Section 1: Professional Dilemma (PD)

ACDB

This scenario is about professional integrity. As stated in the GMC Good Medical Practice Trust domain, it is important to maintain positive, personal and professional values such as honesty, integrity and probity. It is important to refrain from being dishonest and complicit in Andrew’s reason for leaving early. Option A is the most appropriate response as it allows Andrew to take ownership and responsibility for his own actions, alongside encouraging awareness of patient safety for the hospital as they would subsequently be aware that Andrew will not be present to finish his shift. If Andrew will not inform the consultant himself of his leave, the next appropriate action is to remove yourself from the situation presented, Option C, as this ensures that you are not involved in any dishonest behaviour. Option D partially responds with the awareness of making the hospital aware that there is one less doctor around for patient safety, as it is part of your responsibility to raise concern about conduct and performance where indicated, highlighted in the GMC good medical practice’s Safety and Quality domain, however this action means that you are intending to provide false information by explaining that you do not know the reason for his absence. Option D is the least appropriate response as it means that you are complicit in Andrew’s reason for leaving early, which directly involves you being dishonest, alongside putting patients at risk with one less doctor on the ward.

ADCB

This scenario is about empathy and sensitivity. This question relates to the General Medical Council good medical practice’s Working in Partnership with Patient’s domain, while also outlining the importance of providing patients with information that they want or need in a way they can understand. Option A is the most appropriate action as it suggests active listening to understand the reason behind the request from the son before speaking with Mr Ahmed, without committing to following through with the son’s request. Asking Mr Ahmed if he agrees to have his son present, Option D, demonstrates respect for his autonomy and suggests some consideration for the son by providing the option for him to be present, therefore still involving him. Option C is patient centred to explore how much Mr Ahmed wants his family to know about the diagnosis but does not involve any relatives and therefore does not take into consideration the son’s request. Option B is the least appropriate as it directly disregards the son’s request by placing emphasis on respecting Mr Ahmed’s autonomy and therefore not seeming to want to work in partnership.

DABEC

This scenario is about coping with pressure. As part of a multi-disciplinary team, it is not unusual that different members of the team may have conflicting priorities. In order for the team to work well together, maintaining good working relationships with others is key. It is important to be clear about routine practice to set expectations to enable the ward staff and nursing colleagues to understand how you work as well as the challenges you face as part of your role which they may be unaware. The General Medical Council illustrates a key aspect of good medical practice is ensuring that doctors work within their limitations and are prompt in raising concerns about practice (GMC good medical practice’s Safety and Quality domain). Option D addresses the above by questioning Sarah about the response, implying that the response is not as expected, whilst demonstrating a desire to provide guidance and peer support.

It is also unprofessional not to respond to a work-related call from a colleague or not to complete clinical tasks allocated to be addressed on a shift, as this may be deemed as neglectful and dereliction of your duty to support the delivery of effective patient care. Such an action may result in poor care being delivered or delay in care being delivered which may result in poor health outcomes for patients, such as deterioration in health status. Therefore, if not comfortable with questioning Sarah, then Option A shows a willingness to find out whether this is patterned behaviour from Sarah from colleagues, but at the same level which shows some sensitivity. Option B would demonstrate some sensitivity towards Sarah by sharing concern with someone who has the role to mentor Sarah. Whereas option E is similar to option B but addresses this with others who are not in that mentor role while passing on the responsibility to deal with Sarah. Option C is the least appropriate as it somewhat supports the behaviour of Sarah by affirming that the nurses have bleeped several times, whilst ignoring Sarah’s behaviour towards the nurses.

BDECA

This scenario is about professional integrity. This scenario demonstrates a potential breach in patient confidentiality, which is paramount within medical ethics. This needs to be addressed with professional integrity whilst also maintaining a good working relationship. The most appropriate action is Option B, as this shows an approach that follows the General Medical Council’s guidance to protect patient’s confidentiality by not revealing any clinical information, while somewhat staying respectful in answering the question from the colleague. Option D again does the above but appears less of a teamwork response by not engaging in any conversation with the colleague. Option E is somewhat adequate in the sense that the action is explaining to the colleague that the information is confidential, however, this option also implies that the colleague is inappropriate. Option C is similar to response E, however here the action is dismissing the question from the colleague altogether and is may be considered rude. Option A is the least appropriate as this would mean disclosing some confidential information and assuming facts are already known that patient is smoking and is asking for oxygen.

CBEDA

This scenario is about empathy and sensitivity. There is an expectation/professional responsibility as a doctor to flag up concerns in practice (caused by an abusive patient) that have the potential to adversely impact on patients or staff health and wellbeing. Option C is demonstrating responsibility to listen to Sara’s concerns, whilst gathering more information about the incident to assess the risk to either Sara or the patient. Option B is somewhat an adequate action as it shows that you understand that Sara is upset, however, it does assess the risk. Option E is resolving the situation for the patient; however, it does not help Sara address how she is feeling or gather any other information about the incident. Option D demonstrates knowledge that senior involvement may be necessary to protect oneself but does not resolve the immediate issue of how Sara is feeling. Option A is the least appropriate action as this shows no concern for Sara, which could potentially put Sara or the patient at risk.

CABDE

This scenario is about coping with pressure. The General Medical Council stipulates that doctors must recognise and work within the limit of their competence. This may be perceived as unprofessional if nothing is done, and it demonstrates a lack of compassion, poor understanding and insight into the signs/symptoms of the patient’s chronic condition (dementia) and how other factors such as sepsis/infection may affect or impact on the patient. Not responding to the patient may be perceived as dereliction of duty. For example, a clinician failing in their duty of care for a vulnerable patient.

Therefore, Option C is the most appropriate action as you are dealing with the concern straight away. Option A is somewhat addressing the issue of pressures at work, but not acting directly on the issue with Mr Kirkland, but instead with delegation by negotiating a solution to reduce others’ workload so that they can attend to him. Option B assumes that the senior nurse knows best, and it may be perceived as unprofessional if nothing is done to help the patient, demonstrating a lack of compassion, but does display trust in a colleague. Option D is looking for an alternative solution, however, there is no guarantee that there will be someone available to help from a less busy ward, therefore the Mr Kirkland may not be seen for some time. The least appropriate action is response E as it demonstrates a lack of understanding that the senior nurse has shared about priority needing to be given to patients based on urgency.

ABEDC

This scenario is about professional integrity. The General Medical Council’s good medical practice is clear that doctors should be immunised against common serious communicable diseases unless this is contraindicated. While they do not set an absolute duty to be vaccinated against any particular disease, they recognise the potential risk of inadvertently spreading flu and COVID-19 for example to vulnerable patients, and so advise doctors of being vaccinated, unless there are good reasons not to be. From a professional integrity perspective, the most appropriate response is Option A as it demonstrates the importance of trying to understand the views of Alan by exploring his reasons in a respectful way and there may be an unknown reason for why Alan would refuse to have a seasonal influenza vaccination. Option B is reminding Alan of the risks to patients but does not give the option for Alan to give his views. Option E outlines to Alan the best practice guidelines in place to protect society, but this response could just be stating something he is already aware of. Option D does not tackle the scenario from the perspective of patient duty, but instead from a workload point of view and the consequences to workload is less important as it does not directly resolve the issue. The least appropriate action is response C as is imposing action on Alan, disregarding his choice and reasons.

DAECB

This scenario is about empathy and sensitivity. As part of good medical practice, the General Medical Council highlight the importance of working in partnership with patients, including, listening to, and responding to their concerns and preferences. A key component of this includes treating patients politely and considerately. The most appropriate response is Option D as it means that you are addressing the midwife, empathising with her frustration, and also acting with sensitivity towards the patient. The General Medical Council’s good medical practice’s Working in Partnership with Patient’s domain also outlines the importance of providing patients with information that they want or need in a way they can understand. Option A is the best next option as saying sorry is an empathic statement but is less appropriate that Option D as it does not provide the patient with what she needs to know about stopping smoking. Option E shows a level of sensitivity but is not expressing empathy by trying to address patients’ reasons for not quitting smoking. Option C is not appropriate as it empathises with midwife but not with patient, which can be insensitive towards the patient. The least appropriate response is Option B as both perspectives of the midwife and patient should not be ignored in line with the GMC’s importance of working in partnership with patients.

BEDCA

This scenario is about coping with pressure, using effective communication. The General Medical Council prioritises effective communication as a key skill for clinicians. As part of the professional requirements for the medical profession, you are expected to communicate clearly and honestly with patients and their families and to ensure a compassionate, empathetic, and respectful approach. In view of this, Option B is the most appropriate response by directing the patient clearly to the correct person who will be able to advise in this situation and therefore give her the most appropriate information about her place in the queue. This is followed by Option E, as the response aims to reassure the patient that they are a priority. Option D is somewhat adequate by aiming to give a patient another option if she is unhappy with the current wait time, however, it doesn’t appear as sensitive as options B and E as the patient could feel dismissed. Option C is inappropriate as it dismisses the patient’s needs and appears defence. The least appropriate is Option A, as giving into the patient’s complaints means that you are disregarding the rights of other patients, focusing on this patient’s demands only.

BECAD

This scenario is about professional integrity. It is your responsibility as a doctor to ensure that you and the rest of the team have the most up to date and/or relevant information about a patient in order to make decisions about treatment options and to provide the best quality of care (GMC good medical practice’s Patient Safety and Quality domain and the Knowledge, Skills and Performance domain). It is important that as a doctor you raise concerns about risk, unsafe practice, or conduct (GMC good medical practice’s Communication, Partnership and Teamwork domain). It is also important that you are honest and act with integrity when providing feedback (GMC good medical practice’s Maintaining Trust domain). Response Option B demonstrates this by facing the dilemma with the person directly involved in the errors. If you are not comfortable in doing this, then the next best option would be Option E, as this demonstrates the ability to raise concerns with someone who has the role of supporting you in dealing with the errors. The next most appropriate option is to raise it as a significant event, demonstrating an understanding of the significance of the event, but it may not be the most appropriate action in the first instance without trying to directly solve the error. Response A is inappropriate because it ignores the urgency to do something about the error, while undermining the rank of the registrar by talking about the issue with colleagues. Option E is the least appropriate as it undermines the role of the Registrar by asking a nurse to investigate the problem.

CADBE

This scenario is about empathy and sensitivity. The General Medical Council’s standards of practice include the ability to listen to and respond to patients’ concerns and preferences (GMC good medical practice’s Communication, Partnership and Teamwork domain). As a doctor you have a responsibility to work with your patients to address their concerns (General Medical Council [GMC] good medical practice’s Communication, Partnership and Teamwork domain). It is also important to be able to be available to provide support to the relative and patients (GMC good medical practice’s Communication, Partnership and Teamwork domain). Response C demonstrates this by showing genuine attention to mother’s ideas, concerns and expectation, with high level of empathy and sensitivity. The next best option is response A as it shows that you have understood why the mother is concerned and what to help explain the reasons for this but is less empathic than listening actively to her concerns. Response D shows some sensitivity by trying to help the mother find a solution, but is less appropriate than Responses C and A as it doesn’t help the mother with her concerns immediately. Response B is less appropriate as it demonstrates passing on the concern to someone else, so may appear that you are uninterested in supporting the patient. The least appropriate is response E as it not only shows no empathy for the mother’s concerns but it also undermines the ENT consultant.

ACH

This scenario is about empathy and sensitivity. The General Medical Council’s (GMC) standards of practice include the ability to listen to and respond to patients’ concerns and preferences (GMC good medical practice’s Communication, Partnership and Teamwork domain). The GMC’s Good Medical Practice states that Doctors have a duty to be considerate to those close to their patient and to be sensitive and responsive in giving them information and support, while respecting the patient’s right to confidentiality. Therefore, an appropriate response to this situation would be to acknowledges Mary’s distress (option A) to validate Mary’s feelings regarding the news of her Husband’s death. Another appropriate response would be to explain to Mary that everyone did everything they could for her husband (option C), as it acknowledges that you have listened to Mary’s concern of feeling that that you are to blame, while reassuring Mary that you did everything you could have done in the situation presented.

In some cases, as the messenger, the only way to resolve the situation is to defer to a more senior colleague or the primary decision maker, so that Mary has the option of speaking with another person for further explanation or clarification if she would feel that she wanted to so (GMC good medical practice’s Communication, Partnership and Teamwork domain). Therefore, seeking assistance from a senior colleague by and asking Mary if she would like to speak to a more senior doctor (option H), would also be appropriate action to take in this situation. In the first instance, you should try to deal with the situation yourself before escalating to a senior, rather than seeking assistance from a colleague (option F) who may have other priorities and make take them away from their duties.

Informing Mary that her behaviour may be perceived as threatening (option B) and calling security (option E) would be inappropriate responses, as she is likely to be upset about the news of her husband and you have a duty to be sensitive in providing support. Furthermore, explaining to Mary that there was nothing that could be done as her husband had been in cardiac arrest before he arrived (option D) is unlikely to help the situation and likely to make Mary more upset, therefore this would be an inappropriate response.

ADH

This scenario is about coping with pressure. The General Medical Council (GMC) priorities effective communication as a key skill for clinicians. As part of the professional requirements for the medical profession, you are expected to communicate clearly and honestly with patients and their families and to ensure a compassionate, empathetic, and respectful approach. It is your responsibility as a doctor to respond to the patient’s concerns (GMC good medical practice: Communication, Partnership and Teamwork domain). Therefore, reassuring Sarah that previous investigations have been normal (option A) is an appropriate response, as it informs the child’s mother that previous investigations have not shown anything that would explain her son’s pain, as well as reassuring her that investigations have not shown anything concerning.

In this situation it is important to respond to a concern that has been raised by the patient’s mother. Simply hearing more about the situation by asking Sarah more about Ben’s abdominal pain (option H), will reassure the mother that their concerns are being listened to and may lead to some mutually agreed solutions to the problem.

In some cases, the only way to resolve the situation is to defer to another course of support such a so colleague or team, so that Sarah has the option of speaking with another doctor for further explanation or clarification if she would feel that she wanted to so (GMC good medical practice’s Communication, Partnership and Teamwork domain). Therefore, suggesting Sarah calls the GP out of hours service (option D) would be an appropriate action in order to get Ben the medical advice he requires.

It would not be appropriate to arrange to repeat the investigations (option C) as the patient has been investigated with normal results and the patient would need to be reassessed face to face first.

Furthermore, arranging the patient’s immediate re-admission (option B) would be inappropriate as you are just about to leave the hospital and should factor in safety as it is the end of your shift (GMC good medical practice’s Knowledge, Skills and Performance domain and the Safety and Quality domain). Advising the patient to be taken to the Emergency Department (option G) would also be inappropriate as this may not be an appropriate use of resources without knowing more about the situation.

Explaining to the patient’s mum that you will speak to the patient’s GP the next day (option E) and arranging a consultation review for the next clinic (option F) are also inappropriate responses as the patient may be acutely unwell and it may be outside of your competence to suggest this without seeing and examining the patient.

CEH

This scenario is about empathy and sensitivity. It is your responsibility as a doctor to respond to the patient’s concern (GMC good medical practice’s Communication, Partnership and Teamwork domain), in this case, Helen’s concern is not being happy with the professor’s comments. The 4 pillars of medical ethics include autonomy, which is the patient’s right to make decisions about their health. Therefore, apologising to Helen for how she has felt with consultant (option C) would be an appropriate action to take in this situation, as this shows that you respect how she feels about the professor’s comments.

The General Medical Council’s (GMC’s) standards of practice include working in partnership with patients by being able to listen to and respond to their concerns and preferences (GMC good medical practice’s Communication, Partnership and Teamwork domain). Simply hearing more about the situation and why she feels the symptoms are running her life (option E) will reassure Helen that her concerns are being listened to. The GMC good medical practice’s Working in Partnership with Patient’s domain also outlines the importance of providing patients with information that they want or need in a way they can understand. Therefore, giving Helen as much information as possible about her condition (option H), would be appropriate as this would provide Helen with expectations about what this condition means for her, which would help her consider her day-to-day lifestyle.

Explaining to the patient that IBS is often very hard to treat (option B) is an inappropriate response and likely to cause more upset to the patient. It is also possible to manage the symptoms of IBS.

Suggesting that Helen seeks a second opinion (option A) would be inappropriate as her concerns are regarding the professor’s comments about her diagnosis rather than the diagnosis itself. However, the patient is entitled to make a choice about who treats them (GMC good medical practice’s Communication, Partnership and Teamwork domain) if requested.

It would also be inappropriate to reassure Helen that the professor did not mean to upset her (option F) as you do not have all the facts about what exactly was said to the patient, therefore it is difficult to completely reassure the patient (GMC good medical practice’s Maintaining Trust domain). Furthermore, asking a nurse to comfort Helen (option D) may mean that you are taking a nurse away from their own work and it hasn’t dealt with the concerns of the patient at this time.

Telling Professor Khan that Helen is unhappy with her previous consultations (option G) is inappropriate at this moment in time as the patient is upset about his comments and you want to support the patient. You may want to raise your concerns with the professor further down the line to re-establish the patient relationship and rebuild trust (GMC good medical practice’s Safety and Quality domain, Maintaining Trust domain).

CDG

This scenario is about professional integrity. A key component of the General Medical Council (GMC) good medical practice’s Communication, Partnership and Teamwork domain includes treating patients politely and considerately. In its Working in Partnership with Patient’s domain, the GMC also highlights the importance of listening to and responding to patients’ concerns and preferences. In view of these 2 domains, telling Mr Davies you are sorry that he is feeling this way (option D) is an appropriate response as you are acknowledging how he is feeling.

The GMC emphasises the role of teamwork as an important aspect of good medical practice (GMC good medical practice’s Communication, Partnership and Teamwork domain). An integral part of teamwork is supporting each other and working together to achieve a common aim/goal. It may be the case that the registrar did not intend to seem dismissive, but you cannot know that from what Mr Davies has said. Therefore, asking Mr Davies to explain further (option C) would be an appropriate response as it means that he feels listened to, but it also means that you can ask for more information about what has happened before making a decision on what to do next.

In view of the 2 aspects described above (Working in Partnership with Patient’s domain and the role of Teamwork), asking Mr Davies what he would like you to do (option G) would also be appropriate as you are giving Mr Davies the choice on how he would like to proceed with the situation, as you do not yet know whether he would wish to make a complaint about your colleague or how he would like to progress with the Registrar. As the patient has not asked about the formal complaints’ procedure (option E) this would be an inappropriate action at this stage.

It would be inappropriate to explain that you believe the registrar is a good doctor (option B) as it is not appropriate to offer your opinion in this way, as it may seem like you are dismissing the patient’s concerns and colluding with the registrar. Furthermore, explaining how busy the job is (option F) is inappropriate as this is not relevant to what Mr Davies has shared with you about how he feels. At this stage, you want to listen to the patient’s concerns and therefore advising that he discusses this with the consultant (option A) is inappropriate, unless he wants to escalate the matter further.

CDG

This scenario is about coping with pressure. The General Medical Council (GMC) prioritise patient safety as core to good medical practice and part of that outlines the doctor’s responsibility to ensure that their allocated workload is covered appropriately (GMC good medical practice’s Safety and Quality and the Communication, Partnership and Teamwork domains). Your social life commitments are important for your wellbeing, but it is expected that patients’ needs will be given priority in emergency situations. Therefore, asking if your senior colleague is willing to cover (option D) and asking another Foundation doctor to cover (option G) are both appropriate responses as they highlight ways to find a replacement colleague or alternative solution so that the patients are not impacted. Both options are ways where it is you who is taking responsibility to find the cover and not passing this responsibility on to someone else such as the medical staffing or nursing staff.

Finding a balance to also continue with your pre-arranged social commitments is also important. Not defaulting to cancelling your plans (option B) straight away until you have explored alternative options would be ideal. Therefore, telephoning your partner to arrange to meet at the theatre (option C) would be appropriate to give you some time to find alternative cover without cancelling your personal plans.

Leaving the hospital to get home on time (option A) is inappropriate as this is unprofessional and dangerous. It is expected that patients’ needs will be given priority in emergency situations. Furthermore, asking the nursing staff to call Dr Orr on his mobile if there are any problems (option E) and telephoning medical staffing to arrange cover immediately (option F) are also inappropriate actions as you are not Dr Orr’s line manage or the consultant in charge to make these decisions as a Foundation doctor.

BEF

This scenario is about empathy and sensitivity. Peer support is an important aspect of teamwork and as part of a Multi-Disciplinary Team (MDT), doctors are expected to support each other and other colleagues (GMC good medical practice’s Safety and Quality and the Communication, Partnership and Teamwork domains). Therefore, an appropriate action to take in this situation is to offer support and an opportunity to talk things through with Sarah (option B), as this provides her with the opportunity to discuss what has happened and why she feels it is appropriate to remain at work, despite the circumstances.

In addition to peer support, providing feedback and raising concern about conduct is part of the professional responsibilities for all doctors, including providing feedback or raising concern with colleagues (General Medical Council [GMC] good medical practice’s Safety and Quality and the Communication, Partnership and Teamwork domains). Therefore, explaining to Sarah that patient safety may be affected if she remains at work (option E) would be an appropriate response as this highlights the important aspect of patient safety and the risks associated with remaining at work. This would make Sarah think twice about her current situation from a patient safety perspective.

Enquire with medical staffing* whether another F2 doctor has capacity to cover Sarah's shift (option F) would also be appropriate and a proactive action to see if appropriate cover can be provided to allow Sarah to have some time off, whilst considering patient safety.

It would be inappropriate for you to cover Sarah’s duties for her (option C) as it is outside of your scope of practice to take on your colleague’s workload and this would also raise potential risk to patient safety (GMC good medical practice’s Knowledge, Skills and Performance domain and the Patient Safety and Quality domain).

Advising Sarah to book an appointment with occupational health (option A), informing the consultant in charge of the ward about Sarah’s mother (option G), and informing her educational supervisor that Sarah is concerned about how her time off may affect her record (option B) would also be inappropriate actions to take, as she has not asked for your advice or raised any concerns that would require to you take further action at this stage.

BCH

This scenario is about professional integrity. In this scenario, your colleague Emily is not performing to the level that is expected of her. However, the main priority is to ensure that the patient, Mr Lucas, has his procedure performed by a clinician who is competent in the procedure. The General Medical Council (GMC) stipulates that, doctors must only practice within their scope of competence. This is essential to maintain safety in clinical practice and ensures that patients receive appropriate and effective care. Therefore, initially it would be appropriate to speak directly to Emily to explain your concerns (option A) which allows Emily to address the concerns first. There may be reasons that she has told the consultant that she can complete this task. If this is the case, then speaking to her directly can allow you to offer support before jumping straight to seniors unnecessarily. Time in this situation is also important, at a later stage it may be appropriate to discuss the issue up at your next Foundation teaching session (option G), but currently, you need to ensure that the patient receives appropriate and effective care, therefore option G would be inappropriate at this stage.

Linked to this, the GMC emphasises the role of teamwork as an important aspect of good medical practice (GMC good medical practice’s Communication, Partnership and Teamwork domain). It would be more appropriate to encourage Emily to talk to her consultant about the situation herself (option H) rather than speaking to the consultant (option D) which would directly bypasses your colleague and does not allow her to address the concerns first. Also, there has been no clinical error, therefore seeking advice from your medical defence organisation is not appropriate.

It is not appropriate to tell the patient your concerns (option E) about a colleague as it may affect the patient’s confidence in the medical team and the doctor patient relationship. This response may also result in lack of trust and reputation damage (GMC good medical practice’s Communication, Partnership and Teamwork domain and the Maintaining Trust domain), which would be detrimental to establishing an effective working relationship.

According to the GMC seeking support/help/guidance is a professional requirement for the medical profession. The GMC professional requirements for doctors includes a competency framework in which all clinical skills must be assessed, and the clinician deemed to be competent and safe by an appropriately trained/qualified person before they can perform the skill independently or unsupervised on a patient. You have performed the procedure several times before, therefore suggesting to Emily that you will help her to perform the procedure (option C) would be an appropriate action and provide Emily with a learning opportunity, whilst you are there to support and offer the appropriate guidance and ensure patient safety. Whereas, insisting on performing the procedure yourself (option A), is not appropriate as the consultant has asked your colleague to carry out the procedure in the first instance.

AFG

This scenario is about coping with pressure. The GMC standards of practice and guidelines for good practice stipulate that doctors should actively engage in Continuous Professional Development (CPD) and take advantage of any opportunities provided to advance their development as a clinician. It is important that you take the right steps to ensure that you receive and are able to evidence your essential supervision meetings as an F2 doctor. It would be appropriate here to do what you can do in order to attend your meeting. Therefore, it would be appropriate to find a colleague who can support in the department (option A), to ensure that there is sufficient cover to support the consultant and the department, while you attend your meeting with your supervisor as planned. Contacting your educational supervisor to ask him to speak to the consultant (option H) is inappropriate as it is your responsibility to speak to your consultant to find the appropriate cover and explain that you need to attend the meeting with your educational supervisor. It may be appropriate to escalate the situation with your educational supervisor so he/she is aware of the reasons why you have been unable to attend the meeting or attend later, but you should try and find alternative support for the consultant so that you can attend the meeting, rather than asking for your educational supervisor to speak to the consultant directly.

To say that you would stay to help in the department (option C) is somewhat inappropriate for 2 reasons. One reason being that you should not be expected to work more than you allocated hours each shift, as rest periods are important and built into rotas to reduce risk or mistakes and clinical errors. Another reason is that if you agree to stay and help in the department, there is a risk that the meeting with your educational supervisor will have to be cancelled or rearranged again. This would reflect poorly on you and is likely to have an impact on your progression through training. Furthermore, rearranging your meeting (option D) so that you can stay and support on the department is an inappropriate action as you had to cancel your last meeting with your education supervisor, who would also have had to rearrange their schedule to meet with you. It would only be if all other options have been explored and you are unable to find suitable cover that it may be appropriate to stay longer to support with the most urgent clinical priorities. Contacting the LETB for advice regarding your right to study leave (option E) may be appropriate further down the line if you have to end up rearranging the meeting for a third time but would be inappropriate to contact them at this stage. Initially, you should speak to the person involved directly to resolve any issues locally, before escalating up.

It would also be appropriate to remind your consultant that you missed your meeting with your educational supervisor last week due to a similar request to stay on the department (option F), so that the consultant is aware that this is not the first time this has happened, and you have previously agreed to re-arrange your meeting in order to stay on the department longer. It is important that the consultant is aware that his request will have a consequence on you being able to attend your meeting with your supervisor.

In order to do the above, your consultant may need some immediate support and you could offer to help with the most urgent tasks. It would therefore be appropriate for you to contact your educational supervisor to inform him that you may be late (option G) so that you can support your consultant and prioritise the most urgent tasks before leaving to attend your meeting. Option B, insisting on your right to protected study leave, is an inappropriate action, as all clinicians work as part of a multi- disciplinary team, therefore the potential impact on others should also be considered as being important. This is not an appropriate response as it does not take patient care into account and may be considered unprofessional.

BDE

This scenario is about professional integrity. The General Medical Council (GMC) stipulates that, doctors must only practice within their scope of competence. This is essential to maintain safety in clinical practice and ensures that patients receive appropriate and effective care. Not only is this important for the practice of your colleagues, but it is also just as important to take responsibility for your own practice. Recognising your own limitations and that you are becoming overwhelmed and require support with how you are feeling is essential. Asking for help is a positive step and ensures patient safety. Therefore, it would be appropriate to escalate this to a senior colleague on the team (option E) to ask for advice about how to best manage the workload and how you are feeling, including the possibility of prioritising the workload with support. It may be appropriate to consider taking some time taking a break to recuperate (option D), working collaboratively with the rest of the team to ensure that patient care is appropriately covered. Arranging to see your GP or occupational health physician (option B) would also be appropriate to seek advice regarding the impact your personal problems are having on your sleep and as a result, your ability to do your job to your usual competence.

Whereas, focusing on work and putting your personal issues to the back of your mind (option F), is an inappropriate action as you are not taking responsibility for how you are feeling or thinking about the impact that your practice may have on patients. Complaining about your workload to hospital management (option G) may be appropriate if the amount of work is impacting patient safety, however, the cause of you not being able to complete your tasks is due to tiredness, rather than the workload. Moreover, visiting your local pharmacy to obtain a sleep remedy (option H) is somewhat inappropriate as buying a sleep remedy is not helping you to take responsibility and deal with the issues causing your lack of sleep.

If your concern was time management booking a course on time management (option C) may be appropriate as you would benefit from new skills and techniques to help with managing workload better. However, in this scenario it is your lack of sleep and personal issues are having an impact on your general health and wellbeing. Therefore, booking a time management course is unlikely to help deal with how you are performing your duties due to personal issues causing a lack of sleep.

Moreover, arriving at work an hour early each day so that you can complete unfinished tasks (option A) is an inappropriate response. Despite the good intentions behind coming to work early to get the jobs completed, you are tired, and will be more tired after a long shift, and in these circumstances mistakes can happen. Rest periods are essential, so you need to finish your shift when allocated and get the appropriate rest needed, so that you are ready for your next shift.

ABF

This scenario is about professional integrity. One of your responsibilities as a doctor is to ensure the provision of sufficient information about treatment options so that patients can make an informed choice about their medical care, including the consequences of refusing treatment (GMC good medical practice’s Knowledge, Skills and Performance domain and the Communication, Partnership and Teamwork domain). Initially, you should try to explore the reasons why the patient disagrees with your opinion (option A) to understand their concerns. If the patient would still value a second opinion, you should acknowledge to patient that he is entitled to second opinion and facilitate this (option B) and offer to ask a senior colleague to review your diagnosis (option F) to reassure the patient that your diagnosis is correct. Whereas, to request that the patient is transferred to a different clinical team (option C), this could somewhat be interpreted by the patient as defensive and unhelpful.

Explaining to the patient that NHS resources are scarce and that arranging a second opinion would involve unnecessary costs (option D) will antagonise the patient further, as he likely to already be angry. Despite the GMC stating that doctors should minimise waste, improve services and promote the effective use of resources, you should take financial responsibility for delivering your service at a level appropriate to your role. You should understand the roles and policies of local and, where relevant, regional and national agencies involved in healthcare if they affect your role as a doctor. Moreover, asking the patient to put his specific concerns in writing to the Trust's* complaints department (option E) is not an appropriate action as the patient is not complaining about his care, rather forcefully stating that he wants to be referred for a second opinion, that the GMC states that patients are able to make choices about their care and treatment.

The GMC states that ‘All doctors must make the care of patients their first concern. However, the treatment options that can be offered to patients may be affected by limits on resources’ as the patient is asking for a second opinion as he disagrees with the diagnosis, which he is entitled to do. Therefore, to suggest that the patient might seek a second opinion from a specialist in the private sector (option G) or advise the patient that you will discharge him from follow-up (option H) are both inappropriate actions. Whilst communication is integral to establishing a good working relationship with your patient (GMC good medical practice’s Communication, Partnership and Teamwork domain) and it is important to establish boundaries to be able to develop and/or maintain a respectful dialogue between both parties, these responses may be interpreted by the patient as confrontational and unprofessional.

BDG

This scenario is about coping with pressure. According to the General Medical Council (GMC), every healthcare professional must be open and honest with patients and people in their care when something goes wrong with their treatment or care or has the potential to cause harm or distress. This means that health and care professionals must tell the person (or, where appropriate, their advocate, carer or family) when something has gone wrong, apologise to the person (or their advocate, carer or family), offer an appropriate remedy or support to put matters right (if possible) and explain fully to the person (or their advocate, carer or family) the short- and long-term effects of what has happened. Therefore, the most appropriate actions to take this situation would be to ask the patient for permission to check her HIV status (option B), checking if the patient has any risk factors for HIV (option G), and asking your registrar to contact occupational health (option D) in order to be transparent with the patient about what has happened and be proactive in acting on the information that Carrie has disclosed to you.

It is not appropriate adding the HIV request to the blood samples without speaking and getting the patient’s consent to (option A) and following duty of candor in telling the patient what has happened. Ideally the registrar should be the one to speak to the patient. It is not appropriate to introduce anything that may be perceived as further barrier(s) to open and honest communication therefore, potentially jeopardising the working relationship between the clinical team and the patient by asking the nurse is inappropriate (option C).

Looking at the patients records to see if there have been any previous HIV tests performed (option E) does not add anything to the outcome, as the patient may have been at risk of HIV since the last blood test. Currently there is a clear path of what should happen next, and the hospital has clear protocols on what do to regarding a needle stick injury, therefore at the moment (option H) is not appropriate. However, if a complaint arose then it may be appropriate to get advice and support from the defence union. Moreover, completing a significant event form (option F) is something that will be done as a result of the incident, but ideally the registrar should do this, and may have done this already.