita’s clinical supervisor* that she may need further training in breaking bad news to patients and relatives

G. Contact Anita and tell her that the patient and the patient’s relatives are upset

H. Monitor Anita’s future encounters with patients



A - good for empathetic approach from wider team

E - news already broken so can talk

G- allows her to address issue and learn from

D - AFTER discussion with pt / relatives

(b) - shouldn’t apologise without further discussion

F- only if pattern of behaviour
H not your job


You are working in a busy Acute Admissions Unit (AAU)*. A 26 year old mother, Jodie, was recently admitted to the department with pelvic pain. Your FY1 colleague, Rohan, prescribed an oral antibiotic for Jodie. An hour later, a nurse approaches you to inform you that Jodie’s first dose of the antibiotic has been administered, but that she has just observed Jodie breastfeeding her five week old baby. You are aware that the antibiotic that has been prescribed and administered is not recommended for mothers who are breastfeeding. Rohan has now left the ward.

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

A. Seek advice from the paediatric team about the risk to Jodie’s baby

B. Request a new prescription for an appropriate antibiotic

C. Inform your consultant of what has happened

D. Apologise to Jodie, explaining what has happened

E. Advise Jodie about the hospital complaints procedure

F. Attempt to contact Rohan to inform him of his error

G. Arrange for a qualified member of staff to conduct an initial assessment of Jodie’s baby

H. Investigate how Rohan had made an error in prescribing



A - paed team for advice

B - need to change abx

D - will have the info from paed team

(C) should happen but after
(G) nurse shouldn’t do assessment


You are bleeped* to urgently attend to an 87 year old patient, Eileen, who has gone into cardiac arrest. You arrive and see that Eileen appears to be extremely frail and weak. You see no indication of a Do Not Attempt Resuscitation* (DNAR) request. A specialty trainee* also arrives and commences with the resuscitation attempt. You are concerned that resuscitation may not benefit Eileen.

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

A. Advise the nursing staff to contact Eileen’s next of kin, asking them to attend the hospital

B. Ask the specialty trainee about the benefits of the resuscitation attempt

C. Ask the nursing staff involved in Eileen’s care, whether there have been any DNAR discussions with the patient or her family

D. Inform the specialty trainee that you think that the resuscitation attempt would be unethical

E. Immediately contact Eileen’s next of kin, asking for their views on whether resuscitation should be attempted

F. Commence with assisting the specialty trainee in the resuscitation process

G. When the resuscitation team arrives, share your concerns about the benefits of the resuscitation attempt

H. Insist that the specialty trainee delays his attempts until the full resuscitation team have arrived, and the situation can be discussed



C - asking nurses best way to find out about DNCPR

F - obvs commence while you dont know

B - good to ask them

(DEG) - should have commenced while these this could be considered


A fellow FY1, James, tells you that he is finding life as an FY1 doctor very hard. He explains that he is not sleeping well, his concentration has deteriorated, he has made a number of minor mistakes at work and he is no longer enjoying anything.

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

A. Suggest that James may want to consider taking some annual leave

B. Suggest to James that he discusses his difficulties with his educational supervisor*

C. Suggest that James makes an appointment with his GP*

D. Explain to your colleagues that James may need extra support

E. Offer to assist James with some of his workload

F. Explain to James that his impaired functioning may be placing patients at risk

G. Explain to James that you are there if he needs someone to talk to or needs some support

H. Suggest to James that perhaps he should consider whether medicine is the career for him



BC - needs to get correct support

- safety key

DGE - dont address underlying problem

A - not your place


You have just started a night shift on the Medical ward. You are bleeped* by a nurse to attend to an 82 year old patient, Mrs Ratnaike, who is complaining of pain. Mrs Ratnaike is crying and tells you that your FY1 doctor colleague, Haroon, was very rough when he inserted a cannula, just before he hurried away. Mrs Ratnaike says that Haroon mentioned that he was late for a social engagement, and she thinks that he was rushing to leave.

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

A. Telephone Haroon, explaining that he made Mrs Ratnaike cry

B. Apologise to Mrs Ratnaike for Haroon’s behaviour

C. Advise Mrs Ratnaike of the hospital’s complaints procedure

D. Explore with your FY1 doctor colleagues whether they have ever witnessed similar behaviour from Haroon

E. Ensure that Mrs Ratnaike is comfortable

F. Inform your consultant of the incident

G. The next time he is at work, inform Haroon that he made Mrs Ratnaike cry

H. Reassure Mrs Ratnaike that Haroon would not rush a medical procedure



B - you are dealing directly with her so should appologise
E - and make sure she is comfortable

G - Should tell him next time you see him so he can reflect

(c) - this could be a next step

(A) no urgency to tell him

(DF) this is one off so don’t need to gather more info


You are attending to a seven year old child, Aidan, whose mother has brought him to hospital because he has a high temperature. Aidan is very agitated, and is screaming and crying very loudly. As you attempt to examine him, Aidan becomes physically aggressive and tries to kick you.

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

A. Explain to Aidan why you need to examine him

B. Ask Aidan’s mother to help you to examine him

C. Advise Aidan’s mother to bring Aidan back later when he has calmed down

D. Ask one of the nursing staff to help Aidan’s mother to restrain him

E. Ask Aidan why he is upset

F. Continue to examine Aidan as best as you can

G. Tell Aidan that you will give him a sticker if he calms down

H. Tell Aidan that his behaviour is unacceptable



AB - tell him why and get mum to help

E - can address his concerns

(C) delays
(G) parents might NOT LIKE USING REWARDS
(F) unlikely to work
(H) doesn’t calm and is mean


You are undertaking a very busy night shift and started your only break for the evening one minute ago. A nurse approaches you to inform you that she is very concerned about a patient and wants you to see him urgently. She tells you that the patient has a fever and she suspects that he has pneumonia. When you ask for details of further observations, she cannot remember any information about the patien’s heart or breathing rate, but she notes that the patient looks very pale and unwell.

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

A. Finish your break at the time you had planned

B. Bleep* the specialty trainee* to request assistance

C. Finish your break immediately

D. Administer antibiotics to the patient to treat pneumonia

E. Ask the nurse to gather the patient’s observations

F. Ask the nurse why she suspects that the patient has pneumonia

G. Explain to the nurse why it is important to take a break during your shift

H. Assess the patient



CH - finish and examine an unwell pt

E - get nurse to do obs

(B) assess pt before getting trainee

(F) delays pt care


You are about to start a night shift on a medical ward. During handover, Hussein, the FY1 doctor who has been working the day shift, tells you that he has nothing to hand over. When you are on the ward later that evening, a senior nurse informs you that she bleeped* Hussein several times during the day and spoke to him over the telephone about an 88 year old patient with severe chest pain. You review and treat the patient accordingly. When you discuss this incident with Hussein the next day, he states that he was never informed about this patient, and that the nurse is lying.

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

A. Inform Hussein’s clinical supervisor* of the allegations that he has made about the senior nurse

B. Explain the situation to your clinical supervisor, seeking advice on how to proceed

C. Advise Hussein of the severity of his allegations, ensuring that he is aware of what he is saying

D. Inform the senior nurse that Hussein told you that she was lying about the patient with chest pain

E. Speak to the senior nurse involved, obtaining further details about the incident

F. Explore with the other nurses whether they overheard the telephone call between Hussein and the senior nurse

G. Suggest to Hussein that he talks to the senior nurse about the incident

H. Fill in a critical incident form*, documenting the incident



B - early senior advice is key in these delicate sits

C - should make sure he knows how serious this is

G - this could resolve the issue

(EFH ) - not your place to launch an investigation

  1. You have been assisting in the operating theatre. Between cases you go to the coffee room where you notice a patient identification label. The label has confidential patient information written on it and it is stuck to a computer screen. The coffee room is accessible by all members of staff in the hospital. The patient, Mr Cooke, is a member of staff in your hospital who was operated on by your consultant earlier that day. You recognise the handwriting on the label as belonging to your consultant.

A. Remove the patient identification label from the computer screen, placing it in the confidential waste bin

B. Inform Mr Cooke that a label containing his confidential patient information was left on a computer screen in the coffee room

C. Inform your FY1 doctor colleague about the label containing confidential patient information, seeking her advice on how to proceed

D. Inform your consultant that you found the label

E. Report the incident to your clinical supervisor*

F. Complete a critical incident form*, documenting the incident

G. Inform your consultant that he has breached patient confidentiality by leaving the label on display in a public area

H. Put a line through Mr Cooke’s name on the label, so that it is no longer visible



A - prevents further breech of condifentiality
DG - tell him you found it and that it is a breech will help prevent it happening again

(B) could tell the pt but others more important
(C) advice good but others better
(E) no need to escalate yet

(F) incident form appropriate but not yet

(H) - does not address issue


You have been working alongside a fellow FY1 doctor, Neha, on a surgical ward for the past four weeks. Since working with Neha, you have noticed that, although she always appears to be busy and often complains about being overworked, she seems to complete far fewer tasks than you do. You think that some of the nursing team tend to avoid requesting help from Neha and instead ask you to complete the majority of the tasks. When you ask Neha about her workload, she tells you that she feels as if she never stops and is always busy.

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

A. Suggest to Neha that she needs to work more efficiently
B. Ask a fellow FY1 doctor whether they have noticed that Neha can be difficult to work with
C. Speak to your clinical supervisor* about the situation to ask for his advice
D. Ask the nursing team to distribute the tasks more equally between yourself and Neha
E. Ask the nursing team why they avoid asking Neha for her help
F. Explain to Neha that you feel that you are undertaking a disproportionate amount of the workload
G. Start to keep a record of how long Neha is spending on each of the tasks that she completes
H. Ask the senior nurse for his perspective about how the workload is being distributed



CH - senior advice and opinions good (could be more tasks than you know)

F - good to discuss and get college opinion

(A) blunt and might not be true

(BE) - entire team and f1s not as good as just couple senior members


You are working on a surgical ward. A patient has just woken up from her anaesthetic following a laparoscopy, she has normal observations and oxygen saturation. The patient still has her drip and is drowsy. While you are reviewing her, the patient starts to become distressed and demands to go home. Her husband is in the waiting room.

A. Try to find out what is troubling the patient

B. Clarify the post-operative plan for the patient with the team

C. Ask a nurse to try to reassure the patient

D. Take the patient’s drip down in case this is what is troubling her

E. Offer to provide the patient with some pain killers

F. Explain to the patient that she needs to stay in hospital since she has just had an operation

G. Ask a nurse to contact a senior colleague

H. Ask the patient’s husband to come to the ward



A - ALWAYS good

B - need to know plan before continuing which will allow

F - explain the rational for hospital

(H) dont need husband while STILL DORWSY

(G) senior not needed

(DE) possible but not first

(C) likely already happened and delegation not required

  1. Mr Siad is a psychiatric patient who has been brought onto your medical ward with a psychiatric nurse. You are aware that he was admitted to the hospital the previous week and was very disruptive and refused all treatment. Your consultant has told you to book an urgent CT* scan of his head. When you inform Mr Siad that he is booked in for a scan later that day, he tells you that he will refuse to cooperate.

You answered ACE scoring 12 of a possible 12 marks.

A. Inform your consultant that Mr Siad is refusing to cooperate with the CT scan

B. Delay the CT scan for 48 hours, to allow time for Mr Siad to calm down

C. Attempt to explore Mr Siad’s reasons for refusing the CT scan

D. Discuss with your consultant whether it would be appropriate to prescribe sedation for Mr Siad prior to the CT scan

E. Find out from your specialty trainee* if it would be appropriate to assess Mr Siad’s capacity to refuse the CT scan

F. Politely tell Mr Siad that his disruptive behaviour is making it difficult for healthcare workers to work

G. Explain to Mr Siad about why he needs to have the CT scan

H. Ask Mr Siad if he would like a relative to come and accompany him during his stay in the hospital


[must understand psych diagnosis]

C - may be a simple reason for refusal

E - after excluding above can assess capacity with trainee

A - so call to consultant has all the facts

(B) delaying
(D) sedation after call with consultant
(H) not first line

(G) - unclear how he may react

  1. The consultant, Dr Scott, has asked you to write up and submit the results of a full audit cycle to a medical conference. You are aware that the audit was designed and carried out last year by Anthony, an FY2 doctor who is currently working abroad for a year. Owing to delays in the project, Anthony was unable to write up and submit the results before leaving the country. You have not been able to make contact with Anthony to request his permission to use the results of his audit, but Dr Scott has given you reassurance that you have her permission to proceed.

A. Write up and make the submission on Anthony’s behalf, without assuming authorship

B. Seek advice from the Medical Defence Organisation* on how to proceed

C. Continue to try to make contact with Anthony while completing the write up

D. Suggest to Dr Scott that Anthony should complete the write up and submission

E. Report Dr Scott for possible violation of ethics

F. Write up and make the submission as the first author

G. Expand on the original design and complete further work on the audit

H. Discuss your concerns about authorship with Dr Scott



C - Writing up while trying to contact is the best

G - expanding andcontributing justifies your authorship

H - obvs

(F) antony is 1st author

(A) you are co-author

(D) considerable delay

BE - done after exploring concerns

  1. You are due to finish your day shift and hand over to a FY1 doctor, Lucie. You want to leave the hospital on time as you are meeting some of your relatives, whom you have not seen for several months. However, Lucie has’t arrived yet and is now ten minutes late. Lately, Lucie has not seemed to be managing her workload well and has frequently been arriving at work late. When you ask one of the nurses, Justin, if he knows when Lucie will be arriving, he tells you that he does not know, but that he is aware that Lucie has been experiencing personal problems recently.

A. Prepare a detailed handover note for Justin to give to Lucie, ensuring that he is fully briefed on all details

B. Ensure that Lucie’s specialty trainee* is aware that her personal problems are affecting her professional conduct

C. Try to contact Lucie, to establish when she will arrive at the hospital

D. Speak to Justin, to gain more insight into Lucie’s personal problems

E. Contact another available on-call doctor, to establish whether she is willing to take your handover

F. Remain on the ward, to provide Lucie with a handover when she arrives

G. Encourage Lucie to speak to her clinical supervisor* if she is struggling with her workload

H. Ask Lucie whether she needs you to arrange cover for her shift



[good handover and encourage to seek help]

C - good

E - ensures handover

G - good way for her to get help

(F) - if clinical risk you should stay
(A) - writen handovers never as good though 3rd party

(D) shouldn’t ask about personal / professional issues of others

(B) supervisor better than trainee

(H) that is for seniors to do

  1. You are reviewing a patient on a stroke ward with your FY1 colleague, Jacob. The consultant, Dr Henderson, has asked that the patient’s neurological status is assessed on a daily basis. You notice that without conducting any form of examination, Jacob has documented that the patient’s neurological status is unchanged. When Dr Henderson later asks Jacob about the patient, he reports that the findings were unchanged.

A. Talk to Jacob about the importance of undertaking thorough examination

B. Document Jacob’s actions in the patient’s notes

C. Conduct a thorough neurological examination on the patient yourself and document the findings

D. Ask a fellow FY1 colleague if they have ever observed Jacob lie to senior staff

E. Ask Jacob why he lied to Dr Henderson

F. Remain quiet and monitor Jacob throughout the day to determine if he does inform Dr Henderson

G. Write an email to Dr Henderson informing her of Jacob’s lie

H. Speak to Dr Henderson in private to inform her of what has happened



C - priority is to examine pt

H- then speak to consultant

A - should emphasise importance of examination

(E) - this is more likely than A to affect working relationship

(G) - consultant may ask this but less direct for now

(B) dont document behaviour here

  1. You are asked to speak with a patient, Ms Saeed, who was admitted with an infection two days ago. Ms Saeed is very upset and tells you that she would like to make a complaint about a nurse, Russell, who she claims has not looked after her properly. When you explore this further with Ms Saeed, she tells you that she takes blood pressure medication regularly and Russell has not provided her with it since admission and that, when asked, he has not provided a reason for this.

You answered EFH scoring 8 of a possible 12 marks.

A. Tell Russell that Ms Saeed is unhappy with his care

B. Ask Ms Saeed whether she would like to make a formal complaint against Russell

C. Apologise to Ms Saeed on Russell’s behalf

D. Raise Ms Saeed’s complaint with the nurse in charge

E. Review Ms Saeed’s notes and drug chart, establishing whether there is a reason why her blood pressure medication has been withheld

F. Acknowledge Ms Saeed’s concerns, explaining that you will establish why this has happened

G. Arrange for Ms Saeed to be prescribed with the appropriate blood pressure medication straight away

H. Gain an understanding of Russell’s perception of his conversation with Ms Saeed



E - Acknowledge and address concerns

F - drug chart is next step

G - if no reason for stopping found approriate meds needed

(AD) - escalate but don’t deal with immediate query

(C) - not your job to apologies here

(BD) reasonable for later

(H) considered but not as good as others for immediate concerns