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All questions of Type 2 Appropriateness Questions for UCAT Exam

Max is a CT1 (core training year 1) working in an intensive care unit. One of Max’s jobs is to prescribe pain relief to an elderly woman who is in severe pain. Max decides to prescribe morphine to help relieve her pain. However, after Max gives her the drug, she has a reaction, and he realises he has given the wrong dose of the drug. Max is able to stabilise the patient and she will not suffer any long-term consequences are a result. Whilst she is unable to communicate, her son is waiting to speak to her doctor. 
How appropriate are each of the following responses by Max in this situation?
Q. Do not inform her son about the incident
  • a)
    A very appropriate thing to say
  • b)
    Appropriate, but not ideal
  • c)
    Inappropriate, but not awful
  • d)
    A very inappropriate thing to say
Correct answer is option 'D'. Can you explain this answer?

The duty of candour is a key principle in medical ethics. The duty of candour requires doctors to inform patients if they have made a mistake. This is outlined in Good Medical Practice which states “You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress, you should: a) put matters right (if that is possible) b) offer an apology c) explain fully and promptly what has happened and the likely short-term and long-term effects”. Therefore, by failing to inform the patient’s next of kin about the mistake you are violating Good Medical Practice, so this action is very inappropriate.

Robert is a 4th year medical student on his paediatric rotation. Today, he is shadowing Dr Patel, a consultant immunologist. One of Dr Patel’s patients is a six-month-old baby who has recently been diagnosed with a very rare condition called FOXN1 Deficiency. It is a condition which weakens the immune system and there have only been nine reported cases ever. Robert wants to share the case with other medical students but does not want to breach confidentiality.
How appropriate are each of the following responses by Robert in this situation?
Q. Seek advice from Dr Patel
  • a)
     A very appropriate thing to say
  • b)
    Appropriate, but not ideal
  • c)
    Inappropriate, but not awful
  • d)
    A very inappropriate thing to say
Correct answer is option 'A'. Can you explain this answer?

As a medical student, you are not a qualified doctor and therefore it is right to seek advice from a qualified doctor if you are unsure about the course of action. This principle is contained in the GMC guidance which states “As a medical student, this applies to you in relation to the time you’ll spend with patients on a clinical placement. It also means you should only treat patients or give medical advice when you are under the supervision of a registered healthcare practitioner”. Therefore, by seeking advice, you are ensuring you are acting within your competence. Therefore, this action would be very appropriate.

Robert is a 4th year medical student on his paediatric rotation. Today, he is shadowing Dr Patel, a consultant immunologist. One of Dr Patel’s patients is a six-month-old baby who has recently been diagnosed with a very rare condition called FOXN1 Deficiency. It is a condition which weakens the immune system and there have only been nine reported cases ever. Robert wants to share the case with other medical students but does not want to breach confidentiality.
How appropriate are each of the following responses by Robert in this situation?
Q. Approach the parents, without talking to Dr Patel and ask for consent to discuss the case
  • a)
    A very appropriate thing to say
  • b)
    Appropriate, but not ideal
  • c)
    Inappropriate, but not awful
  • d)
    A very inappropriate thing to say
Correct answer is option 'C'. Can you explain this answer?

This action would protect the patient’s right to confidentiality which is outlined in Good Medical Practice which states “You must treat information about patients as confidential. This includes after a patient has died.” However, you are acting out with your competence as you are not a qualified doctor and have not asked a qualified doctor for permission. This principle is contained in the GMC guidance which states “As a medical student, this applies to you in relation to the time you’ll spend with patients on a clinical placement. It also means you should only treat patients or give medical advice when you are under the supervision of a registered healthcare practitioner”. Therefore, this action is inappropriate as you are acting out with your competence. The reason this action is not very inappropriate is because, you are not actively providing advice or treatment. Therefore, this action would be inappropriate but not awful.

Robert is a 4th year medical student on his paediatric rotation. Today, he is shadowing Dr Patel, a consultant immunologist. One of Dr Patel’s patients is a six-month-old baby who has recently been diagnosed with a very rare condition called FOXN1 Deficiency. It is a condition which weakens the immune system and there have only been nine reported cases ever. Robert wants to share the case with other medical students but does not want to breach confidentiality.
How appropriate are each of the following responses by Robert in this situation?
Q. Send a whatsapp message explaining the case to a group chat of medical students removing the patient’s name, age and address.
  • a)
    A very appropriate thing to say
  • b)
    Appropriate, but not ideal
  • c)
    Inappropriate, but not awful
  • d)
    A very inappropriate thing to say
Correct answer is option 'D'. Can you explain this answer?

As this is a very rare condition, just removing the patient’s name, age and address is unlikely to sufficiently anonymise the patient’s information. This is outlined in the GMC’s guidelines which states: “The Information Commissioner’s Office anonymisation code of practice (ICO code) considers data to be anonymised if it does not itself identify any individual, and if it is unlikely to allow any individual to be identified through its combination with other data. Simply removing the patient’s name, age, address or other personal identifiers is unlikely to be enough to anonymise information to this standard.”  Therefore, this action would breach patient confidentiality and so would be very inappropriate.

A group of five second-year medical students are undertaking a group project which forms part of their grade. One of the group members Alex has turned up 20 minutes late to their third team meeting. He has been late to every single meeting. Sarah, the team leader is becoming slightly frustrated as Alex’s lack of punctuality is disrupting the group’s progress. 
How appropriate are each of the following responses by Sarah in this situation?
Q. Wait and see if Alex turns up on time for the next meeting
  • a)
     A very appropriate thing to say
  • b)
     Appropriate, but not ideal
  • c)
    Inappropriate, but not awful
  • d)
    A very inappropriate thing to say
Correct answer is option 'C'. Can you explain this answer?

This action does not address the issue of Alex’s punctuality. This violates GMC guidance which states “It can be difficult to raise concerns about fellow students, who may be people you work with on projects or placements or your friends. But as a student choosing to join a regulated profession, it is your duty to put patients first and this includes patients you see on placements and those treated by your fellow students in the future.”  However, you are not unnecessarily escalating the situation or doing nothing, so this action is not very inappropriate. Although, since it does not address the issue, this action is inappropriate but not awful. 

Robert is a 4th year medical student on his paediatric rotation. Today, he is shadowing Dr Patel, a consultant immunologist. One of Dr Patel’s patients is a six-month-old baby who has recently been diagnosed with a very rare condition called FOXN1 Deficiency. It is a condition which weakens the immune system and there have only been nine reported cases ever. Robert wants to share the case with other medical students but does not want to breach confidentiality.
How appropriate are each of the following responses by Robert in this situation?
Q. Tweet about the case removing the patient’s name, age and address.
  • a)
    A very appropriate thing to say
  • b)
    Appropriate, but not ideal
  • c)
    Inappropriate, but not awful
  • d)
    A very inappropriate thing to say
Correct answer is option 'D'. Can you explain this answer?

This question is very similar to part A, the platform the case is posted on is irrelevant. As this is a very rare condition, just removing the patient’s name, age and address is unlikely to sufficiently anonymise the patient’s information. This is outlined in the GMC’s guidelines which states: “The Information Commissioner’s Office anonymisation code of practice (ICO code) considers data to be anonymised if it does not itself identify any individual, and if it is unlikely to allow any individual to be identified through its combination with other data. Simply removing the patient’s name, age, address or other personal identifiers is unlikely to be enough to anonymise information to this standard.” Therefore, this action would breach patient confidentiality and so would be very inappropriate.

Max is a CT1 (core training year 1) working in an intensive care unit. One of Max’s jobs is to prescribe pain relief to an elderly woman who is in severe pain. Max decides to prescribe morphine to help relieve her pain. However, after Max gives her the drug, she has a reaction, and he realises he has given the wrong dose of the drug. Max is able to stabilise the patient and she will not suffer any long-term consequences are a result. Whilst she is unable to communicate, her son is waiting to speak to her doctor. 
How appropriate are each of the following responses by Max in this situation?
Q. Ask the FY2 to apologise to the son about the error
  • a)
    A very appropriate thing to say
  • b)
    Appropriate, but not ideal
  • c)
    Inappropriate, but not awful
  • d)
    A very inappropriate thing to say
Correct answer is option 'D'. Can you explain this answer?

The duty of candour is outlined in Good Medical Practice which states “You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress, you should: a) put matters right (if that is possible) b) offer an apology c) explain fully and promptly what has happened and the likely short-term and long-term effects” . The key term is “you”, as Max has made the mistake, he should make every effort to be the doctor explaining this mistake. Furthermore, it is usually inappropriate to delegate these difficult conversations to more junior colleagues without direct supervision. Therefore, this action is very inappropriate.

Robert is a 4th year medical student on his paediatric rotation. Today, he is shadowing Dr Patel, a consultant immunologist. One of Dr Patel’s patients is a six-month-old baby who has recently been diagnosed with a very rare condition called FOXN1 Deficiency. It is a condition which weakens the immune system and there have only been nine reported cases ever. Robert wants to share the case with other medical students but does not want to breach confidentiality.
How appropriate are each of the following responses by Robert in this situation?
Q. Do not discuss the case with any other medical students
  • a)
    A very appropriate thing to say
  • b)
    Appropriate, but not ideal
  • c)
    Inappropriate, but not awful
  • d)
    A very inappropriate thing to say
Correct answer is option 'B'. Can you explain this answer?

This action would protect the patient’s right to confidentiality which is outlined in Good Medical Practice which states “You must treat information about patients as confidential. This includes after a patient has died.” However, this action would also jeopardise a valuable learning opportunity for other students which is a very important part of medical education as individual cases allow others to learn important lessons. Therefore, as this action maintains confidentiality but denies fellow medical students an important learning opportunity, so this action is appropriate but not ideal.

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