Test: Most/least appropriateness Questions - UCAT MCQ

Most appropriate: (A)

It is most appropriate to advise Ronnie to reschedule the study session because doctors, including trainee doctors, should support their colleagues. They must treat colleagues fairly, with respect, and they must be aware of how their behaviour may influence others within and outside the team. In this case, Sadie needs support from Ronnie, and cancelling the session meant that she was unable to access the help she needs for the exams from her colleague. Maja’s action in this case may remind Ronnie of that responsibility and the potential impact on Sadie if he fails to help her.

Most appropriate: (B)

It is most appropriate to ask her educational supervisor if he could provide additional information based on the feedback so that she can better understand the issue because this would be most beneficial to Ava-Mae’s personal and professional development. Better understanding of how others’ perceptions of her differ from her perception of herself will help her develop better self-awareness about her communication with patients. All doctors, including trainee doctors, must treat patients politely and considerately. 

Most appropriate: Discuss openly with Lionel about the reasons behind his addiction with painkillers

A is the most appropriate response. This is a complex matter that will inevitably lead to more senior people being involved and this scenario is not asking Joe to manage it on his own. However, in the first instance it is important for Joe to gather information, whilst being non-judgemental and compassionate to his friend and fellow medical student. Addiction is complicated and Joe will be unable to solve all the problems himself, however ascertaining some background reasons and allowing Lionel to open-up and feel supported is a good starting point. He can then decide the best course of action, whether Lionel needs support from an educational supervisor, family, GP, addiction support or all of these.

Most appropriate: Facilitate a discussion between the group regarding the issue that Danielle and Joshua are discussing, to agree on an approach

C is the most appropriate response. Demonstrating good leadership skills by turning a heated distracting discussion into a well facilitated discussion, demonstrating good conflict resolution. Importantly, using this discussion with the goal of finding a practical solution to move forwards will benefit the whole group in progressing with their group task.

Most appropriate: Confirm with the senior doctor which medication she wants to prescribe during the ward round

The most appropriate response is C. By standing up and asking the doctor what she had intended to prescribe you are opening up a conversation, so if a mistake has been made it can be corrected avoiding any patient harm or confusion, however it may be that the doctor intended to prescribe what they have done, then they can explain why. Asking the question is less likely to cause confrontation or lead to conflict. However, as Chrissy has identified that there may be an error it is important for patient safety that she does speak up, even if this is potentially an uncomfortable conversation.

Least appropriate: (C)

It is least appropriate to say nothing to Ronnie because doctors, including trainee doctors, are responsible for raising concerns and giving honest feedback to their colleagues about their behaviour and conduct as this is part of developing strong working relationships, developing trust, and supporting each other to develop. Not saying anything to Ronnie means Ronnie may not realise the implications or impact of his actions. It also means that Sadie may not get access to the assistance she needs for the exams, which could have a significant negative impact on her, academically and otherwise.    

Least appropriate: (C)

It is least appropriate for Ava-Mae to tell her educational supervisor that she would rather discuss the things she has done well instead as it is the responsibility of the supervisor to provide honest feedback about good practice as well as areas requiring further development. Any doctor responsible for teaching, training and assessing, such as the supervisor in this case, must be honest and trustworthy in all their communication, be honest and objective when appraising or assessing the performance of students, and support those who have problems with their performance. Doctors should work with colleagues in the ways that best serve patients’ interests. It is in the best interest of patients and patient safety for the supervisor to discuss all aspects of Ava-Mae’s performance with her. This ensures that Ava-Mae has the opportunity to consider and further develop her communication and interpersonal skills, as these are integral to good medical practice and good patient care.

Least appropriate: Suggest to Lionel that he will not be a good doctor if he does not get help

C is the least appropriate response. Approaching any complex subject with compassion and empathy is important. Blanket judgemental statements such as ‘you will not be a good doctor if…’ are unhelpful and untrue. Understanding that Lionel likely has other things going on in his life culminating in his addiction to painkillers and this may be the first opportunity he has had to open-up to anyone and the first step in getting the help he needs. Immediate judgement statements are likely to alienate him, distance him as a friend and stop him getting the help that he needs. Being a good doctor requires empathy with patients and relatives in many different situations, learning to keep an open mind and understanding the rationale behind things like addiction are paramount to becoming a good doctor. This does not mean that Joe will compromise his own morals or ignore what has been happening as he is likely to escalate and involve his seniors too, however the question asks about his immediate reaction. It is the manner that this is conducted in that is important here.

Least appropriate: Ask Danielle and Joshua to leave their discussion for later and focus on discussing more important things

A is the least appropriate response. It dismisses Danielle and Joshua’s opinions who, although they might not be going about it in the right way, obviously have important issues they want to discuss. Dismissing their points for ‘more important’ things will likely alienate them from the team. They are likely to feel unwelcome and this will hinder the ability of the group to work together. This is not a good demonstration of leadership to the other team members. It does not provide a good team dynamic.

Least appropriate: After the ward round, ask one of the other doctors which medication he would prescribe to the patient

The least appropriate response is A. This is a potential matter of prescribing error and therefore patient safety so it needs to be addressed immediately with the doctor who wrote the prescription. Waiting until after the ward round, means it may be forgotten or already dispensed in error. Also involving another doctor first is likely to lead to additional confusion and conflict with the first doctor by ‘going behind their back’. It is better to raise the matter, politely, contemporaneously with the doctor in question.

Most appropriate: Ask Quentin how he feels about working together, and how she would prefer them to work together to accomplish the project

B is the most appropriate response. Caryn needs to do well in her project, so it is in her best interest to improve the dynamic between herself and Quentin. Trying to ascertain the reasons why their communication is poor or broken down is most important. Understanding that there are usually two sides to most disagreements and that Quentin may see things differently. It may be that he is actually shy or nervous, or that he has other things on his mind. By being honest they may be able to identify any problems and find practical solutions for how they can work better on their upcoming project.

Least appropriate: Explain to Quentin the importance of working together on the project

C is the least appropriate response. Simply stating to Quentin that it is important that they work together without exploring the reasons that communication between them is poor is unlikely to resolve conflict. It could be seen as condescending, as it does not address that there are reasons why they are not working well together.

Most appropriate: Ask Cerys whether there is a more suitable arrangement that would enable them to complete the project together

B is the most appropriate response. Pooja has identified that there are reasons Cerys may be finding their meet ups difficult. It is always more important to ‘ask’ to find if there is more information or a better solution that can work for both of them as this shows understanding and empathy to Cerys and the additional challenges she may be facing. It is a non-judgemental way of finding a practical solution so that they can work better together, and complete their group project which is mutually beneficial. Although option C shows empathy, it is not trying to find a practical solution.

Least appropriate: Explain to Cerys that her absence is having an impact on the group’s ability to complete the project

A is the least appropriate response. This option does not show empathy nor help to find a practical solution for Pooja or Cerys to move forward with their project. Pooja has already recognised that Cerys has other reasons why the regular meet ups might be difficult, she needs to show understanding to Cerys’s situation and see if a different solution might work better for them both.

Most appropriate: Speak with Paul to understand why he feels the need to copy her work

C is the most appropriate response. To be up-front and honest and speak to Paul about his reasoning and gain insight to why he has been doing this. There may be genuine reasons, lack of confidence either in his language skills or dental knowledge. There may be other issues such as a lack of resources, lack of access to a laptop or external commitments. None of these factors make copying or plagiarising essays acceptable but understanding the reasons are important in order to provide the relevant help and support.