Questions 1–4
Hand hygiene on a ward round Tom is a third-year medical student on a surgical placement. He is following Dr Hughes, a consultant surgeon, on the morning ward round. Dr Hughes is checking patients' surgical wounds. Tom notices that, for the last three patients, Dr Hughes has gone straight from one patient to the next without cleaning his hands, even though there is a hand-gel dispenser at the end of every bed. The next patient is an older man who had a hip operation two days ago. Dr Hughes is friendly but very busy, and the ward round is running late.
Question 1 Appropriateness: patient safety How appropriate is each of the following responses by Tom in this situation?
Tom says nothing during the ward round, but as soon as it finishes he tells the nurse in charge of the ward what he saw.
Answer options for question 1 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 2 Appropriateness: patient safety How appropriate is each of the following responses by Tom in this situation?
Before Dr Hughes examines the next patient, Tom politely asks whether he would like Tom to pass him some hand gel.
Answer options for question 2 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 3 Appropriateness: patient safety How appropriate is each of the following responses by Tom in this situation?
Tom quietly tells the next patient that Dr Hughes has not been cleaning his hands, so the patient may want to refuse to be examined.
Answer options for question 3 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 4 Appropriateness: patient safety How appropriate is each of the following responses by Tom in this situation?
Tom makes a point of cleaning his own hands at every bed, hoping that Dr Hughes will notice and follow his example.
Answer options for question 4 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 5–7
Overheard in the lift Priya is a foundation year 1 (FY1) doctor. She steps into a busy hospital lift with Daniel, an FY2 doctor from her team. Several visitors and a porter are also in the lift. Daniel starts talking to Priya about a patient on their ward, using the patient's full name and describing his new diagnosis of bowel cancer in some detail. Priya knows that the patient has not yet told his family about the diagnosis. The lift is slow and they are travelling up six floors.
Question 5 Importance: confidentiality How important is each of the following for Priya when deciding how to respond to the situation?
That people in the lift can hear the patient's name and diagnosis.
Answer options for question 5 A Very important B Important C Of minor importance D Not important at all
Question 6 Importance: confidentiality How important is each of the following for Priya when deciding how to respond to the situation?
That Daniel is a year more senior than Priya.
Answer options for question 6 A Very important B Important C Of minor importance D Not important at all
Question 7 Most appropriate action: confidentiality What is the most appropriate action for Priya to take?
Answer options for question 7 A Stay quiet in the lift, then explain to Daniel afterwards why the conversation was a problem. B Interrupt Daniel straight away, for example by saying quietly that they should talk about it on the ward, and mention it to him privately afterwards. C Report Daniel to their consultant at the end of the day without speaking to him first. D Tell Daniel loudly that he is breaching confidentiality, so the others in the lift know the team takes privacy seriously.
Questions 8–10
A favour for a neighbour Jack is an FY1 doctor at his local hospital. His mother rings him one evening: their elderly neighbour, Mr Reid, was admitted to the hospital yesterday and she is worried about him. She asks Jack to look at Mr Reid's records on the hospital computer system and let her know what is wrong and how he is getting on. Jack can log in to the system for his work, but he is not involved in Mr Reid's care, and Mr Reid is on a different ward.
Question 8 Appropriateness: confidentiality How appropriate is each of the following responses by Jack in this situation?
Jack tells his mother firmly that he cannot help, and ends the call without suggesting anything else.
Answer options for question 8 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 9 Appropriateness: confidentiality How appropriate is each of the following responses by Jack in this situation?
Jack looks up Mr Reid's records but tells his mother only that 'he is doing fine', without giving any details.
Answer options for question 9 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 10 Appropriateness: confidentiality How appropriate is each of the following responses by Jack in this situation?
Jack explains that he cannot look at the records of a patient he is not caring for, and suggests that his mother visits Mr Reid or speaks to his family.
Answer options for question 10 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 11–14
Leaked exam questions Chloe is a second-year medical student. Two days before an important written exam, a message appears in a group chat she shares with about thirty classmates. Ravi, one of her classmates, has posted a file and says it contains the actual questions for the exam, which he found left on a printer in the medical school office. Several people have already replied to thank him. Chloe has not opened the file. She knows the exam counts towards whether students can progress to the next year.
Question 11 Appropriateness: academic integrity How appropriate is each of the following responses by Chloe in this situation?
Chloe leaves the group chat without opening the file, and does nothing else.
Answer options for question 11 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 12 Appropriateness: academic integrity How appropriate is each of the following responses by Chloe in this situation?
Chloe does not open the file, and lets the medical school know that the exam questions appear to have been shared.
Answer options for question 12 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 13 Appropriateness: academic integrity How appropriate is each of the following responses by Chloe in this situation?
Chloe opens the file and uses the questions to revise, reasoning that most of the year group will have seen them anyway.
Answer options for question 13 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 14 Appropriateness: academic integrity How appropriate is each of the following responses by Chloe in this situation?
Chloe messages Ravi privately, urging him to delete the file and tell the medical school himself, and says she will tell the school if he has not done so by the end of the day.
Answer options for question 14 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 15–17
A photo on social media Hannah is an FY1 doctor. One evening she sees that Mark, another FY1 on her ward, has posted a photo on his public social media account. It shows the ward team smiling around a birthday cake in the staff area. In the background the ward whiteboard is clearly visible, and Hannah can read several patients' names and the bays they are in. The post has been up for about an hour and has already had dozens of likes. Mark is a friend and is usually careful.
Question 15 Importance: social media How important is each of the following for Hannah when deciding how to respond to the situation?
That the photo was taken during the team's break, not while they were treating patients.
Answer options for question 15 A Very important B Important C Of minor importance D Not important at all
Question 16 Importance: social media How important is each of the following for Hannah when deciding how to respond to the situation?
That Mark may feel embarrassed when Hannah points out the problem.
Answer options for question 16 A Very important B Important C Of minor importance D Not important at all
Question 17 Most appropriate action: social media What is the most appropriate action for Hannah to take?
Answer options for question 17 A Report the post to the hospital's communications team, without contacting Mark. B Comment on the post to point out that patients' names are visible. C Mention it to Mark when she sees him on the ward the following morning. D Contact Mark straight away, explain that patients' names are visible, and ask him to take the post down.
Questions 18–20
Two calls on a night shift Omar is an FY1 doctor on a busy night shift, covering several wards. Within a few minutes he receives two calls. A nurse on Ward 4 asks him to prescribe regular paracetamol for a patient with mild back pain who has no pain relief prescribed. A nurse on Ward 9 reports that a patient who had surgery this afternoon now has a much lower blood pressure and a faster heart rate than earlier in the evening. The two wards are on different floors. The Ward 4 nurse called first, and has called once before about the same patient.
Question 18 Importance: workload and prioritisation How important is each of the following for Omar when deciding how to respond to the situation?
How unwell each of the two patients might be.
Answer options for question 18 A Very important B Important C Of minor importance D Not important at all
Question 19 Importance: workload and prioritisation How important is each of the following for Omar when deciding how to respond to the situation?
Which of the two calls came in first.
Answer options for question 19 A Very important B Important C Of minor importance D Not important at all
Question 20 Most appropriate action: workload and prioritisation What is the most appropriate action for Omar to take?
Answer options for question 20 A Go to Ward 4 first, as prescribing the paracetamol will only take a few minutes. B Ask the Ward 9 nurse to repeat the observations in an hour and call back if they are no better. C Go to Ward 9 first, and let the Ward 4 nurse know he will prescribe the paracetamol as soon as he has seen the other patient. D Tell the Ward 4 nurse to give the paracetamol now, and say that he will write up the prescription later.
Questions 21–24
A first blood test Ellie is a second-year medical student on her first hospital placement. She has practised taking blood on a model arm in the skills lab but has never done it on a patient. Dr Ahmed, a busy FY1, asks Ellie to take a blood sample from Mrs Clarke in bed 6 while he goes to see another patient, saying, 'You'll be fine — it's easy.' No one else is free to supervise her at the moment. The blood test is routine and is not needed urgently.
Question 21 Appropriateness: working within competence How appropriate is each of the following responses by Ellie in this situation?
Ellie takes the blood sample on her own, as she has watched it done many times.
Answer options for question 21 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 22 Appropriateness: working within competence How appropriate is each of the following responses by Ellie in this situation?
Ellie tells Dr Ahmed she would rather not take the blood, without explaining why, and offers to fill in his request forms instead.
Answer options for question 22 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 23 Appropriateness: working within competence How appropriate is each of the following responses by Ellie in this situation?
Ellie tells Dr Ahmed that she has only practised on a model arm, and asks whether someone could supervise her first attempt when they are free.
Answer options for question 23 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 24 Appropriateness: working within competence How appropriate is each of the following responses by Ellie in this situation?
Ellie explains to Mrs Clarke that she is a student who has never taken blood from a patient before, and goes ahead on her own when Mrs Clarke agrees.
Answer options for question 24 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 25–27
A registrar who smells of alcohol Ben is an FY1 doctor. At 8am he meets his registrar, Dr Lewis, to help her insert a chest drain for a patient on the ward. Standing close to her, Ben notices a strong smell of alcohol, and her speech seems slightly slurred. Dr Lewis is well respected and has always been supportive of Ben. She says she wants to get the procedure done quickly so the patient can be comfortable. The consultant is in the hospital and can be reached by phone.
Question 25 Importance: raising concerns How important is each of the following for Ben when deciding how to respond to the situation?
Dr Lewis's own health and wellbeing.
Answer options for question 25 A Very important B Important C Of minor importance D Not important at all
Question 26 Importance: raising concerns How important is each of the following for Ben when deciding how to respond to the situation?
The safety of the patient who is about to have the chest drain.
Answer options for question 26 A Very important B Important C Of minor importance D Not important at all
Question 27 Most appropriate action: raising concerns What is the most appropriate action for Ben to take?
Answer options for question 27 A Assist with the procedure as planned, and raise his concerns with the consultant afterwards. B Assist with the procedure, but keep a close eye on Dr Lewis and step in if she seems to be making a mistake. C Tell Dr Lewis privately that he is concerned, and contact the consultant straight away so that she does not perform the procedure. D Make an anonymous report about Dr Lewis through the hospital's online reporting system at the end of the day.
Questions 28–31
A prescribing error Grace is an FY1 doctor. While reviewing a patient's drug chart, she realises that yesterday she prescribed an antibiotic at twice the intended dose. One dose has already been given. The patient, Mr Okafor, seems well and has no new symptoms. Grace is embarrassed, as she was criticised for a different mistake last month. Her registrar is working on the same ward today.
Question 28 Appropriateness: honesty about errors How appropriate is each of the following responses by Grace in this situation?
Grace corrects the prescription and checks that Mr Okafor is well, then tells her registrar about the error at the end of the day.
Answer options for question 28 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 29 Appropriateness: honesty about errors How appropriate is each of the following responses by Grace in this situation?
Grace quietly corrects the prescription and tells no one, because Mr Okafor has come to no harm.
Answer options for question 29 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 30 Appropriateness: honesty about errors How appropriate is each of the following responses by Grace in this situation?
Grace corrects the prescription, tells her registrar straight away, and makes sure Mr Okafor is told what has happened.
Answer options for question 30 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 31 Appropriateness: honesty about errors How appropriate is each of the following responses by Grace in this situation?
Grace corrects the prescription and reports the error through the hospital's incident reporting system, but decides not to tell Mr Okafor so as not to worry him.
Answer options for question 31 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 32–34
A thank-you from a patient Aisha is a final-year dental student. She has been treating Mr Patel under supervision in the dental hospital's teaching clinic over several weeks. At his final appointment he thanks her warmly and hands her a small box of chocolates. He then asks for her personal mobile number, explaining that he would like to be able to text her if he has any questions about his new filling. The clinic has a phone line that patients can call with questions about their treatment.
Question 32 Appropriateness: professional boundaries How appropriate is each of the following responses by Aisha in this situation?
Aisha gives Mr Patel her personal number and tells him to text her whenever he likes.
Answer options for question 32 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 33 Appropriateness: professional boundaries How appropriate is each of the following responses by Aisha in this situation?
Aisha thanks Mr Patel for the chocolates, says she will share them with the clinic team, and explains that any questions should go through the clinic's phone line, where the team caring for him can help.
Answer options for question 33 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 34 Appropriateness: professional boundaries How appropriate is each of the following responses by Aisha in this situation?
Aisha politely declines the chocolates, explaining that she would rather not accept gifts from patients, and gives him the clinic's phone number for any questions.
Answer options for question 34 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 35–38
A friend who is struggling Jamie and Nadia are third-year medical students and close friends. Over the past month Nadia has missed several placement sessions, seems withdrawn and has stopped coming to social events. Late one evening she tells Jamie that she is barely sleeping, feels she cannot cope with the course and has been thinking about leaving medicine. She asks him not to tell anyone, as she is worried it will count against her. She has not mentioned any thoughts of harming herself.
Question 35 Importance: supporting colleagues How important is each of the following for Jamie when deciding how to respond to the situation?
That Nadia might find it awkward if Jamie suggests she gets help.
Answer options for question 35 A Very important B Important C Of minor importance D Not important at all
Question 36 Importance: supporting colleagues How important is each of the following for Jamie when deciding how to respond to the situation?
Nadia's health and wellbeing.
Answer options for question 36 A Very important B Important C Of minor importance D Not important at all
Question 37 Importance: supporting colleagues How important is each of the following for Jamie when deciding how to respond to the situation?
That Nadia has asked Jamie not to tell anyone.
Answer options for question 37 A Very important B Important C Of minor importance D Not important at all
Question 38 Most appropriate action: supporting colleagues What is the most appropriate action for Jamie to take?
Answer options for question 38 A Promise to keep it secret, and check in with her regularly himself. B Listen, reassure her that asking for help will not count against her, and encourage her to speak to her GP or the medical school's student support service, offering to go with her. C Tell the medical school's welfare team about Nadia's difficulties the next morning, without letting her know. D Suggest she takes a few days off to rest, and reassure her that she will probably feel better soon.
Questions 39–41
A student in the room Olu is a fourth-year medical student on a GP placement with Dr Shah. Before calling in the next patient, Dr Shah reads her notes: a woman in her twenties with pelvic pain, who will need an intimate examination. Dr Shah tells Olu to stay and watch, as it will be good experience for him. The patient has not been asked whether she is happy for a student to be present. Olu knows that patients are entitled to refuse to have students involved in their care.
Question 39 Appropriateness: consent How appropriate is each of the following responses by Olu in this situation?
Olu stays in the room and, once the patient has sat down, introduces himself as a medical student and asks her whether she minds him staying.
Answer options for question 39 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 40 Appropriateness: consent How appropriate is each of the following responses by Olu in this situation?
Olu stays and, when the patient asks who he is, tells her he is 'one of the doctors' to avoid making her uncomfortable.
Answer options for question 40 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 41 Appropriateness: consent How appropriate is each of the following responses by Olu in this situation?
Before the patient comes in, Olu suggests to Dr Shah that she should be asked whether she minds a student being present, and offers to wait outside while she is asked.
Answer options for question 41 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 42–45
Signing in for a friend Zara is a first-year medical student. Attendance at Thursday's anatomy teaching is compulsory and is recorded on a paper sign-in sheet. Ten minutes before the session, her friend Ben texts her: he has overslept, will not make it in time, and asks Zara to sign his name on the sheet. He says he will catch up on the material later and that 'everyone does it'. Zara knows that students with poor attendance can be referred to the course lead.
Question 42 Appropriateness: honesty and integrity How appropriate is each of the following responses by Zara in this situation?
Zara does not sign Ben in, and posts in the year group chat that Ben tried to get her to sign him in.
Answer options for question 42 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 43 Appropriateness: honesty and integrity How appropriate is each of the following responses by Zara in this situation?
Zara replies that she will not sign for him, and suggests he emails the course administrator to explain that he overslept.
Answer options for question 43 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 44 Appropriateness: honesty and integrity How appropriate is each of the following responses by Zara in this situation?
Zara signs Ben in, as it is the first time he has asked.
Answer options for question 44 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 45 Appropriateness: honesty and integrity How appropriate is each of the following responses by Zara in this situation?
Zara does not sign Ben in, but does not reply to his message either.
Answer options for question 45 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 46–49
An instruction over the phone Lucy is an FY1 doctor. Her registrar, Dr Morgan, phones from clinic and asks her to prescribe co-amoxiclav, a penicillin-based antibiotic, for a patient on the ward with a new chest infection. When Lucy opens the patient's drug chart, she sees that a penicillin allergy is recorded, with 'rash' noted as the reaction. When she mentions this, Dr Morgan sounds rushed and says, 'Just prescribe it, it'll be fine — I'm in the middle of clinic.'
Question 46 Importance: prescribing safety How important is each of the following for Lucy when deciding how to respond to the situation?
That the patient needs antibiotics promptly for the chest infection.
Answer options for question 46 A Very important B Important C Of minor importance D Not important at all
Question 47 Importance: prescribing safety How important is each of the following for Lucy when deciding how to respond to the situation?
That Lucy will be responsible for any prescription she signs.
Answer options for question 47 A Very important B Important C Of minor importance D Not important at all
Question 48 Importance: prescribing safety How important is each of the following for Lucy when deciding how to respond to the situation?
That Dr Morgan is far more experienced than Lucy.
Answer options for question 48 A Very important B Important C Of minor importance D Not important at all
Question 49 Most appropriate action: prescribing safety What is the most appropriate action for Lucy to take?
Answer options for question 49 A Prescribe the co-amoxiclav as instructed, since Dr Morgan is responsible for the decision. B Prescribe the co-amoxiclav, and ask the nurse to watch the patient closely for an allergic reaction. C Politely tell Dr Morgan she is not comfortable prescribing it, and ask to agree a suitable alternative or to check the allergy with the patient first. D Refuse to prescribe anything, and leave the patient's antibiotics for Dr Morgan to sort out after clinic.
Questions 50–52
Overheard on the ward Ifeoma is a fourth-year medical student on a care of the elderly ward. Walking past a side room, she hears a healthcare assistant say sharply to Mr Davies, an elderly patient with dementia who keeps calling out, 'If you don't stop that noise, nobody's bringing you any lunch.' Mr Davies looks frightened. The ward is short-staffed today and the healthcare assistant has been rushing about all morning. Ifeoma's clinical supervisor is away until next week, but the nurse in charge is at the nurses' station.
Question 50 Importance: raising concerns How important is each of the following for Ifeoma when deciding how to respond to the situation?
That the ward is short-staffed and the healthcare assistant is under pressure.
Answer options for question 50 A Very important B Important C Of minor importance D Not important at all
Question 51 Importance: raising concerns How important is each of the following for Ifeoma when deciding how to respond to the situation?
That Ifeoma is a student who will only be on this ward for a few more weeks.
Answer options for question 51 A Very important B Important C Of minor importance D Not important at all
Question 52 Most appropriate action: raising concerns What is the most appropriate action for Ifeoma to take?
Answer options for question 52 A Tell the nurse in charge what she heard, straight away. B Sit with Mr Davies for a while to calm him, without mentioning what she heard to anyone. C Write down what she heard and raise it with her clinical supervisor next week. D Tell the healthcare assistant that she will be reported if she speaks to patients like that again.
Questions 53–55
A direct question from a patient Callum is a fifth-year medical student. He is taking a history from Mrs Hart, who had a biopsy last week. While reading her notes earlier, Callum saw that the result is back and shows cancer. The consultant has arranged to discuss the result with Mrs Hart tomorrow, when her husband can be there too. Partway through the history, Mrs Hart becomes tearful and asks him, 'Have my results come back? Please be honest with me — is it cancer?'
Question 53 Importance: communication with patients How important is each of the following for Callum when deciding how to respond to the situation?
Being honest with Mrs Hart.
Answer options for question 53 A Very important B Important C Of minor importance D Not important at all
Question 54 Importance: communication with patients How important is each of the following for Callum when deciding how to respond to the situation?
That Callum needs to finish the history today to complete an entry in his logbook.
Answer options for question 54 A Very important B Important C Of minor importance D Not important at all
Question 55 Most appropriate action: communication with patients What is the most appropriate action for Callum to take?
Answer options for question 55 A Tell Mrs Hart the result, as she has asked him directly and has a right to know. B Tell Mrs Hart that he has not seen any of her results. C Reassure Mrs Hart that most biopsies turn out to be nothing serious, to ease her worry. D Explain that as a student he is not the right person to discuss results, acknowledge how hard the wait must be, and let the team know straight away that she is anxious and asking about them.
Questions 56–59
A sterilisation warning Megan is a fourth-year dental student treating a patient in a busy teaching clinic. As she opens the sealed pouch of instruments for the procedure, she notices that the indicator strip on the pouch, which changes colour once the instruments have been through the steriliser, has not changed colour. Her clinical supervisor is helping another student across the room. A dental nurse is close by, and spare instrument packs are kept in the clinic.
Question 56 Appropriateness: infection control How appropriate is each of the following responses by Megan in this situation?
Megan swaps the pack for a new one and carries on with the appointment, then tells her supervisor about the faulty pouch once the patient has left.
Answer options for question 56 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 57 Appropriateness: infection control How appropriate is each of the following responses by Megan in this situation?
Megan stops the appointment and sends the patient home, so that she can go to the sterilisation unit and find out for herself what went wrong.
Answer options for question 57 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 58 Appropriateness: infection control How appropriate is each of the following responses by Megan in this situation?
Megan does not use the instruments, asks the dental nurse for a new pack, and tells her supervisor about the faulty pouch so it can be reported.
Answer options for question 58 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 59 Appropriateness: infection control How appropriate is each of the following responses by Megan in this situation?
Megan uses the instruments, reasoning that the hospital's sterilisation unit is very reliable and the strip is probably faulty.
Answer options for question 59 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 60–62
A nurse's worry Ruth is an FY1 doctor on a surgical ward. Late in the afternoon, Jo, an experienced nurse, tells Ruth she is worried about Mr Bell, who had bowel surgery two days ago. His observations are all within normal ranges, but Jo says he 'just doesn't seem right': he is quieter than usual and has eaten nothing today. Ruth has four discharge letters to finish before patients can go home, and she is due to hand over to the evening doctor in an hour.
Question 60 Importance: teamwork How important is each of the following for Ruth when deciding how to respond to the situation?
That Mr Bell's observations are within normal ranges.
Answer options for question 60 A Very important B Important C Of minor importance D Not important at all
Question 61 Importance: teamwork How important is each of the following for Ruth when deciding how to respond to the situation?
Jo's experience and her concern about Mr Bell.
Answer options for question 61 A Very important B Important C Of minor importance D Not important at all
Question 62 Most appropriate action: teamwork What is the most appropriate action for Ruth to take?
Answer options for question 62 A Finish the discharge letters first, then see Mr Bell before handover if there is time. B Ask Jo to repeat Mr Bell's observations in four hours and contact the evening doctor if they change. C Review Mr Bell herself now, then return to the discharge letters, asking a colleague for help if they will not be finished in time. D Pass Jo's concern on to the evening doctor at handover and ask them to see Mr Bell.
Questions 63–65
Signing off an assessment Isaac is a surgical registrar. Sana, an FY1 doctor he knows well from university, is close to the deadline for her end-of-rotation portfolio review. She asks Isaac to sign a form confirming that he watched her insert a urinary catheter and that she did it competently. Isaac did not see her do it, although he believes she is a capable doctor. Sana says she has done several since and that 'it's just a box-ticking exercise'.
Question 63 Appropriateness: honesty and integrity How appropriate is each of the following responses by Isaac in this situation?
Isaac signs the form, but writes in the comments box that he did not see the procedure himself.
Answer options for question 63 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 64 Appropriateness: honesty and integrity How appropriate is each of the following responses by Isaac in this situation?
Isaac explains that he can only sign for procedures he has watched, and offers to observe the next catheter Sana inserts so that he can complete the form honestly.
Answer options for question 64 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Question 65 Appropriateness: honesty and integrity How appropriate is each of the following responses by Isaac in this situation?
Isaac signs the form, as he is confident that Sana is competent.
Answer options for question 65 A A very appropriate thing to do B Appropriate, but not ideal C Inappropriate, but not awful D A very inappropriate thing to do
Questions 66–69
Explaining a procedure Mei is an FY1 doctor. She needs to explain an upcoming endoscopy (a camera test of the stomach) to Mrs Nowak, who speaks very little English, and check that she understands and agrees to it. Mrs Nowak's 12-year-old son is visiting; he speaks fluent English and Polish and offers to translate. A professional telephone interpreting service is available but usually takes about twenty minutes to connect. The endoscopy is planned for tomorrow morning.
Question 66 Importance: consent and communication How important is each of the following for Mei when deciding how to respond to the situation?
That using Mrs Nowak's son would be quicker than waiting for the interpreting service.
Answer options for question 66 A Very important B Important C Of minor importance D Not important at all
Question 67 Importance: consent and communication How important is each of the following for Mei when deciding how to respond to the situation?
That Mrs Nowak fully understands the risks and benefits of the endoscopy.
Answer options for question 67 A Very important B Important C Of minor importance D Not important at all
Question 68 Importance: consent and communication How important is each of the following for Mei when deciding how to respond to the situation?
That the son may be upset by hearing details of his mother's procedure and its risks.
Answer options for question 68 A Very important B Important C Of minor importance D Not important at all
Question 69 Most appropriate action: consent and communication What is the most appropriate action for Mei to take?
Answer options for question 69 A Ask the son to translate, as he is fluent in both languages and his mother trusts him. B Explain the procedure slowly in simple English, and go ahead if Mrs Nowak nods and signs the form. C Ask a member of the ward staff who knows a few words of Polish to help. D Arrange the professional interpreting service and have the conversation once it connects.