The answers for the example questions can be seen below.
Ranking questions
A maximum of 20 marks are available for these questions, where you are asked to rank the questions from most appropriate to least appropriate for a common FY1 situation. Marks are awarded for near misses so if you get some of the answers the wrong way round, you will not score zero. We hope to publish more information on the scoring grid soon.
Question one
Answer: ECDBA
Although it is not appropriate for trainees to stay for an extensive period of time after their shift ends, or do this in a regular basis, saying an extra 30 minutes on this occasion is important to ensure an effective handover. It is more appropriate to provide information directly to your colleague to ensure they receive it and your registrar could also be able to ensure that your colleague received the information. Leaving lists of information on the end of a bed is less effective and leaving a list on the notice board is least effective as your colleague is unlikely to know it is there.
Question two
Answer:DCEAB
It is not a FY1’s responsibility to break bad news to a patient and the full results are not available yet. It would be most appropriate for a senior colleague to speak to Mr Kucera with regards his diagnosis. Informing Mr Kucera that you will speak to him as soon as you get the test results back would still be appropriate as you are giving him some information, although this may not necessarily mean that you would be providing him with the diagnosis. It may be appropriate to discuss Mr Kucera’s fears with him, but by doing this you may not be attending to other ill patients and are asking a colleague to take on your responsibility by holding your bleep. It may also become a difficult conversation when you do not have full details of the results. It would not necessarily be appropriate to tell Mr Kucera that his cancer is back as this has not been confirmed, however it would be inappropriate to provide false hope to a patient when preliminary investigations are strongly suggestive of a recurrence.
Select three best answers
Four marks are available for each correct answer. If you select more than three options you will score zero.
Question three
Answer:BCH
Ensuring patient safety is key to this scenario. It is important to discuss the nurse’s decision with her as there may be something that you have missed when first reviewing the patient. Therefore it would also be important to review the patient again. Also relating to this is the importance of respecting the views of colleagues and maintaining working relationships, even if there is disagreement. As there has been a disagreement regarding patient care, it is important to seek advice from a senior colleague.
Question four
Answer: BCH
Violence against health professionals (and patients) is not acceptable, but for this patient it is in the context of delirium tremens, in which the patient is confused and agitated, so would not have insight into his actions. Hence options G and F are not appropriate. However, an FY1 (or another member of staff) should be protected and hospital security (B) can offer assistance. Even though a patient is confused, they will often calm down if approached in a reasonable manner, reducing the emotion in the situation (C). An FY1 also has a duty to ensure the safety of other staff, so checking on any harm done is important (H). Physically restraining the patient will be difficult and might cause further harm for staff and the patient. It can constitute an assault. Similarly, prescribing extra sedation might exacerbate the confusion and would likely be very difficult to administer without first calming the patient down. Consequently options A & E are not appropriate.
Question five
Answer: ABE
The situation is only described in brief and is likely to be very complicated. Spending time talking with a colleague can offer much clearer insight as well as often being therapeutic in its own right (A). Similarly, advising talking to a more senior member of the team (B) is likely to bring more support as well as being able to bring a different interpretation of how the FY1 is managing (B). If, as it seems, the FY1 is experiencing a crisis of confidence, then it cannot simply be left without any agreed way forward, and the person will usually value a colleague’s support in talking to her consultant (E). Taking a few days annual leave might bring temporary relief, but will probably not have tackled the problem and returning to work is likely to bring heightened anxiety about coping (C). Counselling might be appropriate, but will not be immediately accessible and there needs to be more immediate actions (D). Asking other members to be supportive removes the responsibility from her (G). Similarly, assisting with her workload is likely to increase the feeling of not coping (H)